Publications by authors named "Bilal Chughtai"

224 Publications

Where Is Research in the Era of Electronic Health Records?

Perm J 2022 Jul 20:1-3. Epub 2022 Jul 20.

Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA.

Introduction Data extraction from electronic health records (EHRs) for use in clinical research continues to be labor-intensive and to offer little benefit over traditional paper chart reviews. This is largely due to poor integration of EHR systems with hospital process flow, which still relies heavily on traditional paperwork as a means of documentation. Discussion New methods in data collection through mobile applications have streamlined data entry through better data standardization and improved overall data quality. However, mobile applications address only a portion of the problem. Data entry errors and legacy integration will continue to be an issue when there are changes between practitioners with different EHR systems. The combination of a mobile application with the cloud platform has been applied in multiple specialties to monitor recovery and patient-reported outcomes. Conclusion Mobile applications along with a virtual cloud environment to host data provide a reasonable solution for consolidating patient data and can accelerate population research.
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http://dx.doi.org/10.7812/TPP/22.030DOI Listing
July 2022

Use of the penile cuff test to diagnose bladder outlet obstruction: A systematic review and meta-analysis.

Low Urin Tract Symptoms 2022 Jun 18. Epub 2022 Jun 18.

Department of Urology, Weill Cornell Medical College, New York, New York, USA.

Purpose: Among noninvasive modalities for assessing bladder outlet obstruction (BOO), the penile cuff test (PCT) is the most used in clinical practice. The purpose of this review was to evaluate the performance of PCT in diagnosing and managing BOO.

Materials And Methods: PubMed, Scopus, CINAHL, Embase, Cochrane Library, and Web of Science were searched for studies investigating use of PCT for BOO. Studies evaluating diagnostic parameters, inter-observer agreements, or treatment outcomes using PCT were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed (PROSPERO ID: CRD42022300047). A proportional meta-analysis was done for diagnostic accuracy proportions. The Egger's and the Begg-Mazumdar rank-correlation tests were used to assess publication bias. Risk of bias was assessed using the Gradings of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria.

Results: Of the 272 articles retrieved, 17 were included in qualitative synthesis and meta-analysis was performed on five studies (comprising 448 patients). Two studies evaluating inter-observer agreement demonstrated 95% agreement and five studies evaluating procedures reported a 66%-80% surgical success rate on obstructed patients using PCT. From the proportional meta-analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.85 (95% CI 0.71-0.95) 0.78 (95% CI 0.67-0.87), 0.74 (95% CI 0.52-0.91), and 0.87 (95% CI 0.73-0.96), respectively. Publication bias was noted for PPV but not for sensitivity, specificity, or NPV. Based on the GRADE criteria, there were two low, six moderate, and nine high-quality studies.

Conclusions: PCT performs sufficiently in diagnosing and managing BOO. However, due to variability in obstruction criteria assessment, more studies comparing diagnostic criteria are warranted.
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http://dx.doi.org/10.1111/luts.12454DOI Listing
June 2022

Pharmacotherapy vs. minimally invasive therapies as initial therapy for moderate-to-severe benign prostatic hyperplasia: a cost-effectiveness study.

Prostate Cancer Prostatic Dis 2022 Jun 10. Epub 2022 Jun 10.

Division of Urology Krembil Research Institute, University Health Network, Toronto, ON, Canada.

Background: Recently, minimally invasive therapies (MITs), such as water vapor thermal therapy (WVTT) and prostatic urethral lift (PUL) have become an alternative to surgery or pharmacotherapy to manage benign prostatic hyperplasia (BPH), offering symptom relief with a favorable safety profile. The objective of this study was to evaluate the cost-utility of MITs (WVTT and PUL) compared to pharmacotherapy as initial treatment for patients with moderate-to-severe BPH.

Methods: In this model-based economic evaluation we simulated BPH progression in men (mean age 65 years, average International Prostate Symptom Score 16.6) over their lifetime and estimated healthcare costs (from the US public payer perspective) per quality-adjusted life year (QALY), discounted at 3% annually. Various clinical scenarios were evaluated given that most men undergo several lifelong therapies up to surgical intervention and potentially thereafter. As such, in the study model men could receive up to three lines of therapy: (1) initial pharmacotherapy with MIT as second-line, and transurethral resection of the prostate (TURP) or pharmacotherapy as third-line; (2) initial MIT (WVTT or PUL) with MIT again, TURP or pharmacotherapy as second-line, and TURP as third-line. Model was populated using data from the published literature. Probabilistic analyses were performed.

Results: Initial treatment with WVTT led to the highest QALYs (13.05) and the lowest cost ($15,461). The cumulative QALYs and lifetime costs were 12.92 QALYs and $20,280 for pharmacotherapy followed by WVTT, 12.87 QALYs and $22,424 for pharmacotherapy followed by PUL, 12.86 QALYs and $20,930 for initial treatment with PUL. In the cost-utility analysis, WVTT as initial treatment dominated all three strategies, i.e., generated more QALYs at a lower cost.

Conclusion: WVTT is an effective and cost-saving procedure, and may be an appropriate first-line alternative to pharmacotherapy for moderate-to-severe BPH patients who seek faster improvement and no lifelong commitment to daily medications.
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http://dx.doi.org/10.1038/s41391-022-00561-2DOI Listing
June 2022

Micro-cost analysis of single-use vs. reusable cystoscopy in a single-payer healthcare system.

Can Urol Assoc J 2022 May 20. Epub 2022 May 20.

Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.

Introduction: Single-use flexible diagnostic cystoscopy has recently been developed with comparable functionality to reusable cystoscopes. Prior studies have demonstrated considerable upfront costs of reusable cystoscopy. The objective of this study was to compare costs of reusable cystoscopy to single-use cystoscopy in a single-payer, socialized healthcare system.

Methods: A retrospective micro-cost analysis of reusable cystoscopy in a combined inpatient and outpatient setting at a single institution was performed. The cost analysis was divided into capital, maintenance, reprocessing, and labor. Annual costs were averaged over two fiscal years. Costs were amortized over 5- and 10-year basis as appropriate. The results were compared to theoretical costs of single-use cystoscopes.

