Until then we have some old reports here:
1. Andrology
2. Endourology
3. Reconstruction
4. Calculus Disease
5. Incontinance
6. Oncology
7. Oncology Prostate
8. Prostate BPH
9. Equipment
10. Special Interest
Prostate (BPH) |
| MONTH PUBLISHED | May - 2001 |
Journal: Journal of Urology Authors: Floratos DL, Kiemeney LA, Rossi C, Kortmann BB, Debruyne FM and de La Rosette JJ. Issue: 2001, 165: 1533-1538
Title: Long-term followup of randomized transurethral microwave thermotherapy versus transurethral prostatic resection study.
Abstract: This paper looks at the progress of 155 patients with LUTS suggestive of BPE randomised between TUMT and TURP. Despite giving informed consent, 10 patients refused to participate following randomisation, and one died, leaving 78 patients receiving TUMT and 66 having a TURP. Mean patient age was similar between the 2 groups (68 and 66 years respectively) as was mean prostate volume (42 and 48 ml). Mean follow up was 33 months. At 3 years, the re-treatment rate (medical or surgical) was 19.8% in the TUMT group compared to 12.9% in the TURP patients. This finding is consistent with greater re-treatment rates in other thermotherapy studies and its lack of statistical significance may well represent the relatively small numbers in this study. IPSS decreased in the thermotherapy group from 20 at baseline to 8, 9 and 12 at 1, 2 and 3 years respectively (compared to 20 at baseline in the TURP patients, decreasing to 3, 4 and 3 over the same timescale). Similarly, Qmax improved in TUMT patients from 9.2 ml/sec at baseline to 15.1, 14.5 and 11.9 ml/sec over 3 years (TURP group 7.8 ml/sec at baseline, improving to 24.5, 23.0 and 24.7 ml/sec). Although TUMT has its undoubted advantages, these results show that it does not match TURP on objective criteria. There is a tail-off in Qmax and an increase in IPSS in the third year following TUMT. It will be interesting to see if this trend continues in the longer term for these patients.
Reviewer: Jonathan Rees
| MONTH PUBLISHED | April - 2001 |
Journal: Journal of Urology Authors: Terada N, Aoki Y, Ichioka K, Matsuta Y, Okubo K, Yoshimura K and Arai Y Issue: 2001, 57:701-5
Title: Microwave thermotherapy for benign prostatic hyperplasia with the Dornier Urowave: response durability and variables potentially predicting response
Abstract: This observational Japanese study, undertaken over 3.5 years, assessed the value of microwave therapy (TUMT) in 58 men with symptomatic BPH who had failed medical therapy. It also attempted to identify the preoperative characteristics of those who responded well. The "Urowave" machine was used (Dornier Medical Systems). The International Prostate Symptom Score (IPSS), Quality of Life (QoL) score, peak flow rate (Qmax), postvoid residual (PVR) and pressure flow studies (pQs) were measured. Exclusion criteria included suspicion of prostate cancer, prostate volume > 60cc and evidence of a neuropathic bladder. IPSS values dropped significantly at 3 months, as did the QoL score (p <0.0001). There were no changes in the objective parameters assessed at 3 months. 83% of respondents were subjectively happy with the treatment despite having no objective improvement. 16% of men needed re-treatment within one year, which was the limit of the follow up. High pre-treatment IPSS and a high “obstructive” symptom score were associated with good response, whilst a high urodynamic obstruction grade was associated with poor response. The authors mentioned other parameters that have been associated with successful outcome including thermal dose, transition zone size and the stomal epithelial ratio but did not attempt to evaluate these. Overall, the study results were modest and many questions were left unanswered or poorly answered. Furthermore, the follow up was short, as it is well-known that men treated with TUMT are likely to need re-treatment within 5 years, especially if treated with low energy regimes and so durability has not been truly assessed.
Reviewer: Sandy Gujral
| MONTH PUBLISHED | February - 2001 |
Journal: BJU International Authors: Kirby R, Andersen M, Gratzke P, Dahlstrand C, Høye K. Issue: 2001, 87:192-200
Title: A combined analysis of double-blind trials of the efficacy and tolerability of doxazosin-gastrointestinal therapeutic system, doxazosin standard and placebo in patients with benign prostatic hyperplasia.
Abstract: This paper describes a combined analysis of 1495 patients with BPH from two similarly designed randomised, double-blind, parallel-group studies, comparing the controlled release (GITS, n=651) and standard (n=640) versions of Doxazosin versus placebo (one trial only, n=155). Primary outcome measures were mean changes of IPSS and Qmax' plus several symptom and urinary-related secondary outcomes. Both standard and GITS versions of Doxazosin caused significant improvement in symptoms of BPH (45% reduction in IPSS) but there was also a marked response to placebo (34% reduction in IPSS). There was a comparable improvement in Qmax on GITS and Standard Doxazosin (2.8 and 2.7 ml/sec respectively) and these were significantly greater than with placebo (1.1 ml/sec). Secondary outcome measures (response rates, investigators’ assessment of efficacy, quality of life owing to urinary symptoms and sexual function) were also similar between the two formulations. Interestingly, both versions improved IIEF scores for patients with sexual dysfunction at baseline. The exact figures are not available in this paper (in press elsewhere) but the authors state that the improvements are clinically significant, although less than that with PGE-5 inhibitors. This new formulation of Doxazosin has presumably been developed to improve tolerability. Interestingly, although adverse events (all causalities) were lower with the GITS formulation (41.4%) and placebo (39.1%) than standard Doxazosin (53.6%), adverse events thought to be treatment related occurred in 16.1% of patients on GITS, 25.3% on standard, and 7.7% on placebo. The rates of dizziness were decreased from 9.1% on standard to 5.3% on GITS, compared to 1.9% on placebo. In summary, this study shows similar efficacy of GITS compared to standard Doxazosin and improved tolerability with the GITS version.
Reviewer: Jonathan Rees
| MONTH PUBLISHED | January - 2001 |
Journal: BJU International Authors: Michel MC, Neumann HG, Mehlburger L, Schumacher H, Goepel M. Issue: 2001, 87:31-4
Title: Does the time of administration (morning or evening) affect the tolerability or efficacy of tamsulosin?
Abstract: In an observational study of tamsulosin in Germany, it was noted that approximately 30% of patients were taking their medication in the evening, despite the general recommendation that tamsulosin is taken in the morning. As a result of this finding, this study used the database to retrospectively compare the efficacy and tolerability of morning or evening dosing of tamsulosin. The baseline data were similar in patients using morning (n=4420) or evening dosing (n=2087). The possible bias of patients with more severe LUTS and/or greater susceptibility to side-effects being found in the evening group was excluded. The efficacy and tolerability of tamsulosin treatment was similar for both groups. The morning dosing was actually slightly more effective and better tolerated but, although statistically significant due to the large numbers in this study, it is certainly not clinically relevant. Although the study is retrospective and non-randomised, it would seem reasonable to conclude that the decision to take tamsulosin in the morning or evening can be left to the patient, with no significant alteration in efficacy or tolerability. However, this conclusion would be strengthened by a prospective randomised study.
Reviewer: Jonathan Rees
| MONTH PUBLISHED | June - 2000 |
Journal: Journal of Urology Authors: Malek RS, Kuntzman RS and Barrett DM Issue: 2000, 163: 1730-1733
Title: High power potassium-titanyl-phosphate laser vaporization prostatectomy.
Abstract: This paper reports the safety and efficacy of a 60W KTP laser prostatectomy in an observational study of 55 men with symptomatic BOO due to BPH. During the study there were no cases of significant fluid absorption or blood loss requiring transfusion. Catheter times were short (<24hrs), with no patients requiring re-catheterisation or re-operation within the follow-up time of 2 years. Mean AUA symptom scores, mean peak flow rates and mean PVR improved significantly at all visits compared with the baseline. Complications included dysuria (7%- 4 patients), bladder neck contracture (2%- 1 patient), and delayed haematuria (4%). Sexual function was relatively well preserved, with 30% of men reporting retrograde ejaculation at 3 months. The results from this study, using the higher power KTP laser, are very encouraging, although a randomised, controlled design would have given the results greater validity. Numbers were relatively small, and follow-up is short, with only 14 patients available for the 2-year assessment.
Reviewer: Rob Frymann
| MONTH PUBLISHED | May - 2000 |
Journal: Journal of Urology Authors: Marks LS, Partin AW, Epstein JI, Tyler VE, Simon I, Macairan ML, Chan TL, Dorey FJ, Garris JB, Veltri RW, Santos PB, Stonebrook KA and deKernion JB Issue: 2000, 163: 1451-1456
Title: Effects of a Saw Palmetto herbal blend in men with symptomatic benign prostatic hyperplasia.
Abstract: This paper reports the results of a randomised, placebo controlled trial of Saw Palmetto (a phytotherapeutic agent) against placebo in a six month trial, followed by an open label 18 month extension in a total of 44 men with clinically diagnosed BPH. Parameters assessed were IPSS, maximum flow rate, PVR, total and free serum PSA, testosterone level, dihydrotestosterone level, estradiol level, total prostate volume and transitional zone prostate volume. There was no statistically significant difference between Saw Palmetto and placebo for any of the above parameters. The only significant difference found was in the tissue composition of the prostate transition zone, with a decrease in the percentage of epithelium in the Saw Palmetto group. This was a small study, which may explain why the results failed to reach significance. Further large scale, placebo controlled trials are required before Saw Palmetto can be recommended as a clinically proven effective treatment for symptomatic BPH.
