From evidence‐based medicine to evidence‐balanced medicine for individualized and personalized care: As applied to benign prostatic hyperplasia/male lower urinary tract symptoms

Foo, Keong Tatt

doi:10.1111/iju.13285

Cited by 6 publications

(8 citation statements)

References 8 publications

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“… Emberton 2010 [ 24 ] Review Improved physician–patient communication will help determine the best treatment option for patients with BPH and may ensure greater compliance and treatment success. Foo 2017 [ 10 ] Review Treatment of prostatic adenoma can be individualized and tailored. Final decision-making would be personalized to the patient’s age, comorbidity and preferences (values).…”

Section: Methodsmentioning

confidence: 99%

Patient centred care for the medical treatment of lower urinary tract symptoms in patients with benign prostatic obstruction: a key point to improve patients’ care – a systematic review

et al. 2018

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BackgroundEven though evidence based medicine, guidelines and algorithms still represent the pillars of the management of chronic diseases (i.e: hypertension, diabetes mellitus), a patient centred approach has been recently proposed as a successful strategy, in particular to improve drug adherence. Aim of the present review is to evaluate the unmet needs in LUTS/BPH management and the possible impact of a patient centered approach in this setting.MethodsA National Center for Biotechnology Information (NCBI) PubMed search for relevant articles published from January 2000 until December 2016 was performed by combining the following MESH terms: patients centred medicine, patient centered care, person centered care, patient centered outcomes, value based care, shared decision making, male, Lower Urinary Tract Symptoms, Benign Prostatic Hyperplasia, treatment. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). All studies reporting on patient centred approach, shared decision making and evidence-based medicine were included in the review. All original article, reviews, letters, congress abstracts, and editorials comments were included in the review. Studies reporting single case reports, experimental studies on animal models and studies not in English were not included in the review.ResultsOverall 751 abstracts were reviewed, out of them 87 full texts were analysed resulting in 36 papers included. The evidence summarised in this systematic review confirmed how a patient centred visit may improve patient’s adherence to medication. Although a patient centred model has been rarely used in urology, management of Low Urinary Tract Symptoms (LUTS) and Benign Prostatic Obstruction (BPO) may represent the perfect ground to experiment and improve this approach. Notwithstanding all the innovations in LUTS/BPO medical treatment, the real life picture is far from ideal.ConclusionsRecent evidence shows a dramatical low drug adherence and satisfaction to medical treatment in LUTS/BPH patients. A patient centred approach may improve drug adherence and some unmet needs in this area, potentially reducing complications and costs. However further well designed studies are needed to confirm this data.

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Section: Methodsmentioning

confidence: 99%

Patient centred care for the medical treatment of lower urinary tract symptoms in patients with benign prostatic obstruction: a key point to improve patients’ care – a systematic review

et al. 2018

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“…When making the final decision on treatment modality (watchful waiting, medical or surgical intervention) for a particular patient, age, co-morbidity, social economic background, and patient preferences or values should also be considered. Thus experience and an understanding of the pathophysiology of the disease are important in reaching a final balanced clinical decision for personalised care of the individual patient [3] .…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of clinical benign prostatic hyperplasia

Foo

2017

Asian Journal of Urology

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A disease can be defined as an abnormal anatomy (pathology) and/or function (physiology) that may cause harm to the body. In clinical benign prostatic hyperplasis (BPH), the abnormal anatomy is prostate adenoma/adenomata, resulting in a varying degree of benign prostatic obstruction (BPO) that may cause harm to the bladder or kidneys. Thus clinical BPH can be defined as such and be differentiated from other less common causes of male lower urinary tract symptoms. Diagnosis of the prostate adenoma/adenomata (PA) can be made by measuring the intravesical prostatic protrusion (IPP) and prostate volume (PV) with non-invasive transabdominal ultrasound (TAUS) in the clinic. The PA can then be graded (phenotyped) according to IPP and PV. Multiple studies have shown a good correlation between IPP/PV and BPO, and therefore progression of the disease. The severity of the disease clinical BPH can be classified into stages from stage I to IV for further management. The classification is based on the effect of BPO on bladder functions, namely that of emptying, normal if post-void residual urine (PVRU) < 100 mL; and bladder storage, normal if maximum voided volume (MVV) > 100 mL. The effect of BPO on quality of life (QoL) can be assessed by the QoL index, with a score ≥3 considered bothersome. Patients with no significant obstruction and no bothersome symptoms would be stage I; those with no significant obstruction but has bothersome symptoms (QoL ≥ 3) would be stage II; those with significant obstruction (PVRU > 100 mL; or MVV < 100 mL), irrespective of symptoms would be stage III; those with complications of the disease clinical BPH such as retention of urine, bladder stones, recurrent bleeding or infections would be stage IV. After assessment, further management can then be individualised. A low grade and stage disease can generally be watched (active surveillance) while a high grade and stage disease would need more invasive management with an option for surgery. The final decision making would take into account the patient's age, co-morbidity, social economic background and his preferences/values. Proper understanding of pathophysiology of clinical BPH would lead to better selection of patients for individualised and personalised care and more cost effective management.

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“…The article by Foo discusses the current status of evidencebased medicine for the management of benign prostate hyperplasia (BPH) and male lower urinary tract symptoms (LUTS). 1 The author might think most urologists or physicians treat these common conditions based on their own experience or past practice rather than taking an evidencebased approach. As BPH and LUTS are generally benign, therapeutic decision-making often takes how the patients feel or patient preferences into account.…”

Section: Editorial Commentmentioning

confidence: 99%

“…The present study by Foo proposes using the intravesical prostatic protrusion (IPP) degree and the presenting severity for staging therapeutic strategies for BPH/LUTS based on evidence-balanced medicine for individualized and personalized care. 1 The IPP is a comparatively recent tool, but several authors have pointed out the efficacy of this new index for evaluating the severity of BPH/LUTS as well as for post- robot-assisted laparoscopic radical prostatectomy urinary incontinence. [2][3][4] This new index assesses not only prostate size, but also prostate shape and relationship with the bladder neck and the internal ostium of the urethra.…”

Section: Editorial Commentmentioning

confidence: 99%

“…The author reports that severe IPP (grade 3) is more progressive than mild IPP (grade 1) but, importantly, they concluded that this objective index alone is not enough for decision‐making for BPH/LUTS therapies. To further classify the severity of BPH and treatment by stage, they combined objective (post‐void residual urine volume) and subjective (Quality of Life) indexes to arrive at detailed treatment strategies.…”

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confidence: 99%

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Editorial Comment to From evidence‐based medicine to evidence‐balanced medicine for individualized and personalized care: As applied to benign prostatic hyperplasia/male lower urinary tract symptoms

Shigemura

Fujisawa

2017

Int J of Urology

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From evidence‐based medicine to evidence‐balanced medicine for individualized and personalized care: As applied to benign prostatic hyperplasia/male lower urinary tract symptoms

Cited by 6 publications

References 8 publications

Patient centred care for the medical treatment of lower urinary tract symptoms in patients with benign prostatic obstruction: a key point to improve patients’ care – a systematic review

Patient centred care for the medical treatment of lower urinary tract symptoms in patients with benign prostatic obstruction: a key point to improve patients’ care – a systematic review

Pathophysiology of clinical benign prostatic hyperplasia

Editorial Comment to From evidence‐based medicine to evidence‐balanced medicine for individualized and personalized care: As applied to benign prostatic hyperplasia/male lower urinary tract symptoms

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