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Minerva Urologica E Nefrologica = the... Dec 2017Filling cystometry and pressure flow studies (PFS) are the most widespread used invasive urodynamic techniques in the assessment of male LUTS. However, these techniques... (Meta-Analysis)
Meta-Analysis Review
Clinical significance of intravesical prostatic protrusion in the management of benign prostatic enlargement: a systematic review and critical analysis of current evidence.
INTRODUCTION
Filling cystometry and pressure flow studies (PFS) are the most widespread used invasive urodynamic techniques in the assessment of male LUTS. However, these techniques are time- and cost-intensive. Intravesical prostatic protrusion (IPP) has been proposed as non-invasive method used to diagnose bladder outlet obstruction (BOO) in men with male lower urinary tract symptoms (LUTS). The purpose of the present review is to analyze the diagnostic and therapeutic relevance of IPP.
EVIDENCE ACQUISITION
A comprehensive systematic MEDLINE search was performed for English language reports published before June 2016 using the term "intravesical prostatic protrusion."
EVIDENCE SYNTHESIS
We identified 28 eligible original articles. Determination of IPP seems as useful method to predict BOO. The area under the curve of IPP for the prediction of BOO was found to range from 0.708 (95% CI: 0.615-0.791) to 0.858 (95% CI: 0.809-0.908). IPP seems to have a predictive role in a successful trial without catheter following acute urinary retention. The percentage of successful TWOC in patients with IPP>10 mm was reported at 13% and 18%, respectively, compared to a approximately 80% chance of successful trial in patients with IPP<10 mm. The impact of IPP on postoperative outcomes following surgery for benign prostatic enlargement seems controversial. The heterogeneity of the current studies, the potential intra-observer variability and the potential learning curve need to be taken into account.
CONCLUSIONS
Analysis of IPP may be regarded as potential non-invasive alternative to standard PFS in the assessment of BOO. Patients with IPP>10 mm should be counseled regarding the high chance of need for surgical treatment following acute urinary retention.
Topics: Humans; Male; Prostate; Prostatic Hyperplasia; Treatment Outcome
PubMed: 28263050
DOI: 10.23736/S0393-2249.17.02828-4 -
Frontiers in Surgery 2020Prostatic urethral lift (PUL) is a relatively new minimally invasive treatment procedure for benign prostatic hyperplasia (BPH). In order to analyze the sustainability...
Prostatic urethral lift (PUL) is a relatively new minimally invasive treatment procedure for benign prostatic hyperplasia (BPH). In order to analyze the sustainability of this new protocol, a systematic review and meta-analysis is performed based on the published articles. We performed a critical review according to the preferred reporting items for systematic review and meta-analysis (PRISMA) and MOOSE guidelines. A total of 818 published articles matched our search terms, and 11 studies met the inclusion criteria. Data of each follow-up time point (1, 3, 6, 12, and 24 months) were analyzed in terms of baseline characteristics and functional and sexual health outcomes. The merged means of each time point were calculated using R package meta and shown in the tendency plot. A total of 1,443 patients who underwent PUL are available for the research. At 24 months, the changes of the three indicators are statistically significant (IPSS 9.40 points, < 0.001; Qmax 3.39 ml/s, < 0.001; QoL 1.99 points, < 0.001) but were not as effective as TURP (from literature). The trend plot shows that, as time goes on, the effect of PUL tends to increase first and then weaken. Three items fitted a meaningful curve: IPSS (slope = -1.378 = -12.395, < 0.001), Qmax (slope = -1.382 = -6.429, < 0.001), and QoL (slope = -0.218, = -10.058, < 0.001). Fitted curves of SHIM and PVR are not statistically significant. The regression reveals that IPSS, Qmax, and QoL could be predicted after accepting PUL. PUL appears to be a safe and effective procedure in selected patients with BPH and can improve the symptoms of urinary tract obstruction. However, it is not as effective as TURP and shows no influence to the objective indicators like PVR.
PubMed: 33425981
DOI: 10.3389/fsurg.2020.598728 -
Central European Journal of Urology 2021The clinical effect of pharmacotherapy on prostate morphometric parameters is largely unknown. The sole exception is 5α-reductase inhibitors (5-ARI) that reduce...
The effect of pharmacotherapy on prostate volume, prostate perfusion and prostate-specific antigen (prostate morphometric parameters) in patients with lower urinary tract symptoms and benign prostatic obstruction. A systematic review and meta-analysis.