Results: There were 3415 annual average cystoscopy cases with 171 cases per reusable cystoscope. The capital, maintenance, reprocessing, and labor costs of reusable cystoscopy are $96 000, $99 867, $247 855, and $65 317, respectively. The total annual costs per case for reusable and single-use cystoscopy are $149.06 and $245.57, respectively. The costs of reusable cystoscopy decrease with the number of procedures per year and intersect the costs of single-use cystoscopes at 1265 procedures per year. All costs are CAD.

Conclusions: The cost-effectiveness of reusable cystoscopes is dependent on cystoscopy volume due to considerable upfront costs. Single-use cystoscopes are more cost effective if the total number of cases performed is less than 1265 per year. Additional investigation into the cost-effectiveness of single-use cystoscopes as supplements in the outpatient setting or primary endoscopes in inpatient/emergency settings should be performed.
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http://dx.doi.org/10.5489/cuaj.7828DOI Listing
May 2022

Adverse Events for Overactive Bladder Medications From a Public Federal Database.

Female Pelvic Med Reconstr Surg 2022 Jul 17;28(7):429-435. Epub 2022 May 17.

From the Weill Cornell Medicine/New York Presbyterian Hospital.

Importance: Clinical data on the use of overactive bladder (OAB) medications are limited by the physician interpretation of adverse effects rather than those that are patient reported.

Objective: The aim of the study was to evaluate the association between OAB medications and adverse drug events (ADEs) through the self-reporting U.S. Food and Drug Administration Adverse Event Report System database.

Study Design: The U.S. Food and Drug Administration Adverse Event Report System (FAERS) database was queried from 2004 to 2019. Adverse drug events were recategorized. Disproportionality analysis was used to detect the risk signals for each OAB medication and ADEs. χ 2 values were calculated to assess the association between ADEs and dosage.

Results: A total number of 14,102 reports were identified. The most frequently reported OAB medications were mirabegron (35%), transdermal oxybutynin (27%), and solifenacin (25%). Neuropsychiatric (NP) ADEs were highest with tolterodine and fesoterodine usage (16% and 15.6%, respectively) and transdermal oxybutynin had the lowest (6.5%). Increasing the dose of tolterodine or fesoterodine was not associated with increased NP ADEs. Oxybutynin had the highest risk of affect/mood disorder, agitation, and balance/movement disorder; however, it had the lowest risk of headache/migraine compared with all OAB medications. Mirabegron compared with all other OAB medications had the lowest risk of affect/mood disorder and agitation; however, it had the highest risk of headache and migraines.

Conclusions: The FAERS database not only is a repository of ADEs but also may represent evolving prescribing habits for OAB medications. Transdermal oxybutynin had the lowest NP ADEs and may be appropriate for selected individuals.
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http://dx.doi.org/10.1097/SPV.0000000000001190DOI Listing
July 2022

Rezum to the rescue: Early outcomes of Rezum on patients with recurrent lower urinary tract symptoms after surgical interventions for benign prostatic enlargement.

Andrologia 2022 Sep 26;54(8):e14450. Epub 2022 Apr 26.

Division of Urology, University Health Network, University of Toronto, Toronto, Canada.

We aim to report the short-term outcomes of patients undergoing Rezum as a re-treatment intervention for recurrent lower urinary tract symptoms after prior surgical treatment for benign prostate enlargement. Data from two institutions for baseline International Prostatic Symptom Score with Quality of life item, prostate size, and maximum flow-rate was acquired. Patients were assessed 3-month post-treatment. Outcomes were compared with unpaired t-tests and Fisher's exact tests. Nineteen patients were included. Prior surgical interventions included transurethral resection of the prostate (31.6%, n = 6), Urolift (26.3%, n = 5), transurethral bladder neck incision (15.8%, n = 3), prostate artery embolization (10.5%, n = 2), transurethral needle ablation, greenlight photovaporization of prostate and Rezum (5.3%, n = 1 each). Median age was 69.0 years (IQR 14; range 59-87 years) with a median prostate volume of 65.0 ml (IQR 63; range 22-160 ml). The median time to Rezum treatment was 48 months (IQR 78; range 9-240 months). 63.1% (n = 12) were re-started on benign prostatic enlargement medication and 36.8% (n = 7) had recurrent bothersome symptoms before re-treatment with Rezum. At 3-month follow up, median International Prostatic Symptom Score decreased from 23 to 9 (p < 0.001) and Quality of life from 4 to 2 (p < 0.001). Median maximum flow-rate improved after treatment from 8.6 to 14.8 ml/s (p < 0.001). None of the patients were required to restart medication for benign prostate enlargement.
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http://dx.doi.org/10.1111/and.14450DOI Listing
September 2022

WATER vs WATER II 3-Year Update: Comparing Aquablation Therapy for Benign Prostatic Hyperplasia in 30-80 cc and 80-150 cc Prostates.

Urology 2022 Jul 22;165:268-274. Epub 2022 Apr 22.

Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada. Electronic address:

Objective: To compare the outcomes of Aquablation for small-to-moderate (30-80cc) prostates with the outcomes for large (80-150 cc) prostates at 3-year follow up.

Methods: WATER is a prospective, double-blind, multicenter, international clinical trial comparing the safety and efficacy of Aquablation and TURP in the treatment of LUTS/BPH in men 45-80 year with a prostate of 30cc-80cc. WATER II is a prospective, multicenter, single-arm international clinical trial of Aquablation in men with a prostate of 80cc-150cc. We compare 36-mo outcomes amongst 116 WATER and 101 WATER II study subjects undergoing Aquablation.

Results: International Prostate Symptom Score (IPSS) scores improved from 22.9 and 23.2 at baseline in WATER and WATER II, respectively, to 8.0 and 6.5 at 36-month, with 36-mo reductions of 14.4 and 16.3 points, respectively (P = .247). At baseline, urinary flow rate (Qmax) was 9.4 and 8.7 cc/sec in WATER and WATER II, improving to 20.6 and 18.5 cc/sec, respectively (P = .552) at 36-mo. Improvements in both IPSS and Qmax were immediate and sustained throughout follow-up. At 3 year, 98% and 94% of treated patients were BPH medication-free in WATER and WATER II, respectively (P = .038). At 3yr, 96% and 97% of treated patients were free from surgical retreatment in WATER and WATER II, respectively (P = .613).

