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Bschleipfer T, Abt SD, Becher KF, Dreikorn K, Höfner K, Madersbacher S, Magistro G, Muschter R, Oelke M, Reich O, Rieken M, Salem J, Michel MC, Schönburg S. [Conservative and pharmacological treatment of benign prostatic hyperplasia : The German S2e-guideline 2023-part2]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1048-1056. [PMID: 37796278 DOI: 10.1007/s00120-023-02183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH, in German guidelines: benign prostatic syndrome [BPS]) is considered the most common disease of the lower urinary tract in men and can have a tremendous impact on the quality-of-life of affected patients. Conservative and pharmacological therapy of this disease are of great importance, both in improving LUTS and reducing progression-related complications. OBJECTIVES Presentation of the conservative and pharmacological treatment options according to the current German S2e guideline on BPS. MATERIALS AND METHODS Summary and overview of chapters 9 and 10 of the current German S2e guideline on BPS. RESULTS In addition to a controlled watchful waiting for BPS patients without an absolute indication for prostate surgery, a variety of phytopharmacological formulations and synthetic drugs according to the symptomatology and clinical progress are available. Phytotherapy should, due to inconsistent study data, only be considered for mild to moderate symptoms. Synthetic drugs include alpha-blockers, 5α-reductase inhibitors, phosphodiesterase inhibitors, antimuscarinics and, more recently, the β3-agonist mirabegron in the current guideline. In addition, various combination therapies are listed and evaluated according to their indications, effects and side effects. CONCLUSIONS The current German S2e guideline on the diagnosis and treatment of BPS provides an evidence-based foundation for finding the best possible and most effective medication.
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Affiliation(s)
- Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Ketschendorfer Straße 33, 96450, Coburg, Deutschland.
| | - S Dominik Abt
- Klinik für Urologie, Spitalzentrum, Biel, Biel, Schweiz
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | | | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | | | - Guiseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Matthias Oelke
- Klinik für Urologie, Urologische Onkologie und Roboter-assistierte Chirurgie, St. Antonius-Hospital GmbH, Gronau, Deutschland
| | - Oliver Reich
- Urologische Privatpraxis Prof. Dr. Oliver Reich, München, Deutschland
| | | | - Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Köln, Deutschland
- Klinik für Urologie und Kinderurologie, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland
| | - Martin C Michel
- Abteilung Pharmakologie, Johannes-Gutenberg-Universität, Mainz, Deutschland
| | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Murad L, Bouhadana D, Nguyen DD, Chughtai B, Zorn KC, Bhojani N, Elterman DS. Treating LUTS in Men with Benign Prostatic Obstruction: A Review Article. Drugs Aging 2023; 40:815-836. [PMID: 37556075 DOI: 10.1007/s40266-023-01054-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/10/2023]
Abstract
Benign prostatic obstruction (BPO) is a prevalent condition that affects men, primarily toward their old age. The condition is often accompanied by lower urinary tract symptoms (LUTS), which can significantly impair a patient's quality of life and lead to other medical complications. Accurate diagnosis of BPO is essential for effective management of complications secondary to BPO, and treatment plans should be tailored patients, and occasionally according to surgeon experience. As such, this literature review aims to analyze the current available data on male LUTS secondary to BPO by providing a comprehensive overview of relevant studies, as well as the surgical and medical management guidelines from the Canadian Urological Association (CUA), American Urological Association (AUA), and European Association of Urology (EAU). By synthesizing the existing literature, this review purports to summarize the current body of knowledge surrounding BPO and male LUTS, and support healthcare providers in making informed decisions about the management of male LUTS secondary to BPO, ultimately improving patient outcomes and quality of life.