Reviewer: Rob Frymann
Journal: Urology Authors: Hagerty JA, Ginsberg PC, Harmon JD and Harkaway RC Issue: 2000, 55: 684-689
Title: Pre-treatment with finasteride decreases peri-operative bleeding associated with transurethral resection of the prostate.
Abstract: This study has found that pre-treating a patient with finasteride for 2-4 months prior to TURP significantly reduces peri-operative bleeding against a non-randomised, non-blinded control group. Peri-operative bleeding was defined as "the need for a blood transfusion or a return visit to the emergency room with gross haematuria or clot retention". None of the patients who had less than 30 grams resected had peri-operative bleeding (as defined above), irrespective of the group they were in. There are some obvious criticisms of this study: i) this was not a placebo controlled, randomised trial, therefore the potential for physician bias has not been minimised. ii) the numbers are small, with only 25 patients in the finasteride treatment group, and pre-treatment with finasteride was not standardised (range 2 to 4 months). iii) there was no attempt to determine the pre-operative prostate size, which is the only information the physician will know prior to surgery, not the subsequent resected weight (c.f. symptomatic improvement in LUTS has only been found to be significant in men with prostates >40cc). iv) the outcome parameters are mainly subjective and certainly patient dependant (whether the patient deems their haematuria severe enough to attend the ER). Changes in Hb level or haematocrit may be other useful parameters. The results are therefore inconclusive, and require further investigation before finasteride should be given routinely before TURP.
Reviewer: Rob Frymann
Journal: BJU International Authors: MacDonald R, Ishani A, Rutks I and Wilt TJ Issue: 2000 85: 836-841
Title: A systematic review of Cernilton for the treatment of benign prostatic hyperplasia.
Abstract: Cernilton is a phytotherapeutic agent extracted from Rye grass pollen, and is one of many phytotherapeutic agents used in the treatment of symptomatic BPH. This paper reviews four trials looking at the safety and efficacy of Cernilton. Trials were included in the review if they were either randomised or controlled clinical trails (with the control group receiving either a placebo or another pharmacological treatment), the studies lasted longer than 30 days, and clinical outcomes were reported in the paper. Two studies were placebo controlled, and the other two compared Cernilton with either Tadenan or Paraprost. The outcome parameters and results of the four studies varied. A significant improvement in flow rates was not found in any of the studies. There was a significant improvement in symptom scores with Cernilton over placebo and Tadenan, and a comparable improvement with Paraprost. In conclusion, it would appear that Cernilton does provide a significant improvement in symptom scores of men with symptomatic BPH, but not a significant improvement in flow rates.
Reviewer: Rob Frymann
| MONTH PUBLISHED | February - 2000 |
Journal: Journal of Urology Authors: Foley SJ, Soloman LZ, Wedderburn AW, Kashif KM, Summerton D, Basketter V and Holmes SA Issue: 2000, 163: 496-498
Title: A prospective study of the natural history of haematuria associated with benign prostatic hyperplasia and the effect of finasteride
Abstract: This paper presents the findings of a small, prospective study comparing the giving of finasteride or 'watchful waiting' (after reassurance) to men with haematuria of a prostatic origin. A total of 57 patients were randomised, and approximately two thirds in each group had undergone previous prostatic surgery. The occurrence and severity of haematuria was significantly lower in the finasteride group compared with the 'watchful waiting' group. Surgery was required for 7 patients (26%) in the watchful waiting group, but was not required for any patient in the finasteride group. The results of this study are very interesting, but a further, placebo-controlled, study would be needed to verify the results. The grading of the severity of the haematuria (method of Puchner and Miller) or the need for surgery may have been influenced if the surgeon knew the patient was receiving finasteride.
Reviewer: Rob Frymann
Journal: Urology Authors: Hahn RG, Farahmand BY, Hallin A, Hammar N and Persson PG Issue: 2000, 55: 236-240
Title: Incidence of acute myocardial infarction and cause-specific mortality after transurethral treatments of prostatic hyperplasia.
Abstract: This paper reports on the incidence of acute myocardial infarction (AMI) following either TURP or TUMT and compares this incidence with an age-matched group (controls). Following either TURP or TUMT, the incidence of AMI was 1.5 times higher than expected in the general population, especially two years or longer after surgery. Overall, the TUMT group had a slightly higher risk than the TURP group. Younger patients who had absorbed >100 mls glycine during their TURP were at the highest risk. Worryingly, during the follow-up period (average 3.9 yrs), 216 of the 888 TURP patients (24%) and 60 of the 478 TUMT patients (13%) died. This was not a randomised study, and there was no attempt to diagnose silent MI following surgery, therefore the true incidence of AMI may have been underestimated.
Reviewer: Rob Frymann
Journal: Urology Authors: Ekengren J, Haendler L and Hahn RG Issue: 2000, 55: 231-235
Title: Clinical outcome one year after transurethral vaporization and resection of the prostate.
Abstract: This paper reports the one year follow-up of a randomised trial between TURP and TUVP. Although the method of randomisation was not reported, the two groups were not significantly different in age, but a p-value was not given for other parameters, such as IPSS, Qmax, PSA and prostate volume. There was a significant improvement in symptoms and flow rates following both procedures, with a slightly better result after TURP. Interestingly, all results are given as median values, with a range that implies that some patients were in retention at the time of surgery, which is not commented on in the text. The improvement in flow rates are less impressive than in other studies, with the median flow rate increasing from 4 to 10mL/s in the TUVP group, and from 2 to 11mL/s in the TURP group.
Reviewer: Rob Frymann
| MONTH PUBLISHED | December - 1999 |
Journal: Urology Authors: Shingleton WB, Terrell F, Renfroe DL, Kolski JM and Fowler JE Jr Issue: 1999, 54: 1017-1021
Title: A randomised prospective study of laser ablation of the prostate versus transurethral resection of the prostate in men with benign prostatic hyperplasia.
Abstract: This paper’s main objective was to study the safety and efficacy of KTP/neodymium: YAG laser prostatectomy compared to TURP. There were 50 patients in each group, with similar baseline characteristics. There was a total of 16 complications in the laser group and 7 in the TURP group, but in a sample of this size, there was no significant difference seen. Efficacy of symptom score and peak flow rate was similar in both groups at all visits except at one month, when the TURP group were doing significantly better than the laser group. Follow-up was for 12 months, with 15 patients from the TURP lost to follow-up compared to 7 in the laser group. The paper concludes by saying that laser prostatectomy provides a similar improvement in flow rates and symptoms compared with TURP. Long term efficacy has not been studied, nor has the paper demonstrated comparable safety.
Reviewer: Rob Frymann
| MONTH PUBLISHED | October - 1999 |
Journal: British Journal of Urology Authors: Madersbacher H, Halaska M, Voigt R, Alloussi S and Hofner K Issue: 1999, 84: 646-651
Title: A placebo-controlled, multicentre study comparing the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence
Abstract: Propiverine (Detrunorm) has recently been licensed in the UK for the treatment of urgency and urge incontinence. It has a dual mode of spasmolytic activity, being both a calcium antagonist and an anticholinergic agent. This paper presents the results of a placebo-controlled study comparing propiverine with oxybutynin and placebo in the ratio 2:2:1. Tolerability was assessed by direct patient questioning of adverse events, and efficacy was assessed using voiding diaries, the Gaudenz incontinence questionnaire and data from filling cystometry. Approximately 15% of all patients reported an adverse event during the washout period. The commonest side effect during treatment was a dry mouth, experienced by 53% in the propiverine group, 67% in the oxybutynin group, and 28% in the placebo group. Efficacy was comparable between propiverine and oxybutynin, both showing a significant improvement in maximal bladder capacity, and capacity at first desire to void over placebo. The most significant draw back of propiverine is the price, being over five times more expensive that oxybutynin, and therefore should be reserved as a second line drug for urgency.
Reviewer: Rob Frymann
Journal: British Journal of Urology Authors: McNeill SA, Daruwala PD, Mitchell ID, Shearer MG and Hargreave TB Issue: 1999, 84: 622-627
Title: Sustained release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo-controlled trial
Abstract: This paper attempts to answer the question of the value of giving alfuzosin to patients who present in acute retention in order to improve the success rate of a subsequent trial without catheter (TWOC). Overall, irrespective of treatment group, they found that the mean age for a successful TWOC was some 4.5 years younger than those patients who failed their TWOC (68.4 yrs vs. 72.9 yrs respectively). Despite randomisation, the group of patients receiving alfuzosin had a mean age 5 years younger than the placebo group, which may account for the apparent benefit of alfuzosin (55% successful TWOC vs. 29% successful TWOC). By analysing the results adjusted for age, the benefit of alfuzosin did not reach statistical significance (p=0.052). The study was also closed before it reached the intended recruitment of 100 patients in each arm. Unfortunately, from this study, the use of alfuzosin to improve the outcome of TWOC remains unproven.