INTRODUCTION
The clinical effect of pharmacotherapy on prostate morphometric parameters is largely unknown. The sole exception is 5α-reductase inhibitors (5-ARI) that reduce prostate volume and prostate-specific antigen (PSA). This review assesses the effect of pharmacotherapy on prostate parameters effect on prostate parameters, namely total prostate volume (TPV), transitional zone volume (TZV), PSA and prostate perfusion.
MATERIAL AND METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) reporting on morphometric parameters' changes after pharmacotherapy, as primary or secondary outcomes. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RCTs' quality was assessed by the Cochrane tool and the criteria of the Agency for Healthcare Research and Quality. The effect magnitude was expressed as standard mean difference (SMD). The study protocol was published on PROSPERO (CRD42020170172).
RESULTS
Sixty-seven RCTs were included in the review and 18 in the meta-analysis. The changes after alpha-blockers are comparable to placebo. Long-term studies reporting significant changes from baseline, result from physiologic growth. Finasteride and dutasteride demonstrated large effect sizes in TPV reduction ([SMD]: -1.15 (95% CI: -1.26 to -1.04, p <0.001, and [SMD]:-0.66 (95% CI: -0.83 to -0.49, p <0.001, respectively), and similar PSA reductions. Dutasteride's effect appears earlier (1 vs 3 month), the changes reach a maximum at month 12 and are sustained thereafter. Phosphodiesterase-5 (PDE-5) inhibitors have no effect on morphometric parameters. Phytotherapy's effect on TPV is non-significant [SMD]: 0.12 (95% CI: -0.03 to 0.27, p = 0.13). Atorvastatin reduces TPV as compared to placebo (-11.7% vs +2.5%, p <0.01). Co-administration of testosterone with dutasteride spares the prostate from the androgenic stimulation as both TPV and PSA are reduced significantly.
CONCLUSIONS
The 5-ARIs show large effect size in reducing TPV and PSA. Tamsulosin improves perfusion but no other effect is evident. PDE-5 inhibitors and phytotherapy do not affect morphometric parameters. Atorvastatin reduces TPV and PSA as opposed to testosterone supplementation.
PubMed: 34729231
DOI: 10.5173/ceju.2021.132.R1 -
The Cochrane Database of Systematic... Jun 2023Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate, which can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The... (Review)
Review
BACKGROUND
Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate, which can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH is common. The extract of the berry of the American saw palmetto or dwarf palm plant, Serenoa repens (SR), which is also known by its botanical name of Sabal serrulatum, is one of several phytotherapeutic agents available for the treatment of BPH.
OBJECTIVES
To assess the effects of Serenoa repens in the treatment of men with LUTS consistent with BPH.
SEARCH METHODS
We performed a comprehensive search of multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Web of Science, and LILACS), trials registries, other sources of grey literature, and conference proceedings published up to 16 September 2022, with no restrictions on language or publication status.
SELECTION CRITERIA
We included randomized controlled trials of participants with BPH who were treated with Serenoa repens or placebo/no treatment.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for inclusion at each stage and undertook data extraction and risk of bias assessment and GRADE assessment of the certainty of the evidence. We considered review outcomes measured up to 12 months after randomization as short term, and beyond 12 months as long term. Our main outcomes included urologic symptom scores, quality of life, and adverse events.
