5-alpha-Reductase Inhibitors Prevent the Progression of Benign Prostatic Hyperplasia

Lower urinary tract symptoms (LUTS) associated with clinical benign prostatic hyperplasia (BPH) are a common occurrence in aging men, causing bother and interference with daily activities and affecting disease-specific quality of life. There is increasing evidence to suggest that, in many patients, the signs and symptoms of BPH are progressive. Progression can be measured as continued growth of the prostate gland; worsening of symptoms, bother, or quality of life; deterioration of urinary flow rate; episodes of acute urinary retention (AUR); and need for prostate-related surgery. Furthermore, it has become clear that the risk of disease progression increases with age as well as with increasing prostate volume and serum prostate-specific antigen (PSA) level. The 5-alpha-reductase inhibitor finasteride has been shown not only to improve symptoms, bother, and quality of life but also to prevent progression to AUR and surgery, with a relative risk reduction of over 50%. As the risk for such progression is higher in patients with larger glands or higher serum PSA values at baseline, it is in those patients that finasteride induces an even greater risk reduction, making it a cost-effective treatment choice for patients with LUTS associated with prostatic enlargement.     

Preventing progression in men with mild symptoms of benign prostatic hyperplasia: a potential role for phytotherapy

Prevalence of benign prostate hyperplasia (BPH) is increasing with the aging population worldwide. Throughout the 20th century, men with minimally symptomatic BPH were generally advised to defer treatment. Treatment deferral or watchful waiting has always appeared reasonable because mild lower urinary tract symptoms suggestive of bladder outlet obstruction are not bothersome and are often regarded as part of the aging process, progression is usually slow, and symptoms often regress spontaneously. This review examines the evidence of the natural history of BPH, highlighting the group of patients with mild symptoms, the risk factors for progression, and the potential role of phytotherapy in this group of men.     

Quality of life and sexual function in patients with benign prostatic hyperplasia

Incidence of benign prostatic hyperplasia (BPH), one of the most common conditions affecting adult men, increases dramatically after the age of 50. The various symptoms of BPH, which include lower urinary tract symptoms (LUTS), can adversely affect quality of life (QOL). Many men with BPH and LUTS wait until symptoms become significantly bothersome before seeking medical attention. Evaluating the exact severity and significance of symptoms has been difficult with previous methodology. Over the last decade, assessment tools have become available to quantify the symptoms of BPH and LUTS. This article addresses the impact of BPH, its management, and the overall effects it has on QOL.     

Relationship Between Depression and Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

This article provides an overview of current data on the relationship between depression and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), with a focus on pathophysiology and patient management implications. Review of the literature indicated a clear relationship between LUTS secondary to BPH and depression. It is unknown whether this relationship is bidirectional or unidirectional. Depression is associated with the impact of LUTS on quality of life in men with BPH. Research suggests that depression alters the experience of LUTS in this population. Medical and surgical treatments for BPH may impact quality of life and, therefore, depression. Results conflict on the exact nature of the relationship examined, and on the extent to which the relationship may be attributed to physiological factors such as inflammation. Practicing clinicians should consider using a brief self-administered scale to assess for depression in patients with BPH. There is a clear need for additional research to decisively determine the nature of the relationship between LUTS secondary to BPH and depression, as well as the extent to which change in either condition may be affected by the other.Key words: Benign prostatic hyperplasia, Depression, Lower urinary tract symptomsThe prevalence of benign prostatic hyperplasia (BPH) increases with age.¹ Approximately half of men over age 40 are diagnosed with BPH. Of these men, approximately 50% will develop significant and bothersome lower urinary tract symptoms (LUTS) secondary to BPH, which increase in prevalence between ages 40 and 80 years. LUTS secondary to BPH is associated with decreased quality of life and may include urgency/frequency, incontinence, and nocturia. Symptom severity is impacted by the degree of prostatic enlargement, which is highly variable.¹Depression is another common condition that severely and negatively impacts quality of life, with an estimated lifetime prevalence of 16.5% according to the National Institute of Mental Health.² Depression plays a role in the pathogenesis of a number of chronic diseases, including inflammatory bowel disease, arthritis, asthma, and diabetes³; a relationship has also been identified between depression and urologic diagnoses such as incontinence.⁴ Symptoms of BPH are associated with decreased quality of life and depression, and the literature strongly suggests that there may also be a pathophysiologic relationship between BPH and depression^5,6; in addition, depressive symptoms are also associated with treatments for BPH.^7–9Research has suggested that psychiatric parameters such as depression may have a putative role in the development of LUTS secondary to BPH.⁶ Furthermore, depression may pose an impediment to effective treatment for these patients. Improved understanding of the relationship between BPH and depression could lead to improved management. This area of research is important because clinical depression is associated with a significant increase in mortality, and early detection, intervention, and treatment of clinically relevant depressive symptoms are key factors in patient care.¹⁰Fewer studies have focused on the relationship between depressive symptoms or depressive disorders and BPH, or the nature and direction of this relationship. Thus, a systematic review of the relationship between depression and BPH is needed. We provide a comprehensive summary of contemporary published reports on LUTS secondary to BPH and depression to improve understanding of the relationship between these two conditions and provide a framework for future investigation.     

