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INTRODUCTION AND OBJECTIVE:Prostatic urethral lift (PUL) is a widely utilized minimally invasive treatment for benign prostatic hypertrophy (BPH) indicated in men with prostates less than 80 grams ...

Objective To assess changes over time in the use of antimuscarinics (AM) among visits in adult men treated with bladder outlet obstruction (BOO) medication therapy (ie, alpha blocker and 5-alpha reductase inhibitors). Methods We used the National Ambulatory Medicare Care Survey database (2006-2014) to identify men aged 40 or older, who initiated or continued on BOO medication therapy. Among these visits, we assessed the percentage of AM and evaluated trends of AM use across between 2006 and 2014 using multivariable logistic regression. Results Overall, there were 7561 patient visits in men aged 40 or older, who were treated with BOO medication therapy between 2006 and 2014 which equates to approximately 158 million visits in the United States after incorporating National Ambulatory Medicare Care Survey weights. Overall, AM was used in 3.7% of visits, among those who were treated with BOO medication therapy; use of AM increased with age. In the multivariable analysis, there was no increasing trend in the use of AM in 2006 relative to subsequent years through 2014 (P = .8104). Conclusion Despite a previous study that showed an increasing trend in antimuscarinic use among patients coded for lower urinary tract symptoms or benign prostatic hyperplasia between 1993 and 2010, several recent randomized-controlled trials, and a recommendation in a clinical practice guideline in 2010, we found no increasing trend in antimuscarinic use among visits in men who were treated with BOO medication therapy in 2006 compared to subsequent years. This suggests the potential undertreatment of antimuscarinics and an area for improved prescribing.

INTRODUCTION AND OBJECTIVES:To evaluate the association between alpha-blockers and dementia in patients with benign prostate hyperplasia (BPH).METHODS:Using the National Health Insurance Service da...

INTRODUCTION AND OBJECTIVES:There is little evidence to support the use of prostate- or bladder-specific medications after surgical intervention for benign prostatic hyperplasia (BPH). Our objective is to determine the frequency of medical management of urinary symptoms after transurethral resection of the prostate (TURP).METHODS:Several linked, routinely collected datasets from the province of Ontario, Canada were used for this population-based study. We identified all men older than 65 years of age who underwent their first TURP between April 2003 and March 2016. Men with prior prostate cancer, and those who had a simultaneous bladder tumor resection were excluded. The primary outcome was the probability of using at least 30 days of either an alpha blocker (AB), 5-alpha reductase inhibitor (5ARI), or an anticholinergic/beta-3 agonist (AC/B3). Men were observed for utilization of these medications from 90 days after TURP until censoring or March 2017.RESULTS:We identified 58,038 men with a median age of ...

RESULTS: At day seven, the voiding, storage symptoms scores and IPSS were significantly lower in group A, B and C in comparison to group D (control group) (p