Reviewer: Rob Frymann
| MONTH PUBLISHED | August - 1999 |
Journal: British Journal of Urology Authors: Brehmer M, Wiksell H and Kinn A Issue: 1999, 84: 292-296
Title: Sham treatment compared with 30 or 60 min of thermotherapy for benign prostatic hyperplasia: a randomised study
Abstract: This paper reports the subjective and objective improvements following either 30 or 60 minutes of thermotherapy, or sham, in the treatment of benign prostatic hyperplasia. Objective changes were assessed using uroflowmetry and determination of post-void residual, pressure-flow studies, and completion of frequency volume charts. Subjective changes were assessed using the ICSmale questionnaire (with the exclusion of the questions relating to sexual function) and from this patients were assigned a total for both symptom score and ‘bother’ score. There was objective improvement seen in all three groups, the improvements being most marked in the 30 minute TUMT group. All three groups also showed an improvement in subjective parameters, but this did not reach statistical significance. This may be due to the fact that there were relatively few numbers in each group, and, unlike the IPSS, the ICSmale questionnaire is not designed the give a summed total score for symptoms and bother.
Reviewer: Rob Frymann
| MONTH PUBLISHED | July - 1999 |
Journal: Urology Authors: Lowe FC, Olson PJ and Padley RJ Issue: 1999, 54: 81-85
Title: Effect of terazosin therapy on blood pressure in men with Benign Prostatic Hyperplasia concurrently treated with other antihypertensive medications
Abstract: This paper reports the safety of using Terazosin, an alpha1-blocker, for the treatment of benign prostatic hyperplasia (BPH) in men who are also taking other antihypertensive agents. The results are the retrospective analysis of data collected during a large placebo controlled trial. The study concludes that Terazosin can be safely used to treat BPH irrespective of a patient’s blood pressure status or antihypertensive regimen. However, it should be emphasised that the study only included men taking concomitant diuretics, angiotensin converting enzyme (ACE) inhibitors, beta-blockers and /or calcium channel blockers (except verapamil), but not those patients taking alpha agonists, alpha antagonists, anticholinergics, androgens or antiandrogens. The greatest effect on blood pressure was seen in the group of patients taking only diuretics, however the baseline blood pressure in this group was higher, suggesting initial poor control. Terazosin has been licensed for the treatment of hypertension since 1987, and for BPH since 1993. The manufacturers recommend special precautions if there is a history of syncope.
Reviewer: Rob Frymann
Journal: Urology Authors: Djavan B, Seitz C, Ghawidel K, Basharkhah A, Bursa B, Hruby S and Marberger M Issue: 1999, 54: 18-22
Title: High-energy transurethral microwave thermotherapy in patients with acute urinary retention due to benign prostatic hyperplasia
Abstract: This paper presents the findings of a small, uncontrolled study assessing the safety and efficacy of high energy TUMT for patients presenting in painful acute urinary retention. Outcome parameters were assessed using the IPSS, QoL scores, Qmax and post void residual after resumption of spontaneous voiding. Patients were excluded if they were found to have detrusor failure as the cause of their retention on pressure flow studies. The mean age of patients in the study was 66 years. Over a quarter of the patients were lost to follow up (n=8). Of those evaluated 12 weeks after HE-TUMT, 94% had regained spontaneous voiding, and the IPSS and QoL score had improved by approximately 50%. These are encouraging results and may offer an alternative for patients unsuitable or unwilling to undergo a prostatectomy. However, these results are from a small uncontrolled group, there was a large drop-out rate, the average age was relatively low for this group of patients, and the follow-up was only 12 weeks.
Reviewer: Rob Frymann
| MONTH PUBLISHED | June - 1999 |
Journal: Urology Authors: Gerber GS, Zagaja GP, Bales GT, Chodak GW and Contreras BA Issue: 1999, 51: 1003-1007
Title: Saw Palmetto (Serenoa repens) in men with lower urinary tract symptoms: effect on urodynamic parameters and voiding symptoms
Abstract: This paper presents the effects of Saw Palmetto (a phytotherapeutic agent) on the objective and subjective symptoms of men with previously untreated lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. A dose of 160 mg b.d. was given to 50 men who had a minimum International Prostate Symptom Score (IPSS) of 10. Peak urinary flow and symptom scores were assessed at baseline, two, four and six months, and pressure flow studies were performed at baseline and six months. There was no statistically significant difference during the study in peak flow rates, post void residual volumes, or the detrusor pressure at maximum flow. There was a statistically significant improvement in symptoms scores, with 46% of men experiencing a greater than 50% improvement in their symptom score. Unfortunately, this non-randomised trial did not include a placebo arm with which to compare the results. The improvements seen with Saw Palmetto are not dissimilar to those seen in the placebo arms of other randomised controlled trials.
Reviewer: Rob Frymann
Journal: Journal of Urology Authors: Roehrborn CG, Burkhard FC, Bruskewitz RC, Issa MM, Perez-Marrero R, Naslund MJ and Shumaker BP Issue: 1999, 162: 92-97
Title: The effects of transurethral needle ablation and resection of the prostate on pressure flow urodynamic parameters: analysis of the United States Randomized Study
Abstract: This paper presents the analysis of a randomised control trial assessing the effect of TURP and TUNA on pressure flow parameters, and whether the use of pressure flow studies pre-operatively could predict the degree of symptomatic improvement post-operatively. The original paper found that both TURP (n=56) and TUNA (n=65) induce statistically and clinically significant improvement in AUA symptom, bother and quality of life (QoL) scores, peak urinary flow rate (Qmax) and post-void residual. While TURP offered the greater objective improvement, both procedures were equally effective in enhancing QoL scores, but with fewer complications in the TUNA group. Of the original 121 patients, 67 were assessed pre- and post-treatment with pressure flow studies (i.e. 27 of the 56 having a TURP, and 40 of the 65 having a TUNA). In the resection group, the mean Qmax increased by 12 mls/s (P<0.0001), and the pdetQmax and AG number both decreased from 75.8 to 54.9 cm H2O (P<0.0001), and from 58.9 to 10.9 (P<0.001) respectively, compared to baseline. In the ablation group, the mean Qmax increased by 4.7 mls/s (P<0.001), and the pdetQmax and AG number both decreased from 78.7 to 64.5 cm water (P=0.036), and from 61.2 to 37.2 cm (P<0.001) respectively, compared to baseline. Comparing TURP with TUNA, there was a significant difference in the change in Qmax and AG number between the two procedures (P<0.001). Following resection, 34.6% (19 of 26) were still obstructed, compared to 45% (18 of 40) following ablation six months after treatment. This difference was not significant. On this relatively small sample, none of the baseline urodynamic parameters predicted symptomatic improvement at six months, although there was a trend towards a greater percentage improvement in symptom scores with higher, more obstructed baseline AG numbers.
Reviewer: Rob Frymann
Journal: British Journal of Urology Authors: Wilt TJ, MacDonald R and Ishani A Issue: 1999, 83: 976-983
Title: b-sitosterol for the treatment of benign prostatic hyperplasia: a systemic review.
Abstract: This paper reviews four papers reporting the efficacy of b-sitosterol in men with symptomatic BPO. After a through literature search (via Medline, EMBASE, Phytodok, the Cochrane Library, bibliography of study authors and pharmaceutical company records), four papers were found that satisfied the reviews' criteria. Three studies, using non-glycosylated b-sitosterol, appeared to produce significant improvements in both objective and subjective outcome parameters over placebo, whereas the study using pure b-sitosterol-b-D-glucoside did not. This review highlights the need for a degree of standardisation between trials to allow for a meaningful meta-analysis to be performed, and the need for well designed randomised controlled trials using known concentrations of b-sitosterol in both glycosylated and non-glycosylated forms.
Reviewer: Rob Frymann
| MONTH PUBLISHED | May - 1999 |
Journal: Journal of Urology Authors: Abrams P, Schafer W, Tammela TL, Barrett DM, Hedlund H, Rollema HJ, Matos-Ferreira A, Nordling J, Bruskewitz R, Andersen JT, Hald T, Miller P, Kirby R, Mustonen S, Cannon A, Jacobsen CA, Gormley GJ, Malice MP and Bach MA Issue: 1999, 161: 1513-15
Title: Improvement of pressure flow parameters with finasteride is greater in men with large prostates.
Abstract: The authors present the results of a double blind placebo controlled trial assessing the effect of finasteride, a 5?-reductase inhibitor, on detrusor pressure at maximum flow (pdetQmax) from baseline after twelve months treatment. Secondary outcome measurements assessed the effect on maximum urinary flow (Qmax), obstruction status, prostate volume, and the International Prostate Symptom Score (IPSS). There were 81 patients in the finasteride group and 40 patients in the placebo group. Baseline data from the two groups were not significantly different except for the pdetQmax, which was 7.9 cm H2O higher in the finasteride group (p=0.08). After stratifying prostate size into large (greater than 40 cc) and small (less than 40 cc), the mean treatment effect of finasteride was only statistically significant in the large prostate group for both pdetQmax (p=0.02) and Qmax (p=0.02). Mean prostate volume decreased in the finasteride group (-18.7%) and increased in the placebo group (+4.1%). No patients became unobstructed in either treatment group. Both groups showed a reduction in the IPSS, from 19.5 to 14.6 in the finasteride group, and from 17.3 to 14.1 in the placebo group. The change in symptom score between the two groups was not statistically significant. The authors acknowledge that the study was designed and powered to assess the effect of finasteride on pressure flow parameters, rather than the effect on symptom scores. In conclusion, finasteride does have a statistically significant effect on objective parameters (flow rates, pressure flow parameters) in large prostates (>40cc), but no significant effect on subjective parameters such as symptom scores, over placebo.
