Impact of Changing Trends in Medical Therapy on Surgery for Benign Prostatic Hyperplasia Over Two Decades

This study aimed to assess efficacy and safety data from pilot trials of the radial extracorporeal shock wave therapy (rESWT) to treat benign prostatic hyperplasia (BPH) refractory to current medical therapy. A total of 29 men with lower urinary tract symptoms (LUTS) suggestive of BPH who had responded poorly to medical therapy for at least 6 months and were poor surgical candidates were enrolled. Each participant was treated with rESWT once a week for 8 weeks, each by 2000 impulses at 2.0 bar and 10 hertz of frequency. International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) were evaluated before treatment, after the fourth and eighth rESWT, and 3 months after the end of treatment. Peak urinary flow ( Qmax) and postvoid residual (PVR) were assessed. Safety was also documented. Statistically significant clinical improvements were reported for IPSS, QoL, and IIEF-5 after treatment, and those were sustained until 3 months follow-up. Qmax and PVR improved evidently at 8 weeks with a 63% and 70% improvement, respectively. The only adverse event was the occasional perineum pain or discomfort, which usually disappeared within 3 days. The rESWT may be an effective, safe, and noninvasive treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates.

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Medical therapy for benign prostatic hyperplasia: the road ahead

British Journal of Urology ◽

10.1111/j.1464-410x.1997.tb00808.x ◽

1997 ◽

Vol 79 (S1) ◽

pp. 92-96 ◽

Cited By ~ 3

Author(s):

R.S. KIRBY

Keyword(s):

Benign Prostatic Hyperplasia ◽

Medical Therapy ◽

Prostatic Hyperplasia ◽

The Road

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Effects of Medical Therapy or Surgery on Prostatic and Bladder Resistive Indices in Patients with Benign Prostatic Hyperplasia

Urologia Internationalis ◽

10.1159/000363581 ◽

2014 ◽

Vol 94 (2) ◽

pp. 181-186 ◽

Cited By ~ 2

Author(s):

Suleyman Bulut ◽

Cuneyt Ozden ◽

Binhan Kagan Aktas ◽

Tagmac Deren ◽

Suleyman Tagci ◽

...

Keyword(s):

Benign Prostatic Hyperplasia ◽

Medical Therapy ◽

Power Doppler ◽

Urine Volume ◽

Prostatic Hyperplasia ◽

Doppler Imaging ◽

Urinary Flow ◽

Once Daily ◽

Urinary Tract Symptoms ◽

Posttreatment Period

Introduction: The effects of medical therapy or surgery on bladder and prostatic resistive indices (RIs) in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) were evaluated in the present study. Patients and Methods: A total of 124 consecutive LUTS/BPH patients who were candidates for medical therapy (alfuzosin 10 mg once daily, n = 66) or surgery (transurethral prostatectomy (TUR-P), n = 58) were prospectively included. Baseline assessment of patients was performed with the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and prostatic and bladder RIs measured using power Doppler imaging (PDI). All patients were re-evaluated 3 months after treatment measuring the same parameters. Results: Following medical therapy, mean IPSS (17.2 ± 5.1 vs. 8.3 ± 5.3, p = 0.0001), postvoiding residual (PVR) urine (80.0 ± 80.5 vs. 40.3 ± 38.6, p = 0.0001), and prostatic RI (0.73 ± 0.1 vs. 0.70 ± 0.1, p = 0.0001) were decreased, Qmax (13.7 ± 4.2 vs. 16.9 ± 5.9, p = 0.0001) was increased, and bladder RI remained unchanged (0.70 ± 0.1 vs. 0.70 ± 0.1, p = 0.68). Mean IPSS (25.3 ± 5.6 vs. 6.0 ± 4.5, p = 0.0001), PVR urine volume (134.5 ± 115.5 vs. 35.7 ± 25.9, p = 0.0001), and prostatic (0.78 ± 0.1 vs. 0.67 ± 0.04, p = 0.0001) and bladder RIs (0.72 ± 0.1 vs. 0.64 ± 0.04, p = 0.005) were decreased, and Qmax (8.0 ± 4.5 vs. 17.2 ± 8.2, p = 0.0001) was increased after TUR-P. Conclusions: Our results demonstrated that TUR-P decreased both prostatic and bladder RIs, while α-blocker therapy did not change bladder RI in the early posttreatment period in LUTS/BPH patients.

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