INTRODUCTION AND OBJECTIVES: The patterns of utilization of pharmacotherapy for lower urinary tract symptoms following treatment for prostate cancer are not well characterized. Our objective was to compare the use of overactive bladder (OAB) medications, 5-alpha reductase inhibitors (5-ARIs) and alpha blockers following radical prostatectomy (RP), external beam radiation therapy and brachytherapy (RT), androgen deprivation therapy alone (ADT), and active surveillance (AS). METHODS: We performed a population-based observational cohort study using Surveillance, Epidemiology and End Results-Medicare linked data to identify 9,186 men diagnosed and treated for prostate cancer in 2007 and 2008. Baseline medication use was assessed six months prior to therapy and post-treatment use was captured for the first six months following treatment from Medicare Part D. RESULTS: Among newly diagnosed men, the management strategy was RT in 47%, RP in 25%, AS in 17%, and ADT alone in 11% (Table). There was no difference between groups in pre-diagnosis use of OAB medications (p 0.22). Use of preoperative 5-ARIs was lowest in men undergoing RP (2.0%) and highest in men managed with AS (4.3%; p 0.001). Baseline use of alpha blockers was greatest in men treated with RT (15.2%) and lowest in men managed with AS (9.2%; p 0.001). Following treatment, use of OAB medication increased six-fold in the RP group and doubled in RT treatment group (all p-values 0.001). Utilization of 5-ARIs decreased after treatment in all groups except the AS group. Alpha blocker use declined after treatment in all groups except RT, where an additional 12.7% of patients began to use these medications after treatment. Following RP, 3.7% of men continued to use alpha blockers. CONCLUSIONS: Although 5-ARIs and alpha blockers have no proven role following radical prostatectomy they are erroneously taken by a small but significant proportion of patients. Significant increases were observed for OAB medications after RP and alpha blockers after RT. Changes in medication use should be included in any comparative assessment of prostate cancer treatments. Frequency (%) of OAB medication, 5-ARI, and alpha blocker use prior and following treatment for prostate cancer ADT (n 994) RT (n 4,319) RP (n 1,564) AS (n 2,309) p-value OAB medications Prior to treatment 1.8 1.4 0.9 1.6 0.218 After treatment 2.8 3.2 6.6 1.3 0.001 5-ARIs Prior to treatment 3.3 3.1 2.0 4.3 0.001 After treatment 3.2 2.1 0.7 4.6 0.001 Alpha blockers Prior to treatment 13.7 15.2 11.7 9.2 0.001 After treatment 13.0 27.9 3.7 8.0 0.001

Teruo Inamoto*, Takatsuki, Japan; Akira Tsujimura, Norio Nonomura, Osaka, Japan; Hauhito Azuma, Takatsuki, Japan; Hironobu Akino, Fukui, Japan; Naoki Oguchi, Osaka, Japan; Yasuhide Kitagawa, Kanazawa, Japan; Naoki Segawa, Takatsuki, Japan; Satoshi Tamada, Nobutaka Shimizu, Osaka, Japan; Akihiko Watanabe, Toyama, Japan; Mitsuyoshi Urashima, Tokyo, Japan; Akihiko Okuyama, Yoji Katsuoka, Hirotsugu Uemura, Tatsuya Nakatani, Osaka, Japan; Mikio Namiki, Kanazawa, Japan; Hideki Fuse, Toyama, Japan; Tadashi Matsuda, Osaka, Japan; Yokoyama Osamu, Fukui, Japan

for this article http://dx.doi.org/10.1016/j.juro.2015.08.038 available at http://jurology.com/ Editorial Comment: Precision medicine is a glossy term that is often used as a goal in delivery of optimal outcomes. Notwithstanding costs and access, this concept is a more achievable goal than in the past. For example in the arena of lower urinary tract symptoms in men the ability to hone in on types of symptoms, ie storage vs voiding, and prostate size can help us to prescribe the most appropriate therapy. With a new cadre of available agents that can address nocturia, overactive bladder symptoms and sexual dysfunction we can more precisely diagnose and treat men with lower urinary tract symptoms. This study tests that hypothesis by using either desmopressin or an anticholinergic agent as an add-on to an alpha blocker. The authors found that the addition of desmopressin helped decrease the number of nocturnal episodes, nocturnal urine volume and nocturnal index in men with nocturnal polyuria. Similarly the nocturnal bladder capacity index and urgency episodes decreased in the anticholinergic add-on group. Nocturia is multifactorial and not just related to benign prostatic hyperplasia. Yet we often use classic benign prostatic hyperplasia agents such as alpha blockers in an attempt to treat men with nocturia. Studies such as this highlight the need to hone in on what is causing nocturia in an individual, including concomitant disorders such as diabetes, sleep apnea, polydipsia, reduced bladder capacity and polyuria. The take home message is that, as experts in voiding function in men (and women!), we should tailor our therapies to the specific complaint of the patient and take into account prostate size, types of symptoms and causative etiology of nocturia to deliver better health outcomes and more durable and sustainable results. Steven A. Kaplan, MD Suggested Reading Lose G, Mattiasson A, Walter S et al: Clinical experiences with desmopressin for long-term treatment of nocturia. J Urol 2004; 172: 1021.