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1.
Arch Esp Urol ; 73(2): 140-146, 2020 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32124845

RESUMO

OBJECTIVES: The aim of this study is to evaluate the efficacy, safety and postoperative outcomes of the recently developing endoscopic techniques of Bi-Vap (Richard Wolf®) saline vaporization of the prostate and bipolar plasmakinetic TURP in BPE over 90 ml. METHODS: In total, we included 147 patients treated with BiVap (Richard Wolf®) saline vaporization of the prostate (n=75) and bipolar plasmakinetic TURP(n=72). The inclusion criteria were Qmax ≤10 mL/s,IPSS ≥16, and prostate volume over 90 ml. Operation, hospitalization and catheter removal time were noted. Postoperative complications including urinary tract infection, transient hematuria, severe dysuria, and fever >38°C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative month 3. Preoperative and postoperative values of IPSS score, QoL score, IIEF-5, PVR, Qmax and Qave were compared. Statistical analyses were performed using SPSS 18.0 program and statistical significance was set at p<0.05. RESULTS: The groups were similar with respect to preoperative age, height, weight, creatinine, PSA, prostate volume, IPSS score, Qmax, Qave, QoL score, PVR and IIEF-5 values. The mean operation time was significantly higher (<0.001) removal were significantly lower (0.001) compared to group 1. The groups were similar regarding at postoperative month 3 IPSS score, Qmax, Qave,QoL score, PVR and IIEF-5 values. The only exception was the rate of severe dysuria, which was significant lyhigher in group 2. CONCLUSION: Both BiVap (Richard Wolf®) saline vaporization of the prostate and bipolar plasmakinetic TURP are safe and highly effective minimal invasive techniques, which can be used in the surgical treatment of BPE over 90 ml. Although the longer operation time and higher rate of postoperative irritative symptoms, Bi-Vap (Richard Wolf®) saline vaporization of the prostate seems to be a potential alternative to other techniques with shorter length of stay and time to catheter removal.


Assuntos
Hiperplasia Prostática , Ressecção Transuretral da Próstata , Humanos , Masculino , Hiperplasia Prostática/terapia , Resultado do Tratamento , Volatilização
2.
Urology ; 137: 138-145, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899227

RESUMO

OBJECTIVE: To evaluate treatment preferences of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) before and after using a web-based decision aid (DA). PATIENTS AND METHODS: Between July 2016 and January 2017 patients were invited to use a web-based LUTS/BPH DA. Treatment preferences (for lifestyle advices, medication or surgery) before and after DA use and responses on values clarification exercises were extracted from the DA. RESULTS: In total, 126 patients were included in the analysis. Thirty-four percent (43/126) had not received any previous treatment and were eligible for (continuation of) lifestyle advices or to start medication, as initial treatment. The other 66% (83/126) did use medication and were eligible, either for continuing medication or to undergo surgery. Before being exposed to the DA, 67 patients (53%) were undecided and 59 patients (47%) indicated an initial treatment preference. Half of the patients who were initially undecided were able to indicate a preference after DA use (34/67, 51%). Of those with an initial preference, 80% (47/59) confirmed their initial preference after DA use. Five out of 7 values clarification exercises used in the DA were discriminative between final treatment preferences. In 79%, the treatment preferred after DA use matched the received treatment. Overall, healthcare providers were positive about DA feasibility. CONCLUSION: Our findings suggest that a LUTS/BPH DA may help patients to confirm their initial treatment preference and support them in forming a treatment preference if they did not have an initial preference.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Sintomas do Trato Urinário Inferior , Preferência do Paciente/estatística & dados numéricos , Hiperplasia Prostática , Qualidade de Vida , Idoso , Tratamento Conservador/métodos , Tratamento Conservador/psicologia , Humanos , Estilo de Vida , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/psicologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Países Baixos , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Hiperplasia Prostática/psicologia , Hiperplasia Prostática/terapia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/psicologia , Inquéritos e Questionários , Conduta Expectante
4.
Urology ; 136: 212-217, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31734349

