Alpha-blockers top choice for first-line LUTS treatment

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Most urologists turn to alpha-blockers as first-line treatment for BPH-related lower urinary tract symptoms, while transurethral resection of the prostate remains the most commonly used surgical modality, according to a recent survey.

Stockholm, Sweden-Most urologists turn to alpha-blockers as first-line treatment for BPH-related lower urinary tract symptoms, while transurethral resection of the prostate remains the most commonly used surgical modality, according to a recent survey.

Roman Sosnowski, MD, PhD, of the uro-oncology department at Cancer Memorial Hospital in Warsaw, Poland, reported on the results of the survey developed by the Young Academic Urologist BPH Group, at the European Association of Urology annual congress in Stockholm, Sweden.

The comprehensive survey was carried out via a free online tool using the EAU Newsletter, which is released once per month and distributed via email to about 2,000 members of the European Association of Urology.

The purpose-built questionnaire was comprised of 28 questions that focused on general urologic practice, diagnosis, and medical and surgical management of patients with LUTS due to benign prostatic obstruction (BPO).

Of the EAU members who received the questionnaire, 637 urologists replied. The majority of the respondents were younger than 50 years of age (489/637, 77%); 279 (44%) worked in an academic hospital; and 109 (17%) practiced in private clinics.

Roughly half of the urologists (55%) reported that treating LUTS patients comprised between 20% and 50% of their activities. The survey showed that 29% of patients with BPH/LUTS are treatment naïve upon first presentation.

Three-quarters of all respondents (74%) considered history taking, International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual measurement, and PSA testing to be mandatory diagnostics prior to any surgical intervention.

Alpha-blockers were the first line of treatment for LUTS for 79% of urologists. The second line of treatment was the addition of a 5-alpha-reductase inhibitor (49%).

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Progression top indicator for surgery

The most important indications for surgical treatment were progression (71%), urinary retention (66%), and no response to first-line medical treatment measures (65%). The study also showed that the majority of urologists used prophylactic antibiotics (93%) at the time of surgical treatment.

In terms of surgical treatments, the method most commonly offered is TURP or bipolar-TURP, selected by 69.6% of respondents, followed by open prostatectomy in 63.6%, transurethral incision of the prostate in 48.4%, GreenLight laser (American Medical Systems, Minnetonka, MN) in 37.8%, holmium laser enucleation of the prostate in 34.7%, prostatic stent in 24%, holmium laser resection of the prostate in 22.5%, transurethral microwave therapy in 22%, transurethral needle ablation of the prostate in 21.5%, intraprostatic injection in 21%, and patient’s preference in 19%.

The main advantage of laser prostatectomy in BPO surgery was deemed to be safety (39%), while the main disadvantage was cost (57%).

Laser procedures were chosen/used by a significant but small group of practicing urologists, with 278 of 637 urologists surveyed having experience in performing laser prostatectomy. Of these experienced surgeons, 228 reported their preferred surgical laser treatment of male LUTS as follows: holmium:YAG laser (44%), KPT/LBO:YAG laser (24%), Thulium:YAG laser (18%), and others (13%).

Urologic surgeons most frequently measured the efficacy of surgical treatments by IPSS (80%) and PVR (68%).

Dysuria, UTI most common

Dysuria (26%) and urinary tract infection (12%) were the most common short-term complications, with retrograde ejaculation (67%) and UTI (9%) the most common long-term complications. Furthermore, 7% of all surgically treated patients required re-treatment with secondary TURP (86%), urethrotomy (79%), or bladder neck incision (77%).

The authors also reported that male LUTS appears to be diagnosed and treated in concordance with EAU guidelines by the majority of European urologists. It also showed that open prostatectomy still has an established role among European urologists.UT