Evaluating the acceptability of an online patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia

Empowering patient choice: a systematic review of decision aids for benign prostatic hyperplasia

BACKGROUND

Benign prostatic hyperplasia (BPH) is a complex condition that affects ~3.2 million men in the UK. As men often face multiple treatment options, discussion and consideration of their priorities and preferences is necessary; however, research indicates this is not always adopted in practice.

OBJECTIVES

To evaluate decisional interventions currently available for men with symptomatic BPH, distinct from those designed for prostate cancer.

METHODS

Eight databases (PubMed, Web of Science, EBSCO, Science Direct, Scopus, Google, Cochrane Library, Centre for Reviews and Dissemination) were searched retrieving a total of 1979 results, of which 13 international studies discussing 10 decision aids (DAs) were included. Studies were eligible that targeted adult males experiencing urological symptoms and discussed any DA designed to promote shared decision making within secondary healthcare.

RESULTS

Narrative synthesis found most DAs focused on treatment information provision; however, risk information was not always equally presented. Most DAs lacked strong theoretical links to existing theories on behaviour change, risk communication, and decision making, and sustained implementation within clinical practice. The most effective aids went beyond information provision, to also elicit and integrate patient preferences and values, by adopting multiple behaviour change techniques (BCTs). Risk of bias indicated medium risk with limited information or justification on data collection and analysis methods.

CONCLUSION

Current DAs relevant to BPH lack clear focus on individual patient needs required for delivering patient-centred care. Greater transparency and explicit links to behavioural theory and BCTs related to desired future outcomes, expectations, and values are required to effectively create and implement effective interventions into urological practice.

Benign Prostatic Hyperplasia Knowledge Deficits Among Male Urology Patients

OBJECTIVE

To measure patient knowledge about Benign prostatic hyperplasia (BPH) and identify factors associated with knowledge deficiencies among those newly presenting to our urology clinic.

METHODS

Adult men presenting as new patients to our institution's urology clinic, regardless of chief complaint, were invited to complete a 26-item multiple choice questionnaire to assess basic knowledge about BPH, related symptomatology, and treatment options prior to their initial consultation. Responses were correlated to demographic variables using Analysis of Variance (ANOVA) and multivariable linear modeling.

RESULTS

206 patients completed the questionnaire and had a mean age of 60.8 years. The majority were white (85.6%) and 28.9% were medicare/medicaid insured. The mean correct response rate was 62% (standard deviation of 22.9%) with the worst performing domain being BPH complications. Having a graduate or professional degree (P <.001) and self-referral were associated with significantly higher scores (P = .027).

CONCLUSION

There remain significant knowledge gaps about BPH among men seeking urologic care. Education tools for both patients and primary care physicians may help improve health literacy as well as health outcomes for patients with BPH.

Decision aid for surgical management of benign prostatic hyperplasia - Assessing acceptability of the French version

INTRODUCTION

Exploring all surgical interventions for benign prostatic hyperplasia (BPH) can be time-consuming. We developed the first online CUA-endorsed BPH surgical Patient Decision Aid (PtDA), including all guideline-approved surgical modalities. Our study assesses the acceptability of the tool's French version (FRv) among patients and urologists.

MATERIAL

A PtDA was developed including 9 surgical modalities: monopolar transurethral resection of the prostate (TURP), bipolar TURP, GreenLight photovaporization, endoscopic enucleation of the prostate, Rezum, Urolift, Aquablation, open retropubic prostatectomy, and robotic simple prostatectomy. Ten urologists who perform BPH surgery and 21 patients with a history of BPH surgery were recruited. Alpha-testing was performed for the FRv and compared to the English version (ENv).

RESULTS

In both versions of the PtDA, the language was considered clear (urologists FRv 78%; ENv 92%, patients FRv 91%; ENv 100%) and outcomes correctly reported (urologists FRv 71%; ENv 82%) and well explained (patients FRv 91%; ENv 90%). Most patients believed the PtDA would have been useful during their consultation (FRv=86%, ENv=89%), and all recommended it for future patients. A higher proportion of patients, versus urologists, found the PtDA of appropriate duration (urologists FRv 46%; ENv 64%, patients FRv 90%; ENv 84%) and length (urologists FRv 54%; ENv 64%, patients FRv 57%; ENv 84%). Urologists mainly recommended text lightening and integrating illustrations.

CONCLUSION

While the FRv was found to be acceptable, it underperformed the ENv among urologists due to its information overload. The FRv will be rendered more concise to facilitate its integration into clinical practice.

EVIDENCE GRADE

4.

Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation

INTRODUCTION

Benign prostatic hyperplasia (BPH) is one of the most common diseases affecting men and can present with bothersome lower urinary tract symptoms (LUTS). Historically, transurethral resection of the prostate (TURP) has been considered the gold standard in the treatment of LUTS due to BPH. However, TURP and other traditional options for the surgical management of LUTS secondary to BPH are associated with high rates of sexual dysfunction. In the past decade, several novel technologies, including Aquablation therapy, convective water vapor therapy (Rezum), and transperineal prostate laser ablation (TPLA), have demonstrated promising evidence to be safe and effective while preserving sexual function.

METHODS

In this review, we discuss three ablative minimally invasive surgeries: Aquablation, Rezum, and TPLA. We review their techniques, safety, as well as perioperative and functional outcomes. We go into further detail regarding sexual function after these ablative minimally invasive surgical therapies.

