Modern best practice in the management of benign prostatic hyperplasia in the elderly

Bortnick, Eric; Brown, Conner; Simma‐Chiang, Vannita; Kaplan, Steven A.

doi:10.1177/1756287220929486

Cited by 41 publications

(24 citation statements)

References 35 publications

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“…Maximal urinary flow rate improvements noted in the current meta-analysis, as demonstrated by Aquablation, seem superior to medical and minimally invasive therapies. [2,8] Aquablation functional improvements produced were comparable with those of TURP and photoselective vaporization of the prostate, which are associated with improved Qmax values of 10–13 mL/s at 12-month follow-ups. [33–36]…”

Section: Discussionmentioning

confidence: 91%

Aquablation in men with benign prostate hyperplasia: A systematic review and meta-analysis

Chen¹,

Qin²,

Webb³

et al. 2022

Curr Urol

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Objective: The aim of the study is to investigate improvements in lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH) treated with prostatic Aquablation. Materials and methods: We performed a literature search of clinical trials using the MEDLINE, Embase, and Cochrane Library databases and retrieved published works on Aquablation for the treatment of BPH up to August 2021. Unpublished works, case reports, conference proceedings, editorial comments, and letters were excluded. Risk of bias was assessed using the ROBINS-I tool. Raw means and mean differences were meta-analyzed to produce summary estimates for pre-versus post-International Prostate Symptom Scores, maximum flow rate, and male sexual health questionnaire value changes. An inverse-variance weighted random effects model was used. Results: Seven studies were included in this review (n = 551 patients) that evaluated various urological parameters. At 3 months, the International Prostate Symptom Scores raw mean difference from baseline was −16.475 (95% confidence interval [CI], −15.264 to −17.686; p < 0.001), with improvements sustained for 12 months. Similarly, maximum flow rate improved by +1.96 (95% CI, 10.015 to 11.878; p < 0.001) from pre to 3 months postoperatively. In addition, the male sexual health questionnaire change pooled effect size was −0.55 (95% CI, −1.621 to 0.531; p = 0.321) from preintervention to postintervention at 3 months. Meta-analyses of some outcomes showed large statistical heterogeneity or evidence of publication bias. Conclusions: Aquablation seems to improve lower urinary tract symptoms in men with BPH while providing relatively preserved sexual function. Further research is required to confirm these preliminary results.

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Section: Discussionmentioning

confidence: 91%

Aquablation in men with benign prostate hyperplasia: A systematic review and meta-analysis

Chen¹,

Qin²,

Webb³

et al. 2022

Curr Urol

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“…Patients progress to surgical management after unsuccessful combination therapy. Surgical management is recommended to patients with refractory LUTS, recurrent urinary tract infections, recurrent bladder stones or gross haematuria with bladder outlet obstruction, persistent urinary retention secondary to BPH or high-pressure retention (23,30). Prospective 5-ARI administration before TURP has been indicated to reduce the level of surgical bleeding (31).…”

Section: Benign Prostatic Hyperplasiamentioning

confidence: 99%

5-alpha reductase inhibitors use in prostatic disease and beyond

Chislett¹,

Chen²,

Perera³

et al. 2023

Transl Androl Urol

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in use today (1,2). Their effect relies on the inhibition of the 5-alpha reductase (5α-reductase) enzyme which aids in the conversion of testosterone to dihydrotestosterone (DHT) (3).Since its introduction, the clinical indication for 5-ARIs has grown from BPH to include androgenetic alopecia (AGA) and hirsutism (1). As more pathological processes are identified as being mediated by DHT, the clinical

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“…Several treatments are established in the management of BPH-related symptoms. 2 Alpha blockers and 5-alpha reductase inhibitors are often utilized as first-line pharmacological treatment, although symptoms can remain refractory to medical therapy alone. Surgical intervention encompassing endoscopic and open urological techniques are available, with transurethral resection of prostate (TURP) remaining the reference surgical treatment for BPH.…”

Section: Tablementioning

confidence: 99%

The State of Evidence in Prostate Artery Embolization

Qamhawi

Little

2022

Semin intervent Radiol

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Prostate artery embolization (PAE) has emerged over the past two decades as a minimally invasive, nonsurgical treatment for benign prostatic hypertrophy (BPH). While the majority of evidence for PAE stems from retrospective cohort studies, several seminal randomized controlled trials have been performed comparing short-term outcomes of PAE to transurethral resection of prostate (TURP) and against a sham procedure. Across clinical trials, PAE demonstrates consistent improvement in urological symptoms and quality of life in patients with BPH with low complication rates. When compared to TURP, the results are comparable, but there is a trend for better outcomes in certain clinical parameters with TURP. PAE is a suitable option for patients who are not surgical candidates, prefer nonsurgical treatment with an earlier return to routine activities, and wish to better preserve sexual function.

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Modern best practice in the management of benign prostatic hyperplasia in the elderly

Cited by 41 publications

References 35 publications

Aquablation in men with benign prostate hyperplasia: A systematic review and meta-analysis

Aquablation in men with benign prostate hyperplasia: A systematic review and meta-analysis

5-alpha reductase inhibitors use in prostatic disease and beyond

The State of Evidence in Prostate Artery Embolization

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