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Åkerla J, Pesonen JS, Peltonen E, Huhtala H, Häkkinen J, Koskimäki J, Tammela TLJ, Auvinen A, Pöyhönen A. Do men adapt to lower urinary tract symptoms? An 11-year longitudinal study of male urinary urgency and associated bother. Scand J Urol 2024; 59:47-53. [PMID: 38406924 DOI: 10.2340/sju.v59.18289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/04/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The study objective is to evaluate prognosis and predictors of bother caused by urinary urgency among middle-aged and older men. MATERIAL AND METHODS A population-based sample of men born in 1974, 1964, 1954, 1944, 1934 and 1924 was followed-up from 2004 to 2015. The course of urgency and associated bother was evaluated with the Danish Prostatic Symptom Score at baseline and follow-up. Logistic regression was utilized to explore risk factors of increased bother at follow-up. RESULTS A total of 2,480 men (39%) who had responded at baseline and follow-up were included in the study. Of them, 1,056 men (43%) had persistent mild urgency and 132 men (5%) persistent moderate or severe urgency at follow-up. The proportions of men experiencing at least moderate bother due to persistent urgency at follow-up were 6% (95% confidence interval 4.5-7.3) of those with mild and 79% (71.7-85.9) of the men with moderate or severe urgency. In multivariable-adjusted logistic regression, moderate to severe urgency was strongly associated with bother (odds ratio, OR 55.2, 95% CI 32.1-95.2). Other predictors of bother included cardiac disease (OR 1.8, 95% CI 1.0-31.1), pulmonary disease (OR 1.9, 95% CI 1.1-3.5) and medical treatment (OR 2.7, 95% CI 1.6-4.6). CONCLUSIONS Most men with urinary urgency have mild symptoms and bother. Only one out of five men with persistent moderate or severe urgency adapt to the symptoms. Men with a history of medical treatment for lower urinary tract symptoms (LUTS) or impaired cardiopulmonary health are more likely to experience bother from urinary urgency.
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Affiliation(s)
- Jonne Åkerla
- Department of Urology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Jori S Pesonen
- Department of Urology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Essi Peltonen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jukka Häkkinen
- Department of Urology, Länsi-Pohja healthcare district, Kemi, Finland
| | - Juha Koskimäki
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teuvo L J Tammela
- Department of Urology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Antti Pöyhönen
- Centre for Military Medicine, The Finnish Defence Forces, Riihimäki, Finland
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2
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Liu D, Li C, Li Y, Zhou L, Li J, Wang Y, Wan X, Zhou L, Wang L. Benign prostatic hyperplasia burden comparison between China and United States based on the Global Burden of Disease Study 2019. World J Urol 2023; 41:3629-3634. [PMID: 37831157 DOI: 10.1007/s00345-023-04658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023] Open
Abstract
PURPOSE To determine the difference in the burden of benign prostatic hyperplasia (BPH) between China and the United States from 1990 to 2019. METHODS The prevalence, incidence, Years Lived with Disability (YLD), and their age-standardized rates for BPH in China and USA from 1990 to 2019 were based on the Global Burden of Disease Study 2019 (GBD 2019). The annual percentage changes (APC) of the age-standardized incidence rate (ASIR) and the age-standardized YLD rates (ASYR) were calculated using joinpoint regression analysis. The YLD numbers of six urinary tract diseases were also compared in both countries. RESULTS The absolute burden of BPH increased continuously in both countries, but it was much higher in China than in the United States. The ASIR and ASYR of BPH decreased in China but remained stable or decreased slightly in the United States. BPH incidence and YLD rates decreased in all age groups in China from 1990 to 2019. In the USA, they varied by age group. BPH caused more YLD number than any other urinary tract disease in China. In the USA, prostate cancer (PCa) caused more YLDs than BPH. CONCLUSIONS This research reveals marked BPH burden differences between China and the US (1990-2019). China's higher burden necessitates targeted interventions, while unique trends in both countries demand tailored strategies. These insights enhance understanding of BPH dynamics, informing effective interventions across diverse contexts.
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Affiliation(s)
- Dingwen Liu
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Cheng Li
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Youyou Li
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Liang Zhou
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Jiaren Li
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Yichuang Wang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Xiaomin Wan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Lei Zhou
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Long Wang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
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3
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Daher M, Saqer T, Jabr M, Al-Mousa S. Benign prostatic hyperplasia and metabolic syndrome; prevalence and association: a cross-sectional study in Syria. BMC Urol 2023; 23:187. [PMID: 37974176 PMCID: PMC10655284 DOI: 10.1186/s12894-023-01365-9] [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: 06/06/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Benign Prostatic Hyperplasia (BPH) is considered the most common cause of lower urinary tract symptoms in men aged 40 years and older. BPH is related to sex steroids, but there are increasing studies investigating the relationship between the urinary symptoms and the metabolic syndrome. They still have inconsistent results; some reported a significant positive association, while others found no significant association. In this study, we aim to assess the prevalence rate of metabolic syndrome in BPH patients and whether there is an association between symptoms linked to BPH and metabolic syndrome in the Syrian community. METHODS The participants of this observational cross-sectional study were benign prostatic hyperplasia patients aged 40-year-old and older from Homs, Syria. An interview questionnaire was performed to collect data from all patients who visited the urology clinic of Homs Military Hospital in the period of January 10 to March 10, 2023. We used the International Prostate Symptom Score (IPSS) to assess the urinary symptoms, and we used the US National Cholesterol Education Program Adult Treatment Panel (NCEP ATPIII) criteria to define the metabolic syndrome. RESULTS The final sample size was 426 patients. The overall prevalence of metabolic syndrome was 46.2%. Patients with metabolic syndrome had higher International Prostate Symptom Score compared to patients without metabolic syndrome (21 vs. 18, P < 0.001), and 59.3% of patients with metabolic syndrome suffered from severe symptoms compared to 36.2% of patients without metabolic syndrome who suffered from severe lower urinary tract symptoms (P < 0.001). There was a positive association between (waist circumference, diabetes, triglycerides) (P < 0.001), HDL (P = 0.014) and higher International Prostate Symptom Score. However, there was no statistically significant association between blood pressure and International Prostate Symptom Score (P = 0.879). CONCLUSION Our results showed that patients with metabolic syndrome had a higher International Prostate Symptom Score. This idea should be used to design a new benign prostatic hyperplasia/lower urinary tract symptoms treatment.
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Affiliation(s)
- Mohanad Daher
- Faculty of medicine, Damascus University, Damascus, Syria.
| | - Tareq Saqer
- Faculty of medicine, Damascus University, Damascus, Syria
| | - Mahmoud Jabr
- Faculty of medicine, Al-Baath University, Homs, Syria
| | - Samaher Al-Mousa
- Department of Rheumatology, Tishreen Military Hospital, Damascus, Syria
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4
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Baran C. The effect of acute urinary retention on the results of transurethral resection of the prostate. Urologia 2023; 90:642-646. [PMID: 37491943 DOI: 10.1177/03915603231189627] [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] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. METHODS Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. RESULTS There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. DISCUSSION Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks.
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Affiliation(s)
- Caner Baran
- Çukurova State Hospital, Department of Urology, Adana, Turkey
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Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms: A Markov Model-Based Cost-Effectiveness Analysis. J Am Coll Radiol 2022; 19:733-743. [PMID: 35476943 DOI: 10.1016/j.jacr.2022.02.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to investigate whether prostatic artery embolization (PAE) can be considered a long-term cost-effective treatment option in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia in comparison to transurethral resection of the prostate (TURP). METHODS The in-hospital costs of PAE and TURP in the United States were obtained from a recent cost analysis. Clinical outcomes including nature and rate of adverse events for TURP and PAE along with rates of retreatment because of complications or clinical failure were obtained from peer-reviewed literature. A decision tree-based Markov model was created, analyzing long-term cost-effectiveness for TURP and PAE from a US health care sector perspective. Cost-effectiveness over a time frame of 5 years was estimated while assuming a willingness to pay of $50,000 per quality-adjusted life-year (QALY). The primary outcome was incremental cost-effectiveness ratio. RESULTS PAE resulted in overall cost of $6,464.92 and an expected outcome of 4.566 QALYs. In comparison, TURP cost $9,221.09 and resulted in expected outcome of 4.577 QALYs per treatment. The incremental cost-effectiveness ratio for TURP was $247,732.65 per QALY. On the basis of the willingness-to-pay threshold, PAE is cost effective compared with TURP. CONCLUSIONS On the basis of our model, PAE in comparison with TURP can be regarded as a cost-effective treatment option for patients with lower urinary tract symptoms within the US health care system.