MAIN RESULTS
For this update, we narrowed the review question to only comparisons with placebo. We included 27 studies (of which 9 were new) involving a total of 4656 participants, 19 studies comparing Serenoa repens with placebo, and 8 studies comparing Serenoa repens in combination with other phytotherapeutic agents versus placebo. Most studies included men aged > 50 (mean age range 52 to 68) with moderate urologic symptoms (International Prostate Symptom Score [IPSS] range 8 to 19). Ten studies were funded by the pharmaceutical industry; two studies were funded by government agencies; and the remaining studies did not specify funding sources. Serenoa repens versus placebo or no intervention Results for this comparison are based on predefined sensitivity analyses limited to studies at low risk of bias. Serenoa repens results in little to no difference in urologic symptoms at short-term follow-up (3 to 6 months; IPSS score range 0 to 35, higher scores indicate worse symptoms; mean difference (MD) -0.90, 95% confidence interval (CI) -1.74 to -0.07; I = 68%; 9 studies, 1681 participants; high-certainty evidence). Serenoa repens results in little to no difference in the quality of life at short-term follow-up (3 to 6 months; IPSS quality of life domain range 0 to 6, higher scores indicate worse quality of life; MD -0.20, 95% CI -0.40 to -0.00; I = 39%; 5 studies, 1001 participants; high-certainty evidence). Serenoa repens probably results in little to no difference in adverse events (1 to 17 months; risk ratio (RR) 1.01, 95% CI 0.77 to 1.31; I = 18%; 12 studies, 2399 participants; moderate-certainty evidence). Based on 164 cases per 1000 men in the placebo group, this corresponds to 2 more (38 fewer to 51 more) per 1000 men in the Serenoa repens group. Serenoa repens results in little to no difference in urologic symptoms at long-term follow-up (12 to 17 months, IPSS score, MD 0.07, 95% CI -0.75 to 0.88; I = 34%; 3 studies, 898 participants; high-certainty evidence). Serenoa repens results in little to no difference in quality of life at long-term follow-up (12 to 17 months, IPSS quality of life, MD -0.11, 95% CI -0.41 to 0.19; I = 65%; 3 studies, 882 participants; high-certainty evidence). There were no data on long-term adverse events for this comparison. Serenoa repens in combination with other phytotherapy versus placebo or no intervention Different phytotherapeutic agents that include Serenoa repens may result in little to no difference in urologic symptoms compared to placebo at short-term follow-up (12 to 24 weeks, IPSS score, MD -2.41, 95% CI -4.54 to -0.29; I = 67%; 4 studies, 460 participants; low-certainty evidence). We are very uncertain about the effects of these agents on quality of life (very low-certainty evidence). These agents may result in little to no difference in the occurrence of adverse events; however, the CIs included substantial benefits and harms (12 to 48 weeks, RR 0.91, 95% CI 0.58 to 1.41; I = 0%; 4 studies, 481 participants; low-certainty evidence). Based on 132 cases per 1000 men in the placebo group, this corresponds to 12 fewer (55 fewer to 54 more) per 1000 men in the combined phytotherapeutic agents with Serenoa repens group.
AUTHORS' CONCLUSIONS
Serenoa repens alone provides little to no benefits for men with lower urinary tract symptoms due to benign prostatic enlargement. There is more uncertainty about the role of Serenoa repens in combination with other phytotherapeutic agents.
Topics: Aged; Humans; Male; Middle Aged; Plant Extracts; Prostatic Hyperplasia; Quality of Life; Serenoa
PubMed: 37345871
DOI: 10.1002/14651858.CD001423.pub4 -
Medicina (Kaunas, Lithuania) Mar 2022The aim of this systematic review is to evaluate the impact of radical prostatectomy (RP) on bladder function, with special attention towards detrusor underactivity... (Review)
Review
The aim of this systematic review is to evaluate the impact of radical prostatectomy (RP) on bladder function, with special attention towards detrusor underactivity investigated with the means of urodynamic evaluation. The review was performed in accordance with the PRISMA statement and was registered in the PROSPERO (ID#: CRD42020223480). The studied population was limited to men with prostate cancer who underwent urodynamic study prior to and after radical prostatectomy. Eight hundred twenty-seven studies were screened, with twenty-five finally included. A qualitative analysis was performed. Rates of detrusor underactivity (DU) before surgery were reported in eight studies and ranged from 1.6% to 75% (median of 40.8%). DU occurred de novo after RP in 9.1% to 37% of patients (median of 29.1%). On the other hand, preexisting DU resolved in 7% to 35.5% of affected men. Detrusor overactivity (DO) was the most frequently reported outcome, being assessed in 23 studies. The rate of DO preoperatively was from 5% to 76% (median of 25%). De novo was reported in 2.3-54.4% of patients (median of 15%) and resolved after RP in 19.6% to 87.5% (median of 33%) of affected patients. Baseline rates of bladder outlet obstruction (BOO) varied between studies from 19% to 59.3%, with a median of 27.8%. The most pronounced change after surgery was the resolution of BOO in 88% to 93.8% (median of 92%) of affected patients. Rates of de novo impaired bladder compliance (IBC) varied from 3.2% to 41.3% (median of 13.3%), whereas the resolution of IBC was reported with rates ranging from 0% to 47% (median of 4.8%). BOO, DO, and DU are frequently diagnosed in men scheduled for RP. BOO is improved after RP in most patients; however, there is still a substantial rate of patients with de novo DU as well as DO which may impair functional outcomes and quality of life.