Surgical Results and Prognostic Factors of Anterior Cervical Corpectomy and Fusion for Ossification of the Posterior Longitudinal Ligament

Background

Mechanism of ossification of the posterior longitudinal ligament (OPLL) has not been elucidated clearly. Surgical decompression is usually necessary for the patients with neurological symptoms. Anterior decompression and resection of OPLL seems to be a radical surgical option, because the spinal cord is compressed from the anterior direction.

Methods

Among 229 patients who underwent ACF for OPLL between January 2001 and December 2007 in our hospital, a total of 133 patients responded to the invitation and made return visits, with a follow-up rate of 58.1%. For these patients, clinical data were collected from medical and operative records. Neurological status were evaluated by using the Japanese Orthopedic Association (JOA) scoring system. Radiological evaluations including C2-7 lordotic angle, sagittal vertical axis (SVA), occupying rate of OPLL, double-layer sign and high-intensity zone were obtained from all the patients. Complications and causes of revision surgery were also investigated. Correlations between the long-term surgical outcome and various prognostic factors were statistically analyzed.

Findings

Eighty-four males and forty-nine females completed the follow-up, with a mean age at operation of 56.8 years. The overall average JOA score significantly increased, with a mean recovery rate of 64.1%±14.2%. The mean C2-7 lordotic angle and SVA were also significantly improved, and fusion rate was satisfactory. The incidence of complications was consistent to the previous reports and most of them were controllable by suitable treatments. Multiple regression analysis showed that number of corpectmies and preoperative JOA score were important predictors of surgical outcome.

Conclusions

ACF is a reliable and effective method for treating OPLL patients in terms of neurological recovery, maintenance of radiological parameters, fusion rate and complications. Number of corpectomies and preoperative JOA score are important predictors for the clinical outcome when this procedure is used.     

Psychometric validation of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) in Chinese patients with adolescent idiopathic scoliosis

Background

Scoliosis is a common spinal deformity that occurs often during adolescence. Previous studies suggested that adolescent idiopathic scoliosis (AIS) patients can have various aspects of their lives being affected, due to disease presentation and/or treatment received. It is important to define a reliable instrument based on which the affected patients’ health-related quality of life can be assessed. This study aims to assess the validity, reliability and sensitivity of the EuroQoL 5-dimension 5-level (EQ-5D-5L) in Chinese patients with AIS.

Methods

Adolescent idiopathic scoliosis patients of Chinese descent were prospectively recruited to complete both the traditional Chinese versions of the EQ-5D-5L and the refined Scoliosis Research Society-22 (SRS-22r) questionnaires. Patients’ demographic profiles and corresponding clinical parameters including treatment modalities, spinal curve pattern and magnitude, and duration of bracing were recorded. Telephone interviews were then conducted at least two weeks later for the assessment of test-retest reliability. Statistical analysis was performed: construct validity of the EQ-5D-5L domains were assessed using Spearman’s correlation test against the SRS-22r; whereas intra-class correlation coefficient (ICC) was used to assess the test-retest reliability, and agreement over the test-retest period was expressed in percentages. Also, the sensitivity of the EQ-5D-5L in differentiating various clinical known groups was determined by effect size, independent t-test and analysis of variance.

