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Cavanaugh D, Urbanucci A, Mohamed NE, Tewari AK, Figueiro M, Kyprianou N. Link between circadian rhythm and benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). Prostate 2024; 84:417-425. [PMID: 38193363 PMCID: PMC10922447 DOI: 10.1002/pros.24656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is the most common urologic disease in aging males, affecting 50% of men over 50 and up to 80% of men over 80 years old. Its negative impact on health-related quality of life implores further investigation into its risk factors and strategies for effective management. Although the exact molecular mechanisms underlying pathophysiological onset of BPH are poorly defined, the current hypothesized contributors to BPH and lower urinary tract symptoms (LUTS) include aging, inflammation, metabolic syndrome, and hormonal changes. These processes are indirectly influenced by circadian rhythm disruption. In this article, we review the recent evidence on the potential association of light changes/circadian rhythm disruption and the onset of BPH and impact on treatment. METHODS A narrative literature review was conducted using PubMed and Google Scholar to identify supporting evidence. The articles referenced ranged from 1975 to 2023. RESULTS A clear relationship between BPH/LUTS and circadian rhythm disruption is yet to be established. However, common mediators influence both diseases, including proinflammatory states, metabolic syndrome, and hormonal regulation that can be asserted to circadian disruption. Some studies have identified a possible relationship between general LUTS and sleep disturbance, but little research has been done on the medical management of these diseases and how circadian rhythm disruption further affects treatment outcomes. CONCLUSIONS There is evidence to implicate a relationship between BPH/LUTS and circadian rhythm disruptions. However, there is scarce literature on potential specific link in medical management of the disease and treatment outcomes with circadian rhythm disruption. Further study is warranted to provide BPH patients with insights into circadian rhythm directed appropriate interventions.
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Affiliation(s)
- Dana Cavanaugh
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Tisch Cancer Institute at Mount Sinai, New York, NY, USA
| | - Alfonso Urbanucci
- Prostate Cancer Research Center, Faculty of Medicine and Health Technology and FiCanMid, Tampere University, Tampere, Finland
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Nihal E. Mohamed
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Tisch Cancer Institute at Mount Sinai, New York, NY, USA
| | - Ashutosh K. Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Tisch Cancer Institute at Mount Sinai, New York, NY, USA
| | - Mariana Figueiro
- Tisch Cancer Institute at Mount Sinai, New York, NY, USA
- Light and Health Research Center, Department of Population Health Science and Policy, Mount Sinai Health, New York, NY, USA
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Tisch Cancer Institute at Mount Sinai, New York, NY, USA
- Department of Oncological Sciences, Icahn School of medicine at Mount Sinai, New York, NY, USA
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Lee S, Yoo KH, Kim TS, Cho HJ, Kim W, Oh JK, Li S, Kim SY, Wei W, Huang J, van Uem S, Giudice FD, Lindars DP, Sathe AR, Chung BI. Characteristics of recurrent acute urinary retention in BPH patients in the United States: Retrospective analysis of US-based insurance claims database. Prostate 2023; 83:722-728. [PMID: 36891865 DOI: 10.1002/pros.24509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/04/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE The objective of this study is to analyze characteristics of recurrent acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH), utilizing a population based data set. Also, we sought to report on how AUR was treated, specifically regarding the need and length of catheterization and types of procedures utilized for mitigation. MATERIALS & METHODS A retrospective observational cohort study was performed using Optum's deidentified Clinformatics® Data Mart Database. We compared two groups, BPH patients with AUR (n = 180,737) and BPH patients without AUR (n = 1,139,760) from January 1, 2003 to December 31, 2017. Also, we analyzed the factors affecting the development of multiple episodes of AUR through age-adjusted multivariate analysis. RESULTS In contrast to the 47.7% of patients who had a single AUR episode, 33.5% of AUR patients developed 3 or more subsequent episodes of retention. For age matched patients, the risks of additional episodes of retention increase significantly with older age, Caucasian race, diabetes, neurologic conditions, or low income. Overall, the rate of BPH surgery in AUR patients over the study period decreased and the most common procedure was transurethral resection of the prostate. CONCLUSIONS Risk factors for multiple episodes of AUR included age (60 and older), Caucasian race, lower income socioeconomic status, diabetes, and neurological disorders. Patients with a high probability of developing recurrent episodes of AUR are recommended to receive preemptive BPH medication before such AUR occurrences. Also, more expeditious surgical treatment should be considered rather than temporary catheterization when AUR occurs.