Conclusions: Three-year follow-up demonstrates that Aquablation therapy leads to sustained outcomes, few irreversible complications, and low retreatment rates for the treatment of LUTS/BPH independently of prostate volume.
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http://dx.doi.org/10.1016/j.urology.2022.04.004DOI Listing
July 2022

Rezūm therapy for ≥80-mL benign prostatic enlargement: a large, multicentre cohort study.

BJU Int 2022 Apr 24. Epub 2022 Apr 24.

University of Montreal Hospital Center, Université de Montréal, Montreal, QC, Canada.

Objective: To evaluate the efficacy and safety of Rezūm therapy in benign prostatic hyperplasia (BPH) patients with prostates ≥80 mL.

Methods: A prospective registry was established at two high-volume Canadian centres. Patients had baseline medical history documented, and uroflowmetry and questionnaire results were recorded over 12 months.

Results: Eighty-three patients (median [interquartile range {IQR}] age 69.2 [63.2, 74.8] years) with a prostate size ≥80 mL were included. The median (IQR) prostate volume was 100.0 (88.5, 115.0) mL and 65% had a median lobe. Twenty-one patients had prior urinary retention. The median (IQR) number of injections was 13 (11, 15) and catheterization duration was 9 (7, 14) days. International Prostate Symptom Scores (IPSSs) improved by 24%, 57% and 59% at 1, 3 and 12 months, respectively (P < 0.001). IPSS Quality of Life (QoL) scores improved by 27%, 56% and 70% at these same timepoints (P < 0.001). Maximum urinary flow rate improved by 55% at 3 months (P = 0.002) and 59% at 12 months, and post-void residual urine volume improved by 58% at 3 months (P = 0.006). BPH Impact Index scores improved by 57% at 3 months and 71% at 12 months. International Index of Erectile Function-15 scores improved by 15% at 6 months, and Male Sexual Health Questionnaire for Ejaculatory Dysfunction scores improved by 22.4% at 1 month. Three patients (3.6%) noted reduced/anejaculation. No events of Clavien-Dindo grade III or higher occurred.

Conclusion: This study demonstrates, for the first time, the safety and efficacy of Rezūm therapy in large glands >80 mL. IPSS improved by 59% and IPSS QoL score improved by 70% at 12 months. Objective maximum urinary flow measures improved at 12 months by 59%, while erectile and ejaculatory function remained preserved.
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http://dx.doi.org/10.1111/bju.15753DOI Listing
April 2022

Differences in the Prevalence of Nocturnal Polyuria in the U.S. by Definition: Results from the Epidemiology of Nocturnal Polyuria Study.

J Urol 2022 07 21;208(1):144-154. Epub 2022 Apr 21.

SUNY Downstate Health Sciences University, Brooklyn, New York.

Purpose: Prevalence data on nocturnal polyuria (NP), nocturia caused by overproduction of urine during sleep, is primarily limited to men and varies by NP definition. This U.S.-representative epidemiological study of men and women ≥30 years old assessed the prevalence of NP.

Materials And Methods: Consenting participants completed the baseline EpiNP (Epidemiology of Nocturnal Polyuria) survey (eg Lower Urinary Tract Symptoms Tool, comorbidities). All reporting ≥2 voids/night and a target of 100 random respondents reporting 0 or 1 void/night were asked to complete 3-day bladder diaries. NP was defined as nocturnal polyuria index (NPI) >0.33 (NPI33) and nocturnal urine production >90 ml/hour (NUP90). Extrapolated prevalence was stratified by sex and subgroups: idiopathic (without underlying causes), associated with overactive bladder (NPOAB), bladder outlet obstruction (NPBOO; men) and comorbidities. Voided volumes and timing, including first uninterrupted sleep period, were assessed by subgroup.

Results: A total of 10,190 individuals completed the baseline survey; mean age (range) was 54.4 (30-95). A total of 3,938 individuals were invited to complete the diary; 1,763 (49.3%) completed 3-day bladder diaries. Urine production (maximum nighttime volume, total volume, nocturnal urine production, nocturia index) was higher in both men and women with idiopathic NP and comorbidities. The median number of nighttime voids was greatest for NPBOO in men and NPOAB in women. Bother associated with nighttime voiding differed by NP subgroup but was highest in NPBOO for men (NPI33: 69.6%; NUP90: 71.1%) and NPOAB for women (NPI33: 67.5%; NUP90: 66.0%).

Conclusions: This population-based NP prevalence study including men and women characterizes NP subgroups and provides insights into nocturia treatment by emphasizing factors influencing urine production versus factors influencing bladder capacity.
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http://dx.doi.org/10.1097/JU.0000000000002500DOI Listing
July 2022

Rezūm water vapor therapy for catheter-dependent urinary retention: a real-world Canadian experience.

Can J Urol 2022 04;29(2):11075-11079

University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada.

Introduction: This analysis reported outcomes of treating catheter-dependent urinary retention with Rezūm water vapor therapy.

Materials And Methods: A prospective registry was established at two high-volume Canadian centers. Patients had baseline medical and benign prostatic hyperplasia (BPH) history documented. The subgroup of patients with refractory, catheter-dependent urinary retention was analyzed. The primary outcome was the proportion of patients who were spontaneously voiding and catheter-free at 6 months.

Results: Sixteen patients (age: 68.7 years) with catheter-dependent urinary retention were treated with Rezūm. Average prostate volume was 84.4 mL and 75% had median lobe. All patients had at least one recent failed trial without catheter (TWOC) and 87.5% were on BPH oral therapy. Mean number of vapor injections was 14.5. Visibility and bleeding during procedure were assessed using a 5-point scale, and were rated as 1.4 and 1.3, respectively. Anesthesia was either intravenous propofol sedation (n = 13) or self-administered methoxyflurane inhaler (n = 3). Mean catheter duration until first planned TWOC was 28.4 days. Three patients needed catheter replacement due to initial failed TWOC. One patient was lost to follow up, one patient did not return at 1 month, and one patient did not return at 3 months. At 1 month, 13/14 patients were spontaneously voiding and catheter-free. At 3 months, 14/14 patients were spontaneously voiding, and at 6 months, 15/15 patients were spontaneously voiding and catheter-free (1 patient was lost to follow up).