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6
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Funada S, Luo Y, Yoshioka T, Setoh K, Tabara Y, Negoro H, Yoshimura K, Matsuda F, Efthimiou O, Ogawa O, Furukawa TA, Kobayashi T, Akamatsu S. Development and validation of prediction model for incident overactive bladder: The Nagahama study. Int J Urol 2022; 29:748-756. [PMID: 35393696 PMCID: PMC9546153 DOI: 10.1111/iju.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022]
Abstract
Objectives We aimed to develop models to predict new‐onset overactive bladder in 5 years using a large prospective cohort of the general population. Methods This is a secondary analysis of a longitudinal cohort study in Japan. The baseline characteristics were measured between 2008 and 2010, with follow‐ups every 5 years. We included subjects without overactive bladder at baseline and with follow‐up data 5 years later. Overactive bladder was assessed using the overactive bladder symptom score. Baseline characteristics (demographics, health behaviors, comorbidities, and overactive bladder symptom scores) and blood test data were included as predictors. We developed two competing prediction models for each sex based on logistic regression with penalized likelihood (LASSO). We chose the best model separately for men and women after evaluating models' performance in terms of discrimination and calibration using an internal validation via 200 bootstrap resamples and a temporal validation. Results We analyzed 7218 participants (male: 2238, female: 4980). The median age was 60 and 55 years, and the number of new‐onset overactive bladder was 223 (10.0%) and 288 (5.8%) per 5 years in males and females, respectively. The in‐sample estimates for C‐statistic, calibration intercept, and slope for the best performing models were 0.77 (95% confidence interval 0.74–0.80), 0.28 and 1.15 for males, and 0.77 (95% confidence interval 0.74–0.80), 0.20 and 1.08 for females. Internal and temporal validation gave broadly similar estimates of performance, indicating low optimism. Conclusion We developed risk prediction models for new‐onset overactive bladder among men and women with good predictive ability.
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Affiliation(s)
- Satoshi Funada
- Department of Urology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.,Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Kazuya Setoh
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | | | - Koji Yoshimura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Shusuke Akamatsu
- Department of Urology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
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Xiong Y, Zhang Y, Tan J, Qin F, Yuan J. The association between metabolic syndrome and lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging males: evidence based on propensity score matching. Transl Androl Urol 2021; 10:384-396. [PMID: 33532326 PMCID: PMC7844497 DOI: 10.21037/tau-20-1127] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background To investigate the association between lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH) and metabolic syndrome (MetS) in aging Chinese males. Methods A dataset that included 3,568 non-MetS cases and 1,020 MetS cases (after data cleansing) was downloaded from the China Health and Retirement Longitudinal Study (CHARLS). To balance the intergroup covariates, propensity score matching (PSM) was employed in the analyses. Univariate logistic regression and multivariate logistic regression were then performed to investigate the relationship between LUTS/BPH and MetS in aging Chinese males. Results Before PSM, multivariate logistic regression showed that participants with MetS had a 1.47 times higher risk of LUTS/BPH compared to non-MetS cases in the final model (P<0.001). It also revealed that participants with low high-density lipoprotein (HDL), abdominal adiposity, or high triglycerides had a higher probability of LUTS/BPH [odds ratio (OR) =1.56 for low HDL; OR =1.50 for abdominal adiposity; and OR =1.48 for high triglyceride, P<0.001], while participants with hyperglycemia or hypertension had identical odds of LUTS/BPH (P>0.05). After PSM, 1,000 pairs were successfully matched. It was also found that MetS cases had a 1.60 times higher risk of LUTS/BPH compared to non-MetS cases (P<0.001), and participants with low HDL, abdominal adiposity, high triglycerides, or hyperglycemia had a higher likelihood of LUTS/BPH than their counterparts (P<0.001). However, the probability of LUTS/BPH in hypertensive patients remained similar to that in non-hypertensive patients (P>0.05). Conclusions Aging Chinese males with MetS had a higher probability of LUTS/BPH. Also, patients with low HDL, abdominal obesity, high triglycerides, or hyperglycemia had an increased risk of LUTS/BPH; however, this was not the case for hypertensive patients.
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Affiliation(s)
- Yang Xiong
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yangchang Zhang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Jun Tan
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Qin
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuhong Yuan
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Bortnick E, Brown C, Simma-Chiang V, Kaplan SA. Modern best practice in the management of benign prostatic hyperplasia in the elderly. Ther Adv Urol 2020; 12:1756287220929486. [PMID: 32547642 PMCID: PMC7273551 DOI: 10.1177/1756287220929486] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/03/2020] [Indexed: 11/17/2022] Open
Abstract
Benign prostatic hyperplasia (BPH), with its associated lower urinary tract symptoms (LUTS), can be a debilitating disease in the elderly male. Transurethral resection of the prostate (TURP) remains the gold standard; however, many patients will choose to avoid surgery if possible. Medical therapy is an effective alternative, however, new studies are showing that there may be more side effects than previously realized in the elderly male. Newer, novel minimally invasive techniques, including UroLift® and Rezūm™, are gaining favor as alternative office-based procedural techniques that do not require general anesthesia and may better preserve ejaculatory function. Though promising, at this point, these techniques are not approved for all patients. With a range of medical, procedural, and surgical options for treatment of BPH with LUTS, it is important to have a discussion with your patient regarding the short- and long-term risks and benefits, as well as alternatives, before deciding on a treatment plan for your patient with BPH.
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Affiliation(s)
- Eric Bortnick
- Department of Urology, Mount Sinai Hospital, 1245 Madison Avenue, New York, NY 10029, USA
| | - Conner Brown
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | | | - Steven A Kaplan
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
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Holmium laser technologies versus photoselective greenlight vaporization for patients with benign prostatichyperplasia: a meta-analysis. Lasers Med Sci 2020; 35:1441-1450. [PMID: 31939037 DOI: 10.1007/s10103-020-02953-z] [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: 09/19/2019] [Accepted: 01/02/2020] [Indexed: 02/05/2023]
Abstract
This study aims to compare the efficacy and safety of holmium laser technologies (HoL-Ts) and photoselective greenlight vaporization (PVP) for the treatment of benign prostatic hyperplasia (BPH), and to perform a meta-analysis according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines on PubMed, EMBASE, ClinicalTrial.gov, and the Cochrane Central Register of Controlled Trials up to August 2019. Functional outcomes, perioperative parameters, and complications were included and analyzed. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was used to perform all analyses. A total of six articles composed of 2014 patients were included in this review. In comparison with PVP, HoL-Ts had a better performance in 1-, 3-, and 6-month Qmax (P = 0.02, but I2 = 81%), with less postvoid residual urine volume (PVR) (MD = -33.85, 95% CI -52.13 to -15.57, P = 0.0003) and less total energy used (MD = -31.66, 95% CI -58.99 to -4.33, P = 0.02). Moreover, HoL-Ts had a relatively lower risk of conversion rate (OR = 0.08, 95% CI 0.01 to 0.60, P = 0.01) associated with enough enucleation and less intraoperative bleeding. Subgroup analysis of holmium laser enucleation of prostate (HoLEP) versus PVP suggested that HoLEP presented better results in 1-, 3-, 6-month and 1-year Qmax with less PVR, less energy consumption, and lower conversion rate. Compared with PVP, HoL-Ts had higher 1-, 3-, and 6-month Qmax, less PVR, and less total energy consumption with a relatively lower risk of conversion rate. In subgroup analyses, HoLEP had shown better results in accordance with all HoL-Ts. Nevertheless, well-designed RCTs including overall functional indicators are required to confirm our findings.
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10
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Medical Therapies for Treatment of BPH: Special Considerations in Elderly Men. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-00299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Rastrelli G, Vignozzi L, Corona G, Maggi M. Testosterone and Benign Prostatic Hyperplasia. Sex Med Rev 2019; 7:259-271. [PMID: 30803920 DOI: 10.1016/j.sxmr.2018.10.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are frequent in aging. Nonetheless, their pathogenesis is largely unknown. The androgen dependence of the first phases of prostate development have inspired the historical view that higher testosterone (T) may be involved in BPH occurrence; however, recent evidence suggests a different scenario. AIM To review the available knowledge on the pathogenesis of BPH particularly concerning the role of T and the possible connections with metabolic impairments. METHODS Relevant records were retrieved by an extensive search in Medline, including the following keywords ("testosterone"[MeSH Terms] OR "testosterone"[All Fields]) AND ("prostatic hyperplasia"[MeSH Terms] OR ("prostatic"[All Fields] AND "hyperplasia"[All Fields]) OR "prostatic hyperplasia"[All Fields] OR ("benign"[All Fields] AND "prostatic"[All Fields] AND "hyperplasia"[All Fields]) OR "benign prostatic hyperplasia"[All Fields]). There were no limitations in terms of publication date or study design. MAIN OUTCOME MEASURES Preclinical and clinical studies have been reported, with special emphasis on our contribution and interpretation. RESULTS Inflammation is a key aspect of BPH development. Along with infectious agents, prostate inflammation can be triggered by metabolic stimuli, such as dyslipidemia, an important component of metabolic syndrome (MetS). Low T and hyperestrogenism frequently occur in MetS. Mounting evidence shows that low, rather than high, T and hyperestrogenism may favor prostate inflammation. Considering these data as a whole, we postulate that BPH is the result of the action of multiple factors, which reinforce their mutual detrimental effects. CONCLUSION T is not detrimental for the prostate, and treating hypogonadism could even produce relief from LUTS and limit prostatic inflammation, which generates and maintains the process leading to BPH. Rastrelli G, Vignozzi L, Corona G, et al. Testosterone and Benign Prostatic Hyperplasia. Sex Med Rev 2019;7:259-271.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | - Giovanni Corona
- Sexual Medicine and Andrology Unit Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy.