Results

A total of 227 AIS patients were recruited. Scores of domains of the EQ-5D-5L correlated significantly (r: 0.57-0.74) with the scores of the SRS-22r domains that were intended to measure similar constructs, supporting construct validity. The EQ-5D-5L domain responses and utility scores showed good test-retest reliability (ICC: 0.777; agreement: 76.4?-98.1 %). Internal consistency was good (Cronbach’s α: 0.78) for the EQ-5D-5L utility score. The EQ-5D-5L utility score was sensitive in detecting differences between subjects who had different treatment modalities and bracing duration, but not for curve pattern and its magnitude.

Conclusions

The EQ-5D-5L is found to be a valid, reliable and sensitive measure to assess the health-related quality of life in Chinese AIS patients. This potentiates the possibility of utilizing the EQ-5D-5L to estimate AIS patients’ health-related quality of life, based on which the outcome of various treatment options can eventually be evaluated.

     

La dysfonction érectile associée à une hypertrophie bénigne de prostate (HBP) symptomatique: son lien avec le stade évolutif de l’HBP, et son évolution sous différentes thérapeutiques

Introduction

Although the relationship between the lower urinary tract symptoms (LUTS) and the erectile dysfunction (ED) is no more debated, its underlying mechanism remains obscure so far. Several studies emphasized the correlation between the severity of LUTS and the sexual function, and the impact of the different medications used. This study is the first to highlight the association between the stage of evolution of BPH (complicated and noncomplicated BPH) and the severity of the ED.

Objectives

To assess the correlation between ED and the stage of evolution of BPH, and to evaluate the impact of different medications on ED.

Patients and methods

This is a prospective trial relating of 100 patients admitted for urologic consultation, in the Universitary Hospital Center of Fez in Morocco, in a period of 12 months. To evaluate the severity of ED, we used International Index of Erectile Function (IIEF). In our patients, it was not possible to use the International Prostate Symptom Score (IPSS) to assess the severity of urinary symptoms, and it was not possible to date exactly the beginning of LUTS. Hence, we studied patients’ age, the stage of evolution of BPH (complicated or noncomplicated BPH) and the response of the ED to different treatments.

Results

The average man age was 64.3 years. Forty patients had complicated BPH and 60 patients had noncomplicated BPH. Thirty patients (75%) among 40 with complicated BPH had severe ED, whereas an ED rate of 33% (20 patients) was noticed in patients presenting with noncomplicated BPH. Alpha-blockers (tamsulosin) improved erectile function in 12 patients (20%) among those with noncomplicated BPH. Patients presenting with complicated BPH underwent surgical procedure (either transurethral resection of the prostate or open prostatectomy). Erectile function was not statistically improved in this group of patients.

Conclusion

ED showed a correlation with the stage of evolution of symptomatic BPH. Indeed, the risk of ED is higher in patients with complicated BPH. The alphablockers improved the erectile function in the group of noncomplicated BPH, contrary to the surgical approach.     

Measuring outcomes in primary care: a patient generated measure,MYMOP, compared with the SF-36 health survey.

OBJECTIVE--To assess the sensitivity to within person change over time of an outcome measure for practitioners in primary care that is applicable to a wide range of illness. DESIGN--Comparison of a new patient generated instrument, the measure yourself medical outcome profile (MYMOP), with the SF-36 health profile and a five point change score; all scales were completed during the consultation with'' practitioners and repeated after four weeks. 103 patients were followed up for 16 weeks and their results charted; seven practitioners were interviewed. SETTING--Established practice of the four NHS general practitioners and four of the private complementary practitioners working in one medical centre. SUBJECTS--Systematic sample of 218 patients from general practice and all 47 patients of complementary practitioners; patients had had symptoms for more than seven days. OUTCOME MEASURES--Standardised response mean and index of responsiveness; view of practitioners. RESULTS--The index of responsiveness, relating to the minimal clinically important difference, was high for MYMOP: 1.4 for the first symptom, 1.33 for activity, and 0.85 for the profile compared with < 0.45 for SF-36. MYMOP''s validity was supported by significant correlation between the change score and the change in the MYMOP score and the ability of this instrument to detect more improvement in acute than in chronic conditions. Practitioners found that MYMOP was practical and applicable to all patients with symptoms and that its use increased their awareness of patients'' priorities. CONCLUSION--MYMOP shows promise as an outcome measure for primary care and for complementary treatment. It is more sensitive to change than the SF-36 and has the added bonus of improving patient-practitioner communication.     