RESUMO

OBJECTIVE: To present outcomes for prostatic artery embolization (PAE) to treat urinary retention and gross prostatic hematuria in nonindex benign prostatic hyperplasia patients. MATERIALS AND METHODS: Seventy-five patients undergoing PAE from December 2013 to August 2018 (age = 77.5 ± 8.6, age-adjusted Charlson comorbidity index = 4.6 ± 2.0, prostate volume = 224 mL ± 135 mL) for retention (n = 46) and/or gross prostatic hematuria (n = 55) were retrospectively reviewed. Twenty-six patients had both problems. Urinary retention patients (UR, n = 46, catheterization = 162.4 ± 148.1 days) underwent voiding trials 1-2 months post-PAE, with International Prostate Symptom Score (IPSS), Quality of Life (QoL), and postvoid residual (PVR) recorded at 3, 6, 12, 24, and 36 months. Pre- and post-PAE hematuria-related visits were compared for gross hematuria patients (GH, n = 39), as were transfusion rates for severe hematuria patients requiring bladder irrigation (SH, n = 16). Ninety-day adverse event tabulation used Clavien-Dindo classification. RESULTS: Three months post-PAE, 33/38(87%) UR patients were catheter-free (IPSS = 8.9 ± 5.3, QoL = 1.6 ± 1.7, PVR = 158 mL ± 207 mL). Results were similar at 6 months (catheter-free = 26/28(93%), IPSS = 6.5 ± 4.4, QoL = 1.1 ± 0.9, PVR = 149 mL ± 139 mL), 12 months (catheter-free = 19/20(95%), IPSS = 4.7 ± 4.8, QoL = 0.6 ± 0.9, PVR = 125 mL ± 176 mL), 24 months (catheter-free = 11/12(92%), IPSS = 4.4 ± 3.0, QoL = 0.9 ± 0.8, PVR = 66 mL ± 68 mL), and 36 months (catheter-free = 5/6(83%), IPSS = 5.8 ± 3.8, QoL = 0.8 ± 1.0, PVR =99 mL ± 71 mL). Out of 37, 34(92%) GH patients remained hematuria-free at 483 ± 137 days, with 22 hematuria-related visits pre-PAE vs none post-PAE. Hematuria resolved <48 hours post-PAE in 14/16(87.5%) SH patients, with 36 blood units transfused pre-PAE, 4 units transfused <48 hours post-PAE, and none thereafter. Subsequently, 13/16(81%) remained hematuria-free at 500 ± 501 days; 2/16(13%) required fulguration; 1/16(6%) developed bladder tumor. There were 2 deaths <30 days post-PAE, and 8(11%) Grade-II urinary infections. CONCLUSION: PAE provided safe, effective, and durable treatment for retention and gross hematuria in nonindex benign prostatic hyperplasia patients.


Assuntos
Embolização Terapêutica , Hematúria/etiologia , Hematúria/terapia , Próstata/irrigação sanguínea , Doenças Prostáticas/etiologia , Doenças Prostáticas/terapia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Retenção Urinária/etiologia , Retenção Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Artérias , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
5.
Arch Esp Urol ; 72(9): 968-971, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-31697259

RESUMO

OBJECTIVE: This study aims to describe the presence of bladder foreign body as a rare complication following intraprostatic ethanol injection. CASE REPORTS:  A 71-year-old man and a 70-year-old male with bladder catheter probe due to obstructive benign prostatic enlargement underwent ethanol injection via transrectal echography. RESULTS: The first patient presented a urinary infection with acute urinary retention one year after the procedure. Ultrasonography revealed a 30 cc intravesical foreign body confirmed by urethrocystoscopy. Endoscopic treatment was unsuccessful, and the patient underwent cystotomy with retrieval of a soft, oval, brownish mass. Histological examination of the mass showed benign gland-stromal prostatic hyperplasia with extensive coagulative necrosis. The second patient had an acute urinary retention episode 3 months after surgery. The ultrasonography revealed an abnormal vesicoprostatic mass. Endoscopic treatment was successful, but required 2 sessions. Histological examination of the mass showed acute suppurative inflammation with marked autolysis of prostatic tissue. These foreign bodies in the bladder acted as a nest to promote infection, and generated a valve effect in the bladder neck, resembling a giant vesical lithiasis clinic, which was a diagnostic and therapeutic challenge since few centers worldwide manage this technique for prostatic hyperplasia. CONCLUSIONS: To our knowledge, this is the second report of a "calculus" or "foreign body" formed by prostatic tissue in the urinary tract after the injection of ethanol.