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12
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Åkerla J, Pesonen JS, Pöyhönen A, Häkkinen J, Koskimäki J, Huhtala H, Tammela TLJ, Auvinen A. Impact of lower urinary tract symptoms on mortality: a 21-year follow-up among middle-aged and elderly Finnish men. Prostate Cancer Prostatic Dis 2018; 22:317-323. [PMID: 30410016 DOI: 10.1038/s41391-018-0108-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/25/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The usefulness of lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. Repeated assessments are required to take into account symptom fluctuation and de novo symptom appearance. The study objective was to evaluate mortality in relation to three urinary storage symptoms-urgency, daytime frequency, and nocturia-in middle-aged and elderly men, considering also other time-varying factors during follow-up. METHODS A mail survey of a population-based cohort of men initially aged 50, 60, and 70 years was conducted in Finland in 1994, 1999, 2004, and 2009. The questionnaire included assessments of LUTS based on the Danish Prostatic Symptom Score and comorbidities. The men were followed up for mortality through the population registry through 2014. LUTS-related hazard ratios (HR) were analyzed with time-dependent Cox regression adjusted for the year of birth and comorbidities using variable values updated every 5 years. Sensitivity analyses were conducted using values of all variables fixed to the baseline assessment of 1994. RESULTS Of the 1332 eligible men with data on LUTS from each preceding survey, 514 (38.6%) died during the 21-year follow-up. In time-dependent analyses, daytime frequency, and nocturia were significantly associated with increased mortality: the adjusted HR was 1.42 (95% CI 1.11-1.83) for daytime frequency, 1.38 (1.07-1.79) for nocturia and 1.19 (0.94-1.50) for urgency. In sensitivity analyses with fixed baseline characteristics, only nocturia was suggestively associated with an increased risk of death: the adjusted HR was 1.09 (0.84-1.42) for daytime frequency, 1.41 (0.99-2.02) for nocturia and 0.94 (0.52-1.68) for urgency. CONCLUSIONS Among aging men, LUTS are more accurate predictors of short-term than longer-term mortality risk. Repeated assessments are needed to detect clinically relevant and persistent symptoms, often associated with ill health. Accordingly, men with daytime frequency or nocturia exhibit a 1.4-fold risk of death and therefore, should be evaluated for underlying comorbidity.
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Affiliation(s)
- Jonne Åkerla
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland. .,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Jori S Pesonen
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Antti Pöyhönen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jukka Häkkinen
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Juha Koskimäki
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Teuvo L J Tammela
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Egan KB. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates. Urol Clin North Am 2017; 43:289-97. [PMID: 27476122 DOI: 10.1016/j.ucl.2016.04.001] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article assesses the reported prevalence and incidence rates for benign prostatic hyperplasia and lower urinary tract symptoms (BPH/LUTS) by age, symptom severity, and race/ethnicity. BPH/LUTS prevalence and incidence rates increase with increasing age and vary by symptom severity. The BPH/LUTS relationship is complex due to several factors. This contributes to the range of reported estimates and difficulties in drawing epidemiologic comparisons. Cultural, psychosocial, economic, and/or disease awareness and diagnosis factors may influence medical care access, symptom reporting and help-seeking behaviors among men with BPH/LUTS. However, these factors and their epidemiologic association with BPH/LUTS have not been thoroughly investigated.
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Affiliation(s)
- Kathryn Brigham Egan
- Yale University, 2 Whalley Ave, New Haven, CT 06520, USA; New England Research Institutes Inc., 480 Pleasant Street, Watertown, MA 02472, USA.
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Rohrmann S, Katzke V, Kaaks R. Prevalence and Progression of Lower Urinary Tract Symptoms in an Aging Population. Urology 2016; 95:158-63. [PMID: 27346671 DOI: 10.1016/j.urology.2016.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/06/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the prevalence of lower urinary tract symptoms (LUTS) in males of the general population. MATERIALS AND METHODS In our analysis, we included 8627 men, 48-79 years of age, who participated in the fourth follow-up (FUP) of EPIC-Heidelberg (2007-2009) and replied to questions on LUTS. According to the International Prostate Symptom Score questionnaire, men were categorized as having mild (0-7 points), moderate (8-19 points), or severe LUTS (20-35 points). In addition, we examined progression of LUTS among 7821 men, who also participated in FUP 5 (2010-2012). RESULTS There were 75.3% of men who reported mild, 22.0% who reported moderate, and 2.7% who reported severe LUTS. The prevalence increased with age. At FUP 4, 5.8% (mild symptoms) to 39.7% (severe LUTS) of participants reported use of any type of benign prostatic hyperplasia or LUTS medication. Nocturia, that is, getting up at night at least twice, was the most common symptom, followed by incomplete emptying of the bladder and urgency. There were 54.8% of men who reported worse LUTS in FUP 5, but 27.1% reported an improvement in symptoms. CONCLUSION About a quarter of middle-aged and elderly men reported clinically relevant LUTS. Whereas symptoms in some men actually improve, more than half of men experience worsening of symptoms over a 3-year period in time.
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Affiliation(s)
- Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Pesonen JS, Cartwright R, Mangera A, Santti H, Griebling TL, Pryalukhin AE, Riikonen J, Tähtinen RM, Agarwal A, Tsui JF, Vaughan CP, Markland AD, Johnson TM, Fonsell-Annala R, Khoo C, Tammela TLJ, Aoki Y, Auvinen A, Heels-Ansdell D, Guyatt GH, Tikkinen KAO. Incidence and Remission of Nocturia: A Systematic Review and Meta-analysis. Eur Urol 2016; 70:372-81. [PMID: 26905787 DOI: 10.1016/j.eururo.2016.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
CONTEXT Although vital for decision-making about management, the natural history of nocturia remains uncertain. A systematic review would clarify the issue, but because natural history reviews are uncommon it would require methodological innovations. OBJECTIVE To estimate the incidence and remission of nocturia, and refine methods for meta-analyses assessing natural history. EVIDENCE ACQUISITION We conducted a comprehensive search of PubMed, Scopus, and Cumulative Index of Nursing and Allied Health Literature databases and abstracts of major urologic meetings as far as August 31, 2015. Random effects meta-analyses addressed incidence/remission rates of nocturia; meta-regression explored potential determinants of heterogeneity. Studies were categorized as either low or high risk of bias using a novel instrument specifically designed for longitudinal symptom studies aimed at the general population. EVIDENCE SYNTHESIS Of 4165 potentially relevant reports, 16 proved eligible. Pooled estimates from 13 studies (114 964 person-years of follow-up) demonstrated that annual incidence was strongly associated with age: 0.4% (0-0.8%) for adults aged < 40 yr; 2.8% (1.9-3.7%) for adults aged 40-59 yr; and 11.5% (9.1-14.0%) for adults aged ≥ 60 yr. Of those with nocturia, each year 12.1% (9.5-14.7%) experienced remission. CONCLUSIONS The available evidence suggests that nocturia onset is strongly associated with age, with much higher rates in those over 60 yr; remission occurs in approximately 12% each year. These estimates can aid with management decisions and counseling related to nocturia. PATIENT SUMMARY We reviewed all previous studies of progression of night-time urination (nocturia). We found that in any given year 0.4% of adults aged < 40 yr, 3% of adults aged 40-59 yr, and 12% of adults aged ≥ 60 yr will develop nocturia, while overall 12% of those with nocturia will improve. These findings may be helpful in making decisions about coping with or treating nocturia.
