This study was aimed to compare serial long-term postoperative changes in quality-of-life (QoL) between photoselective-vaporization (PVP) using 120W-High-Performance-System and holmium-laser-enucleation (HoLEP) in benign-prostatic-hyperplasia (BPH) patients and to identify factors influencing the QoL improvement at the short-term, mid-term and long-term follow-up visits after surgery. We analyzed 1,193 patients with a baseline QoL-index ≥2 who underwent PVP (n = 439) or HoLEP (n = 754). Surgical outcomes were serially compared between the two groups at up to 60-months using the International-Prostatic-Symptom-Score (I-PSS), uroflowmetry, and serum PSA. We used logistic regression analysis to identify predictors of QoL improvement (a reduction in the QoL-index ≥50% compared with baseline) at the short-term (12-months), mid-term (36-months), and long term (60-months) follow-up after surgery. In both groups, the QoL-index was decreased throughout the entire follow-up period compared with that at baseline. There were no significant differences in postoperative changes from the baseline QoL-index between the two groups during the 48-month follow-up, except at 60-months. The degree of improvement in QoL at 60-months after HoLEP was greater than that after PVP. A lower baseline storage-symptom-subscore and a higher bladder-outlet-obstruction-index (BOOI) were independent factors influencing QoL improvement at the short-term. No independent factor influences QoL improvement at the mid- or long-term.
Based on permutation importance (Figure 1C, 1D), key predictors were age (p ¼ 0.002) and autonomic dysfunction (p < 0.001) for LUTS trajectory and BMI (p ¼ 0.02) for UI.CONCLUSIONS: LUTS/UI are prevalent complications in men and women with T1DM. A limited number of factors were identified in delineating subphenotypes of LUTS/UI. These data may be relevant to future investigations of mechanisms for distinct endotypes of LUTS/UI, as well as candidates for interventions targeting metabolic factors contributing to variation in symptoms.
and recorded in accordance with the Clavien-Dindo classification system. Statistical analysis was performed using a Mann-Whitney U test. RESULTS: 969 cases of HoLEP were performed at our centre between December 2003 and October 2016. There was a statistically significant improvement in both urinary flow rate and post-void residual volumes (p<0.0001). Median pre-operative flow rate was 8.4ml/s (range 1-26.3) (n¼536) and post-operative flow rate was 19.5ml/s (range 1.8-68.4) (n¼649). Median pre-operative post-void residual volumes were 263mls (range 0-5000) (n¼718) and post-operative residual volumes were 71mls (0-1000).188 patients (23.6%) were discharged from hospital on the day of surgery; 479 (60.1%) on day 1; 85 (10.7%) on day 2; 45 (5.6%) stayed 3 days or more (n¼797). Post-operative early and late complications are recorded within the table. CONCLUSIONS: HoLEP is an effective and safe treatment for bladder outflow obstruction associated with few early and late complications.
well-tolerated in men with BPH. Importantly, treatment with PDE5 inhibitors is not associated with sexual dysfunction-related side effects in men with BPH. Tadarafil appeared on the Japanese market in 2014 as a PDE5 inhibitor, and it provides a new treatment option for BPH. Currently, there are few published studies on the long-term persistence with these drug therapies among BPH patients. The purposes of this study were to evaluate BPH pharmacotherapy persistence.METHODS: Patients 40 years of age or older who received an BPH diagnosis and BPH medication prescription for three a1Bs and one PDE5 inhibitor were identified from September 2013 to September 2017. The study cohort consisted of 1,970 BPH patients in Aichi Medical University Hospital. Medication status such as persistence, switching, adherence and the reasons for discontinuation were examined. Persistence was measured by the length of continuous medication with BPH drugs. Time to discontinuation was defined as the number of days between the first dispense date and the expected end date of the last refill. The cumulative incidence of medication persistence was estimated using Kaplan-Meier method. Patients who remained on treatment until the end of the follow-up were regarded as censored data, and the length of follow-up period was assigned as the time of persistence. The proportion of persistence was compared according to each drug using the log-rank test.RESULTS: The mean patient age were 71.0 years, and the following drugs were prescribed to BPH patients for 684 of tamsulosin, 252 of naftopidil, 882 of silodosin, and 152 of tadalafil. The 1-year persistence rate of each drug were 28.0%, 34.8%, 44.1%, and 47.2%, respectively. The median of time to discontinuation were 70 days, 168 days, 252 days, and 371 days, respectively. Patients taking tadalafil demonstrated statistically significantly greater adherence than those taking alpha a1Bs. As for the medication sequence of the Tadalafil, percentage of a1B-naïve patients was 17.4%, percentage of patients who switch from a1B to Tadalafil was 27%, and percentage of patients who received combination therapy with an a1B was 28%.CONCLUSIONS: Tadalafil was associated with higher levels of persistence and adherence than a1Bs in our large and long-term cohort.
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