Conclusions: Rezūm water vapor therapy can successfully treat catheter-dependent urinary retention after initial failed TWOC in an outpatient setting.
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April 2022

A comprehensive analysis of clinical, quality of life, and cost-effectiveness outcomes of key treatment options for benign prostatic hyperplasia.

PLoS One 2022 15;17(4):e0266824. Epub 2022 Apr 15.

Center for Male Health, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, United States of America.

Treatment options for men with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) have variable efficacy, safety, and retreatment profiles, contributing to variations in patient quality of life and healthcare costs. This study examined the long-term cost-effectiveness of generic combination therapy (CT), prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), photoselective vaporization of the prostate (PVP), and transurethral resection of the prostate (TURP) for the treatment of BPH. A systematic literature review was performed to identify clinical trials of CT, PUL, WVTT, PVP, and TURP that reported change in International Prostate Symptom Score (IPSS) for men with BPH and a prostate volume ≤80 cm3. A random-effects network meta-analysis was used to account for the differences in patient baseline clinical characteristics between trials. An Excel-based Markov model was developed with a cohort of males with a mean age of 63 and an average IPSS of 22 to assess the cost-effectiveness of these treatment options at 1 and 5 years from a US Medicare perspective. Procedural and adverse event (AE)-related costs were based on 2021 Medicare reimbursement rates. Total Medicare costs at 5 years were highest for PUL ($9,580), followed by generic CT ($8,223), TURP ($6,328), PVP ($6,152), and WVTT ($2,655). The total cost of PUL was driven by procedural ($7,258) and retreatment ($1,168) costs. At 5 years, CT and PUL were associated with fewer quality-adjusted life years (QALYs) than WVTT, PVP, and TURP. Compared to WVTT, the incremental cost-effectiveness ratios (ICERs) for both TURP and PVP were above a willingness-to-pay threshold of $50,000/QALY (TURP: $64,409/QALY; PVP: $87,483/QALY). This study provides long-term cost-effectiveness evidence for several common treatment options for men with BPH. WVTT is an effective and economically viable treatment in resource-constrained environments.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0266824PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9012364PMC
April 2022

Manufacturer and User Facility Device Experience Reporting of Events Related to Transvaginal Mesh: Understanding the Data.

Female Pelvic Med Reconstr Surg 2022 05 15;28(5):332-335. Epub 2022 Apr 15.

Department of Urology, Research Gender Affirming Surgery, Urologic Reconstruction, and Female Pelvic Medicine, San Diego, CA.

Objective: The aim of this study was to examine potential bias in reports to the Manufacturer and User Facility Device Experience (MAUDE) database involving vaginal mesh by identifying the party submitting the report, the nature of the complaints, and whether the reports were edited.

Methods: All reports submitted to the MAUDE database involving synthetic transvaginal mesh from January 2000 through December 2017 (40,266 safety reports) were identified. A random 2% sample (900) of these reports was reviewed in depth to determine the specific relevant details, including reporter type (patient, manufacturer, lawyer) and details of the complaint/injury.

Results: Of the 40,226 reports to MAUDE identified, 28,473 (70.7%) were sling reports, and 11,793 (29.3%) described mesh products augmenting pelvic organ prolapse repair. Of the 900 reports reviewed in depth, 46%, 41%, 10%, and 2% of entries were reported by the manufacturer, attorney, health care provider, and patients, respectively. In the 4 years after submission, 18.6% of reports were modified at least once.

Conclusions: The MAUDE database allows physicians, manufacturers, and patients to immediately report adverse events experienced due to medical devices. While this database is an important means to identify potential danger to patients, any individual can file a report and, thus, it should not be the sole source of evidence to consider when assessing device safety. Further, the MAUDE database provides no information into the total number of cases performed without complication.
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http://dx.doi.org/10.1097/SPV.0000000000001177DOI Listing
May 2022

The Role of Pessaries in the Treatment of Women With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Female Pelvic Med Reconstr Surg 2022 Jun 5;28(6):e171-e178. Epub 2022 Apr 5.

From the Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, NY.

Importance: Pessaries are an important conservative therapy for stress urinary incontinence (SUI), but few studies have comprehensively evaluated their utility.

Objective: The objective of this study is to evaluate the existing evidence on the efficacy and safety of pessaries for the treatment of SUI.

Study Design: We searched for the terms "stress urinary incontinence" and "pessar/y/ies/ium" in PubMed, Embase, and Cinhal on June 10, 2020. Studies that characterized subjective and/or objective data were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for SUI were excluded. Two reviewers independently screened and assessed data quality and risk of bias according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Ten studies, including 376 patients, were included. In terms of subjective outcomes, 76% of 72 patients reported feeling continent after pessary treatment compared with 0% of 86 patients surveyed before pessary use (P < 0.0001). Both Urinary Distress Inventory and Incontinence Impact Questionnaire scores decreased significantly by 46.7% (n = 155 baseline, n = 139 follow-up; P < 0.0001) and 67.8% (n = 139 baseline, n = 107 follow-up; P < 0.0001), respectively. Significant objective measures associated with pessary use included increased urethral closure pressure (n = 122; g = 0.56; 95% confidence interval [CI], -0.66 to 1.77; P < 0.049) and decreased pad weight (n = 129 baseline; n = 118 follow-up; g = -0.89; 95% CI, -1.986 to 0.19; P = 0.009). Adverse events significantly decreased at greater than 6 months follow-up compared with less than 6 months follow-up, including pain (31.5%, n = 29/92 vs 14.3%, n = 5/35; P = 0.0513) and discomfort (50%, n = 46/92 vs 29.3%, n = 12/41; P = 0.0268).

