Invasive and Minimally Invasive Treatment Modalities for Lower Urinary Tract Symptoms: What Are the Relevant Differences in Randomised Controlled Trials?

Tubaro, Andrea; Vicentini, Carlo; Renzetti, Roberto; Miano, Lucio

doi:10.1159/000052397

Cited by 27 publications

(30 citation statements)

References 93 publications

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“…Although the popularity of medical therapy recently increased, the functional results of BPH treatment are still much better after surgery. After medical and surgical treatment, the respective mean of symptoms severity decreased from 30 to 60% vs. 60 to 90%, and the respective mean of peak urinary flow rate (Q max ) increased to 40 vs. 140% [1,2] . Nonetheless, the improvement in the results of separate functions does not always imply that the treatment is beneficial because up to 20% of the patients had unfavorable results after transurethral resection of the prostate (TURP) [3,4] .…”

Section: Introductionmentioning

confidence: 99%

Transition Zone Index and Bothersomeness of Voiding Symptoms as Predictors of Early Unfavorable Outcomes after Transurethral Resection of Prostate

Milonas¹,

Šaferis²,

Jievaltas³

2008

Urol Int

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Introduction: The objective of this study was to establish the influence of preoperative parameters on unfavorable outcomes after transurethral resection of the prostate. Patients and Methods: In a prospective study, 90 patients underwent transurethral resection of the prostate. The standardized protocol was used to investigate parameters, preoperatively and after 6 months. The baseline values were analyzed with respect to the probability of predicting the effectiveness of the outcome. Results: All preoperative parameters changed significantly, from 55.1 to 116% (p < 0.001). Treatment was effective for 85.6% of the patients, and the outcomes were unfavorable for 14.4%. The monovariate analysis detected the transition zone index (cut-off 0.48, p = 0.002, OR 7.48) as independent predictor of ineffective outcome. Logistic regression analysis found two the most important parameters – transition zone index (OR 30.26, p = 0.002) and bothersomeness of voiding symptoms (OR 20.7, p = 0.008) for unfavorable outcomes. Conclusions: The parameters that are traditionally used cannot predict unfavorable outcomes. The transition zone index and bothersomeness of voiding symptoms are most important parameters for predicting an unfavorable outcome after TURP.

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Section: Introductionmentioning

confidence: 99%

Transition Zone Index and Bothersomeness of Voiding Symptoms as Predictors of Early Unfavorable Outcomes after Transurethral Resection of Prostate

Milonas¹,

Šaferis²,

Jievaltas³

2008

Urol Int

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“…Bei Miktionsbeschwerden aufgrund eines benignen Prostatahyperplasiesyndroms (BPS) stehen den Patienten eine Vielzahl von Therapieoptionen zur Verfügung [6,9,12,17,18]. Zu unterscheiden ist zwischen den konservativen Möglichkeiten und den operativ/interventionellen Verfahren.…”

Section: Bph-syndromunclassified

“…So sind objektivierbare Befundverbesserungen auch nachweislich im Langzeitverlauf möglich. Die TUR-P gilt heute unverändert als goldener Standard zur Behandlung des BPH-Syndroms.Thermotherapie sowie die meisten "Laserverfahren" können bei symptomatischen Patienten mit nur geringer benigner Prostataobstruktion (BPO) empfohlen werden.Mit der Holmium-Laser-Resektion und der transurethralen Vaporisation der Prostata sind bisher gute Ergebnisse erzielt worden; Langzeitergebnisse fehlen allerdings.Harnröh-renstents haben, wenn überhaupt, nur Bedeutung bei Hochrisikopatienten.Bei Miktionsbeschwerden aufgrund eines benignen Prostatahyperplasiesyndroms (BPS) stehen den Patienten eine Vielzahl von Therapieoptionen zur Verfügung [6,9,12,17,18]. Zu unterscheiden ist zwischen den konservativen Möglichkeiten und den operativ/interventionellen Verfahren.…”

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Benignes Prostatahyperplasie-(BPH)-Syndrom