Reviewer: Rob Frymann
| MONTH PUBLISHED | March - 1999 |
Journal: Urology Authors: Roehrborn CG, McConnell JD, Lieber M, Kaplan S, Geller J, Malek GH, Castellanos R, Coffield S, Saltzman B, Resnick M, Cook TJ and Waldstreicher J Issue: 53(3): 473-480
Title: Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia
Abstract: The authors report data derived from the PLESS study. A subset of 312 of the 3040 men in the study had a baseline PSA and prostate volume recorded. Probabilities and incidence of acute retention and surgery were calculated. The risk of developing acute retention or requiring surgery was directly related to PSA and prostate volume. If patients were stratified by increasing prostate volume and PSA, finasteride was shown to reduce these risks by 50% and 43% respectively. The authors conclude that PSA and prostate volume are useful markers of risk factors for complications of BPH.
Reviewer: Jon Cartledge
| MONTH PUBLISHED | February - 1999 |
Journal: Journal of Urology Authors: Fracisca EAE, d`Ancona FCH, Meuleman EJH, Debruyne FMJ and de la Rosette JJMCH Issue: 1999; 161: 486-490
Title: Sexual function following high energy mircowave thermotherapy: results of a randomised controlled study comparing transurethral microwave thermotherapy to transurethral prostatic resection
Abstract: The authors report sexual function in 147 patients randomised to high energy microwave thermotherapy or TURP using a self-administered questionnaire evaluating sexual function before, and 3 and 12 months after treatment. Antegrade ejaculation occurred at 3 months in 27% of the TURP group versus 74% of the high energy microwave thermotherapy group and at 1 year in 37% and 67 % respectively. While no significant difference was observed between the two treatments with regard to morning erection, sexual activity, premature loss of erection or orgasms, more patients undergoing TURP reported changes in sexual function and a reduction in satisfaction (17% versus 36%, and 55% versus 21% respectively).
Reviewer: Andrew Elves
Journal: Urology Authors: Djavan B, Shariat S, Fakhari M, Ghawidel K, Seitz C, Partin A, Roehrborn C and Marberger M. Issue: 53(2): 251-259
Title: Neoadjuvant and adjuvant alpha-blockade improves early results of high-energy transurethral microwave thermotherapy for lower urinary tract symptoms of benign prostatic hyperplasia: a randomised, prospective clinical trial.
Abstract: Patients undergoing transurethral microwave thermotherapy therapy were randomised to receive either tamsulosin (0.4 mg) from a period 2 weeks prior to operation to 6 weeks after operation, or no additional therapy. There was no placebo. The authors report that at 2 weeks and 6 weeks post-op, the patients on alpha-blocker had a significantly lower International Prostate Symptom Score (IPSS) than those on no additional therapy by 12 weeks, however, no difference was evident. There was no difference in Qmax between groups. The authors conclude that adding an alpha-blocker leads to a greater early symptom reduction following transurethral microwave thermotherapy.
Reviewer: Jon Cartledge
| MONTH PUBLISHED | January - 1999 |
Journal: Journal of Urology Authors: Kolman C, Girman CJ, Jacobsen SJ and Lieber MM Issue: 1999, 161: 122-127
Title: Distribution of post void residual urine volume in randomly selected men
Abstract: Post-void residual urine is often performed as part of the routine assessment of men with lower urinary tract symptoms although its usefulness is controversial. In this study, post-void residual urine was assessed by trans-abdominal ultrasound in 477 randomly selected men as part of a baseline urological evaluation. The authors found a significant correlation between post-void urine and prostate volume but no association with IPSS, age or flow rate. Men with post-void residual urine of greater than 50 ml at baseline were found to have approximately a 3-fold increased risk of acute retention over the next 4 years, although it is not clear whether this was independent of enlarged prostate volume.
Reviewer: Andrew Elves
| MONTH PUBLISHED | November - 1998 |
Journal: Journal of Urology Authors: Javle P, Jenkins S, Machin DC and Parsons KF. Issue: 1998, 160: 1713-1717
Title: Grading of benign prostatic obstruction can predict the outcome of transurethral prostatectomy.
Abstract: Transurethral prostatectomy (TURP) remains the gold standard for the treatment of benign prostatic obstruction. However, up to 33% of patients are dissatisfied with the outcome of surgery. The authors investigate whether urodynamic grading of benign prostatic obstruction and detrusor contractility can predict the outcome of TURP. A series of 55 men, apparently suitable candidates for TURP, were evaluated before and three months after surgery. Assessment included completion of the International Prostate Symptom Score, uroflowmetry, ultrasonography (prostate size and residual urine) and standard pressure flow study. No significant difference in the preoperative mean IPSS index, maximum flow rate, residual urine and prostate volume was observed between those patients with equivocal and unequivocal pressure flow studies. Urodynamic grading of obstruction and detrusor contractility predicted treatment outcome with a sensitivity of 87%, specificity of 93% and positive predictive value of 95%. The authors conclude that grading of obstruction and detrusor contractility can reliably predict treatment outcome.
Reviewer: Andrew Elves
| MONTH PUBLISHED | October - 1998 |
Journal: Urology Authors: Riehmann M, Bayr WH, Drinka PJ, Schultz S, Krause P, Rhodes PR, Heisey D and Bruskewitz RC. Issue: 1998, 52 (4): 625-630
Title: Position related changes in voiding dynamics in men.
Abstract: The authors examined the flow rate and post micturition residual volume in 2 healthy volunteers and in 53 nursing home residents. Multiple measurements in the healthy volunteers revealed a standing mean peak flow rate of 28.2 ml/s and a lying mean peak flow rate of 16.8 ml/s. There was no difference in residual volume. The lower lying flow rate was mimicked in nursing home residents, who also had a slightly higher lying than standing residual volume. The authors conclude that the reduced recumbent urinary flow rate may predispose bedridden patients to UTI.
Reviewer: Jonathan Cartledge
| MONTH PUBLISHED | September - 1998 |
Journal: Prostate Cancer and Prostatic Diseases Authors: Benaim EA, Montaya JD, Saboorian MH, Litwiler S and Roehrborn CG. Issue: 1998, 1(5): 250-55
Title: Characterization of prostate size, PSA and endocrine profiles in patients with spinal cord injuries.
Abstract: The authors examined prostatic morphology in 43 patients with spinal cord injury, aged 27-73 years (mean age 51 +/- 9.8 s.d.) 8.8-22.2 years following injury. They found that the increase in the total prostate volume and transitional zone volume was significantly less (P=0.26) than expected when using the Dallas Clinical Cohort of men with BPH, but not significantly different from the Olmsted County Study of community dwelling men without a clinical diagnosis of BPH or prostate disorder (P=0.875). The researchers ensured that there were no abnormalities in the pituitary-gonadal axis by confirming that there were no age related abnormalities in the testicular volume, serum total and free testosterone, DHT, FSH or LH. Therefore, the study suggests that factors other than hormones influence prostate growth and that intact neural pathways may play a role in the process. Unfortunately, they omitted to mention if any of the patients had urinary diversion or were self-catheterising. This would be important, as bladder neck physiology and urethral flow may influence the development of benign adenomatous disease. Under these circumstances urinary diversion would account for the study findings.
Reviewer: James Green
Journal: Prostate Cancer and Prostatic Diseases Authors: Luckas B, Grange JC, Comet D, McCarthy C and the BPH Group in General Practice Issue: 1998, 1(5): 276-83
Title: Three year prospective study of 3228 clinical BPH patients treated with alfuzosin in General Practice.
Abstract: This large study, sponsored by Laboratoires Synthelabo, confirms the long term safety and efficacy of alfuzosin for the treatment of BPH. Symptom score was significantly reduced by 54% at 3 months and this was maintained up to 36 months (48.4%). Health Related Quality of Life (HRQL) score was significantly improved by 45.5% at 12 months and this was maintained up to 36 months. Only 0.3% of patients suffered acute urinary retention, 3.7% underwent operation for BPH and adverse events (vertigo, dizziness etc) occurred in 4.2%.
Reviewer: James Green
| MONTH PUBLISHED | July - 1998 |
Journal: Urology Authors: Kaplan SA, Reis RB, Cologna A, Suaid HJ, Martins ACP, Kohn IJ and Te AE. Issue: 1998, 52 (1): 12-16
Title: Intermittent alpha-blocker therapy in the treatment of men with lower urinary tract symptoms.