Cross-Cultural Adaptation and Validation of the Dutch Version of the Hip and Groin Outcome Score (HAGOS-NL)

Background

Valid and reliable questionnaires to assess hip and groin pain are lacking. The Hip and Groin Outcome Score (HAGOS) is a valid and reliable self-reported measure to assess symptoms, activity limitations, participation restrictions and quality of life of persons with hip and/or groin complaints. The purpose of this study was to translate and cross-culturally adapt the HAGOS into Dutch (HAGOS-NL), and to evaluate its internal consistency, validity and reliability.

Methods

Translation and cross-cultural adaption of the Dutch version of the HAGOS (HAGOS-NL) was performed according to international guidelines. The study population consisted of 178 adult patients who had undergone groin hernia repair surgery in the previous year. All respondents filled in the HAGOS-NL, the SF-36, and the SMFA-NL for determining construct validity of the HAGOS-NL. To determine reliability, 81 respondents filled in the HAGOS-NL after a time interval of two weeks.

Results

Factor analysis confirmed the original six-factor solution of the HAGOS. Internal consistency was good for all the subscales of the HAGOS-NL. High correlations were observed between the HAGOS-NL and the SF-36 and SMFA-NL, indicating good construct validity. The HAGOS-NL showed high reliability, except for the subscale Participation in Physical Activities which was moderate.

Conclusions

The HAGOS was successfully translated and cross-culturally adapted from English into Dutch (HAGOS-NL). This study shows that the HAGOS-NL is a valid and reliable instrument for the assessment of functional status and health-related quality of life in patients with groin complaints.     

The effect of erectile dysfunction on quality of life following treatment for localized prostate cancer

All forms of prostate cancer therapy carry significant risk of erectile dysfunction, but patients value sexual function so highly that they are often willing to choose a therapy that offers a shorter life expectancy but better potency following treatment. Advances in research methodology now allow reliable collection of meaningful data regarding patients' health-related quality of life, including both objective evaluation of patients' functional status and their perceptions of their own health and its impact on their existence. In the past decade, several validated and reliable questionnaires have been developed that are specifically designed to measure HRQOL in men with prostate cancer. Studies using these instruments have found that function and perceived bother may not be correlated; patients may express satisfaction with their therapy despite loss of sexual function. Erectile aids, including sildenafil, can be helpful for patients following treatment for localized prostate cancer.     

Issues and developments on the consumer recovery construct

The consumer recovery model has had increasing influence on mental health practices in the United States, Western Europe, and several other countries. However, adoption of the model has reflected political decisions rather than empirical evidence of the validity of the model or its value for treatment services. The recovery construct is poorly defined, and until recently there has been no reliable and valid measure with which to base a research program. We have developed an empirical measure that is well-suited for both research and clinical applications: the Maryland Assessment of Recovery in Serious Mental Ill-ness (MARS). We briefly describe the MARS and present preliminary data demonstrating that recovery is not a simple by-product of traditional outcome do-mains, but seems to be a distinct construct that may have important implications for understanding consumers with serious mental illness and for evaluating the outcome of treatment programs.     

Phosphodiesterase type 5 inhibitors for the treatment of male lower urinary tract symptoms

Both lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) and erectile dysfunction have a very high prevalence among aging men, and there is some clinical evidence that they may share a common pathophysiology. Consequently, several preliminary studies of phosphodiesterase type 5 inhibitors-sildenafil and tadalafil-have recently been conducted in men with concomitant erectile dysfunction and lower urinary tract symptoms to determine whether these agents are effective for the treatment of symptomatic BPH. These studies have demonstrated efficacy, both alone and in combination with an alpha-blocker, in treating lower urinary tract symptoms along with sexual dysfunction. However, larger-scale randomized studies are necessary to determine long-term safety, efficacy, and cost effectiveness.     