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Affiliation(s)
- Jori S Pesonen
- Department of Urology, Päijät-Häme Central Hospital, Lahti, Finland; Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Urogynaecology, Imperial College London, London, UK
| | - Altaf Mangera
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Henrikki Santti
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tomas L Griebling
- Department of Urology, University of Kansas and The Landon Center On Aging, Kansas City, KS, USA
| | - Alexey E Pryalukhin
- North-Western State Medical University named after I.I. Mechnikov, Department of Urology, Saint Petersburg, Russia; Department of Pathology, Saarland University Medical Center, Homburg, Germany
| | - Jarno Riikonen
- Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland
| | - Riikka M Tähtinen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Arnav Agarwal
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Johnson F Tsui
- Department of Urology, Lenox Hill Hospital, New York, NY, USA
| | - Camille P Vaughan
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA, USA
| | - Alayne D Markland
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA, USA
| | - Theodore M Johnson
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA, USA
| | | | - Charlie Khoo
- Department of Urology, Royal Free Hospital, London, UK
| | - Teuvo L J Tammela
- Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland
| | - Yoshitaka Aoki
- Department of Urology, University of Fukui, Faculty of Medical Sciences, Fukui, Japan
| | - Anssi Auvinen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Diane Heels-Ansdell
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.
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Marshall LM, Holton KF, Parsons JK, Lapidus JA, Ramsey K, Barrett-Connor E. Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men. Prostate Cancer Prostatic Dis 2014; 17:265-72. [PMID: 25000909 PMCID: PMC4214078 DOI: 10.1038/pcan.2014.22] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/29/2014] [Accepted: 05/15/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Knowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission. METHODS In community-dwelling US men aged ≥65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000-2002) and then every 2 years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or BPH during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modelingof the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared with stable trajectories, and with remitting compared with progressing trajectories. Lifestyle, body mass index (BMI) (kg/m(2)), mobility, mental health (Short-Form 12), medical history and prescription medications were considered for selection. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for variables in each model. RESULTS We identified 10 AUA-SI trajectories: 4 stable (1277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%) and one mixed (20 men, 1%). Men in progressing compared with stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0-3.8), poor mental health (OR=1.9, 95% CI: 1.1-3.4), BMI≥25.0 kg m(-2) (OR=1.7, 95% CI: 1.0-2.8), hypertension (OR=1.5, 95% CI: 1.0-2.4) and back pain (OR=1.5, 95% CI: 1.0-2.4). Men in remitting compared with progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1-4.9) and less often had a history of problem drinking (OR=0.4, 95% CI: 0.2-0.9). CONCLUSIONS Several non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men.
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Affiliation(s)
- Lynn M. Marshall
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland OR
- Department of Public Health and Preventive Medicine, Oregon Health and Science, Portland OR
- Department of Medicine, Bone and Mineral Unit, Oregon Health and Science University, Portland OR
| | - Kathleen F. Holton
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland OR
| | - J. Kellogg Parsons
- Division of Urology, University of California San Diego, La Jolla, CA
- University of California San Diego Moores Cancer Center, La Jolla, CA
- Department of Surgery, San Diego Veterans Affairs Medical Center, La Jolla, CA
| | - Jodi A. Lapidus
- Department of Public Health and Preventive Medicine, Oregon Health and Science, Portland OR
- Biostatistics Design Program, Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland Oregon
| | - Katrina Ramsey
- Department of Public Health and Preventive Medicine, Oregon Health and Science, Portland OR
- Biostatistics Design Program, Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland Oregon
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Komiya A, Kino M, Kato T, Suzuki H, Ichikawa T, Fuse H. Correlations Among Urinary, Sexual, and Testicular Functions and Health-Related Quality of Life. JOURNAL OF MEN'S HEALTH 2013. [DOI: 10.1089/jomh.2012.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Martin S, Lange K, Haren MT, Taylor AW, Wittert G. Risk factors for progression or improvement of lower urinary tract symptoms in a prospective cohort of men. J Urol 2013; 191:130-7. [PMID: 23770136 DOI: 10.1016/j.juro.2013.06.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE We determined the metabolic, lifestyle and physical factors associated with progression or improvement of storage and voiding lower urinary tract symptoms in a population based cohort of men. MATERIALS AND METHODS After the exclusion of men with prostate or bladder cancer and/or surgery from the study, progression and improvement of storage and voiding lower urinary tract symptoms was assessed using the AUA-SI (American Urological Association symptom index) in 780 men, age 35 to 80 years at baseline, who attended 5-year followup clinics. RESULTS Storage and voiding lower urinary tract symptoms progressed in 39.8% (308) and 32.3% (250) of men, and improved in 33.1% (256) and 23.4% (181), respectively. In final adjusted regression models greater bother and physical activity at baseline predicted improvement in storage and voiding lower urinary tract symptoms, while greater income, high-density lipoprotein cholesterol and lower triglycerides predicted improvement of storage lower urinary tract symptoms only. Being widowed, higher plasma estradiol and depression at baseline predicted the progression of storage and voiding lower urinary tract symptoms, while greater abdominal fat mass and obstructive sleep apnea risk predicted the progression of storage lower urinary tract symptoms only. Older age, lower high-density lipoprotein cholesterol, testosterone, income, previous benign prostatic hyperplasia and erectile dysfunction at baseline predicted the progression of voiding lower urinary tract symptoms only. The initiation or continued use of α-blockers or anticholinergics (storage lower urinary tract symptoms), and 5α-reductase inhibitors (voiding lower urinary tract symptoms), were associated with symptom improvement. CONCLUSIONS Lower urinary tract symptoms may progress or remit. Even accounting for medication use, progression may be associated with modifiable disease, or metabolic or behavioral factors, which are also risk factors for type 2 diabetes and cardiovascular disease. These factors should be looked for and managed.
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Affiliation(s)
- Sean Martin
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia; School of Medicine, University of Adelaide, Adelaide, South Australia
| | - Kylie Lange
- School of Medicine, University of Adelaide, Adelaide, South Australia
| | - Matthew T Haren
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia; Population Research and Outcome Studies, University of Adelaide, Adelaide, South Australia
| | - Anne W Taylor
- SANSOM Institute, Division of Health Sciences, University of South Australia, Adelaide, South Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia; School of Medicine, University of Adelaide, Adelaide, South Australia.
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Nicholson TM, Ricke EA, Marker PC, Miano JM, Mayer RD, Timms BG, vom Saal FS, Wood RW, Ricke WA. Testosterone and 17β-estradiol induce glandular prostatic growth, bladder outlet obstruction, and voiding dysfunction in male mice. Endocrinology 2012; 153:5556-65. [PMID: 22948219 PMCID: PMC3473198 DOI: 10.1210/en.2012-1522] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Benign prostatic hyperplasia (BPH) and bladder outlet obstruction (BOO) are common in older men and can contribute to lower urinary tract symptoms that significantly impact quality of life. Few existing models of BOO and BPH use physiological levels of hormones associated with disease progression in humans in a genetically manipulable organism. We present a model of BPH and BOO induced in mice with testosterone (T) and 17β-estradiol (E(2)). Male mice were surgically implanted with slow-releasing sc pellets containing 25 mg T and 2.5 mg E(2) (T+E(2)). After 2 and 4 months of hormone treatment, we evaluated voiding patterns and examined the gross morphology and histology of the bladder, urethra, and prostate. Mice treated with T+E(2) developed significantly larger bladders than untreated mice, consistent with BOO. Some mice treated with T+E(2) had complications in the form of bladder hypertrophy, diverticula, calculi, and eventual decompensation with hydronephrosis. Hormone treatment caused a significant decrease in the size of the urethral lumen, increased prostate mass, and increased number of prostatic ducts associated with the prostatic urethra, compared with untreated mice. Voiding dysfunction was observed in mice treated with T+E(2), who exhibited droplet voiding pattern with significantly decreased void mass, shorter void duration, and fewer sustained voids. The constellation of lower urinary tract abnormalities, including BOO, enlarged prostates, and voiding dysfunction seen in male mice treated with T+E(2) is consistent with BPH in men. This model is suitable for better understanding molecular mechanisms and for developing novel strategies to address BPH and BOO.
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Homma Y, Gotoh M, Yokoyama O, Masumori N, Kawauchi A, Yamanishi T, Ishizuka O, Seki N, Kamoto T, Nagai A, Ozono S. JUA clinical guidelines for benign prostatic hyperplasia. Int J Urol 2011. [DOI: 10.1111/j.1442-2042.2011.02861.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Moreno Sierra J, Fernandez Pérez C, Cano Escudero S, Fuentes Ferrer M, Tolosa LB, Silmi Moyano Á. Progression of Null or Mild Lower Urinary Tract Symptoms Indicative of Benign Prostatic Hyperplasia After 2 Years of Follow-up in Non-treated Men Aged 40 Years or Older. Urology 2011; 77:693-8. [DOI: 10.1016/j.urology.2010.07.459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/30/2010] [Accepted: 07/09/2010] [Indexed: 10/18/2022]
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22
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Andersson KE, Fullhase C, Soler R, Guimaraes Souza NK. Update on Uropharmacology: Bladder Dysfunction, Nitric Oxide, and Reactive Oxygen Species. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0057-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bushman W. Etiology, epidemiology, and natural history of benign prostatic hyperplasia. Urol Clin North Am 2010; 36:403-15, v. [PMID: 19942041 DOI: 10.1016/j.ucl.2009.07.003] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Historically, benign prostatic hyperplasia (BPH) has been a major focus of urologic practice and surgery. But a simplistic causal relationship among prostatic enlargement, progressive obstruction, lower urinary tract symptoms, retention, and complications of retention has been challenged by recognition of the incomplete overlap of prostatic enlargement with symptoms and obstruction. The result has been a greater focus on symptoms than prostatic enlargement and a shift from surgery to medical treatment. Therefore, the question can be asked whether BPH per se, the glandular enlargement as it contributes to bladder dysfunction, or hyperplastic enlargement as a biomarker for generalized lower urinary tract dysfunction are concerns. This article addresses these issues.