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Affiliation(s)
- Liam Murad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
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Gravas S, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Sakalis VI, Schouten N, Speakman MJ, Tikkinen KAO, Cornu JN. Summary Paper on the 2023 European Association of Urology Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2023; 84:207-222. [PMID: 37202311 DOI: 10.1016/j.eururo.2023.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology. OBJECTIVE To present a summary of the 2023 version of the European Association of Urology guidelines on the management of male LUTS. EVIDENCE ACQUISITION A structured literature search from 1966 to 2021 selected the articles with the highest certainty evidence. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS The assessment of men with LUTS should be practical. A careful medical history and physical examination are essential. Validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms should be used. Prostate-specific antigen should be ordered if a diagnosis of prostate cancer changes the treatment plan. Urodynamics should be performed for selected patients. Men with mild symptoms are candidates for watchful waiting. Behavioural modification should be offered to men with LUTS prior to, or concurrent with, treatment. The choice of medical treatment depends on the assessment findings, predominant type of symptoms, ability of the treatment to change the findings, and the expectations to be met in terms of the speed of onset, efficacy, side effects, and disease progression. Surgery is reserved for men with absolute indications, and for patients who fail or prefer not to receive medical therapy. Surgical management has been divided into five sections: resection, enucleation, vaporisation, and alternative ablative and nonablative techniques. The choice of surgical technique depends on patient's characteristics, expectations, and preferences; surgeon's expertise; and availability of modalities. CONCLUSIONS The guidelines provide an evidence-based approach for the management of male LUTS. PATIENT SUMMARY A clinical assessment should identify the cause(s) of symptoms and define the clinical profile and patient's expectations. The treatment should aim to ameliorate symptoms and reduce the risk of complications.
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Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Vasileios I Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece.
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
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Abubakar M, Prasad R, Salim SS, Basavaraju D, Khan M, Lateef IK, Furqan A, Raza S, Gupta I, Singla D, Adil H, Naeem A. Orthostatic Hypotension in Benign Prostatic Hyperplasia Patients and Its Association With Alpha-1 Antagonist Use: A Comprehensive Literature Review. Cureus 2023; 15:e44097. [PMID: 37750139 PMCID: PMC10518119 DOI: 10.7759/cureus.44097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Orthostatic hypotension (OH) is frequently observed in benign prostatic hyperplasia (BPH) patients undergoing alpha-1 adrenergic antagonist (A1AA) therapy. While previous studies have acknowledged the prevalence of OH in BPH patients on A1AAs, limited data exist on ranking the safety of different A1AAs. This comprehensive review explores the underlying mechanisms of OH, examines numerous factors influencing its development, and provides insights into effective treatment strategies such as hydration, gradual postural changes, leg exercises, compression stockings, and tilt-table training for BPH management. The review highlights the significance of individualized care, interdisciplinary collaboration, and further research to optimize A1AA treatment, improve patient outcomes, and enhance quality of life.
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Affiliation(s)
- Muhammad Abubakar
- Department of Internal Medicine, Siddique Sadiq Memorial Trust Hospital, Gujranwala, PAK
- Department of Internal Medicine, Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, PAK
| | - Rachna Prasad
- Department of Internal Medicine, Stanley Medical College, Chennai, IND
| | - Siffat S Salim
- Department of Surgery, Holy Family Red Crescent Medical College Hospital, Dhaka, BGD
| | - Deepak Basavaraju
- Department of Internal Medicine, Mysore Medical College and Research Institute, Mysore, IND
| | - Munazza Khan
- Department of Internal Medicine, Medical University Pleven, Pleven, BGR
| | - Ibrahim K Lateef
- Department of Internal Medicine, Medical University Pleven, Pleven, BGR
| | - Ahmad Furqan
- Department of Internal Medicine, Lahore Medical and Dental College, Lahore, PAK
| | - Saud Raza
- Department of Internal Medicine, Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, PAK
| | - Ishita Gupta
- Department of Internal Medicine, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND
| | - Deepak Singla
- Department of Internal Medicine, Government Medical College, Patiala, Patiala, IND
| | - Hira Adil
- Department of Community Medicine, Khyber Girls Medical College, Peshawar, PAK
| | - Ather Naeem
- Department of Cardiology, Punjab Institute of Cardiology, Lahore, PAK
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Müderrisoglu AE, de la Rosette JJMCH, Michel MC. Potential side effects of currently available pharmacotherapies in male lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Expert Opin Drug Saf 2023; 22:1213-1224. [PMID: 38064204 DOI: 10.1080/14740338.2023.2293206] [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: 07/31/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION The drug classes of α1-adrenoceptor antagonists, 5α-reductase inhibitors, and phosphodiesterase type 5 inhibitors are guideline-recommended treatments of lower urinary tract symptoms suggestive of benign prostatic hyperplasia; muscarinic receptor antagonists and β3-adrenoceptor agonists are also recommended if storage symptoms are insufficiently addressed with one of the other three drug classes. AREAS COVERED We provide a narrative review (no formalized literature searches performed) of the tolerability of these drug classes with emphasis on the more recently introduced medications, on combination treatment, and on more lately emerging risks. EXPERT OPINION/COMMENTARY The tolerability profiles are distinct between drug classes but, with few exceptions, similar within a drug class. Within a drug, formulations with longer duration of action tend to have better tolerability. Efficacy gains using combination treatment at least partly come at a cost of lesser tolerability. Greater susceptibility to experience adverse events based on age, comorbidities, and comedications appears conceptually important but remains under-investigated in this therapeutic area.