Abstract: This study compares intermittent with continuous dosing of alfuzosin in the treatment of benign prostatic hyperplasia. Men over 50 years of age with lower urinary tract symptoms for more than 1 year, and who opted for medical treatment, were given alfuzosin of 7.5 mg/day for 3 months. Responders (40% fall in IPSS and 30% increase in Qmax) were randomised to continue alfuzosin of 7.5mg/day, to take alfuzosin of 7.5 mg on alternate days or to stop treatment. Out of 111 commenced on treatment, 79 responders were randomised. After 3 and 6 months, the IPSS and Qmax of patients on both continuous and intermittent alfuzosin were equivalent whereas patients whose treatment was withdrawn had relapsed by 3 months. The authors conclude that intermittent dosing is as effective as continuous treatment using alfuzosin. They ask if this approach would be effective for other agents and whether alternative dosing regimes would also be effective.
Reviewer: Jonathan Cartledge
Journal: Urology Authors: Uchida T, Muramoto M, Kyunou H, Iwamura M, Egawa S and Koshiba K. Issue: 1998, 52 (1): 66-71
Title: Clinical outcome of high-intensity focused ultrasound for treating benign prostatic hyperplasia: preliminary report.
Abstract: Fifty-seven men with mild to moderate lower urinary tract symptoms were treated with High Intensity Focussed Ultrasound (HIFU) by a previously published regime, and a new HIFU2 protocol. HIFU2 uses a smaller trans-rectal probe with concurrent transverse monitoring and an automatic temperature cut out at 37oC. All patients had epidural anaesthesia and IV sedation, average treatment time was 55 minutes. At 12 months both HIFU and HIFU2 significantly improved IPSS and quality of life. Qmax and prostate volume only improved with HIFU2. The authors conclude that HIFU2 is effective technology at destroying prostate tissue, but more development is needed.
Reviewer: Jonathan Cartledge
| MONTH PUBLISHED | January - 1998 |
Journal: British Journal of Urology Authors: Hansen BJ, Mortensen S, Mensink HJA, Flyger H, Riehmann M, Hendolin N, Nordling J, Hald T, and the Alfech Study Group. Issue: 1998, 81: 36-41.
Title: Comparison of the Danish prostatic symptom score with the international prostatic symptom score, the Madsen-Iversen and Boyarsky symptom indexes.
Abstract: Should the IPSS be accepted so universally or can it be improved upon. This study suggests that refinements included in the Danish symptom score may make it better in evaluating LUTS secondary to bladder outflow obstruction and evaluating any response to treatment.
Reviewer: Mark Feneley
Journal: Urology Authors: Roehrborn CG, Preminger G, Newhall P, Denstedt J, Razvi H, Chin LJ, Perlmutter A, Barzell W, Whitmore W, Fritzsh R, Sanders J, Sech S and Womack S. Issue: 1998, 51 (1): 19-27.
Title: Microwave thermotherapy for benign prostatic hyperplasia with the Dornier urowave: Results of a randomized, double blind, multicenter, sham-controlled trial.
Abstract: A total of 220 patients in 5 institutions with BPH were randomised to receive 90W transurethral microwave therapy, with monitoring of urethral and rectal temperature, or a sham treatment which involved catheterisation but no delivery of energy, under local anaesthetic. The authors do not report treatment time. Primary outcome measure was improvement in AUA score, secondary outcome measures flow rate, problem index, BPH impact index & QOL. At six months follow up they report improvement (p<0.05) in AUA score & flow rate for treatment over sham. Active treated patients experienced more frequency, dysuria and ejaculatory dysfunction. The authors conclude that microwave thermotherapy improves patients perceptions of symptoms more than the recorded improvement, and point out that longer follow up is required.
Reviewer: Mark Feneley
| MONTH PUBLISHED | December - 1997 |
Journal: Urology Authors: Keetch DW, Andriole GL, Ratliff TL and Catalona WJ. Issue: 1997, 50 (6): 901-905.
Title: Comparison of percent free prostate-specific antigen levels in men with benign prostatic hyperplasia treated with finasteride, terazosin, or watchful waiting.
Abstract: Eighty five percent of PSA is protein bound in the circulation, the remainder existing as Free PSA. Assay of Free PSA and Total PSA allows calculation of Free/Total PSA ratio and is reported as making the use of this test more sensitive and specific for the detection of prostate cancer. In this paper the authors reviewed 69 men with BPH that were either receiving no treatment, an alpha-blocker, terazosin, or finasteride. They reviewed case records of these men for pre-treatment total PSA (free PSA was not assayed at that time) and compared this with total PSA following at least 6 months of finasteride(n=33), terazosin (n=14) watchful waiting (n=22). The three groups were similar for age, DRE, duration of therapy, pre-treatment PSA, pre-treatment AUA score. They compared post-treatment total PSA, free PSA and ratio free/total PSA between the three groups. Median PSA fell to 1.1 from 2.5 in men taking finasteride, there was no difference in the terazosin or watchful waiting groups. Free PSA was significantly lower in the finasteride treated group over the other groups. There was no difference however in the median ratio free/total PSA between the groups. The authors conclude that finasteride appears to lower free PSA as well as total PSA, but does not apper to change the ratio of free/total PSA.
Reviewer: Mark Feneley
| MONTH PUBLISHED | November - 1997 |
Journal: British Journal of Urology Authors: Donovan JL, Kay HE, Peters TJ, Abrams P, Coast J, Matos-Ferreira A, Rentzhog L, Bosch JLHR, Nordling J, Gajewski JB, Barbalias G, Schick E, Mendes Silva M, Nissenkorn I, de la Rosette JJMCH and the ICS-’BPH’ Study Group Issue: 1997, 83 (5): 712-721.
Title: Using the ICSQoL to measure the impact of lower urinary tract symptoms on quality of life: evidence from the ICS-‘BPH’ study.
Abstract: Quality of life questionnaires are currently being refined in a similar manner to prostate symptom scores 7-10 years ago. The validity of the International Continence Society - Quality of Life questionnaire is subjected to further scrutiny by this study from twelve countries covering over 1600 men. A detailed and validated QoL questionnaire will be included in future BPH studies. Clinically a single question - how much do LUTS interfere with life seems adequate. (See reference below).
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: B. Lukacs, D. Comet, JC. Grange, P. Thibault and the BPH group in General Practice Issue: 1997, 80 (5): 722-730.
Title: Construction and validation of a short-form benign prostatic hypertrophy health-related quality-of-life questionnaire.
Abstract: This paper on QoL questionnaires aims to find a more user-friendly but equally valid form of the QoL-20 scale. The QoL-9 was practical, reliable and consistently answered. Whether it will be a clinically useful adjunct to the single question mentioned above is unclear. (See reference above).
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: MV Hansen and A Zdanowski Issue: 1997, 80 (5): 787-792.
Title: The agreement among urological experts on the diagnostic management of patients with common urological problems.
Abstract: Thirty three urologists were asked to investigate and treat 53 simulated urological conditions. The probability of the urologists using a certain test in a certain patient was recorded and the cost implications evaluated. Most consistency was seen treating stone patients, then bladder cancer, prostate cancer and lastly BPH. These were all university based consultants.
Reviewer: Mark Feneley
| MONTH PUBLISHED | October - 1997 |
Journal: British Journal of Urology Authors: Abrams P, Speakman M, Stott M, Arkell D and Pocock R Issue: 1997, 80: 587-596
Title: A dose-ranging study of the efficacy and safety of tamsulosin, the first prostate-selective a1A-adrenoceptor antagonist, in patients with benign prostatic obstruction (symptomatic benign prostatic hyperplasia)
Abstract: This paper presents the findings of a double blind placebo controlled trial assessing the efficacy and safety of tamsulosin (a prostate-selective a1A-adrenoceptor antagonist) at three different doses for the treatment of men with LUTS due to BPO. A total of 126 men were randomised to receive either placebo (n=28), 0.2mg tamsulosin (n=35), 0.4mg tamsulosin (n=30) or 0.6mg tamsulosin (n=33) once daily for 4 weeks. Efficacy was assessed using the Boyarsky symptom score, uroflowometry and data from pressure-flow studies. All groups experienced a reduction in total symptom scores including placebo (down 18%), however, the greatest reduction was seen in the 0.4mg and 0.6mg groups (down 28%). There was also a significant improvement in flow rates at the two higher doses of tamsulosin (up 20%) compared to placebo (down 1%), as well as a significant reduction in pdetQmax with the 0.4mg dose (down 28%). The paper concludes that tamsulosin is well tolerated and effective in treating men with LUTS due to BPO. Optimal effect can be achieved at a dose of 0.4mg. This study was supported by Yamanouchi, the makers of tamsulosin.
Reviewer: Rob Frymann
| MONTH PUBLISHED | July - 1997 |
Journal: European Urology Authors: Abrams P. Issue: 1997, 32: 39-46.
Title: Effects of Doxazosin in Men with Lower Urinary Tract Symptoms and Benign Prostatic Obstruction.
Abstract: Doxazosin was shown in three double-blind, placebo controlled trials to significantly improve flow rates and reduce detrusor pressure resulting in decreased voiding time and increased voided volume. There was a significant reduction in urethral resistance. The conclusion was that doxazosin was an important treatment option in benign prostatic obstruction, but whether this produces a clinically relevant reduction in symptoms or improvement in quality is debatable.