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Affiliation(s)
- Wade Bushman
- Department of Urology, University of Wisconsin Medical School, K6-562 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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Subjective cognitive complaints relate to white matter hyperintensities and future cognitive decline in patients with cardiovascular disease. Am J Geriatr Psychiatry 2009; 17:976-85. [PMID: 20104055 PMCID: PMC2813459 DOI: 10.1097/jgp.0b013e3181b208ef] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Elderly patients with cardiovascular disease (CVD) often report cognitive difficulties including reduced cognitive processing speed and attention. On cross-sectional examination, such reports relate more closely to mood than to objective measures of cognitive performance, thus questioning the validity of subjective cognitive complaints as a marker of neurodegenerative processes. This study examined the longitudinal relationship among self-reported cognitive difficulties, depression, and performance on objective tests of global cognition in patients with CVD. PARTICIPANTS AND METHODS Forty-seven patients with CVD (aged 55-85 years) completed a measure of perceived cognitive dysfunction (Cognitive Difficulties Scale [CDS]), a medical history questionnaire, the Dementia Rating Scale (DRS), and the Beck Depression Inventory (BDI) at baseline and 12 months later. Baseline brain imaging was available on a small subsample (N = 17). RESULTS Hierarchical linear regression revealed that increased report of cognitive difficulties at baseline was significantly associated with poorer DRS performance at follow-up (F[3, 43] = 4.45, p = 0.008, CDS partial r = -0.30, p = 0.048), independent of age, education, baseline DRS, and BDI scores. Greater perceived cognitive dysfunction at baseline also related to higher level of white matter lesions (r = 0.53, df = 15, p = 0.028). CONCLUSIONS Self-reported cognitive difficulties may reflect early changes in cognitive aging that are difficult to detect using global cognitive screening measures at a single time point. However, these perceived difficulties relate to objectively measured cognitive decline over time. Thus, they may provide important clinical information about early neurodegenerative processes that should be carefully monitored.
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Tsukamoto T, Masumori N, Nakagawa H, Arai Y, Komiya A, Ichikawa T, Takei M, Yamaguchi A, Liu Y, Crane MM. Changes in prostate volume in Japanese patients with benign prostatic hyperplasia: Association with other urological measures and risk of surgical intervention. Int J Urol 2009; 16:622-7. [DOI: 10.1111/j.1442-2042.2009.02323.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kaplan SA, Roehrborn CG, Chapple CR, Rosen RC, Irwin DE, Kopp Z, Aiyer LP, Mollon P. Implications of recent epidemiology studies for the clinical management of lower urinary tract symptoms. BJU Int 2009; 103 Suppl 3:48-57. [DOI: 10.1111/j.1464-410x.2009.08372.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Speakman MJ. Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia (LUTS/BPH): More Than Treating Symptoms? ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eursup.2008.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Lower Urinary Tract Symptoms Revisited: A Broader Clinical Perspective. Eur Urol 2008; 54:563-9. [DOI: 10.1016/j.eururo.2008.03.109] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 03/31/2008] [Indexed: 11/21/2022]
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Abstract
In the United States, research into the etiology of benign prostatic hyperplasia (BPH) and the incidence and treatment of lower urinary tract symptoms (LUTS) in racial/ethnic minority patients is just beginning, despite a high incidence of both conditions in these populations. The relative risks for the development of BPH and commonly comorbid conditions in African Americans and Latinos may be increased compared with the white majority population. This heightened risk may be attributable to factors such as autonomic hyperactivity and metabolic abnormalities, which appear at a higher rate in African Americans and Latinos. Differences in genetic factors related to androgen receptor CAG repeats, the androgen signaling pathway, and in the cellular composition of the prostate also contribute to racial/ethnic differences in the incidence of clinical BPH and LUTS. Despite the disproportionately high rates of BPH-associated risk factors and comorbidities associated with the condition, a large proportion of minority patients with BPH and LUTS are undiagnosed and untreated. Expanding the information base on BPH and LUTS in minority patients may help to narrow existing ethnic/racial disparities in treatment and to reduce the impact of LUTS on the quality of life of these patients.
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How to engage the Latino or African American patient with benign prostatic hyperplasia: crossing socioeconomic and cultural barriers. Am J Med 2008; 121:S11-7. [PMID: 18675612 DOI: 10.1016/j.amjmed.2008.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Disparities based on race and ethnicity still exist in the US healthcare system. Such disparities are reflected in the diagnosis and treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) among African Americans and Latinos. The prevalence of risk factors for BPH and LUTS and symptom progression are higher in these populations, but treatment is less common. African American men and Latinos frequently have other serious comorbidities, such as cardiovascular disease, diabetes mellitus, and metabolic syndrome. Health plan constraints and variabilities, race/ethnicity, socioeconomic status, language, healthcare-seeking behaviors, and cultural beliefs and practices influence the treatment of BPH and LUTS, oftentimes resulting in unequal access to care or inferior quality of care. The provision of nondiscriminatory treatment poses a challenge to clinicians that can partially be addressed by improving the cultural competence of practitioners in minority communities. An awareness of the customs and healing traditions of African Americans and Latinos may also facilitate culturally appropriate care and improve outcomes, and the participation of clinicians in continuing education/professional development programs to increase knowledge about minority health issues is recommended. Conversely, improving the health literacy of African American and Latino patients with BPH and LUTS can help avoid ineffective nontraditional methods of treatment.
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Häkkinen JT, Shiri R, Koskimäki J, Tammela TLJ, Auvinen A, Hakama M. Depressive symptoms increase the incidence of nocturia: Tampere Aging Male Urologic Study (TAMUS). J Urol 2008; 179:1897-901. [PMID: 18353384 DOI: 10.1016/j.juro.2008.01.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE We assessed the effects of depressive symptoms on the incidence of nocturia in men. MATERIALS AND METHODS The target population comprised all men who were 50, 60 or 70 years old and residing in the Tampere area in 1994. A self-administered questionnaire was mailed to 3,143 randomly selected men in 1994 and a second round was mailed to the 2,837 who were alive and eligible in 1999. The followup sample consisted of 1,580 men with information on nocturia available at baseline and followup. RESULTS The incidence of mild to severe nocturia was 75 cases per 1,000 person-years (95% CI 66-85) and that of moderate or severe nocturia was 9 (95% CI 7-11). Men with depressive symptoms at study entry were at 2.8 times higher risk (95% CI 1.5-5.2) for moderate or severe nocturia than those without depressive symptoms. A dose response relation was found between the severity of depressive symptoms at baseline and the incidence of moderate or severe nocturia. Each unit increment in the short form of the Mental Health Inventory score on a scale of 5 to 30 increased the incidence rate ratio of moderate or severe nocturia by 10% (95% CI 4-16). Only untreated depressive symptoms increased the incidence of moderate or severe nocturia (adjusted RR 3.3, 95% CI 1.7-6.2) but not medically treated symptoms. Nocturia at study entry had no significant effect on depressive symptoms during followup. CONCLUSIONS Our findings show a unidirectional effect of depressive symptoms on the incidence of moderate or severe nocturia. Untreated depressive symptoms may cause nocturia.
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Affiliation(s)
- Jukka T Häkkinen
- Department of Urology, Tampere University Hospital, Tampere, Finland.
