BPH/LUTS: OTC alpha-blocker use feasible

July 6, 2017

Studies of bipolar plasma vaporization of the prostate and thulium vapoenucleation were among the other noteworthy research in BPH/LUTS presented at the AUA annual meeting in Boston.

Doreen E. Chung, MDStudies of bipolar plasma vaporization of the prostate and thulium vapoenucleation were among the other noteworthy research in BPH/LUTS presented at the AUA annual meeting in Boston. The take-home messages were presented by Doreen E. Chung, MD, of New York-Presbyterian, New York.

 

It seems feasible to use tamsulosin (Flomax) as an over-the-counter medication in men with LUTS. Among men shown a mock-up of drug packaging and asked if the medication would be appropriate for their use, 93% and 98% met appropriate self-selection criteria on unmitigated and mitigated analyses, respectively, and the decision to use tamsulosin appeared appropriate for most men, even among those with low health literacy.

 

At 5-year follow-up, bipolar plasma vaporization of the prostate (button TURP) appears to be safe and effective, but is associated with a 12% urethral stricture rate and 8% bladder neck contracture rate.

 

Thulium vapoenucleation appears to be a very durable procedure. At 5 years, medium PSA reduction was 77%, stricture and bladder neck contractor rate was 3%, and 2% of patients required retreatment for recurrent tissue.

 

A comparison of tadalafil (Cialis), 5 mg daily, with a complementary medicine regimen consisting of three ingredients found no differences in change in International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR), but fewer adverse events were seen with the complementary therapy.

 

In men with lower urinary tract symptoms (LUTS), transdermal testosterone replacement plus tadalafil, 5 mg daily, versus tadalafil alone showed similar overall improvements in IPSS, Qmax, and PVR, but greater improvements were seen with the combination therapy in quality of life and the IPSS storage subscore.

 

 

Continue to the next page for more take-home messages.

 

  • A Cochrane review and meta-analysis comparing desmopressin to other interventions for nocturia in men with LUTS found desmopressin was associated with a decrease in nocturnal voids of approximately one per night, and similar reductions were seen with alpha-blockers. The quality of evidence overall was low.

  • In patients with BPH and overactive bladder, silodosin (Rapaflo), 8 mg, plus fesoterodine (Toviaz), 4 mg, and silodosin plus mirabegron (Myrbetriq), 50 mg, showed similar improvements in symptom scores at 12 weeks, but on urodynamics, the fesoterodine group had greater improvements in detrusor overactivity incidence.

  • A visual analog scale may be a good option to the IPSS in patients with low literacy. While 42% of patients needed help filling out the IPSS, only 10% needed help filling out the visual analog scale.

  • Metformin appears to inhibit proliferation of epithelial cells by suppressing expression of the IGF-1 receptor and may be protective against proliferation.

  • Study findings suggest a potential role for periprostatic fat pro-inflammatory secretome in BPH pathogenesis.

  • In men with moderate to severe BPH, the robot-assisted waterjet ablation system (Aquablation) appears to be superior to TURP in the treatment of large prostates as well as in preventing anejaculation events.

  • Outpatient radiofrequency thermal therapy using the RezÅ«m System showed very good improvements in IPSS, Qmax, and quality of life at 2 years and no new erectile dysfunction. Median lobe treatments can also be performed and were done in 31% of patients.

  • Men with prostate volume of 30-80 cc undergoing the prostatic urethral lift (UroLift) procedure experienced symptom improvement by 1 month, and improvements were durable to 5 years. Sexual function, including ejaculatory function, was preserved.

  • At 13-year follow-up, holmium laser enucleation of the prostate continued to be safe and effective with very few early or late complications.

  • Robotic simple prostatectomy appears safe and effective for the treatment of BPH, with good functional outcomes and low morbidity. Significant improvements were seen in IPSS, PVR, and Qmax at 7 months.

  • Photovaporization using the 180-watt GreenLight XPS laser appears to be an acceptable technique in patients with very large prostates (>200 grams). However, OR times, energy density, PSA drop at 2 years, and LUTS are a concern, and careful counseling is recommended.

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