Conclusions: Based on both subjective and objective measures, pessaries are an effective conservative treatment option for SUI. This supports pessary use, though larger studies with longer-term follow-up are warranted.
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http://dx.doi.org/10.1097/SPV.0000000000001180DOI Listing
June 2022

Disproportional signal of sexual dysfunction reports associated with finasteride use in young men with androgenetic alopecia: A pharmacovigilance analysis of VigiBase.

J Am Acad Dermatol 2022 Mar 26. Epub 2022 Mar 26.

Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2022.03.037DOI Listing
March 2022

GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database.

World J Urol 2022 Jul 26;40(7):1755-1762. Epub 2022 Mar 26.

Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.

Purpose: We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database.

Methods: Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. Eligible study participants underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume.

Results: In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p < 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4-2.8, p < 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07-1.0, p = 0.02)]. PVR also decreased 93.1 ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6-152.6, p < 0.01).

Conclusion: We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.
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http://dx.doi.org/10.1007/s00345-022-03986-5DOI Listing
July 2022

I Can't Get No Satisfaction: Patient-reported Outcomes After Different Treatment Options for Lower Urinary Tract Symptoms.

Eur Urol Focus 2022 Mar 23;8(2):377-379. Epub 2022 Mar 23.

Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address:

Effective clinical management of benign prostatic obstruction is determined by the ability to address lower urinary tract symptoms as measured via patient-reported outcomes (PROs). Minimally invasive surgical therapies (MISTs) offer better erectile or ejaculatory side effects and potentially faster recovery time in comparison to transurethral resection of the prostate (TURP). Premature excitement for MISTs derives from prospective sham-controlled trials with several years of follow-up data. Currently there is a lack of randomized controlled trials that directly compare MISTs to TURP and of a clearer definition of treatment failure. These types of studies are important in comparing efficacy between treatments. In head-to-head comparison, TURP yields the most robust improvement in PROs when compared to MISTs. At best, MISTs may achieve equivalent urological symptom-relief profiles to TURP; however, noninferiority assessments are needed. MISTs are potentially advantageous for their side-effect profiles and lower complication rates, but consistency in reporting these data is needed. PATIENT SUMMARY: We looked at the current data on patient-reported outcomes after each type of treatment for lower urinary tract symptoms. We found that the efficacy of these procedures is difficult to compare given the lack of direct studies comparing new options to the standard procedure. We can only conclude that the standard procedure, transurethral resection of the prostate, will provide the best relief of voiding symptoms as reported by patients.
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http://dx.doi.org/10.1016/j.euf.2022.03.002DOI Listing
March 2022

A Community-Based Education Program for Overactive Bladder in a Predominantly Minority Older Female Population: A Pilot Study.

Urol Int 2022 23;106(7):664-671. Epub 2022 Mar 23.

Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, New York, USA.

Introduction: Knowledge gaps regarding available treatment and social stigmatization are barriers to care in patients with overactive bladder (OAB). We assessed the feasibility of an OAB education program targeting older community-dwelling females.

Methods: Community-dwelling women over 55 years old were recruited. Eligible participants underwent an education program covering continence-promotion strategies. The Overactive Bladder Questionnaire-Short Form and Short Form-12 were completed at baseline, 1 week, 3 months, and 6 months post-intervention to measure symptom bother and condition-specific and general quality of life (QoL). Data were analyzed using a linear mixed-effects model for repeated measures.

Results: Thirty-seven female patients with OAB symptoms at baseline were assessed with the majority from Latino/Hispanic or Black/African American ethnic/racial backgrounds. For our youngest subgroup (≤68 years old), significant improvements were observed at 3 and 6 months compared to 1 week post-intervention for symptom bother (3 months, -22.75, p = 0.006; 6 months, -25.76; p = 0.001) and condition-specific and health-related QoL subscale scores for concern (3 months, +23.76, p = 0.006; 6 months, +22.15, p = 0.011) and social interaction (3 months, +21.11, p = 0.017; 6 months, +20.51; p = 0.021). For all age subgroups, improvements in general QoL measures for mental health were seen at 3 and 6 months compared to baseline (3 months, +7.57, p = 0.02; 6 months, +6.70; p = 0.048).

Conclusions: Statistically significant improvements in symptom bother, condition-specific, and general QoL measures were observed following an OAB education program pilot study in a predominantly minority female population. Further studies are needed to support efficacy and optimize program design.
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http://dx.doi.org/10.1159/000522646DOI Listing
July 2022

Can Women Accurately Predict Their Voided Volumes?

Female Pelvic Med Reconstr Surg 2022 03;28(3):160-164

Division of Urology, Weill Cornell Medicine, New York, NY.

Importance: Voiding diaries can be onerous, we sought to investigate if some women can predict their voided volumes.

Objectives: The objective of this study is to determine the accuracy of estimated voided volumes and characteristics most predictive of accuracy.

Study Design: We prospectively collected data on 101 women undergoing urodynamics for lower urinary tract symptoms and/or prolapse at a tertiary care facility. Data collection included postvoid residual volume, urodynamic diagnosis, flow time and rate, and a 1-time measurement of voided volume into a blinded uroflow. Linear and logistic regression analyses were performed to examine predictors of estimated voided volume (mL).

Results: Mean age was 58.2 years (standard deviation, 12.8 years). The median estimated voided volume and actual voided volume were 240 and 215 mL, respectively. The average percent error was 15% (63% of patients being within a 30% margin of error and 32.7% being within a 20% margin of error). On linear regression analysis, smaller voids of 101 to 200 mL were associated with greater accuracy (R2 = 0.37 P = 0.001) and diagnosis of anxiety was associated with a higher voided volume percent error (P = 0.028). Logistic regression analysis revealed that for every 1 year increase in age, there was a 3% decrease in odds of predicting voiding volume within 30% (odds ratios, 0.97; P = 0.041).

Conclusions: Nearly two-thirds of women estimated their voided volume within 30% of the actual void and one-third of women could predict within 20%. This should be taken into consideration when obtaining patient history, particularly with age and diagnosis of anxiety, and may substantiate use of voiding diaries for accurate measurement in specific populations.
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http://dx.doi.org/10.1097/SPV.0000000000001148DOI Listing
March 2022

The gut, vaginal, and urine microbiome in overactive bladder: a systematic review.