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Heidler S, Deveza C, Temml C, Ponholzer A, Marszalek M, Berger I, Bluhm A, Madersbacher S. The Natural History of Lower Urinary Tract Symptoms in Females: Analysis of a Health Screening Project. Eur Urol 2007; 52:1744-50. [PMID: 17822835 DOI: 10.1016/j.eururo.2007.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 08/06/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyse over 6.5 yr the natural history of lower urinary tract symptoms (LUTS) of continent women participating in a health investigation. METHODS Women participating in a health screening survey in the area of Vienna in 1998-1999 underwent a detailed health investigation and completed the Bristol Female LUTS questionnaire. In 2005, all women still living in the area of Vienna were contacted by mail to complete the Bristol LUTS questionnaire again. For the current study, only women without urinary incontinence at baseline and follow-up were eligible. RESULTS A total of 223 women (mean age, 50.3 yr; range, 21-79) were included in this 6.5-yr longitudinal study. At baseline, 80 women (35.9%) reported LUTS; this number increased to 105 (47.1%) 6.5 yr later. The calculated mean annual incidence of LUTS was 5.3% and revealed no clear dependency on age: 20-39 yr, 5.6%; 40-59 yr, 5.9%; > or =60 yr, 3.7%. The mean annual remission rate of LUTS was 4.6% without clear age dependency. Symptoms most likely to improve were "urgency"; "frequency"; "nocturia" and "feeling of incomplete bladder emptying" had the highest tendency of worsening. CONCLUSIONS This longitudinal study on the natural history of LUTS in women without urinary incontinence provides estimates for incidence and remission rates over 6.5 yr. Compared with men, LUTS in women are a dynamic rather than a necessarily progressive disorder.
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Affiliation(s)
- Stefan Heidler
- Department of Urology and Andrology, Donauspital, Vienna, Austria
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Kuo HC. Videourodynamic Analysis of Pathophysiology of Men with Both Storage and Voiding Lower Urinary Tract Symptoms. Urology 2007; 70:272-6. [PMID: 17826488 DOI: 10.1016/j.urology.2007.03.063] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Revised: 02/25/2007] [Accepted: 03/20/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Lower urinary tract symptoms (LUTS) are highly prevalent among men; however, not all men with LUTS have urodynamically confirmed bladder outlet obstruction. Overactive bladder symptoms are often caused by bladder dysfunctions alone or in combination with bladder outlet obstruction. A detailed diagnosis to identify the causes of LUTS in men seems mandatory to correctly target different therapy to the various underlying pathologic features. METHODS A total of 1407 male patients referred for investigation of LUTS were included in this study. All patients had both storage and voiding symptoms. A videourodynamic study was performed for the diagnosis of bladder dysfunction and bladder outlet dysfunction. The videourodynamic results were also correlated with patient age and compared with the presenting symptoms. RESULTS The videourodynamic study revealed that of the 1407 patients with bladder dysfunction, 148 (10.5%) had increased bladder sensation, 724 (51.5%) had detrusor overactivity, 149 (10.6%) had detrusor underactivity, and 82 (5.8%) had a combination of detrusor overactivity and detrusor underactivity. The causes of bladder outlet dysfunction included bladder neck dysfunction in 19 patients (1.4%), benign prostatic obstruction in 413 (29.4%), urethral sphincter pseudodyssynergia in 30 (2.1%), and poor relaxation of urethral sphincter in 283 (20.1%). CONCLUSIONS The results of this study have indicated that LUTS can result from a complex interplay of pathophysiologic features that can include bladder dysfunction and bladder outlet dysfunction such as benign prostatic obstruction or poor relaxation of the urethral sphincter. About one third of men with LUTS who were older than 55 years of age had benign prostatic obstruction. Patients younger than 55 years old were more likely to have poor relaxation of the urethral sphincter as a likely cause of LUTS.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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Khastgir J, Khan A, Speakman M. Acute urinary retention: medical management and the identification of risk factors for prevention. ACTA ACUST UNITED AC 2007; 4:422-31. [PMID: 17673913 DOI: 10.1038/ncpuro0860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 06/06/2007] [Indexed: 11/08/2022]
Abstract
Male lower urinary tract symptoms associated with benign prostatic hyperplasia can be progressive in some patients and lead to adverse consequences such as acute urinary retention (AUR), which might require prostate surgery. This Review identifies baseline and dynamic variables that have been recognized as risk factors that might predispose men to AUR. Evidence for the use of medical therapy to reduce the risk of benign prostatic hyperplasia progression, which might prevent AUR, has been critically evaluated. The literature describing the pharmacological management of men with AUR, and in those who have successfully voided after removal of a catheter, has been critically appraised in this article.
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Affiliation(s)
- Jay Khastgir
- Bristol Urological Institute, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
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Gades NM, Jacobson DJ, McGree ME, Lieber MM, Roberts RO, Girman CJ, Jacobsen SJ. Dropout in a longitudinal, cohort study of urologic disease in community men. BMC Med Res Methodol 2006; 6:58. [PMID: 17169156 PMCID: PMC1764019 DOI: 10.1186/1471-2288-6-58] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 12/14/2006] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Reasons for attrition in studies vary, but may be a major concern in long-term studies if those who drop out differ systematically from those who continue to participate. Factors associated with dropout were evaluated in a twelve-year community-based, prospective cohort study of urologic disease in men. METHODS During 1989-1991, 2,115 randomly selected Caucasian men, ages 40-79 years from Olmsted County, Minnesota were enrolled and followed with questionnaires biennially; 332 men were added in follow-up. A random subset (approximately 25%) received a urologic examination. Baseline characteristics including age, benign prostatic hyperplasia (BPH) symptoms, comorbidities, and socioeconomic factors were compared between subjects who did and did not participate after the twelfth year of follow-up. RESULTS Of the 2,447 men, 195 died and were excluded; 682 did not participate in 2002. Compared with men in the 40-49 year age group, men > or = 70 years of age at baseline had a greater relative odds of dropout, 2.65 (95% CI: 1.93, 3.63). In age-adjusted analyses, relative to men without stroke, men who had suffered a stroke had a higher odds of dropout, age-adjusted OR 3.07 (95% CI: 1.49, 6.33). Presence of at least one BPH symptom was not associated with dropout, (age-adjusted OR 1.12 (95% CI: 0.93, 1.36)). CONCLUSION These results provide assurance that dropout was not related to primary study outcomes. However, factors associated with dropout should be taken into account in analyses where they may be potential confounders.
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Affiliation(s)
- Naomi M Gades
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Debra J Jacobson
- Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michaela E McGree
- Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michael M Lieber
- Department of Urology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Rosebud O Roberts
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Cynthia J Girman
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Epidemiology, Merck Research Laboratories, Blue Bell, Pennsylvania, USA
| | - Steven J Jacobsen
- Research and Development, Southern California Permanente Medical Group, Pasadena, California, USA
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Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int 2005; 96:1301-6. [PMID: 16287449 DOI: 10.1111/j.1464-410x.2005.05815.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the long-term outcomes of untreated bladder outlet obstruction (BOO), assuming that, if there is little or no deterioration, a conservative approach to management is justified, as there is little information on the natural history of untreated BOO and lower urinary tract symptoms (LUTS) in men, and studies to date suggest that neither BOO nor LUTS inevitably progress to a stage at which prostatectomy is required. PATIENTS AND METHODS Men aged >45 years who were investigated in our department between 1972 and 1986, diagnosed with BOO, and who initially opted for no specific treatment were invited for repeat symptomatic and urodynamic evaluation. Identical methods of assessment were used, allowing results to be compared directly. RESULTS In all, 1068 men were initially diagnosed with BOO; 428 (40%) of these died. Of the 170 men who initially opted for a conservative approach and attended for repeat assessment, 141 (83%) remained untreated, with a mean follow-up of 13.9 years. The only significant urodynamic changes were a reduction in detrusor contractility and an increased prevalence of detrusor overactivity. Most patients reported no change in their symptoms but a significant minority experienced a gradual deterioration. Of the 29 men in whom the conservative approach failed, 22 proceeded to surgery for LUTS, and seven for acute urinary retention. CONCLUSIONS Patients with untreated BOO do not significantly deteriorate urodynamically in the long term, with only a minority deteriorating symptomatically. These findings justify a conservative approach to men with LUTS associated with BOO.
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Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated detrusor underactivity. BJU Int 2005; 96:1295-300. [PMID: 16287448 DOI: 10.1111/j.1464-410x.2005.05891.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the long-term symptomatic and urodynamic outcomes of men with untreated detrusor underactivity (DUA) as there has been little long-term follow-up information on men with DUA, a cause of lower urinary tract symptoms (LUTS) in a significant minority of men. PATIENTS AND METHODS Neurologically intact men aged > 18 years who were investigated in our department between 1972 and 1986, diagnosed with DUA, and who initially opted for no specific treatment were invited for a repeat symptomatic and urodynamic evaluation. Identical methods of assessment were used, allowing results to be compared directly. RESULTS In all, 224 men were initially diagnosed with DUA; 87 (39%) of these died. Of the 69 men who initially opted for a conservative approach and attended for repeat assessment, 58 (84%) remained untreated, with a mean follow-up of 13.6 years. There were no significant changes in symptoms over the follow-up. The only significant urodynamic finding was an increase in the proportion of patients with detrusor overactivity, but with no apparent worsening of chronic retention. Of the 11 men in who failed the conservative approach, eight proceeded to surgery for LUTS, and three for acute urinary retention. CONCLUSIONS These results provide important information on the natural history of DUA. In men with DUA presenting with LUTS there are few symptomatic and urodynamic changes with time.