Assuntos
Etanol , Corpos Estranhos , Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Idoso , Etanol/administração & dosagem , Etanol/efeitos adversos , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Humanos , Masculino , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/etiologia
6.
Arch Ital Urol Androl ; 91(3)2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577095

RESUMO

During the last years, pharmaceutical innovations in primary care are dramatically less frequent and will be even more rare in the next future. In this context, preclinical and clinical research oriented their interest toward natural compounds efficacy and safety, supporting the development of a new "nutraceutical" science. Medicinal plants, in the form of plant parts or extracts of them, are commonly used for the treatment of prostate diseases such as benign hypertrophy, prostatitis and chronic pelvic pain syndrome. The pharmacological properties searched for the treatment of prostatic diseases are anti-androgenic, anti-estrogenic, antiproliferative, antioxidant and anti-inflammatory. The most studied and used medicinal plants are Serenoa repens, Pygeum africanum and Urtica dioica. Other promising plants are Cucurbita pepo, Epilobium spp, Lycopersum esculentum, Secale cereale, Roystonea regia, Vaccinium macrocarpon. In parallel, epidemiological studies demonstrated that diet may play an important role on incidence and development of prostatic diseases. The Mediterranean diet is rich of elements with anti-oxidant properties that act as a protective factor for prostatic cancer. Similarly, low intake of animal protein, high intake of fruits and vegetable, lycopene and zinc are a protective factor for benign prostatic hyperplasia (BPH). Serenoa repens in the treatment of symptoms of BPH has been tested either alone or, more frequently, in combination with other medicinal plants, alpha-blockers and inhibitors of 5- alpha reductase (5-ARI). Recent meta-analyses found the effectiveness of Serenoa repens similar or inferior of that of finasteride and tamsulosin but clearly higher than that of placebo in the treatment of mild and moderate low urinary tract symptoms (LUTS), nocturia and discomfort. Clinical trials showed potential synergistic effect of Serenoa repens with other medicinal plants and drugs. In addition to Serenoa repens, there are many other medicinal plants for which clinical evidence is still controversial. Urtica dioica, Pygeum africanum and Curcubita pepo can be considered as an adjunct to the common therapies and their use is supported by studies showing improvement of symptoms and flowmetric indices. Lycopene and selenium are natural products with antioxidant and anti-inflammatory action. The combination of lycopene and selenium with Serenoa repens was able to reduce inflammation in histological prostate sections and to further improve symptom scores and urinary flow in patients with BPH on tamsulosin treatment. Similar effects could be obtained with the use of other carotenoids, such as astaxanthin, and/or zinc. Efficacy on symptoms of patients with BPH of some polyphenols such as quercitin, equol and curcumin have been demonstrated by clinical studies. Pollen extract is a mixture of natural components able to inhibit several cytokines and prostaglandin and leukotriene synthesis resulting in a potent anti-inflammatory effect. Pollen extracts significantly improve symptoms, pain, and quality of life in patients affected by chronic pelvic pain syndrome and chronic prostatitis. Beta-sitosterol is a sterol able to improve urinary symptoms and flow measures, but not to reduce the size of the prostate gland. Palmitoylethanolamide (PEA) is an endogenous fatty acid amide-signaling molecule with anti-inflammatory and neuroprotective effects that can have an interesting role in the management of chronic pelvic pain syndrome and chronic urological pain. Finally, several plant-based products have been subjected to preclinical, in vitro and in vivo, investigations for their potential pharmacological activity against prostate cancer. Some epidemiological studies or clinical trials evaluated the effects of beverages, extracts or food preparations on the risk of prostate cancer. Some plant species deserved more intense investigation, such as Camelia sinensis (green or black tea), Solanum lycopersicum (common tomato), Punica granatum (pomegranate), Glycine max (common soy) and Linum usitatissimum (linen).


Assuntos
Suplementos Nutricionais , Fitoterapia , Extratos Vegetais/uso terapêutico , Plantas Medicinais , Hiperplasia Prostática/terapia , Neoplasias da Próstata/terapia , Humanos , Masculino , Hiperplasia Prostática/prevenção & controle , Neoplasias da Próstata/prevenção & controle
7.
Arch Esp Urol ; 72(8): 786-793, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31579037