Topics: Humans; Male; Prostatectomy; Quality of Life; Retrospective Studies; Urinary Bladder, Underactive; Urodynamics
PubMed: 35334557
DOI: 10.3390/medicina58030381 -
Journal of Clinical Medicine May 2021Malignant ureteric obstruction occurs in a variety of cancers and has been typically associated with a poor prognosis. Percutaneous nephrostomy (PCN) can potentially... (Review)
Review
BACKGROUND
Malignant ureteric obstruction occurs in a variety of cancers and has been typically associated with a poor prognosis. Percutaneous nephrostomy (PCN) can potentially help increase patient longevity by establishing urinary drainage and treating renal failure. Our aim was to look at the outcomes of PCN in patients with advanced cancer and the impact on the patients' lifespan and quality of life.
MATERIALS AND METHODS
A literature review was carried out for articles from 2000 to 2020 on PCN in patients with advanced malignancies, using MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library, clinicaltrials.gov, and Google Scholar. All English-language articles reporting on a minimum of 20 patients who underwent PCN for malignancy-associated ureteric obstruction were included.
RESULTS
A total of 21 articles (1674 patients) met the inclusion criteria with a mean of 60.2 years (range: 21-102 years). PCN was performed for ureteric obstruction secondary to urological malignancies ( = -633, 37.8%), gynaecological malignancies ( = 437, 26.1%), colorectal and GI malignancies ( = 216, 12.9%), and other specified malignancies ( = 205, 12.2%). The reported mean survival times varied from 2 to 8.5 months post PCN insertion, with an average survival time of 5.6 months, which depended on the cancer type, stage, and previous treatment.
CONCLUSIONS
Patients with advanced malignancies who need PCN tend to have a survival rate under 12 months and spend a large proportion of this time in the hospital. Although the advent of newer chemotherapy and immunotherapy options has changed the landscape of managing advanced cancer, decisions on nephrostomy must be balanced with their survival and quality of life, which must be discussed with the patient.
PubMed: 34072127
DOI: 10.3390/jcm10112354 -
Medicine Jul 2020Water vapor thermal therapy (WVTT) is a minimally invasive procedure for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). There... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Water vapor thermal therapy (WVTT) is a minimally invasive procedure for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). There are no known systematic reviews reporting the effectiveness and safety of this increasingly common BPH therapy.
METHODS
We performed a systematic review and meta-analysis of studies utilizing WVTT for symptomatic BPH. The international prostate symptom score (IPSS), IPSS-quality of life (IPSS-QOL), BPH impact index (BPHII), and maximum flow rate (Qmax) were calculated as the weighted mean difference relative to baseline and reported in minimal clinically important difference (MCID) units. MCID thresholds were -3 for IPSS, -0.5 for IPSS-QOL, -0.5 for BPHII, and 2 mL/s for Qmax. The surgical retreatment rate was calculated using life-table methods.
RESULTS
We identified 5 cohorts treated with WVTT from 4 studies (514 patients; 40% with median lobe obstruction) with 2 years median follow-up (range: 6 months to 4 years). The IPSS, IPSS-QOL, BPHII, and Qmax significantly improved at all intervals between 3 months and 4 years; this benefit ranged from 3.3 to 3.8 MCID units for IPSS, 3.9 to 4.6 MCID units for IPSS-QOL, 6.8 to 8.2 MCID units for BPHII, and 1.5 to 3.0 MCID units for Qmax. The surgical retreatment rate was 7.0% at 4 years of follow-up data. Most adverse events were nonserious and transient; dysuria, urinary retention, and urinary tract infection were most common. No cases of de novo erectile dysfunction occurred.
CONCLUSIONS
WVTT provided improvement in BPH symptoms that exceeded established MCID thresholds, preserved sexual function, and was associated with low surgical retreatment rates over 4 years.
Topics: Ablation Techniques; Humans; Lower Urinary Tract Symptoms; Male; Prostatic Hyperplasia; Steam
PubMed: 32791742
DOI: 10.1097/MD.0000000000021365 -
European Urology Focus Sep 2020The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the...
CONTEXT
The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge.
OBJECTIVE
To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic.