Comparative Effectiveness of Oral Drug Therapies for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: A Systematic Review and Network Meta-Analysis

Introduction

Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are common in elder men and a number of drugs alone or combined are clinically used for this disorder. But available studies investigating the comparative effects of different drug therapies are limited. This study was aimed to compare the efficacy of different drug therapies for LUTS/BPH with network meta-analysis.

Materials and Methods

An electronic search of PubMed, Cochrane Library and Embase was performed to identify randomized controlled trials (RCTs) comparing different drug therapies for LUTS/BPH within 24 weeks. Comparative effects were calculated using Aggregate Data Drug Information System. Consistency models of network meta-analysis were created and cumulative probability was used to rank different therapies.

Results

A total 66 RCTs covering seven different therapies with 29384 participants were included. We found that α-blockers (ABs) plus phosphodiesterase 5 inhibitors (PDE5-Is) ranked highest in the test of IPSS total score, storage subscore and voiding subscore. The combination therapy of ABs plus 5α-reductase inhibitors was the best for increasing maximum urinary flow rate (Qmax) with a mean difference (MD) of 1.98 (95% CI, 1.12 to 2.86) as compared to placebo. ABs plus muscarinic receptor antagonists (MRAs) ranked secondly on the reduction of IPSS storage subscore, although monotherapies including MRAs showed no effect on this aspect. Additionally, PDE5-Is alone showed great effectiveness for LUTS/BPH except Qmax.

Conclusions

Based on our novel findings, combination therapy, especially ABs plus PDE5-Is, is recommended for short-term treatment for LUTS/BPH. There was also evidence that PDE5-Is used alone was efficacious except on Qmax. Additionally, it should be cautious when using MRAs. However, further clinical studies are required for longer duration which considers more treatment outcomes such as disease progression, as well as basic research investigating mechanisms involving PDE5-Is and other pharmacologic agents alleviate the symptoms of LUTS/BPH.     

幽门螺杆菌根除治疗对帕金森病患者运动症状的影响

目的:探讨幽门螺杆菌(HP)根除治疗对帕金森病(PD)患者运动症状的影响及其安全性,为临床治疗提供参考。方法:选取2013年1月-2015年10月医院收治的PD患者120例,根据尿素呼吸试验(UBT)检测结果,将PD患者分为HP组(n=32)和非HP组(n=88),两组均进行抗PD的常规治疗,HP组在此基础上采用HP根除治疗(奥美拉唑+克拉霉素+阿莫西林),采用帕金森病评定量表(UPDRS)评估两组患者治疗前后的运动症状,并对治疗过程中的不良反应进行统计分析。结果:120例PD患者中,HP感染32例占26.67%,经HP根除治疗后,HP检测阴性者26人,成功根除率81.25%。组间比较,治疗前两组UPDRS Ⅳ评分有统计学差异(P0.05),而UPDRS Ⅲ评分、Hoehn-Yahr分级、"开"期和"关"期时间无统计学差异(P0.05);治疗后两组"开"期和"关"期时间存在统计学差异(P0.05),而UPDRS Ⅲ评分、UPDRS Ⅳ评分、Hoehn-Yahr分级无统计学差异(P0.05)。组内比较,治疗后,HP组UPDRS Ⅲ评分和UPDRS Ⅳ评分均较治疗前下降,差异有统计学意义(P0.05),且"开"期时间明显延长,"关"期时间明显缩短,差异均有统计学意义(P0.05),而非HP组治疗前后上述各项指标比较,差异均无统计学意义(P0.05)。HP根除组不良反应发生率与非HP组相比,差异无统计学意义(P0.05)。结论:HP感染与PD的发生有关,HP根除治疗能显著改善PD患者的运动症状,安全有效,值得临床推广使用。     

Clinical and Imaging Predictors of Surgical Outcome in Multilevel Cervical Ossification of Posterior Longitudinal Ligament: An Analysis of 184 Patients

Objective

To investigate the clinical and imaging predictors of surgical outcomes in patients with ossification of the posterior longitudinal ligament (OPLL).

Materials and Methods

From May 2010 to April 2012, a total of 200 consecutive patients with cervical OPLL were recruited for this study. Of them, 184 patients (130 men and 54 women) who could be tracked for more than 24 months after surgery were finally included for analysis. Their demographic, clinical and radiological data were collected preoperatively. The recovery ratio in terms of JOA score was used to assess the outcome of the patients preoperatively and at 2 years postoperatively. A JOA recovery rate less than 50% was considered a poor outcome.