RESUMO

INTRODUCTION: Bothersome lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) are increasingly common amongst ageing men leading to poor quality of life. Surgical treatment options targeted at the obstructing prostate are often required to relief the bladder outlet obstruction, following failure or discontinuation of medical therapies. Transurethral resection of the prostate (TURP) has been the mainstay and gold standard for benign prostate surgery for last few decades. Currently with technological advancements, numerous minimally invasive surgical therapies have been employed to provide effective symptom relief while minimalizing morbidities and preserving sexual function. Prostatic hydroablation (Aquablation) is a new technique which involves high velocity water jets used in non-thermal ablation of the obstructing prostatic tissue robotically delivered by a transurethral cystoscopic handpiece and guided by real time transrectal ultrasound imaging. Recent trials have shown that aquablation is safe and effective in the treatment of symptomatic BPH while maintaining sexual preservation. METHOD: Aquablation using the Aquabeam system (PROCEPT BioRobotics, Redwood Shores, CA, USA) combines the precision of autonomous robotic execution in delivering high velocity waterjets via a cystoscopic handpiece with accurate anatomical prostatic mapping using real time transrectal ultrasound imaging. The initial part of the surgery involves careful treatment planning tailored to the prostatic anatomy with preservation of important landmarks nearby, then, high velocity waterjet streams are delivered to ablate the obstructing prostatic tissue without use of any heat. Following the ablation and removal of handpiece, a routine cystoscopic bladder washout is performed and haemostasis achieved with balloon tamponade from a 3 way catheter placed under tension empolying a custom designed catheter tensioning device. RESULTS: Initial studies involving a few case series and a phase II trial demonstrated the safety and effectiveness of aquablation in treatment of symptomatic BPH. Subsequently, a large multicentre international prospective randomised blinded clinical trial (WATER) was conducted to assess the efficacy of aquablation versus TURP. Results from this pivotal trial showed non-inferior symptom relief compared to transurethral prostate resection but with a lower risk of sexual dysfunction. WATER II study was then conducted to assess the safety and feasibility from a multicentre prospective study of aquablation in the treatment of symptomatic large-volume BPH. The results from this study showed that aquablation is feasible and safe in treating men with men with large prostates (80-150 mL). CONCLUSION: The current landscape of BPH surgical treatment should be individualized with a shared decision- making process based on prostatic anatomy and clinical parameters combined with patient's preferences to select the ideal treatment option for each patient. Aquablation is one such option that involves a robotically delivered hydroablation technique based on individualised real time ultrasonic prostatic mapping that can offer safe and effective treatment for symptomatic BPH while minimising sexual dysfunction. Larger trials with longer follow up data will be required to further validate the long term effectiveness of aquablation.


Assuntos
Técnicas de Ablação , Hiperplasia Prostática , Procedimentos Cirúrgicos Robóticos , Ressecção Transuretral da Próstata , Técnicas de Ablação/métodos , Humanos , Masculino , Estudos Prospectivos , Hiperplasia Prostática/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Ultrassonografia , Água
8.
Urology ; 134: 192-198, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31542460

RESUMO

OBJECTIVE: To test the hypothesis that transurethral prostate procedures (TUPPs) eliminating tissue result in greater medication discontinuation and lower de novo initiation rates than procedures inducing tissue necrosis. METHODS: Retrospective review of all men undergoing first time TUPPs at a large tertiary center from 2001 to 2016 was completed. Procedure type and urologic medication use before, 3-12 months after, and greater than 12 months after TUPP were analyzed with simple open prostatectomy as a comparator. Tissue-eliminating TUPPs included transurethral resection of the prostate and laser prostatectomy. Tissue-necrosing procedures included microwave therapy (transurethral microwave therapy) and radiofrequency ablation (transurethral needle ablation), which were grouped in analyses. Medication types were 5-alpha reductase inhibitors (5ARI), alpha blockers, anticholinergics, and beta-3 agonists (B3A). RESULTS: A total 5150 TUPPs were analyzed. Preoperative medication use significantly varied across TUPPs for 5ARI (P <.01), alpha-blockers (P .01), and anticholinergics (P .047), but not B3A (P .476). Transurethral resection of the prostate and laser prostatectomy were associated with significantly higher medication discontinuation rates and lower resumption and initiation rates compared to tissue-necrosing procedures. Relative to TUPPs, simple prostatectomy had significantly higher medication discontinuation, as well as the lowest resumption and initiation rates. CONCLUSION: Tissue-eliminating benign prostatic hyperplasia procedures were associated with better medication discontinuation, resumption, and de novo initiation rates compared to tissue-necrosing benign prostatic hyperplasia procedures.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Micro-Ondas/uso terapêutico , Prostatectomia , Hiperplasia Prostática/terapia , Terapia por Radiofrequência , Ressecção Transuretral da Próstata , Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 3/uso terapêutico , Idoso , Antagonistas Colinérgicos/uso terapêutico , Desprescrições , Humanos , Masculino , Prostatectomia/métodos , Estudos Retrospectivos
9.
Int J Comput Assist Radiol Surg ; 14(11): 1859-1869, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377964