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Affiliation(s)
- Sinyeong Lee
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, Seoul Medical Center, Seoul, Korea
| | - Koo Han Yoo
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Taek Sang Kim
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, Kosin University Hospital, Busan, Korea
| | - Hyuk Jin Cho
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, College of Medicine, Seoul Saint Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Wansuk Kim
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, Mokdong Hospital, Ewha Womans University, Seoul, Korea
| | - Jin Kyu Oh
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, Gachon University College of Medicine, Incheon, Korea
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Sang Youn Kim
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Wuran Wei
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Jianlin Huang
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Stefanie van Uem
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Francesco Del Giudice
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Maternal Infant and Urologic Sciences, "Sapienza", University of Rome, Rome, Italy
| | - David P Lindars
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Abha R Sathe
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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Ayangbesan A, Kavoussi N. Racial Disparities in Diagnosis and Management of Benign Prostatic Hyperplasia: A Review. Curr Urol Rep 2022; 23:297-302. [PMID: 36217002 DOI: 10.1007/s11934-022-01118-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW We sought to perform a contemporary literature review highlighting the racial disparities which exists in the evaluation and management of benign prostatic hyperplasia (BPH). RECENT FINDINGS Current literature suggests that racial disparities exist in the diagnosis of BPH and treatment lower urinary tract symptoms (LUTS). This is seen in the presentation and diagnosis of the disease as well as a difference in preventative care with discordant incidences of medical and surgical management among racial groups. The racial disparities that exist in the diagnosis and management of BPH and LUTS require further investigation to better identify the underlying causes. This will ultimately allow for continued improvement in care delivery and a more personalized approach in patient management.
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Affiliation(s)
- Abimbola Ayangbesan
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Nicholas Kavoussi
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
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Lee J, Choo MS, Yoo S, Cho MC, Son H, Jeong H. Intravesical Prostatic Protrusion and Prognosis of Non-Muscle Invasive Bladder Cancer: Analysis of Long-Term Data over 5 Years with Machine-Learning Algorithms. J Clin Med 2021; 10:jcm10184263. [PMID: 34575374 PMCID: PMC8468209 DOI: 10.3390/jcm10184263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/28/2022] Open
Abstract
We aim to investigate the significance of intravesical prostate protrusion (IPP) on the prognosis of non-muscle invasive bladder cancer (NMIBC) after the transurethral resection of bladder tumors (TURBT). For newly diagnosed NMIBC, we retrospectively analyzed the association between prognosis and IPP for at least a 5-year follow-up. A degree of IPP over 5 mm in a preoperative CT scan was classified as severe. The primary endpoint was recurrence-free survival, and the secondary endpoint was progression-free survival. The machine learning (ML) algorithm of a support vector machine was used for predictive model development. Of a total of 122 patients, ultimately, severe IPP was observed in 33 patients (27.0%). IPP correlated positively with age, BPH, recurrence, and prognosis. Severe IPP was significantly higher in the recurrence group and reduced in the recurrence-free survival group (p = 0.038, p = 0.032). Severe IPP independently increased the risk of intravesical recurrence by 2.6 times. The addition of IPP to the known oncological risk factors in the prediction model using the ML algorithm improved the predictability of cancer recurrence by approximately 6%, to 0.803. IPP was analyzed as a potential independent risk factor for NMIBC recurrence and progression after TURBT. This anatomical feature of the prostate could affect the recurrence of bladder tumors.