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Affiliation(s)
- A Elif Müderrisoglu
- Department of Medical Pharmacology, Istanbul Medipol University, Istanbul, Turkiye
| | | | - Martin C Michel
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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A comprehensive review of medical therapy on benign prostatic hyperplasia. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Sabnis RB, Mulawkar PM, Joshi RN. The Urological Society of India guidelines on management of benign prostatic hyperplasia/benign prostatic obstruction (Executive summary). Indian J Urol 2021; 37:210-213. [PMID: 34465948 PMCID: PMC8388351 DOI: 10.4103/iju.iju_121_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
| | | | - Rohit N Joshi
- Department of Urology, Aarna Superspeciality Hospital, Ahmedabad, Gujarat, India
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[Benign prostatic obstruction-associated symptoms of the lower urinary tract : Treatment with anticholinergics in combination with alpha-blockers]. Urologe A 2021; 60:1188-1191. [PMID: 34357409 DOI: 10.1007/s00120-021-01617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
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9
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Miernik A, Gratzke C. Current Treatment for Benign Prostatic Hyperplasia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:843-854. [PMID: 33593479 DOI: 10.3238/arztebl.2020.0843] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 02/28/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is characterized by the occurrence of.disorders of urine storage and bladder emptying. Most men over the age of 60 years are affected to some degree. METHODS A selective literature search with additional scrutiny of guidelines and meta-analyses. RESULTS The management of patients with BPH is complex. Emptying and retention disorders can be treated by various pharmacological and surgical means. Transurethral resection of the prostate (TURP) has long been considered the gold standard for operative treatment. Transurethral enucleation procedures show a better risk profile in some uses, however, and have, above all, largely displaced suprapubic prostatectomy. Numerous innovative treatment options have been developed in recent years, but their long-term effects remain to be determined. These treatment techniques can nevertheless be used in individual cases after thorough discussion with the patient. CONCLUSION The care of patients with BPH should be interdisciplinary. The efficacy and safety of many new developments in the area of pharmacological and minimally invasive treatment remain to be demonstrated in randomized trials.