Int Urogynecol J 2022 05 2;33(5):1157-1164. Epub 2022 Mar 2.

Department of Urology, Weill Cornell Medicine/New York Presbyterian Hospital, 525 E. 68th Street, New York, NY, 10021, USA.

Introduction And Hypothesis: The objective was to systemically review the current literature on the association of gut, vaginal, and urinary dysbiosis in female patients with overactive bladder (OAB).

Methods: We performed a comprehensive literature search following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols for systematic reviews. In the EMBASE, CINAHL, and Medline databases, a search was conducted using key words such as "microbiome," "microbiota," "microflora," "overactive bladder," "urge," "gut," "vaginal." Articles were screened using the online tool www.covidence.org . Two independent reviewers screened studies at each stage and resolved conflicts together. We excluded papers that discussed pediatric patients and animal studies. In total, 13 articles met this criterion, which included 6 abstracts.

Results: After identifying 817 unique references, 13 articles met the criteria for data extraction. Articles were published from 2017 to 2021. No study reported the same microbiota abundance, even in healthy individuals. Overall, there was a loss of bacterial diversity in OAB patients compared with controls. Additionally, the bacterial composition of the controls and OAB patients was not significantly different, especially if the urine was collected midstream. Overall, the composition of the microbiome is dependent on the specimen collection methodology, and the metagenomic sequencing technique utilized. OAB urine microbiome is more predisposed to alteration from the gut or vaginal influences than in controls.

Conclusions: Current evidence suggested a potential relationship among gut, vaginal, and urinary microbiome in OAB patients, but there are very limited studies.
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http://dx.doi.org/10.1007/s00192-022-05127-3DOI Listing
May 2022

Large, Multi-Center, Prospective Registry of Rezūm Water Vapor Therapy for Benign Prostatic Hyperplasia.

Urology 2022 Jul 17;165:261-267. Epub 2022 Feb 17.

University of Montreal Hospital Center, Université de Montréal, Montreal, Canada.

Objective: To illustrate the role of Rezūm convective water vapor ablation for treatment of lower urinary tract symptoms secondary to Benign prostatic hyperplasia.

Methods: A prospective registry was established for Rezūm therapy in Canada at two high-volume centers. All patients had baseline medical and Benign prostatic hyperplasia history documented, along with uroflowmetry and validated questionnaires up to 12 months post-surgery.

Results: 229 patients (mean age 67.3 years), including 83 with prostate volumes ≥80 mL, were treated from April 2019 to December 2020. The mean prostate volume was 71.5 mL (range 20-160 mL) and 55% had a median lobe. The mean number of injections was 11 (range: 4-28) and mean procedural length was 4.8 minutes (range: 1.5-14). The mean duration of postprocedure catheterization was 9.8 days. International Prostate Symptom Scores improved from baseline by 29%, 53%, and 59% at 1, 3, and 12 months, respectively. International Prostate Symptom Scores quality of life improved from baseline by 30%, 50%, and 67% at 1, 3, and 12 months, respectively. Qmax improved by 60% at 3 months and 74% at 12 months. Post-void residual volume improved by 51% and 61% at 3 and 12 months, respectively. No statistically significant changes were seen in International Index of Erectile Function-15 or Male Sexual Health Questionnaire for Ejaculatory Dysfunction scores. No Clavien-Dindo events ≥Grade III occurred.

Conclusion: Rezūm therapy is a safe, effective, and quick outpatient procedure for prostate glands over a wide range of volumes. Clinically significant improvements are seen in all validated questionnaires. Objective maximum flow measures improved, while erectile and ejaculatory function remains preserved.
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http://dx.doi.org/10.1016/j.urology.2022.02.001DOI Listing
July 2022

Natural history of lower urinary tract symptoms among men undergoing stereotactic body radiation therapy for prostate cancer with and without a Rectal Hydrogel Spacer.

World J Urol 2022 May 19;40(5):1143-1150. Epub 2022 Feb 19.

Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA.

Purpose: Stereotactic body radiation therapy (SBRT) is increasingly used for prostate cancer, but has morbidity as both the bladder and rectum are radiated during treatment. Our goal was to document and compare lower urinary tract symptoms (LUTS) among men who underwent SBRT with and without SpaceOAR hydrogel (Augmenix, Inc., Bedford, MA).

Methods: We performed a retrospective analysis of 87 men (50 SpaceOAR and 37 non-SpaceOAR) who underwent SBRT. Primary outcomes were patient reported symptoms during radiation therapy, pharmacotherapy usage, and urologic and bowel survey scores up to 6-months post-SBRT.

Results: 78% of men were on α-inhibitors at the end of SBRT, an increase from 27.6% baseline usage (p < 0.001). Post-SBRT urinary frequency was more common in the non-SpaceOAR group versus the SpaceOAR group (68% versus 38%, p = 0.006), as was nocturia (35% vs. 8%, p = 0.002). Acute gastrointestinal symptoms did not differ. 58.8% of men were on α-inhibitors at 6-months of follow-up post-SBRT, an increase from 27.6% baseline usage (p < 0.001). Importantly, there was a difference of α-inhibitor use between non-SpaceOAR and SpaceOAR groups at the end of SBRT and at 1.5-, 3-, and 6-months follow up (86% vs. 53% [p = 0.002], 83% vs. 53% [p = 0.005], 72% vs. 49% [p = 0.038], respectively).

Conclusion: LUTS after SBRT remains a significant problem for men undergoing treatment for prostate cancer. LUTS affects men during and up to 6-months following SBRT. Owing to these increased LUTS, preemptive minimally invasive solutions and their mechanisms of protection, including the SpaceOAR, should be further investigated.
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http://dx.doi.org/10.1007/s00345-022-03953-0DOI Listing
May 2022

Review of the Economics of Surgical Treatment Options for Benign Prostatic Hyperplasia.

Curr Urol Rep 2022 Jan 14;23(1):11-18. Epub 2022 Feb 14.