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Zhang B, Chen X, Liu YH, Gan Y, Liu PH, Chen Z, Xia WP, Dai GY, Ru F, Jiang ZX, He Y. Periprostatic fat thickness measured on MRI correlates with lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia progression. Asian J Androl 2021; 23:80-84. [PMID: 32859870 PMCID: PMC7831837 DOI: 10.4103/aja.aja_51_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study investigated the correlation between periprostatic fat thickness (PPFT) measured on magnetic resonance imaging and lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia (BPH) progression. A total of 286 treatment-naive men diagnosed with BPH in our department between March 2017 and February 2019 were included. Patients were divided into two groups according to the median value of PPFT: high (PPFT >4.35 mm) PPFT group and low (PPFT <4.35 mm) PPFT group. After the initial evaluation, all patients received a combination drug treatment of tamsulosin and finasteride for 12 months. Of the 286 enrolled patients, 244 completed the drug treatment course. Patients with high PPFT had larger prostate volume (PV; P = 0.013), higher International Prostate Symptom Score (IPSS; P = 0.008), and lower five-item version of the International Index of Erectile Function (IIEF-5) score (P = 0.002) than those with low PPFT. Both high and low PPFT groups showed significant improvements in PV, maximum flow rate, IPSS, and quality of life score and a decrease of IIEF-5 score after the combination drug treatment. The decrease of IIEF-5 score was more obvious in the high PPFT group than that in the low PPFT group. In addition, more patients in the high PPFT group underwent prostate surgery than those in the low PPFT group. Moreover, Pearson's correlation coefficient analysis indicated that PPFT was positively correlated with age, PV, and IPSS and negatively correlated with IIEF-5 score; however, body mass index was only negatively correlated with IIEF-5 score.
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Affiliation(s)
- Bo Zhang
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yu-Hang Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yu Gan
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Pei-Hua Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wei-Ping Xia
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Guo-Yu Dai
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Feng Ru
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ze-Xiang Jiang
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
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Shamout S, Carlson K, Brotherhood HL, Crump T, Baverstock R. Incidence and predictors of early and late hospital readmission after transurethral resection of the prostate: a population-based cohort study. BJU Int 2020; 127:238-246. [PMID: 32790101 DOI: 10.1111/bju.15191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the incidence and predictors of hospital readmission and emergency department (ED) visits in patients with benign prostatic hyperplasia treated by transurethral resection of the prostate (TURP). PATIENTS AND METHODS We conducted a retrospective cohort study using a linked administrative dataset from Calgary, Canada. Participants were men who underwent their first TURP procedure between 2015 and 2017. We examined patient demographics, and type of surgery (elective or urgent). Comorbidities were scored using the Charlson comorbidity index (CCI). The primary outcomes were unplanned hospital readmissions and ED visits at 30, 60 and 90 days after TURP. The secondary aim was to identify potential predictors across these groups. RESULTS We identified 3059 men, most of whom underwent elective TURP (83%). The mean (sd) patient age was 71.0 (10.0) years. A total of 224 patients (7.4%) were readmitted to the hospital within 30 days, 290 (9.5%) within 60 days, and 339 (11.1%) within 90 days of discharge. The frequency of return visits within 30, 60 and 90 days of TURP were 21.4%, 26% and 28.6%, respectively. The most responsible diagnoses for ED visit within 90 days were haematuria (15.4%) and retention of urine (12.8%). Multivariable analysis showed that age (odds ratio [OR] 1.61, P < 0.001), surgery type (OR 2.20, P < 0.001), and CCI score (OR 2.03, P < 0.001) were independently associated with odds of readmission and ED visits at all time points. CONCLUSION Older age, poorer health and urgent surgery predicted return to ED or readmission after TURP; efforts should be made to improve selection, counselling and preoperative optimization based on these risks.
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Affiliation(s)
- Samer Shamout
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada.,Vesia [Alberta Bladder Centre], Calgary, AB, Canada
| | - Kevin Carlson
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada.,Vesia [Alberta Bladder Centre], Calgary, AB, Canada
| | - Hilary L Brotherhood
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Trafford Crump
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Richard Baverstock
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada.,Vesia [Alberta Bladder Centre], Calgary, AB, Canada
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