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Pang R, Zhou XY, Wang X, Wang B, Yin XL, Bo H, Jung JH. Anticholinergics combined with alpha-blockers for treating lower urinary tract symptoms related to benign prostatic obstruction. Cochrane Database Syst Rev 2021; 2:CD012336. [PMID: 33567116 PMCID: PMC8094929 DOI: 10.1002/14651858.cd012336.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) represent one of the most common clinical complaints in men. Alpha-blockers are widely used as first-line therapy for men with LUTS secondary to BPO, but up to one third of men report no improvement in their LUTS after taking alpha-blockers. Anticholinergics used in addition to alpha-blockers may help improve symptoms but it is uncertain how effective they are. OBJECTIVES: To assess the effects of combination therapy with anticholinergics and alpha-blockers in men with LUTS related to BPO. SEARCH METHODS We performed a comprehensive search of medical literature, including the Cochrane Library, MEDLINE, Embase, and trials registries, with no restrictions on the language of publication or publication status. The date of the latest search was 7 August 2020. SELECTION CRITERIA We included randomized controlled trials. Inclusion criteria were men with LUTS secondary to BPO, ages 40 years or older, and a total International Prostate Symptom Score of 8 or greater. We excluded trials of men with a known neurogenic bladder due to spinal cord injury, multiple sclerosis, or central nervous system disease, and those examining medical therapy for men who were treated with surgery for BPO. We performed three comparisons: combination therapy versus placebo, combination therapy versus alpha-blockers monotherapy, and combination therapy versus anticholinergics monotherapy. DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted data according to the Cochrane Handbook for Systematic Reviews of Interventions. We used the GRADE approach to rate the certainty of evidence. MAIN RESULTS We included 23 studies with 6285 randomized men across three comparisons. The mean age of participants ranged from 54.4 years to 73.9 years (overall mean age 65.7 years). Of the included studies, 12 were conducted with a single-center setting, while 11 used a multi-center setting. We only found short-term effect (12 weeks to 12 months) of combination therapy based on available evidence. Combination therapy versus placebo: based on five studies with 2369 randomized participants, combination therapy may result in little or no difference in urologic symptom scores (mean difference (MD) -2.73, 95% confidence interval (CI) -5.55 to 0.08; low-certainty evidence). We are very uncertain about the effect of combination therapy on quality of life (QoL) (MD -0.97, 95% CI -2.11 to 0.16; very low-certainty evidence). Combination therapy likely increases adverse events (risk ratio (RR) 1.24, 95% CI 1.04 to 1.47; moderate-certainty evidence); based on 252 adverse events per 1000 participants in the placebo group, this corresponds to 61 more adverse events (95% CI 10 more to 119 more) per 1000 participants treated with combination therapy. Combination therapy versus alpha-blockers alone: based on 22 studies with 4904 randomized participants, we are very uncertain about the effect of combination therapy on urologic symptom scores (MD -2.04, 95% CI -3.56 to -0.52; very low-certainty evidence) and QoL (MD -0.71, 95% CI -1.03 to -0.38; very low-certainty evidence). Combination therapy may result in little or no difference in adverse events rate (RR 1.10, 95% CI 0.90 to 1.34; low-certainty evidence); based on 228 adverse events per 1000 participants in the alpha-blocker group, this corresponds to 23 more adverse events (95% CI 23 fewer to 78 more) per 1000 participants treated with combination therapy. Combination therapy compared to anticholinergics alone: based on three studies with 1218 randomized participants, we are very uncertain about the effect of combination therapy on urologic symptom scores (MD -3.71, 95% CI -9.41 to 1.98; very low-certainty evidence). Combination therapy may result in an improvement in QoL (MD -1.49, 95% CI -1.88 to -1.11; low-certainty evidence). Combination therapy likely results in little to no difference in adverse events (RR 1.26, 95% CI 0.81 to 1.95; moderate-certainty evidence); based on 115 adverse events per 1000 participants in the anticholinergic alone group, this corresponds to 4 fewer adverse events (95% CI 7 fewer to 13 more) per 1000 participants treated with combination therapy. AUTHORS' CONCLUSIONS Based on the findings of the review, combination therapy with anticholinergics and alpha-blockers are associated with little or uncertain effects on urologic symptom scores compared to placebo, alpha-blockers, or anticholinergics monotherapy. However, combination therapy may result in an improvement in quality of life compared to anticholinergics monotherapy, but an uncertain effect compared to placebo, or alpha-blockers. Combination therapy likely increases adverse events compared to placebo, but not compared to alpha-blockers or anticholinergics monotherapy. The findings of this review were limited by study limitations, inconsistency, and imprecision. We were unable to conduct any of the predefined subgroup analyses.