RESUMO

PURPOSE: With X-ray radiation protection and dose management constantly gaining interest in interventional radiology, novel procedures often undergo prospective dose studies using anthropomorphic phantoms to determine expected reference organ-equivalent dose values. Due to inherent uncertainties, such as impact of exact patient positioning, generalized geometry of the phantoms, limited dosimeter positioning options, and composition of tissue-equivalent materials, these dose values might not allow for patient-specific risk assessment. Therefore, first the aim of this study is to quantify the influence of these parameters on local X-ray dose to evaluate their relevance in the assessment of patient-specific organ doses. Second, this knowledge further enables validating a simulation approach, which allows employing physiological material models and patient-specific geometries. METHODS: Phantom dosimetry experiments using MOSFET dosimeters were conducted reproducing imaging scenarios in prostatic arterial embolization (PAE). Associated organ-equivalent dose of prostate, bladder, colon, and skin was determined. Dose deviation induced by possible small displacements of the patient was reproduced by moving the X-ray source. Dose deviation induced by geometric and material differences was investigated by analyzing two different commonly used phantoms. We reconstructed the experiments using Monte Carlo (MC) simulations, a reference male geometry, and different material properties to validate simulations and experiments against each other. RESULTS: Overall, MC-simulated organ dose values are in accordance with the measured ones for the majority of cases. Marginal displacements of X-ray source relative to the phantoms lead to deviations of 6-135% in organ dose values, while skin dose remains relatively constant. Regarding the impact of phantom material composition, underestimation of internal organ dose values by 12-20% is prevalent in all simulated phantoms. Skin dose, however, can be estimated with low deviation of 1-8% at least for two materials. CONCLUSIONS: Prospective reference dose studies might not extend to precise patient-specific dose assessment. Therefore, online organ dose assessment tools, based on advanced patient modeling and MC methods, are desirable.


Assuntos
Embolização Terapêutica/métodos , Imagens de Fantasmas , Próstata/irrigação sanguínea , Hiperplasia Prostática/diagnóstico por imagem , Radiografia Intervencionista/métodos , Adulto , Relação Dose-Resposta à Radiação , Humanos , Masculino , Método de Monte Carlo , Estudos Prospectivos , Próstata/diagnóstico por imagem , Hiperplasia Prostática/terapia , Doses de Radiação , Radiometria
10.
Urologe A ; 58(9): 1029-1038, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31451881

RESUMO

The demographic developments of western society and the resulting increase in the number of very old patients in urology represents a challenge for the design of clinical studies and, consequently, recommendations of guidelines. While in internal medicine there is already a subspecialization with a focus on the treatment of elderly and multimorbid patients, in urology there is hardly any subspecialization into the problems of geriatric patients. Thus, using a case study as an example, the treatment decisions for benign prostatic hyperplasia (BPH) in geriatric patients are discussed. In addition the available evidence from the literature and guidelines are presented in order to assiste in daily management of geriatric patients with lower urinary tract symptoms and to critically discuss potential fields of application and limitations of the existing guidelines. In this context, we also examine the challenges when choosing a drug therapy and in deciding which of the many surgical options should be used.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/terapia , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/terapia , Urologia/normas , Idoso , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/etiologia
11.
Urologiia ; (3): 7-12, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356007

RESUMO

INTRODUCTION: In recent years, there has been a persistent tendency to a decrease in surgical treatment of patients with lower urinary symptoms (LUTS). This fact can be explained by variety drugs which have acceptable safety and high efficiency for treatment of urinary disorders. As part of our survey of men in Moscow region, the trends in prescribing the different drugs for the LUTS was studied. In addition, the duration of therapy and patient adherence were analyzed. MATERIALS AND METHODS: A prospective multicenter epidemiological study "Characteristics of lower urinary tract symptoms in men in the Moscow region" was carried out using data obtained from April 1 to May 31, 2017 with anonymous survey of 525 men with mean age of 64.2+/-9.93 years, living in Moscow and went to the urologist with urinary disorders. All respondents answered questions from specially designed questionnaire consisted from 140 items. All medical data were analyzed, including received drugs, the duration of the therapy and subjective assessment of efficiency. RESULTS: A total of 419 patients from 525 (79.8%) received any kind of therapy. The most commonly used drugs were -blockers, which consisted 65% of all prescriptions. Other drugs were administered significantly rarely. It is surprisingly, that 85.6% of respondents in Moscow region received the original -blockers, not generic drugs. Satisfaction rate was 74.3%. Most of patients (58.3%) had received -blockers for 1-3 years and 33.3% administered these drugs for more than 3 years. Combined drug therapy was the second most popular (25.5%). The most commonly used combination included -blockers and inhibitors of 5-reductase. In 90.6% cases the appointment was made by urologist. CONCLUSION: Drug therapy is the most popular treatment in patients with LUTS. Our data suggest that -blockers as monotherapy or in combination with inhibitors of 5-reductase is the most often prescribed therapy. These results are in concordance with the main conclusions of international studies dedicated to this issue.


Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Idoso , Quimioterapia Combinada , Humanos , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Moscou , Estudos Prospectivos , Hiperplasia Prostática/terapia
12.
Urologiia ; (3): 80-83, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356017

RESUMO

AIM: The aim of our study was to evaluate efficiency of thulium laser enucleation of the prostate (ThuLEP) for the treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A retrospective analysis of 112 patients with BPH who underwent ThuLEP (n=60) or holmium laser enucleation of the prostate (HoLEP) (n=52) at our institution from January 2017 to June 2017 was carried out. The perioperative data and complication rate were assessed. Severity of lower urinary tract symptom (LUTS) was evaluated after 1, 6 and 12 months using International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]. To shorten learning curve, we modified the technique and simplified the intervention. To reduce noise during surgery, we performed ThuLEP using Vela XL. RESULTS: There were significant differences in pre- and perioperative parameters, including operative time (113.15+/-12.14 vs. 118.08+/-15.76 min, p=0.46), decrease in serum sodium concentration (3.49+/-0.83 vs. 3.48+/-0.84 mmol/L, P=0.97), hemoglobin drop (1.37+/-0.18 vs. 1.43+/-0.38 g/dL, p=0.65), catheterization time (2.15+/-0.38 vs. 2.27+/-0.39 days, p=0.52) and hospital stay (6.95+/-0.82 vs 7.56+/-1.36 days, p=0.25) between the two groups (ThuLEP and HoLEP). Compared with the HoLEP group, intraoperative noise was lower in ThuLEP group (47.22+/-10.31 vs. 59.45+/-9.65 db, p<0.05). At 1-, 6- and 12 months follow-up, the LUTS severity (I-PSS, QoL score and Qmax) were significantly improved in both groups in comparison with the baseline values. Furthermore, there was no difference in LUTS severity between two groups (p>0.05). CONCLUSION: ThuLEP is comparable to the holmium laser in terms of efficiency, safety and indications and represent minimally invasive treatment option for patients with LUTS secondary to BPH.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Seguimentos , Hólmio , Humanos , Masculino , Hiperplasia Prostática/terapia , Estudos Retrospectivos , Túlio , Resultado do Tratamento
13.
Urologiia ; (3): 134-141, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356027

RESUMO

Benign prostatic hyperplasia (BPH) is one of the most common diseases of the genitourinary system. BPH prevalence increases in men with advancing age, highlighting the necessity of minimally invasive surgical procedure including super-selective prostatic artery embolization (PAE). The current role of the PAE for BPH treatment according to recent national and international publications is discussed in this review. The data from the largest studies are structured and presented along with our experience in PAE. In addition, a need to continue research on this topic is underlined.


Assuntos
Embolização Terapêutica , Hiperplasia Prostática , Humanos , Masculino , Hiperplasia Prostática/terapia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
14.
Curr Urol Rep ; 20(8): 45, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31218458

RESUMO

PURPOSE OF REVIEW: To provide an economic context within which to consider treatment options for benign prostatic hyperplasia (BPH). To this end, this review provides a comparison of the costs of combination medical therapy, operative treatment, and office-based therapies for BPH from a payer perspective. RECENT FINDINGS: Analysis of Medicare charges from the authors' institution, as well as local retail costs of medication, demonstrated a wide range in costs of commonly used BPH treatments. In this study, interventions for BPH reached cost equivalence with combination medical therapy within 6 months to 8 years. A myriad of options for managing men with symptomatic BPH exist. It is prudent not only to consider surgeon preference and patient-specific factors when selecting a treatment but also to understand the economic impact different BPH therapies confer.


Assuntos
Hiperplasia Prostática/economia , Hiperplasia Prostática/terapia , Terapia Combinada/economia , Custos e Análise de Custo , Humanos , Masculino , Medicare/economia , Estados Unidos , Procedimentos Cirúrgicos Urológicos Masculinos/economia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Agentes Urológicos/economia , Agentes Urológicos/uso terapêutico
15.
Urology ; 132: 183-188, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254572

