BPH
Flomax use has been controversial in regards to its association with dementia with some retrospective studies showing an association, however a large study in 2019 found no association. (8)
The 5 major BPH studies showed large volume prostate more impacted than smaller studies.
If qMAX <10cc/sec, you have obstruction
Patients with high flow (>10cc/sec) then urodynamics may help
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SEE URINARY RETENTION FOR MORE RELATED INFO
PHOTOSELECTIVE VAPORIZATION (PVP) has been shown to be noninferior to TURP (GOLIATH STUDY), a 2016 study showed 17.6% required repeat treatment at a mean of 9.2 months. The only variable showen to predict failure was peak flow rate of less than 15ml/sec immediately after removing urethral catheter post PVP. Average prostate size 48.5g in this study. (1)
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BASELINE SYMPTOMS OF LUTS: Large German study of 7,821 men showed LUTS increased with age with 28.6% mean >70 with bothersome symptoms with 4.2% having severe symptoms vs. 1.6% men age 50-59yrs. Nocturia most bothersome symptom with 55% of men got up at least once a night and 27% at least twice. (2) Allopurinol is associated with reduced medication and surgery for BPH. (3)
FINASTERIDE vs. DUTASTERIDE
2016 etrospective study of 2,778 patients treated w/ early finasteride + AB compared to 4,125 patients treated w/ early dutasteride + AB cohort. After adjusting for confounding using IPT weighting, no statistically significant difference was observed between dutasteride and finasteride for AUR (hazard ratio [HR] = 0.845, 95% CI = 0.660-1.070, P = 0.1643), prostate-related surgery (HR = 0.806, 95% CI = 0.568-1.171, P = 0.2525), and clinical progression (HR = 0.834, 95% CI = 0.663-1.043, P = 0.1122). The authors conclude clinical and economic outcomes were similar between the early dutasteride + AB and early finasteride + AB cohorts, with no statistically significant differences detected. (4)
NSAIDS
Retrospective studies have shown conflicting data of the effect of NSAIDS on BPH/LUTS. 2 RCT did show I-PSS improvement and flow rate improvement and a meta-analysis found NSAIDs improved symptoms by 2.9 I-PSS points and flow by 0.89ml/sec. (5,6,7)
OTHER MEDICATIONS
One study showed allopurinol use is associated with lowered risk of BPH medication, diagnosis and surgery. A possible explanation could be antioxidative effects of urate-lowering allopurinol. decreased risk for all three BPH endpoints: BPH medication (HR 0.81; 95% CI 0.75–0.88), BPH diagnosis (HR 0.78; 95% CI 0.71–0.86) and BPH-related surgery (HR 0.67; 95% CI 0.58–0.76) after multivariable adjustment. The risk association did not change by cumulative use. The risk decrease disappeared after 1–2 years lag time. Only BMI modified the risk association; the risk decrease was observed only among men with BMI above the median (27.3 kg/m2); p for interaction <0.05 for each endpoint. (9)
The 5 major BPH studies showed large volume prostate more impacted than smaller studies.