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Affiliation(s)
- Ran Pang
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xin-Yao Zhou
- Internal Medicine & Outpatients Management Office, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiangling Wang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Bin Wang
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue-Lai Yin
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hai Bo
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
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Chang CW, Juan YS, Yang YH, Lee HY. The Relationship Between Lower Urinary Tract Symptoms and Severity of Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2021; 36:1533317521992657. [PMID: 33635087 PMCID: PMC10623918 DOI: 10.1177/1533317521992657] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Urinary incontinence (UI) is more prevalent in elderly populations with dementia than those without dementia. Alzheimer's disease (AD) is the most common cause of dementia. Urge UI, the most common type of UI in AD patients, causes more morbidity and mortality. However, it is inconvenient to obtain the report of urodynamic study from AD patient to diagnose urinary incontinence. Nevertheless, it is easier to obtain subjective or objective questionnaires from the patients or the caregivers. The data collected from the questionnaires are used to evaluate if severity of dementia is associated with urge UI and other lower urinary tract symptoms (LUTs). PATIENTS AND METHODS A total of 43 AD patients were enrolled in this study, all of whom were checked post-void residual (PVR) urine amount by sonography after voiding. The severity of dementia was evaluated by questionnaire including Cognitive Abilities Screening Instrument (CASI), Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR), and Clinical Dementia Rating Sub-of-Box (CDR-SB). The LUTs were assessed with International Consultation of Incontinence Questionnaire (ICIQ) and Overactive bladder symptom scores (OABSS) questionnaire. Independent t test and Pearson's correlation analysis were calculated. RESULTS The average age in both AD with/without urge UI patients is 78 years old. The scores of CDR-SB, OABSS and ICIQ are significantly different in these 2 groups (p = 0.023, p = 0.003, p = 0.001; respectively). However, the neurophysiological scores of CASI, MMSE, CDR, CDR-SB is not correlated with OABSS (r = 0.047, p = 0.382; r = 0.074, p = 0.317; r = 0.087, p = 0.288; r = 0.112, p = 0.237; respectively). Interestingly, if we separate each individual symptom of OAB, there is a significant correlation between CDR-SB and urge UI score (r = 0.314, p = 0.023). CONCLUSIONS Higher lower urinary tract symptom scores are noted in AD patients with urge UI. The CDR-SB score is highly correlated with urge UI in AD patients.
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Affiliation(s)
- Che-Wei Chang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yung-Shun Juan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung
| | - Hsiang-Ying Lee
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
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Valladales-Restrepo LF, Machado-Alba JE. Potentially inappropriate prescriptions of anticholinergic drugs in patients with benign prostatic hyperplasia. Aging Male 2020; 23:785-792. [PMID: 30955405 DOI: 10.1080/13685538.2019.1595572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prostatic hyperplasia is frequent in the elderly, and it can be associated with urinary retention in patients who use cholinergic antagonists. The objective was to estimate the anticholinergic burden of drugs prescribed to patients diagnosed with benign prostatic hyperplasia. METHODS A cross-sectional study using a population database to identify prescriptions of cholinergic antagonists drugs used in the management of benign prostatic hyperplasia. The anticholinergic burden was evaluated using the Anticholinergic Drug Scale. RESULTS Three thousand seven hundred and sixty patients with benign prostatic hyperplasia were identified, with a mean age of 68.26 ± 10.46 years. Of these patients, 2961 (78.8%) received pharmacological treatment mainly with tamsulosin monotherapy (34.7%, n = 1026). Overall, 34.7% (n = 1303) of all patients were taking cholinergic antagonists. Patients aged 75-84 years (OR: 1.985, 95%CI: 1.063-3.709) and those 85 or older (OR: 2.52, 95%CI: 1.287-4.948) had a greater probability of having an anticholinergic burden score ≥3 points. Of the patients not receiving pharmacological treatment for benign prostatic hyperplasia, 35% (n = 280) were taking medications with anticholinergic properties. CONCLUSIONS A high proportion of patients with benign prostatic hyperplasia were receiving medical management for the relief of symptoms, mostly via monotherapy. However, one-third of patients received some type of medication with anticholinergic properties, being much more frequent after 75 years.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnologica de Pereira-Audifarma S.A, Pereira, Colombia