Reviewer: Mark Feneley
Journal: European Urology Authors: Hansen MV, Zdanowski A. Issue: 1997, 32: 34-38.
Title: The use of a simple home flow test as a quality indicator for male patients treated for lower urinary tract symptoms suggestive of bladder outlet obstruction.
Abstract: The home flow test was assessed in this study as an adjunct to the follow-up of patients with lower urinary tract symptoms (LUTS). Patients (172) treated with TURP or transurethral microwave therapy (TUMT) were included in this study. Patients were asked to produce perform uroflowmetry and home flow tests. The home flow tests agreed well with the maximum flow on uroflowmetry and to the subjective effect of therapy. This could usefully be included in assessment of patients.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Ramon J, Lynch TH, Eardley I, Elkman P, Frick J, Jungwirth A, Pillai M, Wiklund P, Goldwasser B, Fitzpatrick JM. Issue: 1997, 80: 128-135.
Title: Transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia: a collaborative multicentre study.
Abstract: A case series of 68 patients undergoing TUNA for BPH. Again, like many of the alternative treatments for BPH, TUNA appears to produce a satisfactory short-term symptomatic improvement with only a small change in the flow rate, which are shown also in sham studies. This makes the interpretation of the results unreliable.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Mostafid AH, Harrison NW, Thomas PJ, Fletcher MS. Issue: 1997, 80: 116-122.
Title: A prospective randomized trial of interstitial radiofrequency versus transurethral resection for the treatment of benign prostatic hyperplasia.
Abstract: A good study using the P(det) Q(max), IPSS and QOL scores as outcome measures following IRFT and TURP. P(det) Q(max) fell significantly in both groups but half the IRFT treated group remained obstructed on the Abrams-Griffiths nomogram and the flow rates at 6 months were disappointing. Both had good symptomatic results but TURP always came out better. The results of long term follow-up are awaited.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Chandiramani VA, Palace J, Fowler CJ. Issue: 1997, 80: 100-104.
Title: How to recognise patients with parkinsonism who should not have urological surgery.
Abstract: Urologists are always wary of operating on men with lower urinary tract symptoms and parkinsonism. This may however mean we are not operating on men who may benefit from a simple procedure. This paper identifies a number of clinical parameters that if present would suggest that certain men with parkinsonism should be treated medically rather than surgically. These include (i) urinary symptoms that precede or present with parkinsonism, (ii) urinary incontinence and idiopathic Parkinson's disease (iii) erectile failure preceding or presenting with parkinsonism (iv) worsening bladder function after urological surgery. At least 80% of patients in this study had two of these characteristics and these patients should be referred for a sphincter EMG before surgery.
Reviewer: Mark Feneley
| MONTH PUBLISHED | June - 1997 |
Journal: Journal of Urology Authors: Marks LS, Partin AW, Gormley GJ, Dorey FJ, Shery ED, Garris JB, Subong EN, Stoner E and deKernion JB . Issue: 1997, 157: 2171-2178.
Title: Prostate tissue composition and response to finasteride in men with symptomatic benign prostatic hyperplasia.
Abstract: Finasteride is not uniformly effective in reducing prostate size or relieving symptoms due to benign prostatic enlargement. A recent meta-analysis of all finasteride trials conducted to date suggested that finasteride is more effective in men with larger prostates. In this study the authors examined the changes in prostate tissue following treatment with finasteride and compared this to a placebo group to identify histological indicators of treatment outcome (IPSS score and flow rates). There were no significant differences between treatment and controls with regard to IPSS score or flow rate. However, PSA, serum dihydrotestosterone and prostate volume showed significant decreases in the finasteride compared to the control group. More particularly treatment with finasteride resulted in a significant reduction in the inner gland epithelium with little effect upon stroma. The authors also found a linear correlation between inner gland epithelium content before treatment and reduction in prostate volume.
Reviewer: Mark Feneley
| MONTH PUBLISHED | February - 1997 |
Journal: European Urology Authors: Hahn RG, Nilsson A, Farahmand BY, Persson PG. Issue: 1997, 31: 199-203.
Title: Blood haemoglobin and the long-term incidence of acute myocardial infarction after transurethral resection of the prostate.
Abstract: This study examined risk factors for acute myocardial infarction post-TURP. There were 52 infarcts in 811 patients (6%). The strongest risk factor was a low haemoglobin which doubled the risk, and there was an associated relationship with a previous myocardial infarct. Risk factors that were not proven included age greater than 75 years, blood loss at operation, water absorption during surgery or premorbid condition.
Reviewer: Mark Feneley
Journal: European Urology Authors: Buzelin JM, Roth S, Geffriaud-Ricouard C and Delauche-Cavallier MC. Issue: 1997, 31: 190-198.
Title: Efficacy and safety of sustained-release alfuzosin 5 mg in patients with benign prostatic hyperplasia. ALGEBI Study Group.
Abstract: In this randomised controlled study, 390 patients were randomly assigned to receive either slow release alfuzosin bd or placebo. There was a fall in the International Prostate Symptom Score (IPSS) in 13% more patients with alfuzosin (31%) than placebo (18%). Therefore, the number needed to treat (NNT) to get a benefit with alfuzosin over and above placebo is 8. There were minimal side-effects in both groups and the drug was well tolerated.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Thomas KJ, Cornaby AJ, Hammadeh M, Philp T and Matthews PN. Issue: 1997, 79: 186-189.
Title: Transurethral vaporization of the prostate: a promising new technique.
Abstract: This was a pilot study assessing the efficacy and safety of transurethral vaporization of the prostate (TUVP) using a grooved roller electrode in 116 patients with symptomatic BPH. Assessment was by flow rate, residual volume and symptom score. The authors found the technique easy to master although glands greater than 60g were considered too large to vaporize. Mean symptom scores improved by 67% and mean peak flow increased from 8.5ml/s to 20.5ml/s. One advantage of TUVP is said to be a reduction in haemorrhage. No patients required blood transfusion. Another advantage is said to be a shorter hospital stay although only 57% of patients had their catheters removed within 24 hours. There were 11 UTI's and 15% developed retrograde ejaculation. None of the sexually-active patients developed post-operative erectile dysfunction. The authors rightly point out that a randomized trial of TUVP against TURP is required.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Ahmed M, Bell T, Lawrence WT, Ward JP and Watson GM. Issue: 1997, 79: 181-185.
Title: Transurethral microwave thermotherapy (Prostatron version 2.5) compared with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a randomized, controlled, parallel study.
Abstract: This was a well-constructed, randomized trial of a high-energy protocol with transurethral microwave thermotherapy (TUMT) against TURP in 60 patients with moderate to severe bladder outflow obstruction who were unequivocally obstructed on the Abrams-Griffiths nomogram. Follow up was for 6 months so durability was not assessed. The AUA symptom score in the TUMT group did show a significant reduction (18.4 to 5.2). However, in contrast to TURP, the TUMT patients remained urodynamically obstructed after treatment. The most likely explanation for the improved symptom score after TUMT is a placebo response. The trial also showed that TUMT is not without significant complications: three patients needed an indwelling catheter for 10 days to 6 weeks and 4 of 18 sexually-active men suffered with retrograde ejaculation after TUMT.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Mulligan ED, Lynch TH, Mulvin D, Greene D, Smith JM and Fitzpatrick JM. Issue: 1997, 79: 177-180.
Title: High-intensity focused ultrasound in the treatment of benign prostatic hyperplasia.
Abstract: This study also evaluated transrectal delivery of HIFU in thirteen patients. Two patients required TURP within 5 months because of no subjective symptomatic improvement and one other developed a urethral stricture. In the other patients the mean IPSS was reduced from 23 to 6 after 6 months and this appeared to be maintained at 2 years. The mean Qmax initially improved from 9.9 pre-treatment to 14.2ml/s at 6 months but by two years had reduced to 10.6ml/s. Although HIFU is at an early stage of clinical evaluation, neither of these studies demonstrate results which match the objective improvement after TURP and as with all of the new technology treatments of BPH, durability will need to be carefully assessed in long-term randomised trials.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Sullivan LD, McLoughlin MG, Goldenberg LG, Gleave ME and Marich KW. Issue: 1997, 79: 172-176.
Title: Early experience with high-intensity focused ultrasound for the treatment of benign prostatic hyperplasia.
Abstract: This study, the first of two in this issue which look at high intensity focused ultrasound (HIFU) for BPH, used the transrectal Sonablate 200 probe in 25 patients with BPH. Patients with large prostates, middle lobes and many prostatic calculi were found to be unsuitable for this treatment. The best results were obtained when the bladder neck was treated. In these patients the mean AUA symptom score decreased from 20.25 to 9.5 and Qmax increased from 9.18 to 13.7. 10 patients required catheterisation for between 3 and 6 days. This new treatment modality is now reaching the stage of development at which a randomised trial against TURP may be justified.
Reviewer: Mark Feneley
| MONTH PUBLISHED | January - 1997 |
Journal: Journal of Urology Authors: Petas A, Talja M, Tammela T, Taari K, Lehtoranta K, Valimaa T and Tormala P. Issue: 1997, 157: 173-176.