RESUMO

OBJECTIVE: To present a configurable mathematical method to optimize long-term clinical decision-making for benign prostatic hyperplasia. METHODS: We designed a Markov chain model to simulate the different health states associated with benign prostatic hyperplasia and the transition between these states based on specific interventions: observation, pharmacotherapy, and 4 types of minimally invasive laser surgery. Transition probabilities, disutility scores, and costs for each health state were derived from the literature, expert opinion, and hospital administration data. Disutility was defined as the complement to one of the utility (1-utility), with utility representing the overall quality of life associated with a particular state. Linear programming was used to compute the Markov decision model. Primary outcomes include cost-effectiveness curves comparing the average treatment cost across permitted disutility levels while considering all modeled interventions. RESULTS: To achieve optimal patient outcomes (low International Prostate Symptoms Score), the model favored surgical interventions and increased costs of treatment. Between different desired disutility values (breakpoints), the model recommends performing 2 recommend treatments in relative proportions to achieve the lowest cost and optimal outcome. The model is limited by its theoretical basis and reliance on literature for transition probabilities and quality of life assessment. CONCLUSION: This model provides a tool for doctors, administrators, and patients to optimize cost-efficacy when considering multiple treatments and different severities of benign prostatic hyperplasia and may be configured to other disease states or clinical practices. Further studies are necessary to validate this model for real-life application.


Assuntos
Tomada de Decisão Clínica/métodos , Cadeias de Markov , Hiperplasia Prostática/terapia , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Masculino , Modelos Estatísticos , Hiperplasia Prostática/economia
16.
Curr Urol Rep ; 20(7): 39, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31152253

RESUMO

PURPOSE OF REVIEW: Rezum is a new minimally invasive treatment for benign prostate enlargement using thermal transurethral water vapour therapy. We review the evidence with advantages and disadvantages of this technique. RECENT FINDINGS: There are five studies reported including a randomised control trial looking at the outcomes of Rezum. The outcomes show an IPSS reduction by 45-60%, QoL improvement with a score reduction of 37-59%, the Qmax improvement by 44-72% and the PVR reduction by 20-38%. Convective water vapour therapy using the Rezum system has been shown to have successful outcomes in the treatment of LUTS resulting from BPH. The reported complications are infrequent and often minor, and it seems to be relatively cost-effective.


Assuntos
Hiperplasia Prostática/terapia , Vapor , Ressecção Transuretral da Próstata/métodos , Humanos , Masculino , Hiperplasia Prostática/complicações , Resultado do Tratamento
17.
Int J Nanomedicine ; 14: 3145-3154, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118628

RESUMO

Background: Gold nanoparticles (AuNps) are promising agents for prostate cancer therapy. Herein, the in vivo effects of 20 and 50 nm sized AuNps on experimentally induced benign prostatic hyperplasia (BPH) was examined. Materials and methods: Adult male rats were divided into four groups (n=6-8 each). A negative control group and three groups were injected daily with testosterone (3 mg/kg/subcutaneously) to induce BPH. Animals receiving testosterone were randomized to untreated BPH group and two BPH groups which were treated intraperitoneally with 20 and 50 nm AuNps (5 mg/kg/daily) in addition to testosterone. After three weeks, histopathological changes and serum levels of testosterone and dihydrotestosterone (DHT) were analyzed. In addition, the prostate tissue levels of transforming growth factor-ß1 (TGF-ß1), vascular endothelial growth factor-a (VEGF-A) and interleukin-6 (IL-6) were measured using ELISA. Results: There were significant increases in the prostate weight/body weight ratio, serum testosterone and DHT and in the prostate tissue content of TGF-ß1, IL-6 and VEGF-A in the untreated BPH group. histological examination showed morphological abnormalities with more proliferation in the glandular epithelial and stromal area and with abundant epithelial papillary folds in the BPH group. Simultaneous administration of 50 nm AuNps with testosterone tended to increase the prostate weight/body weight ratio and increase the tissue level of IL-6 in compared to the BPH group. Conversely, treatment with 20 nm AuNps significantly reduced the elevated tissue content of TGF-ß1, IL-6, and VEGF-A. Histopathological examination also showed that 20 nm but not the 50 nm AuNps administration ameliorates testosterone-induced prostatic hyperplasia. Conclusions: In experimentally induced BPH, AuNps can inhibit the progression of BPH in a size-dependent manner. while 20 nm AuNps ameliorate BPH by its inhibitory effects on the prostatic cell proliferation, inflammation and angiogenesis, the 50 nm AuNps could potentially exacerbate the development of BPH in rats, mainly through enhancing the inflammatory process.