New York Presbyterian Hospital, Weill Cornell Medicine, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA.

Purpose Of Review: The goal of this paper is to review the literature detailing US-based analyses for cost and cost-effectiveness of surgical treatment options for benign prostatic hypertrophy (BPH) and associated LUTS.

Recent Findings: TURP offers the greatest degree of symptom improvement with its associated costs dependent upon operating room time, equipment, and length of hospital stay. Other studied surgical treatment modalities, including transurethral laser ablative, thermal ablative, and convective water vapor modalities as well as prostatic urethral lift and transabdominal procedures, generally carry higher costs and lower cost-effectiveness in both inpatient and outpatient settings, with specific exceptions. Compared to TURP, HoLEP and Greenlight PVP have demonstrated superior cost-effectiveness for mild, moderate, and severe BPH. Convective water vapor ablation, as with transurethral microwave/thermoablative therapies, has been observed to be less expensive per procedure than TURP on average. However, it conferred lower degrees of IPSS symptom improvement. Moreover, compared to TURP, prostatic artery embolization has demonstrated lower average costs coupled with inferior objective improvement in maximal flow rate, prostate volume reduction, PSA decline and minimal improvement in IPSS subjective outcome measures. For this review, selection bias, asymmetric patient groups, issues with study aggregation, and understudied cost contributors (including retreatment costs, long-term durability of symptom relief, recovery time, and work productivity limitations) were identified as key limitations. Nevertheless, this overview takes important steps to understand the costs of surgical treatment options for BPH, allowing for more informed clinical and policy decisions.
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http://dx.doi.org/10.1007/s11934-022-01083-zDOI Listing
January 2022

Pilot Study of "Less is More" Rezum for Treatment of BPH.

Urology 2022 Jul 6;165:256-260. Epub 2022 Feb 6.

Department of Urology, Weill Cornell Medical College, New York, NY. Electronic address:

Objective: To assess the outcomes of a "less is more" treatment approach consisting of a single water vapor treatment per prostate lobe for benign prostatic hyperplasia (BPH).

Methods: Retrospective cohort study in a single urologic clinic of men with moderate to severe symptomatic BPH with and without median lobes undergoing thermal water vapor therapy. Single injection of thermal water vapor was given in each prostate lobe. The primary endpoint compared maximum urine flow rate (Qmax), post-void residual (PVR), International Prostatism Symptom Score (IPSS), and the IPSS Quality of Life scale (IPSS QoL) at baseline and at 1, 3, 6, and 12 months.

Results: The study included 52 men with mean prostate volume and IPSS of 52.8cc and 20.3cc, respectively. IPSS was reduced by -3.95 ± 7.5 at 3 months (P = .02875), -8.5 ± 9.3 at 6 months (P = .01767), and -11.63 ± 8.4 at 12 months (P = .005908). IPSS QoL improved by -1.75 ± 1.2 t 12 months (P = .003799) and QMax by 5.36 ± 3.7 mL/s at 12 months (P = .008445). Time to post-operative catheter removal was 3.5 ± 1.3 days. One patient reported ejaculatory dysfunction. All other adverse events were mild to moderate in severity and resolved quickly.

Conclusion: Thermal water vapor therapy with single injection per lobe is both an effective and safe treatment for BPH that provides comparable improvements in lower urinary tract symptoms and quality of life to the traditional approach that employed variable number of injections by prostate volume.
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http://dx.doi.org/10.1016/j.urology.2022.01.039DOI Listing
July 2022

Real-world data comparing minimally invasive surgeries for benign prostatic hyperplasia.

World J Urol 2022 May 2;40(5):1185-1193. Epub 2022 Feb 2.

Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA.

Objectives: To assess the differences in surgical outcomes between the prostatic urethral lift (PUL) and previous thermal energy procedures for the treatment of benign prostatic hyperplasia (BPH).

Methods: We present an observational population-based study of 2694 men with BPH in New York State and California who received PUL, transurethral needle ablation (TUNA), or transurethral microwave therapy (TUMT) in outpatient and ambulatory surgery settings from 2005 to 2018. For these surgical procedures, short-term outcomes were reported and compared using a Chi-square test and mixed-effect logistic regressions. Long-term outcomes were described using Kaplan-Meier failure curves and compared using a Log-rank test and Cox regressions.

Results: A significant portion of PUL patients had a comorbidity count ≥ 2 (n = 838, 37.0%). PUL exhibited the lowest 30 day and 90-day inpatient or ER readmission rates among all surgical techniques except for 90-day ER readmission (p < 0.05). No differences were observed for 1- and 3-year risks of reoperation between PUL [5.5% (95% CI 4.4-6.8%) and 14.9% (95% CI 10.9-20.1%)], TUNA [7.4% (95% CI 5.0-10.9%) and 11.3% (95% CI 8.3-15.4%)] and TUMT [8.5% (95% CI 4.7-15.2%) and 15.3% (95% CI 9.5-24.0%)]. 1- and 3-year risks of stricture development for PUL were 0.2% (95% CI 0.0-0.7%) and 0.2% (95% CI 0.0-0.07%), respectively.

Conclusion: In a patient population with chronic conditions, patients treated with PUL exhibited similar 30- and 90-day inpatient or ER readmission rates when compared to previous reports. However, 1- and 3-year reoperation risks for PUL closely resembled previous thermal energy surgical procedures.
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http://dx.doi.org/10.1007/s00345-021-03926-9DOI Listing
May 2022

The Prevalence of Nocturnal Polyuria in the United States: Results from the Epidemiology of Nocturnal Polyuria Study.

Eur Urol Focus 2022 Jan 13. Epub 2022 Jan 13.

Evidera, Bethesda, MD, USA. Electronic address:

Background: The prevalence of nocturnal polyuria (NP), which is passing large volumes of urine during the main sleep period, has been investigated primarily in middle-aged to older men. There is thus a gap in the NP evidence base for women and for younger individuals.

Objective: To estimate the prevalence of nocturia due to NP in the USA.

Design, Setting, And Participants: This large epidemiologic study used a US population-representative sample of men and women aged ≥30 yr to assess the prevalence of NP (NCT04125186).

