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Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective

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Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective

Auteurs : Mohamed A. Elkoushy [Égypte] ; Ahmed M. Elshal [Égypte] ; Mostafa M. Elhilali

Source :

Canadian Urological Association Journal [ 1911-6470 ] ; 2015.

RBID : PMC:4707884

Abstract

Introduction:

We assessed the change of patients’ profile presenting for symptomatic benign prostatic hyperplasia (BPH) over 16 years and its impact on surgical outcomes over this time.

Methods:

We reviewed a prospectively maintained database of patients treated with laser for symptomatic BPH since March 1998. Patients were divided into 3 consecutive time-based groups: Group 1 for patients who underwent surgery before April 2004; Group 2, between April 2004 and March 2009; and for Group 3 from April 2009 to August 2014. We reviewed demographic and preoperative data, including prostate volume; international prostate symptoms score (IPSS), quality of life (QoL), and peak flow rate (Qmax). We also recorded any perioperative and long-term complications.

Results:

A total of 1835 patients were included in our study, including 542 (29.5%) in Group 1, 614 (33.5%) in Group 2, and 679 (37%) in Group 3. Preoperative prostate volume was positively correlated with age at surgery (r = 0.62, p < 0.001), total energy used (r = 0.47, p < 0.001), and total operative time (r = 0.47, p < 0.001). Patients in Group 3 were significantly older (75.28 ± 8.47 in Group 3 vs. 71.11 ± 8.9 in Group 2 vs. 65.3 ± 9.04 years in Group 1, p <0.001), were more coagulopathic (18.7% Group 3 vs. 12.3% Group 2 vs. 5.9% Group 1, p < 0.001), and had significantly larger prostates (87.96 ± 49.80 in Group 3 vs. 78.44 ± 50.84 in Group 2 vs. 74.50 ± 46.53 Group 1, p < 0.001). Preoperative prostatic medications significantly increased over time (72.6% in Group 1 vs. 85.5% in Group 2, vs. 87.4% Group 3, p < 0.001). IPSS, QoL and Qmax were significantly abnormal in patients in Group 3 (p < 0.001). After a mean follow-up of 3 years, the number of patients who did not require reoperation progressively increased (94.1% Group 1 vs. 96.1% Group 2 vs. 98.3% Group 3). Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with postoperative urinary incontinence.

Conclusions:

Patients presenting for surgery due to symptomatic BPH over the last 16 years were significantly older, more morbid, and had larger prostates and more abnormal voiding parameters. Over time, patients used prostatic medications more frequently. Despite the changes in patient profiles, perioperative safety and complication rates between groups were comparable, likely due to advancements in laser technology and techniques. Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with reversible postoperative urinary incontinence.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707884