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Sarma AV, McLaughlin JC, Jacobsen SJ, Logie J, Dolin P, Dunn RL, Cooney KA, Montie JE, Schottenfeld D, Wei JT. Longitudinal changes in lower urinary tract symptoms among a cohort of black American men: the Flint Men's Health Study. Urology 2005; 64:959-65. [PMID: 15533486 DOI: 10.1016/j.urology.2004.06.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Accepted: 06/17/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the progression of lower urinary tract symptoms in a longitudinal population-based cohort of black men. Population-based studies of prostatism and longitudinal data regarding changes in lower urinary tract symptom severity have largely focused on white men, with little attention directed toward black men. METHODS In 1996, a probability sample of 369 black men, aged 40 to 79 years, residing in Genesee County, Michigan, and without a prior history of prostate cancer/surgery participated in a prostate cancer screening protocol that included completing the American Urological Association Symptom Index (AUASI). Four years after baseline, 175 of the 369 men agreed to participate in the follow-up protocol. Of the 175 men, 149 had not reported undergoing treatment for benign prostatic hyperplasia and had complete symptom data. These men were included in this study. Differences between baseline and follow-up AUASI scores were examined. RESULTS The mean and standard deviation AUASI scores at baseline and follow-up were 7.1 (6.4) and 7.0 (6.8), respectively. Although overall no statistically significant change was found in the mean AUASI during the 4 years of follow-up (-0.11; SD 6.2; P = 0.7), the average change in the symptom score and the variability in the change increased with patient age at baseline from a mean of -0.42 (SD 5.0) among men in their 40s to 2.1 (SD 6.6) among men in their 70s. Of the 91 men (61.1%) who reported mild to no symptoms (AUASI score 7 or less) at baseline, 24 (26.4%) reported moderate to severe symptoms (AUASI score 8 or more) at follow-up. This progression of symptom severity was observed across all ages. CONCLUSIONS In this population-based study of longitudinal changes in urinary symptoms in black men, we found a substantial percentage of men demonstrated a measurable progression in urinary symptom severity over time. Additional studies are needed to examine critically any racial differences in lower urinary tract symptom progression.
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Affiliation(s)
- Aruna V Sarma
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan 48109-0759, USA
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Speakman M, Batista J, Berges R, Chartier-Kastler E, Conti G, Desgrandchamps F, Dreikorn K, Lowe F, O'Leary M, Perez M, Trachtenberg J, Tubaro A, Meesen B, Smets L, Stoevelaar H. Integrating risk profiles for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia: a combined analysis of external evidence and clinical expertise. Prostate Cancer Prostatic Dis 2005; 8:369-74. [PMID: 16130013 DOI: 10.1038/sj.pcan.4500827] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The RAND appropriateness method was used to explore the relevance of risk factors for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). A total of, 12 international experts assessed the appropriateness of various treatments for 243 risk profiles. Highest appropriateness rates were found for alpha1-adrenoceptor antagonists (68% of profiles) and combination therapy (46%). A large prostate volume was the dominant argument in favour of 5alpha-reductase inhibitors and combination therapy, but was irrelevant for the choice of surgery. Considerable postvoid residual, severe symptoms and poor maximum flow rate were the most important factors in favour of surgery.
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Affiliation(s)
- M Speakman
- Taunton & Somerset Hospital, Taunton, UK.
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Blanker MH, Prins J, Bosch JLHR, Schouten BWV, Bernsen RMD, Groeneveld FPMJ, Bohnen AM. Loss to Follow-Up in a Longitudinal Study on Urogenital Tract Symptoms in Dutch Older Men. Urol Int 2005; 75:30-7. [PMID: 16037705 DOI: 10.1159/000085924] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 02/02/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe loss to follow-up (LTFU) in a longitudinal community-based study on urogenital tract dysfunction in older men. PATIENTS AND METHODS A cohort study of men recruited from a Dutch municipality was performed. A baseline study and two follow-up rounds--all with questionnaires and additional measurements--were performed with, on average, 2.1-year intervals. Baseline characteristics were compared between participants and non-participants in the first and in the second follow-up study. RESULTS The response rates in the first and in the second follow-up were 78.0 and 80.0%, respectively. Various characteristics were found to be related to LTFU (i.e., more than 5% difference in response rate). Lower urinary tract symptoms were related to LTFU in the first and second follow-up. Sexual dysfunction was related to LTFU only in the second follow-up. Adjustment for confounders yielded odds ratios for the primary outcome variables (lower urinary tract symptoms, sexual dysfunction, and health status) that approximated the value of 1. LTFU according to these variables was different in men with and without other chronic illnesses. CONCLUSIONS LTFU seems not to be related to the primary outcome variables in this study. Describing response patterns in longitudinal studies is important, especially in studies involving older participants, as often is the case in urological research.
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Affiliation(s)
- Marco H Blanker
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
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Crawford ED. Management of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: the central role of the patient risk profile. BJU Int 2005; 95 Suppl 4:1-5. [PMID: 15871729 DOI: 10.1111/j.1464-410x.2005.05484.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E David Crawford
- University of Colorado Health Sciences Center, Aurora, Colorado 80010, USA.
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Fong YK, Milani S, Djavan B. Natural history and clinical predictors of clinical progression in benign prostatic hyperplasia. Curr Opin Urol 2005; 15:35-8. [PMID: 15586028 DOI: 10.1097/00042307-200501000-00009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Prevalence of benign prostatic hyperplasia (BPH) is increasing with the aging population worldwide. Knowledge of the natural history of BPH is crucial for primary, secondary and tertiary prevention of its progression. This review examines the evidence of the natural history of BPH, highlighting the group of patients with mild symptoms and the risk factors for progression. RECENT FINDINGS Several community and clinical studies have demonstrated the progressive nature of BPH. Different surrogate endpoints, which include symptom score, peak urinary flow rate, prostate volume, and the occurrence of acute urinary retention and need for surgery, have been described. Prostatic specific antigen and prostate volume are the two most common predictors of clinical progression and are helpful to the clinician for identifying high-risk patients. SUMMARY With further understanding of the natural history and the predictors of progression of BPH, management can be better tailored according to risk stratification and the results of clinical trials of effectiveness can be better interpreted.
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Affiliation(s)
- Yan Kit Fong
- Department of Urology, University of Vienna, Vienna, Austria.
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Artibani W. Integrating the Patient Risk Profile in the Management of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia (LUTS/BPH). ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.eursup.2004.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs FDR, Fourcade R, Kiemeney L, Lee C. The prevalence of male urinary incontinence in four centres: the UREPIK study. BJU Int 2004; 92:943-7. [PMID: 14632852 DOI: 10.1111/j.1464-410x.2003.04526.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To report the results of the prevalence and health status associated with male urinary incontinence (UI) in a population-based, multicentre study in four countries, and to assess the epidemiology of this condition. SUBJECTS AND METHODS A standard questionnaire asking about frequency and amount of urine loss, use of pads and stress incontinence, was used to measure the prevalence of UI among men in four countries (Boxmeer, The Netherlands; Auxerre, France; Birmingham, UK; and Seoul, Korea). Self-reported urinary leakage was also recorded, with details of visits to the doctor for the symptoms. The samples were selected randomly from population registers of men aged 40-79 years, which provided representative samples in each community. RESULTS In all, 4979 men responded; from incontinence symptom scores, 7.3% of men aged 40-79 years in Auxerre, 16.3% in Boxmeer, 14.4% in Birmingham and 4.3% in Seoul reported mild to severe UI. On a self-reported question, 14.8% and 14.5% of men in Birmingham and Boxmeer thought that they had urinary leakage, compared with 7.5% and 7.1% of men in Auxerre and Seoul, but typically the reported incontinence was leaking drops of urine a few times a week. Of men with urinary leakage in the three European centres, 25.9% visited the doctor with this problem, compared with only 9.0% of men in Seoul. Of men in the European centres, 5.9% used pads at least occasionally, compared with only 1.6% of men in Seoul. UI was age-related and the reporting of it varied among centres, with 14.4% of men in Birmingham and 12.7% of men in Boxmeer aged 40-49 years reporting mild to severe UI, compared with 5.2% in Auxerre and 1.9% in Seoul. Among men aged 60-69 years the corresponding percentages were 13.7% in Birmingham, 22.6% in Boxmeer, 9.2% in Auxerre and 8.0% in Seoul. CONCLUSIONS UI is more common in older men and relatively uncommon among younger men. Some men reported no problems on the symptom questionnaire but replied positively to a direct question. Surprisingly many men wear protective pads at least occasionally as a result of their problem. UI appears to be a problem for men and which remains largely untreated; this may partly be a result of cultural differences.