Title: A randomized study to compare biodegradable self-reinforced polyglycolic acid spiral stents to suprapubic and indwelling catheters after visual laser ablation of the prostate.
Abstract: In this small randomised study a self-reinforced polyglycolic acid spiral stent is compared to suprapubic catheters and indwelling catheters following neodynium: YAG laser ablation of the prostate. Of the 27 patients receiving the spiral stent, 20 voided freely on day 1 or 2 post-operatively, compared to 8 of 23 with suprapubic catheters alone. In those patients with an indwelling urethral catheter, mean time to removal of the catheter was 6.5 days. There was no significant difference in outcome with regard to flow rates or symptom scores between the groups. While the results would indicate a significant reduction in the catheterisation time following use of the spiral stent, suprapubic catheterisation was still required for 1-2 days in most patients and there would appear to be no advantage with regard to outcome.
Reviewer: Mark Feneley
Journal: European Urology Authors: Weisser H, Behnke B, Helpap B, Bach D and Krieg M. Issue: 1997, 31: 97-101.
Title: Enzyme activities in tissue of human benign prostatic hyperplasia after three months' treatment with the Sabal serrulata extract IDS 89 (Strogen) or placebo.
Abstract: Phytotherapy is extremely popular in Europe. In this randomised, double blind study patients with benign prostatic obstruction were given extract IDS 89 of Sabal serrulata or placebo for three months. The activity of epithelial and stromal enzymes including 5a reductase in BPH tissue changed only moderately and the relationship between phytotherapy, enzyme activity and benign prostatic obstruction is unclear. Further work is needed.
Reviewer: Mark Feneley
Journal: Cancer Authors: Stephan C, Lein M, Jung K, Schnorr D, Loening SA. Issue: 1997, 79: 104-109.
Title: The influence of prostate volume on the ratio of free to total prostate specific antigen in serum of patients with prostate carcinoma and benign prostatic hyperplasia.
Abstract: The ratio of free to total PSA (f-PSA to t-PSA) may help to distinguish patients with prostate cancer from those with BPH because f-PSA% is lower in patients with prostate cancer. However, this study shows that f-PSA% increases with prostate size. F-PSA% as a diagnostic test was most sensitive and specific when used in prostates of less than 40 ml. Above 40 ml in size, the test performed poorly and limits the use of this test.
Reviewer: Mark Feneley
| MONTH PUBLISHED | December - 1996 |
Journal: Journal of Urology Authors: Soderdahl DW, Knight RW and Hansberry KL. Issue: 1996, 156: 1354-6.
Title: Erectile dysfunction following transurethral resection of the prostate.
Abstract: The authors have objectively measured the incidence of erectile dysfunction following transurethral resection of the prostate in 40 men assessing pre-operative and post-operative nocturnal penile tumescence. Patients were also asked to complete a questionnaire post-operatively describing their perceived potency level before and after surgery. No significant difference was observed in penile tumescence, number of erectile events or duration of event before and after surgery. Penile rigidity improved post-operatively though this was not significant. A subjective decrease in quality of erection after surgery was reported in 27.5% of patients. However a significant number of these patients equated retrograde ejaculation with decreased potency.
Reviewer: Mark Feneley
Journal: Journal of Urology Authors: Matthiesen TB, Rittig S, Norgaard JP, Pedersen EB and Djurhuus JC. Issue: 1996, 156: 1292-9.
Title: Nocturnal polyuria and naturesis in male patients with nocturia and lower urinary tract symptoms.
Abstract: The authors investigated the circadian variation in urine output, plasma angiotensin II, aldosterone, atrial naturetic peptide, arginine vasopressin and blood pressure in 17 elderly men with nocturia and lower urinary tract symptoms and 10 age matched controls without nocturia. Loss of diurnal variation was observed in 11 of the 17 subjects with nocturia while 6 subjects had a diurnal variation in urine output comparable to controls. Loss of diurnal variation was associated with an increase in nocturnal sodium excretion. The authors conclude that nocturia in a large proportion of elderly men with lower urinary tract symptoms is due to nocturnal polyuria and naturesis.
Reviewer: Mark Feneley
Journal: European Urology Authors: Madersbacher S, Klingler CH, Schatzl G, Schmidbauer G, Marberger M. Issue: 1996, 30: 437-455.
Title: The urodynamic impact of transrectal high-intensity focused ultrasound on bladder outflow obstruction.
Abstract: This uncontrolled prospective study analysed the use of high intensity focused ultrasound (HIFU) in the treatment of BPH. Temperatures greater than 80oC are generated resulting in necrosis of all cellular elements within the focal area. Of 30 patients, 80% were obstructed pre-operatively on urodynamic grounds, but only 37% post-operatively. However, only 4 patients were clearly unobstructed after the procedure. The authors conclude the HIFU should not be considered as an alternative for severely obstructed patients or those with an absolute indication for surgery.
Reviewer: Mark Feneley
Journal: European Urology Authors: Jung P, Matttelaer P, Wolff JM, Mersdorf A, Jakse G. Issue: 1996, 30: 418-423.
Title: Visual laser ablation of the prostate: efficacy evaluated by urodynamics and compared to TURP.
Abstract: In this unrandomised study, patients with significant morbidity underwent visual laser ablation of the prostate and those without underwent TURP. Both groups underwent pre-operative pressure/flow studies to clarify the nature of their disease. Patients in the TURP group did significantly better regarding peak urinary flow compared to VLAP, which performed very badly in big prostates. However, it did cause less morbidity.
Reviewer: Mark Feneley
Journal: European Urology Authors: Matani Y, Mottrie AM, Stockle M, Voges GE, Fichtner J, et al. Issue: 1996, 30: 414-417.
Title: Transurethral prostatectomy: a long-term follow-up study of 166 patients over 80 years of age.
Abstract: This retrospective series of 166 patients aged over 80 years undergoing TURP in Germany revealed that more than 85% patient did relatively well from TURP. The mortality was not significantly worse than the expected mortality in this age group. Patients were operated on providing they had voiding symptoms and outcome is defined by a limited number of characteristics; nevertheless it appeared to be favourable.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Mueller EJ, Ziedman EJ, Desmond P, Thompson IM, Optenberg SA and Wasson J Issue: 1996, 78: 893-896.
Title: Reduction of length of stay and cost of transurethral resection of the prostate by early catheter removal.
Abstract: Accompanied by a commentary by Mr David Kirk, this is a non-randomised report of 119 patients having their catheters removed one day post-TURP being compared to 152 patients who had a TURP the previous year. Immediate complications, including transfusion, failure to void and clot retention, occurred in 5% and 6.6 % respectively. Hospital stay was reduced from 3.1 to 1.28 days in the group whose catheters were managed aggressively, theoretically saving hundreds of dollars per patient.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Carter AC / BLUES Issue: 1996, 78: 876-885.
Title: A standard protocol for the evaluation of laser treatment of the prostate
Abstract: A protocol suggested by the British Laser Urological Evaluation Society for use in any trial of operative intervention for benign prostatic obstruction. It includes sections for demographic details, operative details such as anaesthetic details, peri- and post-operative complications and progress at three follow-up visits, plus a patient acceptability and sexual function questionnaire. More sophisticated evaluations such a section for pre- and post-operative cystometry is not included in the "core" dataset.
Reviewer: Mark Feneley
| MONTH PUBLISHED | November - 1996 |
Journal: Journal of Urology Authors: Kaplan S A and Reis R B. Issue: 1996, 156: 1668-1672.
Title: Significant correlation of the American Urological Association symptom score and a novel urodynamic parameter: Detrusor contraction duration.
Abstract: The poor correlation of the I-PSS score with urodynamic parameters has been highlighted by a number of authors. This study revisits this issue and introduces a new parameter detrusor contraction duration. Increasing symptoms as assessed by the I-PSS was associated with worsening urodynamic parameters though those with the greatest correlation were detrusor instability and duration of detrusor contraction.
Reviewer: Mark Feneley
Journal: Journal of Urology Authors: Madersbach S, Klingler H C, Schatzl G, Stuling T, et al. Issue: 1996, 156: 1662-1667.
Title: Age related changes in urodynamic changes in patients with benign prostatic hyperplasia
Abstract: This authors evaluate the I-PSS score, prostate volume, non-invasive uroflowmetry, residual volume and pressure flow studies in two hundred and twenty two patients with a clinical diagnosis of benign prostatic enlargement, uro-flow less than 15mls per second, and I-PSS score> 7. There was no correlation between age and I-PSS (contrary to a later paper in this months J. Urol), but there was a significant decrease in maximum flow rate and voided volume with age. Prostate volume increased with age. Pressure flow studies demonstrated a decrease in cystometric capacity and flow rate with age but no change in detrusor pressure at maximum flow, maximum detrusor pressure or passive urethral pressure profile. Instability increased with age. The authors stress the importance of pressure flow studies in men over 80 years of age owing to the low incidence of urodynamically proven obstruction in those with flow rates between 10-14 ml/sec.
Reviewer: Mark Feneley
Journal: European Urology Authors: Debruyne FMJ, Witjes WPJ, Fitzpatrick J, Kirby RS, Kirk D, Prezioso D. Issue: 1996, 30: 369-376.