DOI: 10.5489/cuaj.3066
PubMed: 26788224
PubMed Central: 4707884

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<author><name sortKey="Elkoushy, Mohamed A" sort="Elkoushy, Mohamed A" uniqKey="Elkoushy M" first="Mohamed A." last="Elkoushy">Mohamed A. Elkoushy</name>
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<wicri:noCountry code="subfield">QC</wicri:noCountry>
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<affiliation wicri:level="1"><nlm:aff id="af2-cuaj-11-12-372">Department of Urology, Suez Canal University, Ismailia, Egypt;</nlm:aff>
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<author><name sortKey="Elkoushy, Mohamed A" sort="Elkoushy, Mohamed A" uniqKey="Elkoushy M" first="Mohamed A." last="Elkoushy">Mohamed A. Elkoushy</name>
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<affiliation wicri:level="1"><nlm:aff id="af2-cuaj-11-12-372">Department of Urology, Suez Canal University, Ismailia, Egypt;</nlm:aff>
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<author><name sortKey="Elshal, Ahmed M" sort="Elshal, Ahmed M" uniqKey="Elshal A" first="Ahmed M." last="Elshal">Ahmed M. Elshal</name>
<affiliation><nlm:aff id="af1-cuaj-11-12-372">Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC;</nlm:aff>
<wicri:noCountry code="subfield">QC</wicri:noCountry>
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<affiliation wicri:level="1"><nlm:aff id="af3-cuaj-11-12-372">Urology and Nephrology Center, Mansoura University, Mansoura, Egypt</nlm:aff>
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<author><name sortKey="Elhilali, Mostafa M" sort="Elhilali, Mostafa M" uniqKey="Elhilali M" first="Mostafa M." last="Elhilali">Mostafa M. Elhilali</name>
<affiliation><nlm:aff id="af1-cuaj-11-12-372">Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC;</nlm:aff>
<wicri:noCountry code="subfield">QC</wicri:noCountry>
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<series><title level="j">Canadian Urological Association Journal</title>
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<front><div type="abstract" xml:lang="en"><sec><title>Introduction:</title>
<p>We assessed the change of patients’ profile presenting for symptomatic benign prostatic hyperplasia (BPH) over 16 years and its impact on surgical outcomes over this time.</p>
</sec>
<sec><title>Methods:</title>
<p>We reviewed a prospectively maintained database of patients treated with laser for symptomatic BPH since March 1998. Patients were divided into 3 consecutive time-based groups: Group 1 for patients who underwent surgery before April 2004; Group 2, between April 2004 and March 2009; and for Group 3 from April 2009 to August 2014. We reviewed demographic and preoperative data, including prostate volume; international prostate symptoms score (IPSS), quality of life (QoL), and peak flow rate (Qmax). We also recorded any perioperative and long-term complications.</p>
</sec>
<sec><title>Results:</title>
<p>A total of 1835 patients were included in our study, including 542 (29.5%) in Group 1, 614 (33.5%) in Group 2, and 679 (37%) in Group 3. Preoperative prostate volume was positively correlated with age at surgery (<italic>r</italic>
 = 0.62, p < 0.001), total energy used (<italic>r</italic>
 = 0.47, <italic>p</italic>
 < 0.001), and total operative time (<italic>r</italic>
 = 0.47, <italic>p</italic>
 < 0.001). Patients in Group 3 were significantly older (75.28 ± 8.47 in Group 3 vs. 71.11 ± 8.9 in Group 2 vs. 65.3 ± 9.04 years in Group 1, <italic>p</italic>
 <0.001), were more coagulopathic (18.7% Group 3 vs. 12.3% Group 2 vs. 5.9% Group 1, <italic>p</italic>
 < 0.001), and had significantly larger prostates (87.96 ± 49.80 in Group 3 vs. 78.44 ± 50.84 in Group 2 vs. 74.50 ± 46.53 Group 1, p < 0.001). Preoperative prostatic medications significantly increased over time (72.6% in Group 1 vs. 85.5% in Group 2, vs. 87.4% Group 3, p < 0.001). IPSS, QoL and Qmax were significantly abnormal in patients in Group 3 (<italic>p</italic>
 < 0.001). After a mean follow-up of 3 years, the number of patients who did not require reoperation progressively increased (94.1% Group 1 vs. 96.1% Group 2 vs. 98.3% Group 3). Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with postoperative urinary incontinence.</p>
</sec>
<sec><title>Conclusions:</title>
<p>Patients presenting for surgery due to symptomatic BPH over the last 16 years were significantly older, more morbid, and had larger prostates and more abnormal voiding parameters. Over time, patients used prostatic medications more frequently. Despite the changes in patient profiles, perioperative safety and complication rates between groups were comparable, likely due to advancements in laser technology and techniques. Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with reversible postoperative urinary incontinence.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">Can Urol Assoc J</journal-id>
<journal-id journal-id-type="iso-abbrev">Can Urol Assoc J</journal-id>
<journal-id journal-id-type="publisher-id">CUAJ</journal-id>
<journal-title-group><journal-title>Canadian Urological Association Journal</journal-title>
</journal-title-group>
<issn pub-type="ppub">1911-6470</issn>
<publisher><publisher-name>Canadian Medical Association</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26788224</article-id>
<article-id pub-id-type="pmc">4707884</article-id>
<article-id pub-id-type="doi">10.5489/cuaj.3066</article-id>
<article-id pub-id-type="publisher-id">cuaj-11-12-372</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject>
</subj-group>
</article-categories>
<title-group><article-title>Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Elkoushy</surname>