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Affiliation(s)
- P Boyle
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
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MacDonald D, McNicholas TA. Drug treatments for lower urinary tract symptoms secondary to bladder outflow obstruction: focus on quality of life. Drugs 2004; 63:1947-62. [PMID: 12930164 DOI: 10.2165/00003495-200363180-00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Benign prostatic hyperplasia (BPH), now referred to as lower urinary tract symptoms suggestive of bladder outflow obstruction (LUTS/BOO), is a significant cause of morbidity in ageing men. Surgery has virtually eliminated BPH-related mortality, and so the focus for men and their urologist is improvement in urinary symptoms and quality of life. Numerous tools have been developed to quantify symptoms and impact on quality of life--the most commonly used is the International Prostate Symptom Score. Sexual function and the avoidance of BPH-related complications such as acute urinary retention and surgery are also important to men--tools are available to assess sexual function but the benefits of complication avoidance are difficult to quantify. Approximately one million men in the UK have brought their symptoms to the attention of their doctor and been given a diagnosis of BPH, but extrapolation from community based studies suggests that many more (up to 2.5 million men) may have significant symptoms without seeking attention. Histopathological BPH, diminishing peak urinary flow rate, worsening lower urinary tract symptoms and increasing impact on quality of life all become more common as men age. Two groups of drugs are commonly used to treat LUTS/BOO--alpha-adrenoreceptor antagonists and 5alpha-reductase inhibitors. Both groups have been shown to improve quality of life measures in randomised, placebo-controlled trials--usually by approximately twice as much as placebo.
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Affiliation(s)
- Donald MacDonald
- Wolfson Institute for Biomedical Research, University College London, London, UK
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46
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Jiménez-Cruz F. Identifying Patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia (LUTS/BPH) at Risk for Progression. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/j.eursup.2003.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Masumori N, Tsukamoto T, Rhodes T, Girman CJ. Natural history of lower urinary tract symptoms in men--result of a longitudinal community-based study in Japan. Urology 2003; 61:956-60. [PMID: 12736015 DOI: 10.1016/s0090-4295(02)02594-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the longitudinal changes in the International Prostate Symptom Score (IPSS), bother score, and quality-of-life index in a community-based study in Japan. Of 289 men between 40 and 79 years of age who were analyzed in the first community-based study, 223 (77.2%) participated in a follow-up study conducted 3 years later. The IPSS, bother score, and quality-of-life index, as well as medical histories and current medication use, were evaluated. RESULTS Neither the average IPSS, bother score, nor quality-of-life index significantly changed after 3 years in any age decade. However, changes in the IPSS varied among individuals, because 32%, 35%, and 33% of the men reported improved, stable, and worsened IPSS, respectively. Transurethral resection of the prostate was performed on 0%, 4%, and 21% of the men in the mild (0 to 7), moderate (8 to 19), and severe (20 to 35) IPSS categories, respectively. Neither prostate volume nor peak urinary flow rate significantly predicted progression of the IPSS after 3 years. CONCLUSIONS Although no definite general symptomatic progression was observed in the participants during 3 years, changes in subjective urinary symptoms varied among individuals ranging from improvement to worsening. The men with a more severe IPSS had a greater chance of transurethral resection of the prostate within 3 years.
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Affiliation(s)
- Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Dallosso HM, Matthews RJ, McGrother CW, Clarke M, Perry SI, Shaw C, Jagger C. An investigation into nonresponse bias in a postal survey on urinary symptoms. BJU Int 2003; 91:631-6. [PMID: 12699474 DOI: 10.1046/j.1464-410x.2003.04172.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate nonresponse bias in a postal survey on urinary symptoms in people aged >or= 40 years. SUBJECTS AND METHODS Nonresponders to a postal survey on incontinence and other urinary symptoms were studied. A random sample of 1050 nonresponders (stratified for age and sex) was traced by a team of interviewers. Eligible nonresponders were asked several questions from the postal questionnaire, and their reason for not participating in the postal survey. RESULTS Only 1% of those not responding were not traced in person or accounted for, and 12% were identified as not eligible to be in the survey sample (moved from address, deceased, residential home). Half of the eligible nonresponders (51%) did not answer the interviewer's questions, the main reason being general unwillingness or disinterest. The number in whom poor health was the reason increased with age. Comparing nonresponders who answered the interviewer's questions with a random sample of responders from the postal survey showed little difference in the reporting of urinary symptoms, although there were differences in general health and long-term health problems. Separate analyses by age showed greater reporting of some urinary symptoms and of poorer general health in the older nonresponders (>or= 70 years). CONCLUSION Overall, for people aged >or= 40 years there was no evidence of a nonresponse bias in the reporting of urinary symptoms, providing confidence in such prevalence rates. However, poorer general health and greater reporting of some urinary symptoms by the older nonresponders (>or= 70 years) suggests prevalence rates in this age group may be underestimated.
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Affiliation(s)
- H M Dallosso
- Department of Epidemiology and Public Health, University of Leicester, UK.
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Edwards JE, Moore RA. Finasteride in the treatment of clinical benign prostatic hyperplasia: a systematic review of randomised trials. BMC Urol 2002; 2:14. [PMID: 12477383 PMCID: PMC140032 DOI: 10.1186/1471-2490-2-14] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2002] [Accepted: 12/12/2002] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia affects older men. This systematic review determined efficacy and adverse effects of finasteride. REVIEW METHODS PubMed, the Cochrane Library, reference lists of reports, and reviews were searched for randomised, double-blind trials of finasteride in benign prostatic hyperplasia. Outcomes included symptom score, urinary flow rate, prostate volume, discontinuation, and adverse effects. Relative risk and NNT or NNH were calculated for dichotomous data. Sensitivity analyses assessed influences of baseline symptom severity, initial prostate volume, a dominating trial, and previous interventions. RESULTS Three trials had active controls and 19 had placebo. In placebo-controlled trials, 8820 patients received finasteride 5 mg and 5909 placebo over 3-48 months. Over 48 months finasteride produced greater improvements in total symptom score, maximum urinary flow rate, and prostate volume. Significantly more sexual dysfunction, impotence, ejaculation disorder and decreased libido occurred with finasteride at 12 months; the NNH for any sexual dysfunction at 12 months was 14. Significantly fewer men treated with finasteride experienced acute retention or had surgery at 24 or 48 months than with placebo; at 12 months the NNT was 49 (31 to 112) to avoid one acute urinary retention and 31 (21 to 61) to avoid one surgery. Sensitivity analyses showed benefit with finasteride 5 mg to be constant irrespective of the initial prostate volume. CONCLUSIONS Information from many patients in studies of high quality showed beneficial effects of finasteride in terms of symptoms, flow rate and prostate volume. More utility would result if patient centred outcomes were reported in dichotomous form.
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Affiliation(s)
- Jayne E Edwards
- Pain Research and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospitals, The Churchill, Headington, Oxford, UK
| | - R Andrew Moore
- Pain Research and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospitals, The Churchill, Headington, Oxford, UK
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Djavan B, Nickel JC, de la Rosette J, Abrams P. The urologist view of BPH progression: results of an international survey. Eur Urol 2002; 41:490-6. [PMID: 12074790 DOI: 10.1016/s0302-2838(02)00065-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the opinion amongst the international urological community on whether benign prostatic hyperplasia (BPH) is a progressive disease. METHODS A 15-item questionnaire was distributed to the mailing list of the publication European Urology Today as well as being accessed through the website of the European Association of Urology (EAU). The survey included questions on: whether BPH was a progressive disorder; what evidence there was to support this, including clinical parameters that could be identified; risk factors for progression; and prevention of progression. RESULTS A total of 472 completed questionnaires from 47 countries were evaluated. Overall, the urologists surveyed agreed that BPH was a progressive disease, and that some patients were more prone to this than others. Increased post-void residual urine, reduced flow rate, increased urinary symptoms and urodynamic evidence of obstruction were considered to be the most significant risk factors for progression. Half of the urologists surveyed considered that current medical therapies could prevent progression of BPH, while a significant proportion thought that surgery was an effective preventative measure. CONCLUSIONS BPH, although a benign disease, has a considerable impact on the patient's quality of life. Its progressive nature and the identification of risk factors for progression warrant further investigation. In the future, there is likely to be a shift in the paradigm from treatment of BPH complications to include the prevention of BPH progression.
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Affiliation(s)
- B Djavan
- Department of Urology, University of Vienna, Wahringer Gurtel 18-20, 1090 Vienna, Austria.
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