Assuntos
Ouro/uso terapêutico , Nanopartículas Metálicas/uso terapêutico , Hiperplasia Prostática/induzido quimicamente , Hiperplasia Prostática/terapia , Animais , Di-Hidrotestosterona/sangue , Modelos Animais de Doenças , Difusão Dinâmica da Luz , Humanos , Interleucina-6/metabolismo , Masculino , Nanopartículas Metálicas/ultraestrutura , Tamanho da Partícula , Hiperplasia Prostática/sangue , Hiperplasia Prostática/patologia , Ratos Sprague-Dawley , Eletricidade Estática , Testosterona/sangue , Fator A de Crescimento do Endotélio Vascular/metabolismo
18.
World J Urol ; 37(6): 1023-1027, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31037402

RESUMO

PURPOSE: When medications fail to satisfactorily treat bothersome lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), procedural treatments are indicated. There is much interest in minimally invasive office-based treatments which can be performed under local anesthesia, allow fast recovery and have minimal morbidity. The purpose of this article is to review recent literature regarding safety and efficacy of office-based minimally invasive therapies for BPO. METHODS: A literature search using PUBMED and Medline was performed regarding minimally invasive office-based treatments for BPO, including the prostatic urethral lift (Urolift), water vapor therapy (Rezum) and stents. Literature published within the last 5 years were reviewed. RESULTS: The prostatic urethral lift (Urolift) is a safe and efficacious treatment for LUTS-BPO whilst also preserving sexual function. Rezum appears to be a safe and effective treatment in Phase 2 trials. Memokath prostatic stents do not appear to be a durable treatment; Allium prostatic stents warrant further investigation prior to recommendation. CONCLUSIONS: The prostatic urethral lift (Urolift) is a safe and effective treatment for LUTS-BPO whilst preserving sexual function. Rezum also appears to be a safe and effective treatment in small RCTs comparing performance with TURP. Memokath prostatic stents do not appear to have treatment durability. Further studies would be warranted to determine whether Allium prostatic stents are safe effective treatments for LUTS-BPO.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Hiperplasia Prostática/terapia , Obstrução Uretral/terapia , Humanos , Sintomas do Trato Urinário Inferior/complicações , Masculino , Visita a Consultório Médico , Hiperplasia Prostática/complicações , Obstrução Uretral/etiologia
19.
Scand J Urol ; 53(2-3): 151-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096824

RESUMO

Background: Transurethral resection of the prostate (TURP) is 'Gold Standard' treatment for moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) with bladder-outlet obstruction (BOO). However, TURP is associated with a risk of complications, so minimally invasive methods have been developed. Prostate artery embolization (PAE) is a new minimally invasive procedure. This study reports the outcomes of PAE when introduced in a 'real life' clinical setting in a Swedish County hospital. Methods: A prospective, single-center, single-arm study in a consecutive vascular-anatomy 'all comers' population, eligible for TURP or adenomaenukleation, but unsuitable for this, treated with PAE from January 2015 to June 2018. Defined improvement of IPSS/QoL scores, or freedom from urinary catheter if previous urinary catheter-dependent, or clean intermittent catheterization (CIC) were considered as clinically successful treatments. PAE was performed until arterial stasis using the Perfected technique. Most patients were treated during a day-care procedure. Results: Of 37 treated men, bilateral PAEs were achieved in 32 patients, unilateral PAEs in four patients, and bilateral failure in one patient due to difficult vascular anatomy. Clinically successful treatment was achieved in 84%, without serious adverse events. Conclusions: PAE was introduced in Sweden, showing PAE as a novel and good minimally invasive alternative in treatment of symptomatic BPH, possible to perform as a day-care procedure.


Assuntos
Embolização Terapêutica/métodos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hiperplasia Prostática/complicações , Suécia , Ressecção Transuretral da Próstata , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/complicações
20.
Presse Med ; 48(4): 447-453, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31047745

RESUMO

Benign Prostatic Hyperplasia (BPH) concerns 50% of men older that 60 Years old and can induce symptoms also earlier. Medical treatment are mostly alpha blockers (AB), 5-alpha réductase inhibitors (5ARI) and phospho-diestérase inhibitors. In case of failure or poor tolerance of drug treatment, surgery can be indicated, after evaluation of the Bladder Outlet Obstruction (BOO), based on urodynamic studies. Endoscopic or open surgery is selected according to the size of the prostate, the expertise of the urologist and patient preference. Surgical treatment is very efficient but carries frequent complications, especially retrograde ejaculation which is very frequent and can compromise fertility and sexual pleasure. Prostatic Artery Embolisation, an outpatient intervention performed by Interventional Radiologists and available in France since 2012 is a new alternative to surgery in case of failure or poor tolerance of medical treatment. It consists in super-selective injection of calibrated micro-particles into both prostatic arteries after femoral artery puncture at the groin. It is safe and efficient and provides appropriate symptomatic improvement BOO related to BPH.


Assuntos
Embolização Terapêutica , Hiperplasia Prostática/terapia , Artérias , Humanos , Masculino , Próstata/irrigação sanguínea , Hiperplasia Prostática/diagnóstico
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