EVIDENCE ACQUISITION
Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria.
EVIDENCE SYNTHESIS
Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence).
CONCLUSIONS
To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal.
PATIENT SUMMARY
We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care.
Topics: Betacoronavirus; COVID-19; Clinical Decision-Making; Coronavirus Infections; Endoscopy; Humans; Laparoscopy; Neoplasm Grading; Neoplasm Staging; Pandemics; Pneumonia, Viral; Practice Guidelines as Topic; Robotic Surgical Procedures; SARS-CoV-2; Standard of Care; Urologic Diseases; Urologic Neoplasms; Urologic Surgical Procedures; Urology
PubMed: 32532703
DOI: 10.1016/j.euf.2020.05.020 -
Urology Research & Practice Jan 2024This systematic review was done to critically appraise the various evidence available in the literature for the presenting symptoms, diagnosis, and management modalities...
OBJECTIVE
This systematic review was done to critically appraise the various evidence available in the literature for the presenting symptoms, diagnosis, and management modalities for primary bladder neck obstruction diagnosed on invasive urodynamics in young adult men 18-50 years of age.
METHODS
A search was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials databases until July 2022 to find English-language studies relevant to the topic.
RESULTS
A total of 10 studies were included. The estimated difference in International Prostate Symptom Score between baseline and 3 months in the subgroup of medical and surgical treatment was found to be -8.82 and -11.25, respectively (P = .37), and after 12 months, it was found to be -7.69 and -17.70 respectively (P .001). The pooled estimate for the difference in Qmax between baseline and 3 months after medical and surgical treatments in the subgroup was found to be 2.92 and 7.03, respectively (P = .18), and after 12 months, it was found to be 4.54 and 7.74, respectively (P .001). The pooled estimate of the difference in post-void residue before and after 3 months of medical and surgical treatments in a subgroup was found to be -31.15 and -70, respectively (P .001), and after 12 months, it was found to be -31.49 and -156.00, respectively (P .001). Quality of life scores improved in both subgroups.
CONCLUSION
The alpha-blockers are effective in managing primary bladder neck obstruction in the short term, while bladder neck incision is preferred for better longterm outcomes.
PubMed: 38451127
DOI: 10.5152/tud.2024.23155 -
PloS One 2017To investigate the diagnostic value of urodynamic bladder outlet obstruction (BOO) in the selection of patients for transurethral surgery of the prostate. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To investigate the diagnostic value of urodynamic bladder outlet obstruction (BOO) in the selection of patients for transurethral surgery of the prostate.
MATERIALS AND METHODS
We systematically searched online PubMed, Embase, and Cochrane Library databases from January 1989 to June 2014.
RESULTS
A total of 19 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 2321 patients with a median number of 92 patients per study (range: 12-437). Of the 19 studies, 15 conducted conventional transurethral prostatectomy (TURP), and 7 used other or multiple modalities. In urodynamic bladder outlet obstruction (BOO) positive patients, the pooled mean difference (MD) was significant for better improvement of the International Prostate Symptom Score (IPSS) (pooled MD, 3.48; 95% confidence interval [CI], 1.72-5.24; p < 0.01; studies, 16; participants, 1726), quality of life score (QoL) (pooled MD, 0.56; 95% CI, 0.14-1.02; p = 0.010; studies, 9; participants, 1052), maximal flow rate (Qmax) (pooled MD, 3.86; 95% CI, 2.17-5.54; p < 0.01; studies, 17; participants, 1852), and post-void residual volume (PVR) (pooled MD, 32.46; 95% CI, 23.34-41.58; p < 0.01; studies, 10; participants, 1219) compared with that in non-BOO patients. Some comparisons showed between-study heterogeneity despite the strict selection criteria of the included studies. However, there was no clear evidence of publication bias in this meta-analysis.
CONCLUSIONS
Our meta-analysis results showed a significant association between urodynamic BOO and better improvements in all treatment outcome parameters. Preoperative UDS may add insight into postoperative outcomes after surgical treatment of benign prostatic hyperplasia.
Topics: Aged; Humans; Male; Middle Aged; Patient Selection; Prostate; Prostatic Hyperplasia; Quality of Life; Transurethral Resection of Prostate; Treatment Outcome; Urinary Bladder Neck Obstruction; Urodynamics
PubMed: 28241023
DOI: 10.1371/journal.pone.0172590