Outcome Measurements And Statistical Analysis: Consenting participants completed an online survey (Lower Urinary Tract Symptoms Tool and comorbidities). All who reported two or more voids per night and 100 random respondents each reporting no or one void per night were asked to complete a 3-d bladder diary. Two NP definitions were used: nocturnal urine production >90 ml/h (NUP90) and Nocturnal Polyuria Index >0.33 (NPI33). Crude and population-adjusted prevalence results were calculated from completed diaries for the following subgroups by sex and age: idiopathic NP; NP with overactive bladder (NP-OAB) or bladder outlet obstruction (NP-BOO; men only); NP associated with other comorbidities; and no NP (did not meet the NPI33 or NUP90 definition).

Results And Limitations: Among the 10,190 respondents who completed the survey, the mean age was 54.4 yr (range 30-95); 3,339 reported two or more nocturnal voids and 1,763 completed the 3-d diary (response rate 49.3%). The adjusted overall NP prevalence was 31.5% among men and 38.5% among women using the NPI33 definition, and 23.8% among men and 18.1% among women using NUP90. The adjusted idiopathic NP prevalence was lower among men (NPI33: 5.2%; NUP90: 1.4%) than among women (NPI33: 9.8%; NUP90: 4.0%). The prevalence of idiopathic NP decreased with age as NP associated with other possible causes increased with age in men (most common, BOO) and women (most common, OAB).

Conclusions: This is the first population-based study of NP prevalence to include men, women, and young adults. NP is common; a multifactorial etiology should be considered, particularly as age increases.

Patient Summary: In this population-based US study, we examined the frequency of nighttime urination among men and women aged ≥30 y and older. We found that nighttime urination is common among men and women. Many conditions can lead to increased nighttime urination as people age.
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http://dx.doi.org/10.1016/j.euf.2021.12.016DOI Listing
January 2022

Office-Based Procedures for BPH.

Curr Urol Rep 2021 Dec 16;22(12):63. Epub 2021 Dec 16.

Division of Urology, Department of Surgery, University of Toronto, Room 503G, 149 College Street, Toronto, ON, M5T 1P5, Canada.

Purpose Of Review: Benign prostatic hyperplasia (BPH) is a common disease in men. A rapidly rising demand for safe and effective therapy for BPH has generated novel minimally invasive surgical treatments (MISTs). With multiple procedural options in the urology armamentarium for BPH therapy, we describe the current therapies and outcomes for office-based procedures for BPH including quality of life, voiding symptoms, and sexual function.

Recent Findings: There are three FDA-approved MISTs (Rezūm, Urolift, and iTind) and three emerging MISTs for BPH. Preliminary data suggest improvement in voiding symptoms and quality of life while minimizing unwanted sexual side effects. Long term data is required on the durability and safety of MISTs for BPH. MISTs mark a paradigm shift in BPH management. Sandwiched between conservative medical management and conventional transurethral surgery, these novel technologies promise to combine efficacy approaching that of TURP while sparing the negative side effects. We envision a future where BPH can be diagnosed and treated in an office-based setting with a standard cystoscope in one procedure.
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http://dx.doi.org/10.1007/s11934-021-01081-7DOI Listing
December 2021

Evaluating the acceptability of an online patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Can Urol Assoc J 2021 Aug;15(8):247-254

Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.

Introduction: The growing number of surgical options available to treat benign prostatic hyperplasia (BPH), may overwhelm patients and urologists when deciding on an optimal treatment. Therefore, we developed an online patient decision aid (PtDA) that includes all guideline-approved surgical modalities. The objective of this study was to assess the acceptability of the PtDA among former BPH surgery patients and urologists that treat BPH surgically.

Methods: The International Patient Decision Aids Standards were used to develop a PtDA that includes monopolar transurethral resection of the prostate (TURP), bipolar TURP, GreenLight photovaporization, endoscopic enucleation of the prostate, Rezum, Urolift, Aquablation, open retropubic prostatectomy, and robotic simple prostatectomy as management options. Eleven urologists that regularly treat BPH and 19 patients who received BPH surgery were recruited. Alpha-testing was performed using a validated acceptability scoring system.

Results: For all sections of the PtDA, most urologists agreed that the language used was easy to follow (91.9%), that the amount of information provided was adequate (63.6%), that the length of the PtDA was appropriate (63.6%), and that the outcomes reported were correct (81.8%). All 19 patient participants agreed that the language used was easy to follow, and most found that the amount of information provided was adequate (84.2%), that the length of the PtDA was appropriate (84.2%), and that the outcomes reported were well-explained (89.5%).

Conclusions: Our PtDA was found to be acceptable among urologists and patients. These results demonstrate that most of the participants either recommend the use of this tool or plan to incorporate it in their clinical practice.
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http://dx.doi.org/10.5489/cuaj.7492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418264PMC
August 2021

Editorial Comment.

J Urol 2022 03 8;207(3):608. Epub 2021 Dec 8.

Department of Urology, Weill Cornell Medical College, New York, New York.

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http://dx.doi.org/10.1097/JU.0000000000002312.01DOI Listing
March 2022

New Technologies for Treatment of Benign Prostatic Hyperplasia.

Urol Clin North Am 2022 Feb 25;49(1):11-22. Epub 2021 Oct 25.

Department of Urology, Weill Cornell Medical College, 25 East 68th Street, Starr 9, New York, NY 10065, USA.

BPH is a common disease in aging men which impacts quality of life. With advancing age expectation coupled with the rising demand for BPH therapy, new technologies have been developed that target rapid recovery and symptom relief, low complication rates, and the ability to perform the procedure in an outpatient setting with local anesthesia. MIST technologies have fostered BPH medical care with ejaculation preservation. Techniques and outcomes for BPH technologies including Aquablation, Rezūm, UroLift, iTind, Optilume BPH, XFLO, Zenflow, and Butterfly are reviewed and evaluated. Given the novelty of these technologies, long-term data are required to assess safety and efficacy.
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http://dx.doi.org/10.1016/j.ucl.2021.07.007DOI Listing
February 2022
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