Results

Compared with good outcome group, an older mean age at operation, a longer mean duration of symptoms, a lower mean pre-operativer JOA score, and a higher proportion of diabetics were observed in poor outcome group. Patients in poor outcome group were more likely to present kyphotic cervical alignment, smaller mean transverse area of the spinal cord, and intramedullary signal abnormalities. The result of multivariate stepwise logistic regression showed that a longer duration of symptoms and the presence of T1 hypo-intensity intramedullary changes on MRI were significant risk factors of lower JOA recovery ratios.

Conclusion

A longer duration of symptom, T1 hypointensity on MRI and a history of minor trauma were highly predictive of a poor outcome for patients undergoing surgical treatment of OPLL. Age at operation, the history of diabetes, the preoperative JOA score, the transverse area of the spinal cord and T2 hyper-intensity on MRI were also associated with the prognosis of OPLL.     

Expectations of Stress Urinary Incontinence Surgery in Patients With Mixed Urinary Incontinence

Mixed urinary incontinence is estimated to affect 30% of all women who have urinary incontinence, and it has been shown to be more bothersome to women than pure stress incontinence. Given the degree of bother, many women will undergo surgical correction for incontinence. Patients have high expectations about the success of these interventions. Understanding mixed incontinence and the effects of our interventions can help guide therapeutic choices and manage patients’ expectations.Key words: Urodynamics, Mixed urinary incontinence, Sling, Anti-incontinence surgery, Urgency incontinenceIt has been estimated that approximately 30% of women with urinary incontinence have mixed urinary incontinence (MUI). Degree of bother is higher among women with MUI compared with those who have pure stress urinary incontinence (SUI).¹ MUI can be a very challenging and costly condition to treat.^2,3 Patients with MUI are often offered conservative therapy such as physical therapy, weight-loss strategies, and behavioral modification. Some patients also benefit from treatments aimed directly at urgency, frequency, and urgency incontinence (overactive bladder), which currently include pharmacologic therapy (antimuscarinic or β-3 agonists), chemodenervation (botulinum toxin), or neuromodulation (sacral or posterior tibial nerves).⁴ However, many patients with MUI progress to surgical therapies for treatment of SUI. This article reviews the literature available that can help clinicians manage expectations of SUI surgeries on patients with MUI.     

The Role of Minimally Invasive Surgical Techniques in the Management of Large-gland Benign Prostatic Hypertrophy

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) are among the most common medical issues for aging men. Population-based studies suggest that 13.8% of men in their 40s and more than 40% of men over age 60 have BPH. When LUTS are refractory to medical therapy and bothersome enough to warrant surgical intervention, transurethral resection of the prostate and open simple prostatectomy have been the historical reference-standard procedures for decades. Both procedures are highly effective and offer durable improvements in urinary functional outcomes. However, they also have the potential for considerable perioperative complications and morbidity. In an effort to limit surgical morbidity, a variety of minimally invasive surgical techniques to treat BPH have been introduced. Herein we present a comprehensive, evidence-based review of the efficacy and safety profile of modern minimally invasive treatments for large-gland BPH.Key words: Benign prostatic hypertrophy, Lower urinary tract symptoms, GreenLight photovaporization, Holmium laser enucleation of the prostate (HoLEP), Robotic simple prostatectomyLower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) are among the most common medical issues for aging men. Population-based studies suggest that 13.8% of men in their 40s and more than 40% of men over age 60 have BPH.¹ When LUTS are refractory to medical therapy and bothersome enough to warrant surgical intervention, transurethral resection of the prostate (TURP) and open simple prostatectomy (SP) have been the historical reference-standard procedures for prostates < 80 g and ≥ 80 to 100 g, respectively, for decades.²Both procedures are highly effective and offer durable improvements in urinary functional outcomes.^3–5 However, they also have the potential for considerable perioperative complications and morbidity. A recent prospective study of more than 10,654 patients undergoing TURP reported an overall short-term morbidity rate of 11.1%. Among the most common complications reported were surgical reoperation (5.6%), transfusions (2.9%), and transurethral resection syndrome (1.4%).⁶ Furthermore, the risks of both complications and mortality increased with gland size.⁶ The morbidity of open SP is even higher, with 7.5% of patients requiring transfusions and 3.7% requiring surgical intervention for severe bleeding, even in contemporary series.⁷In an effort to limit surgical morbidity, a variety of minimally invasive surgical techniques to treat BPH have been introduced. Although a large body of research exists investigating the overall safety and efficacy of such procedures, there remains a paucity of evidence regarding the safety and efficacy of these procedures in the management of large prostates ≥ 80 g in size (Figure 1).Open in a separate windowFigure 1Example of large-gland benign prostatic hyperplasia on computed tomography scan in the axial (above) and coronal (below) planes.     

