Bladder Outlet Obstruction Relief and Symptom Improvement Following Medical and Surgical Therapies for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: A Systematic Review,European Urology

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Bladder Outlet Obstruction Relief and Symptom Improvement Following Medical and Surgical Therapies for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: A Systematic Review
European Urology ( IF 25.3 ) Pub Date : 2024-05-14 , DOI: 10.1016/j.eururo.2024.04.031
Massimiliano Creta ₁ , Giorgio I Russo ₂ , Naeem Bhojani ₃ , Marcus J Drake ₄ , Christian Gratzke ₅ , Benoit Peyronnet ₆ , Claus Roehrborn ₇ , Kari A O Tikkinen ₈ , Jean-Nicolas Cornu ₉ , Ferdinando Fusco ₁₀

Affiliation

Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
Urology Section, Department of Surgery, University of Catania, Catania, Italy.
Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
Department of Urology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Urology, Rennes Academic Hospital, University of Rennes, Rennes, France.
Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.
Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Charles Nicolle University Hospital, Rouen Cedex, France.
Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy.

Background and objective

Symptomatic benefit and urodynamic obstruction relief represent relevant outcomes of therapies for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). We summarized evidence from studies concurrently assessing variations in terms of symptoms severity and invasive urodynamic measures of obstruction following medical and surgical therapies for LUTS/BPH.

Methods

We performed a systematic review of PubMed, Scopus, and Web of Science in June 2023.

Key findings and limitations

We identified 29 publications: 14 (872 patients) and 15 (851 patients) studies addressing medical and surgical therapies, respectively. The mean percentage total International Prostate Symptom Score (IPSS) improvements ranged from −2.5% to 56.3% and from 35.1% to 82.1% following medical and surgical therapies, respectively. The corresponding mean percentage Bladder Outlet Obstruction Index (BOOI) improvements ranged from 7.8% to 53.5% and from 22.4% to 138.6%, respectively. Holmium laser enucleation of the prostate (HoLEP) provided IPSS improvements in the higher range and the greatest BOOI reduction.

Conclusions and clinical implications

Globally, based on available evidence, more pronounced symptomatic benefits are observed following treatments providing greater deobstructive effect. In detail, patients undergoing surgery exhibit greater IPSS and BOOI improvements than those receiving medical therapy.

中文翻译：

提示良性前列腺增生的下尿路症状的药物和手术治疗后膀胱出口梗阻缓解和症状改善：系统评价

背景和目标

症状获益和尿动力学阻塞缓解代表了提示良性前列腺增生（LUTS/BPH）的下尿路症状治疗的相关结局。我们总结了研究的证据，同时评估了 LUTS/BPH 药物和手术治疗后梗阻的症状严重程度和侵入性尿动力学测量的变化。

方法

我们于 2023 年 6 月对 PubMed、Scopus 和 Web of Science 进行了系统评价。

主要发现和局限性

我们确定了 29 篇出版物：14 篇（872 名患者）和 15 篇（851 名患者）分别涉及药物和手术治疗的研究。内科和手术治疗后国际前列腺症状评分（IPSS）总改善的平均百分比分别为 -2.5% 至 56.3% 和 35.1% 至 82.1%。相应的膀胱出口梗阻指数（BOOI）平均百分比改善范围分别为 7.8% 至 53.5% 和 22.4% 至 138.6%。钬激光前列腺剜除术（HoLEP）在更高范围内提供了 IPSS 改善，并最大限度地降低了 BOOI。