If qMAX <10cc/sec, you have obstruction
Patients with high flow (>10cc/sec) then urodynamics may help
-----
SEE URINARY RETENTION FOR MORE RELATED INFO
PHOTOSELECTIVE VAPORIZATION (PVP) has been shown to be noninferior to TURP (GOLIATH STUDY), a 2016 study showed 17.6% required repeat treatment at a mean of 9.2 months. The only variable showen to predict failure was peak flow rate of less than 15ml/sec immediately after removing urethral catheter post PVP. Average prostate size 48.5g in this study. (1)
____
BASELINE SYMPTOMS OF LUTS: Large German study of 7,821 men showed LUTS increased with age with 28.6% mean >70 with bothersome symptoms with 4.2% having severe symptoms vs. 1.6% men age 50-59yrs. Nocturia most bothersome symptom with 55% of men got up at least once a night and 27% at least twice. (2) Allopurinol is associated with reduced medication and surgery for BPH. (3)
FINASTERIDE vs. DUTASTERIDE
2016 etrospective study of 2,778 patients treated w/ early finasteride + AB compared to 4,125 patients treated w/ early dutasteride + AB cohort. After adjusting for confounding using IPT weighting, no statistically significant difference was observed between dutasteride and finasteride for AUR (hazard ratio [HR] = 0.845, 95% CI = 0.660-1.070, P = 0.1643), prostate-related surgery (HR = 0.806, 95% CI = 0.568-1.171, P = 0.2525), and clinical progression (HR = 0.834, 95% CI = 0.663-1.043, P = 0.1122). The authors conclude clinical and economic outcomes were similar between the early dutasteride + AB and early finasteride + AB cohorts, with no statistically significant differences detected. (4)
NSAIDS
Retrospective studies have shown conflicting data of the effect of NSAIDS on BPH/LUTS. 2 RCT did show I-PSS improvement and flow rate improvement and a meta-analysis found NSAIDs improved symptoms by 2.9 I-PSS points and flow by 0.89ml/sec. (5,6,7)
OTHER MEDICATIONS
One study showed allopurinol use is associated with lowered risk of BPH medication, diagnosis and surgery. A possible explanation could be antioxidative effects of urate-lowering allopurinol. decreased risk for all three BPH endpoints: BPH medication (HR 0.81; 95% CI 0.75–0.88), BPH diagnosis (HR 0.78; 95% CI 0.71–0.86) and BPH-related surgery (HR 0.67; 95% CI 0.58–0.76) after multivariable adjustment. The risk association did not change by cumulative use. The risk decrease disappeared after 1–2 years lag time. Only BMI modified the risk association; the risk decrease was observed only among men with BMI above the median (27.3 kg/m2); p for interaction <0.05 for each endpoint. (9)
- Popeneciu, Ionel Valentin, et al. "Risk factors for long-term outcome in photoselective vaporization of the prostate." Scandinavian journal of urology 50.4 (2016): 313-318.
- Rohrmann, Sabine, Verena Katzke, and Rudolf Kaaks. "Prevalence and progression of lower urinary tract symptoms in an aging population." Urology 95 (2016): 158-163.
- Kukko, Ville, et al. "Allopurinol and risk of benign prostatic hyperplasia in a Finnish population-based cohort." Prostate cancer and prostatic diseases (2017): 1.
- DerSarkissian, Maral, et al. "Comparing Clinical and Economic Outcomes Associated with Early Initiation of Combination Therapy of an Alpha Blocker and Dutasteride or Finasteride in Men with Benign Prostatic Hyperplasia in the United States." Journal of managed care & specialty pharmacy 22.10 (2016): 1204-1214.
- Lloyd, G. L., Ricke, W. A., & McVary, K. T. (2019). Inflammation, Voiding and Benign Prostatic Hyperplasia Progression. The Journal of Urology, 201(5), 868–870.
- Kahokehr, A., Vather, R., Nixon, A., & Hill, A. G. (2013). Non‐steroidal anti‐inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta‐analysis of randomized controlled trials. BJUI, 111(2), 304–311.
- Sutcliffe, S., Grubb, R. L., Platz, E. A., Ragard, L. R., Riley, T. L., Kazin, S. S., … Andriole, G. L. (2012). Non-steroidal anti-inflammatory drug use and the risk of benign prostatic hyperplasia-related outcomes and nocturia in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. BJUI, 110(7), 1050–1059.
- Sik, Tae Bum, et al. “PD19-03 CORRELATION OF ALPHA BLOCKER WITH DEMENTIA IN PATIENTS WITH BENIGN PROSTATE HYPERPLASIA: A NATIONWIDE POPULATION-BASED STUDY USING THE NATIONAL HEALTH INSURANCE SERVICE DATABASE.” The Journal of Urology, vol. 201, 2019.
- Kukko, Ville, et al. "Allopurinol and risk of benign prostatic hyperplasia in a Finnish population-based cohort." Prostate cancer and prostatic diseases (2017): 1.