Résultats fonctionnels de la radiofréquence par Prostiva? dans le traitement de l’hypertrophie bénigne de la prostate (HBP) non compliquée résistante aux traitements médicamenteux

Objective

To assess prospectively on objective and subjective parameters functional outcomes of prostatic thermotherapy by radiofrequency (Prostiva?) on urinary discomfort and sexual life in the treatment of uncomplicated symptomatic and resistant to drug treatment benign prostatic hypertrophy (BPH).

Patients and methods

Patients with eligibility criteria for this treatment published by HAS have been treated in our urology unit. They were called at one month for a clinical examination and analysis of objective data (maximum urine flow [Qmax], post-voiding residual, international prostate score symptom [IPSS]). They were contacted in December 2009 and submitted to a questionnaire on urinary symptoms (IPSS), quality of life (question 8 of IPSS), assessment of sexual function (IIEF, DAN SEX) and subjective assessment of treatment (Likert score).

Results

From December 2006 to January 2009, 20 patients (median age: 63 years) were treated with Prostiva?. Four patients had acute retention of urine in the immediate postoperative needing a urinary catheterization in emergency. We made a systematic evaluation of all patients at one month and in December 2009. The median follow-up was 20.6 months (12?C37 months). There was a significant improvement of IPSS (?6.7 points; IC95= [?10.3; ?3.1]), an improvement of sexuality functions, quality of life data, and a sense of global improvement of urinary symptoms (+ 1.8 = improved on the Likert score). Four patients were considered as failures: three patients resumed drug therapy, one patient received a prostate resection.

Conclusion

Our single centre study performed in selected patients according to the criteria of HAS consolidated the results of published studies. Results were positive on urinary symptoms, with a low morbidity and a positive subjective evaluation on symptoms. It demonstrated the safety of thermotherapy on patients?? sexuality and even better, the positive impact of the treatment on erections and satisfaction relations.     

Events per person year--a dubious concept.

In 1982 a new measure was introduced in research into osteoporosis and is now used everywhere in the literature. The so called "fracture rate" relates the number of fractures (single in some patients, multiple in others) to the cumulative time of observation of all patients. This concept, however, has no sound basis. Counting events instead of patients usually violates basic statistical assumptions and invalidates the use of common statistical tests and estimators. Its clinical interpretation is rather dubious. The use of such a measure impedes the search for valid and clinically meaningful outcome criteria and should be abandoned.     

Update on the american urological association guidelines for the treatment of benign prostatic hyperplasia

The updated 2003 American Urological Association (AUA) Guidelines for the treatment of benign prostatic hyperplasia (BPH) are the culmination of an exhaustive effort predicated on scientifically accepted methods of reviewing the medical literature. In this second publication of the guidelines, a multidisciplinary panel reviewed a new meta-analysis of outcome data from the BPH literature from before and after 1994. The major differences between the 2 guidelines are the changes in our understanding of the biology of the prostate and the introduction of new therapies. The vast majority of randomized controlled trials, particularly with respect to minimally invasive therapies and progression of BPH, were performed after the release of the 1994 guidelines. Also, the most recent AUA panel carefully reviewed unpublished data to make the guidelines as timely as possible. Studies that were subsequently published included those on the value of combination medical therapy for BPH. The panel agreed on updated recommendations for the treatment of moderate-to-severe lower urinary tract symptoms associated with BPH, and diagnostic algorithms were revised. The durability and utility of the present guidelines should exceed that of its predecessor.