RESULTS

Aquablation is a surgeon-guided, robot-executed, heat-free ablative waterjet procedure with sustained functional outcomes at 5 years while having no effect on sexual activity. Rezum is an innovative office-based, minimally invasive surgical option for BPH that delivers convective water vapor energy into prostate adenoma to ablate obstructing tissue. Rezum leads to significant improvements in Qmax, IPSS while preserving sexual function. TPLA is another office-based technology which uses a diode laser source to produce thermoablation. It leads to improvement in Qmax, IPSS, and QoL while preserving ejaculatory function.

CONCLUSIONS

Overall, ablative minimally invasive surgical therapies have demonstrated excellent safety and efficacy profiles while preserving sexual function. These modalities should be discussed with patients to ensure informed and shared decision-making. Ablative minimally invasive surgical therapies may be particularly interesting to patients who value the preservation of their sexual function.

Treating LUTS in Men with Benign Prostatic Obstruction: A Review Article

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.

Safety and efficacy of GreenLight PVP in octogenarians: evaluation of the Global GreenLight Group database

INTRODUCTION

The present study analyzes the largest international GreenLight database, the Global GreenLight Group (GGG), to evaluate the functional and safety profile of GreenLight photoselective vaporization of the prostate (PVP) in octogenarians.

METHODS

The GGG is a database comprised of patients that underwent GreenLight PVP from 2011 to 2019 performed by 8 experienced urologists at 7 international hospitals. Patients 80 years or older at the time of surgery were categorized as octogenarians. They were compared to a similar group of PVP patients below the age of 80.

RESULTS

Among 3,648 patients, 586 men were above the age of 80. Compared to patients under the age of 80, octogenarians had larger prostates (76.0 vs 71.9 ml, p = 0.02) and a lower BMI (25.6 vs 26.7, p = 0.045). Operative time was not significantly longer in octogenarians. The improvement in functional outcomes between 80-year-old patients and control patients was not significantly different at one-year follow-up, with the exception of maximum urinary flow (Q_max) that favoured younger patients (10.3 vs 12.6 ml/s, p = 0.02). The odds of transfusion were greater for older patients [OR 8.2 (95% CI 3.6-18.9, p < 0.01)], but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0 vs 11.9%, p < 0.01).

CONCLUSIONS

GreenLight PVP is a safe option in well-selected octogenarians in a cohort of patients treated by surgeons experienced with the technology. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was higher in octogenarians.

Extended-duration thromboprophylaxis for abdominopelvic surgery: Development and evaluation of a risk-stratified patient decision aid to facilitate shared decision making

Background

Extended-duration thromboprophylaxis is used to decrease risk of venous thromboembolism (VTE) after surgery but may increase the risk of bleeding. The decision to complete a course of extended-duration thromboprophylaxis can be challenging.

Objective

The objective of this study was to develop an acceptable patient decision aid (PtDA) to facilitate shared decision making for the use of extended-duration thromboprophylaxis following major abdominal surgery.

Methods

An evidence-based, risk-stratified PtDA was created. The evidence on benefits and harms of a 28-day postoperative course of low-molecular-weight heparin (LMWH) versus in-hospital prophylaxis only were synthesized. Outcomes included minor bleeding, major bleeding, clinically significant VTE, and fatal VTE. Risks were calculated and reported by Caprini score. Alpha testing of the PtDA draft with various stakeholders was performed using a 10-question survey to assess acceptability of the PtDA with patients, thrombosis experts, and surgeons. The primary outcome was the acceptability of the PtDA.

Results

Acceptability testing was performed with 11 patients, 11 thrombosis experts, and 11 surgeons. Most responders felt the language on the PtDA was easy to follow (28/33, 85%), and that the information was well balanced between management options (9/11 [82%] patients; 17/21 [80%] clinicians). Most patients (9/11, 82%) and clinicians (18/22, 82%) believed it would be a useful clinical tool, and were satisfied with the overall quality of the PtDA (27/33, 82%).

Conclusions

A risk-stratified, evidence-based PtDA was created to facilitate shared decision making for the use of extended-duration LMWH following major abdominal surgery. This clinical tool was acceptable with patients and physicians and is available at https://decisionaid.ohri.ca/decaids.html.

Assessing the Accuracy, Quality, and Readability of Information Related to the Surgical Management of Benign Prostatic Hyperplasia

Objectives: To assess the accuracy, quality, and readability of online educational health information in English related to the most common benign prostatic hyperplasia (BPH) guideline-approved surgical treatments. Methods: The terms "benign prostatic hyperplasia," "BPH," and all eight guideline-approved treatment modalities studied, were searched to retrieve the first five relevant websites and first two paid advertised websites related to the surgical treatment options for BPH. These modalities included transurethral resection of the prostate (TURP), GreenLight photovaporization, endoscopic enucleation of the prostate, Rezum, Urolift, Aquablation, open simple prostatectomy, and robotic simple prostatectomy (RSP). All relevant websites were assessed for their accuracy, quality, and readability using standardized scoring systems. Results: The mean accuracy score for each of the treatment modalities were all indicative of good accuracy, with 76%-99% of the information presented as being accurate. The median quality score was statistically different across the eight treatment modalities (p = 0.015). The median readability grade level was statistically different across the eight treatment modalities (p = 0.009). Websites that described TURP (median readability grade level, 9.00 [interquartile range (IQR) 8.00-10.80]) were significantly easier to read than those related to RSP (median readability grade level, 14.35 [IQR, 11.08-16.50]) (p = 0.011). No other statistically significant differences were found within the other treatment modality websites. Conclusions: The majority of websites retrieved were found to be of high accuracy, good quality, and poor readability. Additionally, it was found that none of the retrieved websites included descriptions for all the other included treatment modalities. Given these findings, the authors recommend the development of centralized resources with all guideline-approved treatment modalities and accurate, readable, and high-quality information related to the surgical treatment of BPH.