Title: The international terazosin trial: a multicentre study of the long term efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia.
Abstract: The alpha blocker terazosin gives a small improvement in flow rates and better reduction in the International Prostate Symptom Score than placebo. Fewer patients withdrew from the study on terazosin because of lack of efficacy than in the placebo arm. The study departs from usual analytical protocols when it drops an intention-to-treat approach and gives results just for evaluable patients. This gives statistically significant results in places it otherwise would not.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: van Iersel MP, Thomas CMG, Witjes WPJ, de Graaf R, de la Rosette J Issue: 1996, 78: 742-746.
Title: Clinical implications of the rise and fall of prostate specific antigen after laser prostatectomy.
Abstract: The effect of visual laser ablation of the prostate on serum PSA has not previously been described. Forty-five patients undergoing this procedure had serial estimations postoperatively up to 52 weeks. At 24 hours the mean PSA was 23 times higher than the preoperative level, dependent upon the prostate size and energy applied. Gradually the PSA reached a new level, mean 1.7 ng/ml below the preoperative level, by 78 days postoperatively. The authors conclude that the serum PSA is potentially misleading until 4 months after laser prostatectomy.
Reviewer: Mark Feneley
| MONTH PUBLISHED | September - 1996 |
Journal: British Journal of Urology Authors: Witjes WPJ, de Wildt MJAM, Rosier PFWM, Caris CTM, Debruyne FMJ and de la Rosette JJMCH. Issue: 1996, 156: 1026-1034.
Title: Variability of clinical and pressure flow study variables after six months of watchful waiting in patients with lower urinary tract symptoms and benign prostatic enlargement.
Abstract: This paper examines the variability over a six month period of clinical and pressure flow study variables in 121 patients with a clinical diagnosis of benign prostatic enlargement undergoing watchful waiting. Patients without bladder outlet obstruction (defined using the Griffiths nomogram) experienced significant symptomatic improvement, while those with obvious bladder outlet obstruction did not. Mean pressure-flow variables were reproducible within each patient subgroup though significant intra-individual variability was observed. Interestingly, detrusor pressure at maximal flow and urethral resistance factor in the obstructed group improved significantly indicating a reduction in the severity of obstruction. The authors draw attention to the observed physiological variability with time, highlighting the importance of control arms in studies evaluating new therapies.
Reviewer: Mark Feneley
Journal: Journal of Urology Authors: Ezz El Din K, Kiemeney LALM, de Wildt MJAM, Rosier PFWM, Debruyne FMJ and de la Rosette JJMCH. Issue: 1996, 156: 1020-1025.
Title: Correlation between bladder outlet obstruction and lower urinary tract symptoms as measured by The International Prostate Symptom Score.
Abstract: This paper attempts to delineate the relationship between voiding symptoms according to the I-PPS score and urodynamic findings in 803 patients. A statistically significant correlation between all I-PPS questions and objective parameters of obstruction was found. The filling component correlated better with obstruction than did the voiding urodynamics and total I-PPS score. There was no clear correlation between the grade of obstruction and voiding questions, nor between frequency and instability. However a weak correlation was observed between urgency and nocturia questions with respect to instability. The authors conclude that bladder outlet obstruction can not be diagnosed from symptoms alone, nor is it possible to define a subgroup of patients in whom urodynamic investigation is indicated.
Reviewer: Mark Feneley
Journal: European Urology Authors: Porru D, Pau AC, Fornasier V, Sorgia M, Delisa A, et al. Issue: 1996, 30: 34-39.
Title: Evaluation of bladder contractility in men undergoing transurethral resection of the prostate.
Abstract: In the search for the ideal preoperative parameters to predict a good response from TURP, this study suggests alternative better ways. Parameters derived from pressure/flow studies included URA (the extent of the removal of obstruction), Wmax and W which measure the changes in detrusor contractility. The authors found that patients with obstruction had a fading detrusor contraction and that the removal of obstruction restored the pattern to normal. Patients who did less well from surgery did not have this pattern.
Reviewer: Mark Feneley
Journal: European Urology Authors: Pansadoro V, Emiliozzi P, Defidio L, Scarpone P, Sabatini G, et al. Issue: 1996, 30: 24-27.
Title: Prostate-specific antigen and prostatitis in men under fifty.
Abstract: Patients were selected who had a low probability of BPH or prostate cancer based on age. PSA was increased in men with acute prostatitis (5/7), chronic prostatitis (2/13), and abacterial prostatitis (2/32) but none with prostatodynia (0/20). In some cases, PSA did not return to normal after antibiotics. It is difficult to say whether such PSA elevations are greater than a normal population without similar complaints but indicate that prostatitis can cause elevated PSA.
Reviewer: Mark Feneley
Journal: European Urology Authors: Lee AJ, Russell EBAW, Garraway WM, Prescott RJ. Issue: 1996, 30: 11-17.
Title: Three-year follow-up of a community-based cohort of men with untreated benign prostatic hyperplasia.
Abstract: This study examined the change in symptoms over a 3 year period prospectively in 217 patients who had a working clinical definition of BPH. Symptoms both improved and deteriorated, but very few of those men with symptoms and bothersomeness that improved after 1 year maintained the improvement at three years. The symptoms most likely to cause increasing bothersomeness were nocturia, urgency, dribbling, intermittency, incomplete emptying, weak stream and frequency.
Reviewer: Mark Feneley
Journal: European Urology Authors: te Slaa E, de la Rosette JJMCH. Issue: 1996, 30: 1-10.
Title: Lasers in the treatment of benign prostatic obstruction: past, present, and future.
Abstract: This review article describes the broad areas of laser use in TURP, its problems and outcomes and the hopes for the future.
Reviewer: Mark Feneley
| MONTH PUBLISHED | August - 1996 |
Journal: British Journal of Urology Authors: Jensen KM, Jorgensen JB, Mogensen P. Issue: 1996, 78: 213-218.
Title: Long-term predictive role for urodynamics: an 8-year follow-up of prostatic surgery for lower urinary tract symptoms.
Abstract: Pivotal to this Danish study is the interview undertaken 6 months and 8 years after TURP in 139 and 79 men respectively by the same investigators. Success is defined in terms of the patients overall subjective evaluation of the outcome: much better, better, worse or much worse. The difference in the proportion of patients reporting success after 8 years compared with 6 months is similar (11% vs 15%), whether or not the patients were obstructed according to the Abrams-Griffiths nomogram. Long-term failure was more likely to be reported by younger men without bladder outflow obstruction.
Reviewer: Mark Feneley
Journal: Journal of Urology Authors: De La Rossette JJMCH, de Wildt MJAM, Hofner K, Carter S St C, Debruyne FMJ and Tubaro A. Issue: 1996, 156: 97-102.
Title: High energy thermotherapy in the treatment of benign prostatic hyperplasia: results of the European benign prostatic hyperplasia study group.
Abstract: Many new therapies for BPH are now available though long-term follow up is presently awaited for many modalities before the benefits can be assessed. This paper reports the results of high energy transurethral microwave thermotherapy in the treatment of BPH. One hundred and sixteen patients were evaluated using symptom scores, trans-rectal ultrasound, free voiding and pressure flow studies. Sixty seven patients have achieved 1 year follow up. Improvement in all parameters was observed at three months and this appears to be sustained at 1 year in those patients in whom follow up is available. Irritative symptoms were noted in a large number of patients for up to 4 weeks. The authors conclude that high energy transurethral microwave thermotherapy shows significant improvement in subjective and objective outcome measures, and best candidates for this procedure are those patients with moderate to severe bladder outlet obstruction.
Reviewer: Mark Feneley
Journal: European Urology Authors: Saporta L, Aridogan IA, Erlich N, Yachia D. Issue: 1996, 29: 439-445.
Title: Objective and subjective comparison of transurethral resection, transurethral incision and balloon dilatation of the prostate.
Abstract: This study evaluated transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and transurethral balloon dilatation of the prostate (TUBDP) in the treatment of patients with bladder outflow obstruction. There were 20 patients in each group and within 3 years 5 patients in the TUBDP had required additional treatment, 3 patients in the TUIP group and 1 patient in the TURP group. Overall, the TURP group did better regarding objective and subjective features of the disease.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Pit MJ, Tegelaar RJ and Venema PL. Issue: 1996, 78: 99-103.
Title: Isothermic irrigation during transurethral resection of the prostate: effects on peri-operative hypothermia, blood loss, resection time and patient satisfaction.
Abstract: Reductions in body temperature and resultant cardiac stress are known to occur during TURP and may be the cause of documented increases in long-term postoperative mortality. This prospective randomised trial from The Netherlands compared those parameters listed above plus age, body weight and weight of tissue resected, in 59 men undergoing TURP under spinal anaesthesia. Group 1 received isothermic irrigation (37.5 0C) using a counter-current fluid heater and group 2 received irrigation at room temperature (20.6 0C). Statistical differences were observed with respect to reductions in core (upper rectal) temperature and patient perception of cooling, both being significantly greater in group 2; no differences were observed between groups with respect to other parameters. The authors suggest there are strong arguments for performing every TURP using isothermic irrigation since it does not negatively interfere with the procedure.
Reviewer: Mark Feneley