- Fundación Universitaria Autónoma de las Américas, Avenida de las Américas Calle, Pereira, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnologica de Pereira-Audifarma S.A, Pereira, Colombia
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Prise en charge de l’obstacle sous vésical lié à une HBP chez les patients à terrain particulier et/ou ayant une complication. Prog Urol 2018; 28:868-874. [DOI: 10.1016/j.purol.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/25/2022]
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Jiwrajka M, Yaxley W, Ranasinghe S, Perera M, Roberts MJ, Yaxley J. Drugs for benign prostatic hypertrophy. Aust Prescr 2018; 41:150-153. [PMID: 30410211 DOI: 10.18773/austprescr.2018.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Benign prostatic hyperplasia is a common condition It can cause problems with urine storage and voiding and the severity of symptoms may be unrelated to the size of the prostate When drug treatment is required benign prostatic hyperplasia can be managed with monotherapy or combination therapy Most patients are managed with selective alpha blockers Patients with larger prostate volumes may benefit from a 5-alpha-reductase inhibitor usually in combination with an alpha blocker
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Affiliation(s)
- Manasi Jiwrajka
- Royal Brisbane and Women's Hospital.,Faculty of Medicine, University of Queensland, Brisbane.,Department of Surgery, Austin Health, University of Melbourne
| | - William Yaxley
- Royal Brisbane and Women's Hospital.,Faculty of Medicine, University of Queensland, Brisbane.,Department of Surgery, Austin Health, University of Melbourne
| | - Sachinka Ranasinghe
- Royal Brisbane and Women's Hospital.,Faculty of Medicine, University of Queensland, Brisbane.,Department of Surgery, Austin Health, University of Melbourne
| | - Marlon Perera
- Royal Brisbane and Women's Hospital.,Faculty of Medicine, University of Queensland, Brisbane.,Department of Surgery, Austin Health, University of Melbourne
| | - Matthew J Roberts
- Royal Brisbane and Women's Hospital.,Faculty of Medicine, University of Queensland, Brisbane.,Department of Surgery, Austin Health, University of Melbourne
| | - John Yaxley
- Royal Brisbane and Women's Hospital.,Faculty of Medicine, University of Queensland, Brisbane.,Department of Surgery, Austin Health, University of Melbourne
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Add-on Therapy With the α-Blockers Tamsulosin and Naftopidil Improves Voiding Function by Enhancing Neuronal Activity in Prostatic Hyperplasia Rats. Int Neurourol J 2018; 22:20-29. [PMID: 29609419 PMCID: PMC5885138 DOI: 10.5213/inj.1836064.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose Benign prostatic hyperplasia (BPH) impacts quality of life in men by causing lower urinary tract symptoms. α1-Adrenoceptor (α1-AR) blockers improve lower urinary tract symptoms. We investigated the efficacy of add-on therapy with α1-AR blockers on BPH rats. Methods Rats in the drug-treated groups were orally administered each drug once a day for 30 days after orchiectomy. To induce BPH, rats were castrated and testosterone (20 mg/kg) was injected subcutaneously once per day for 30 days. Cystometry was conducted to measure voiding contraction pressure and the interval contraction time, immunohistochemistry was performed to measure c-Fos and nerve growth factor (NGF) expression in the neuronal voiding centers, and nicotinamide adenine dinucleotide phosphate-diaphorase histochemistry was used to measure nitric oxide synthase (NOS) expression. Results Orchiectomy and testosterone injection decreased voiding contraction pressure and the interval contraction time, suggesting BPH symptoms. Voiding contraction pressure and the interval contraction time were greater in the group that received the combination treatment (tamsulosin with naftopidil) than in the tamsulosin monotherapy or naftopidil monotherapy groups. c-Fos, NGF, and NOS expression in the neuronal voiding centers was enhanced by BPH induction. c-Fos, NGF, and NOS expression was suppressed by the combination treatment (tamsulosin with naftopidil) to a greater extent than was the case for tamsulosin monotherapy or naftopidil monotherapy. Conclusions Combination therapy of tamsulosin and naftopidil showed greater efficacy for the treatment of BPH than tamsulosin monotherapy or naftopidil monotherapy; therefore, combination therapy can be considered as a novel therapeutic method for BPH.