<given-names>Mohamed A.</given-names>
</name>
<degrees>MD, MSc, PhD</degrees>
<xref ref-type="aff" rid="af1-cuaj-11-12-372"><sup>*</sup>
</xref>
<xref ref-type="aff" rid="af2-cuaj-11-12-372"><sup>†</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Elshal</surname>
<given-names>Ahmed M.</given-names>
</name>
<degrees>MD, FEBU, PhD</degrees>
<xref ref-type="aff" rid="af1-cuaj-11-12-372"><sup>*</sup>
</xref>
<xref ref-type="aff" rid="af3-cuaj-11-12-372"><sup>§</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Elhilali</surname>
<given-names>Mostafa M.</given-names>
</name>
<degrees>MD, PhD, FRCSC</degrees>
<xref ref-type="aff" rid="af1-cuaj-11-12-372"><sup>*</sup>
</xref>
<xref rid="c1-cuaj-11-12-372" ref-type="corresp"></xref>
</contrib>
<aff id="af1-cuaj-11-12-372"><label>*</label>
Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC;</aff>
<aff id="af2-cuaj-11-12-372"><label>†</label>
Department of Urology, Suez Canal University, Ismailia, Egypt;</aff>
<aff id="af3-cuaj-11-12-372"><label>§</label>
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt</aff>
</contrib-group>
<author-notes><corresp id="c1-cuaj-11-12-372">Correspondence: Dr. Mostafa M. Elhilali, Professor of Urology, Royal Victoria Hospital, McGill University Health Centre, 1001 Boulevard Decarie, D05.5327, Montreal, QC, Canada H4A 3J1; <email>mostafa.elhilali@muhc.mcgill.ca</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><season>Nov-Dec</season>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub"><day>14</day>
<month>12</month>
<year>2015</year>
</pub-date>
<volume>9</volume>
<issue>11-12</issue>
<fpage>372</fpage>
<lpage>378</lpage>
<permissions><copyright-statement>Copyright: © 2015 Canadian Urological Association or its licensors</copyright-statement>
<copyright-year>2015</copyright-year>
</permissions>
<related-article related-article-type="commentary" id="d36e110" vol="9" page="379" issue="11-12" ext-link-type="pmc"><bold>See related article on page 379.</bold>
</related-article>
<abstract><sec><title>Introduction:</title>
<p>We assessed the change of patients’ profile presenting for symptomatic benign prostatic hyperplasia (BPH) over 16 years and its impact on surgical outcomes over this time.</p>
</sec>
<sec><title>Methods:</title>
<p>We reviewed a prospectively maintained database of patients treated with laser for symptomatic BPH since March 1998. Patients were divided into 3 consecutive time-based groups: Group 1 for patients who underwent surgery before April 2004; Group 2, between April 2004 and March 2009; and for Group 3 from April 2009 to August 2014. We reviewed demographic and preoperative data, including prostate volume; international prostate symptoms score (IPSS), quality of life (QoL), and peak flow rate (Qmax). We also recorded any perioperative and long-term complications.</p>
</sec>
<sec><title>Results:</title>
<p>A total of 1835 patients were included in our study, including 542 (29.5%) in Group 1, 614 (33.5%) in Group 2, and 679 (37%) in Group 3. Preoperative prostate volume was positively correlated with age at surgery (<italic>r</italic>
 = 0.62, p < 0.001), total energy used (<italic>r</italic>
 = 0.47, <italic>p</italic>
 < 0.001), and total operative time (<italic>r</italic>
 = 0.47, <italic>p</italic>
 < 0.001). Patients in Group 3 were significantly older (75.28 ± 8.47 in Group 3 vs. 71.11 ± 8.9 in Group 2 vs. 65.3 ± 9.04 years in Group 1, <italic>p</italic>
 <0.001), were more coagulopathic (18.7% Group 3 vs. 12.3% Group 2 vs. 5.9% Group 1, <italic>p</italic>
 < 0.001), and had significantly larger prostates (87.96 ± 49.80 in Group 3 vs. 78.44 ± 50.84 in Group 2 vs. 74.50 ± 46.53 Group 1, p < 0.001). Preoperative prostatic medications significantly increased over time (72.6% in Group 1 vs. 85.5% in Group 2, vs. 87.4% Group 3, p < 0.001). IPSS, QoL and Qmax were significantly abnormal in patients in Group 3 (<italic>p</italic>
 < 0.001). After a mean follow-up of 3 years, the number of patients who did not require reoperation progressively increased (94.1% Group 1 vs. 96.1% Group 2 vs. 98.3% Group 3). Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with postoperative urinary incontinence.</p>
</sec>
<sec><title>Conclusions:</title>
<p>Patients presenting for surgery due to symptomatic BPH over the last 16 years were significantly older, more morbid, and had larger prostates and more abnormal voiding parameters. Over time, patients used prostatic medications more frequently. Despite the changes in patient profiles, perioperative safety and complication rates between groups were comparable, likely due to advancements in laser technology and techniques. Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with reversible postoperative urinary incontinence.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Égypte</li>
</country>
</list>
<tree><noCountry><name sortKey="Elhilali, Mostafa M" sort="Elhilali, Mostafa M" uniqKey="Elhilali M" first="Mostafa M." last="Elhilali">Mostafa M. Elhilali</name>
</noCountry>
<country name="Égypte"><noRegion><name sortKey="Elkoushy, Mohamed A" sort="Elkoushy, Mohamed A" uniqKey="Elkoushy M" first="Mohamed A." last="Elkoushy">Mohamed A. Elkoushy</name>
</noRegion>
<name sortKey="Elshal, Ahmed M" sort="Elshal, Ahmed M" uniqKey="Elshal A" first="Ahmed M." last="Elshal">Ahmed M. Elshal</name>
</country>
</tree>
</affiliations>
</record>

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Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective

Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective

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Abstract

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