Zwergel¹

2001

Der Urologe A

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Urologe [A] 4•2001 | 319Fort-und Weiterbildung BPH-SyndromDie konventionellen Operationen (transurethrale Resektion der Prostata (TUR-P) bzw. die offenen Adenomektomien für große Prostatadrüsen) stellen eine kausale und effektive Therapie mit sicherer Gewebeentfernung dar. So sind objektivierbare Befundverbesserungen auch nachweislich im Langzeitverlauf möglich. Die TUR-P gilt heute unverändert als goldener Standard zur Behandlung des BPH-Syndroms.Thermotherapie sowie die meisten "Laserverfahren" können bei symptomatischen Patienten mit nur geringer benigner Prostataobstruktion (BPO) empfohlen werden.Mit der Holmium-Laser-Resektion und der transurethralen Vaporisation der Prostata sind bisher gute Ergebnisse erzielt worden; Langzeitergebnisse fehlen allerdings.Harnröh-renstents haben, wenn überhaupt, nur Bedeutung bei Hochrisikopatienten.Bei Miktionsbeschwerden aufgrund eines benignen Prostatahyperplasiesyndroms (BPS) stehen den Patienten eine Vielzahl von Therapieoptionen zur Verfügung [6,9,12,17,18]. Zu unterscheiden ist zwischen den konservativen Möglichkeiten und den operativ/interventionellen Verfahren. Die konventionellen chirurgischen Optionen und die wesentlichen interventionellen Therapiemöglichkeiten und deren aktuelle Bedeutung werden dargestellt. Operative Therapie des benignen ProstatahyperplasiesyndromsBei Patienten mit erheblichen obstruktiven Miktionsbeschwerden und gleichzeitig nachweisbarer großer, insbesondere endovesikal wachsender Prostata ist in der Regel die vollständige Entfernung der benignen Prostatahyperplasie notwendig. Dies kann endoskopisch (transurethral) oder offen-chirurgisch erfolgen.᭤Absolute Operationsindikationen gelten für Patienten mit: q rezidivierenden Harnverhalten, q immer wiederkehrenden Harnwegsinfekten, q gleichzeitig nachweisbaren Blasensteinen, q rezidivierenden Makrohämaturien und q Niereninsuffizienz, soweit sie als Folge des BPH-Syndroms auftreten. ᭤ Absolute OperationsindikationenUrologe A 2001 · 40:319-329

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“…Although medical therapy has recently become more popular, the functional results of BPH treatment are still much better after surgery. After medical and surgical treatment, the respective mean of symptoms severity decreased from 30% to 60% vs. 60% to 90%, and the respective mean of peak urinary flow rate (Qmax) increased to 40% vs. 140% (1,2). Nonetheless, the improvement in the results of separate functions does not always imply that the treatment is beneficial because up to 20% of the patients had unfavorable results after transurethral resection of the prostate (TURP) (3,4).…”

Section: Introductionmentioning

confidence: 99%

“…Comparing all BPH interventional treatment modalities, functional results are the best after an open operation (1,5). During the open surgery, up to 97% of transition zone can be enucleated and that has a direct impact on the outcome (6).…”

Section: Introductionmentioning

confidence: 99%

Significance of operative parameters on outcomes after transurethral resection of the prostate

Milonas¹

2010

Medicina

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as the strongest independent predictor of ineffective outcome. Logistic regression analysis revealed two important parameters of unfavorable outcomes: residual prostatic weight ratio (cutoff value, 0.71; P<0.001; OR, 62.16) and residual prostate weight (cutoff value, 26.6 mL; P=0.013; OR, 9.98). When the values of both these parameters were lower than their cutoff values, the probability of an ineffective outcome was reduced to 3%; however, when they were higher, the probability of an unfavorable outcome was increased to 95%.Conclusions. Residual prostatic weight ratio and residual prostatic weight are significant operative parameters for the prediction of outcomes after transurethral resection of the prostate.

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Invasive and Minimally Invasive Treatment Modalities for Lower Urinary Tract Symptoms: What Are the Relevant Differences in Randomised Controlled Trials?

Cited by 27 publications

References 93 publications

Transition Zone Index and Bothersomeness of Voiding Symptoms as Predictors of Early Unfavorable Outcomes after Transurethral Resection of Prostate

Transition Zone Index and Bothersomeness of Voiding Symptoms as Predictors of Early Unfavorable Outcomes after Transurethral Resection of Prostate

Benignes Prostatahyperplasie-(BPH)-Syndrom

Significance of operative parameters on outcomes after transurethral resection of the prostate

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