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Combination treatment for male lower urinary tract symptoms with anticholinergic and alpha-blockers. Curr Opin Urol 2018; 28:277-283. [PMID: 29432226 DOI: 10.1097/mou.0000000000000489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although alpha-adrenergic antagonists (α-blockers) are effective for relieving voiding lower urinary tract symptoms (LUTS) in men, storage symptoms often persist. The aim of this manuscript is to evaluate the efficacy and safety of combination therapy with α-blockers and muscarinic receptor antagonists (anticholinergics). RECENT FINDINGS High-quality evidence confirms that the addition of an anticholinergic improves micturition diary parameters, such as daytime and nocturnal frequency and urgency incontinence episodes, as well as total and storage subset scores on the International Prostate Symptom Score. Most studies demonstrate a statistically significant improvement over α-blocker monotherapy. Both, incidence of urinary retention and study withdrawal because of treatment-related adverse events with combination therapy, are low. Urodynamic indices, such as maximum flow rate and postvoid residual volume, are also minimally impacted by combination therapy. Outcomes on validated questionnaires and quality-of-life (QoL) indices also indicate a significant improvement. SUMMARY The addition of an anticholinergic to an α-blocker in men with storage and voiding LUTS is an effective practice in reducing both categories of symptoms. The addition of anticholinergic is associated with a low rate of urinary retention and the impact on efficient bladder emptying is minimal. Not unexpectedly, QoL is improved.
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Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Kaufman RP, Trainer A, Arther A, Badlani G, Plante M, Desai M, Doumanian L, Te AE, DeGuenther M, Roehrborn C. WATER: A Double-Blind, Randomized, Controlled Trial of Aquablation ® vs Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia. J Urol 2018; 199:1252-1261. [PMID: 29360529 DOI: 10.1016/j.juro.2017.12.065] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE We compared the safety and efficacy of Aquablation and transurethral prostate resection for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. MATERIALS AND METHODS In a double-blind, multicenter, prospective, randomized, controlled trial 181 patients with moderate to severe lower urinary tract symptoms related to benign prostatic hyperplasia underwent transurethral prostate resection or Aquablation. The primary efficacy end point was the reduction in International Prostate Symptom Score at 6 months. The primary safety end point was the development of Clavien-Dindo persistent grade 1, or 2 or higher operative complications. RESULTS Mean total operative time was similar for Aquablation and transurethral prostate resection (33 vs 36 minutes, p = 0.2752) but resection time was lower for Aquablation (4 vs 27 minutes, p <0.0001). At month 6 patients treated with Aquablation and transurethral prostate resection experienced large I-PSS improvements. The prespecified study noninferiority hypothesis was satisfied (p <0.0001). Of the patients who underwent Aquablation and transurethral prostate resection 26% and 42%, respectively, experienced a primary safety end point, which met the study primary noninferiority safety hypothesis and subsequently demonstrated superiority (p = 0.0149). Among sexually active men the rate of anejaculation was lower in those treated with Aquablation (10% vs 36%, p = 0.0003). CONCLUSIONS Surgical prostate resection using Aquablation showed noninferior symptom relief compared to transurethral prostate resection but with a lower risk of sexual dysfunction. Larger prostates (50 to 80 ml) demonstrated a more pronounced superior safety and efficacy benefit. Longer term followup would help assess the clinical value of Aquablation.
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Affiliation(s)
| | - Neil Barber
- Frimley Park Hospital, Frimley Health Foundation Trust, Surrey, United Kingdom
| | | | | | | | - Tev Aho
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - Andrew Thomas
- Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | | | | | - Andrew Trainer
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, Nebraska
| | - Andrew Arther
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, Nebraska
| | - Gopal Badlani
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark Plante
- University of Vermont Medical Center, Burlington, Vermont
| | - Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Leo Doumanian
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Alexis E Te
- Weill Cornell Medical College, New York, New York
| | | | - Claus Roehrborn
- Department of Urology, Southwestern Medical Center, University of Texas Southwestern, Dallas, Texas.
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