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MINERVA UROLOGICA E NEFROLOGICA
Rivista di Nefrologia e Urologia
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536
Minerva Urologica e Nefrologica 2016 Nov 23
The influence of luts medical treatment on bph surgery: do we operate too late?
Fabrizio PRESICCE 1, Cosimo DE NUNZIO 1, Mauro GACCI 2, Roman SOSNOWSKY 3, Riccardo LOMBARDO 1, Francesco PORPIGLIA 4, Andrea TUBARO 1 ✉
1 Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy; 2 Department of Urology, Ospedale Careggi, University of Florence, Florence, Italy; 3 Department of Urooncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; 4 Division of Urology, Department of Oncology, University of Turin, Turin, Italy
BACKGROUND: To systematically collect the available evidence on the influence of Lower Urinary Tract Symptoms (LUTS) medical treatment on BPH surgery.
EVIDENCE ACQUISITION: A systematic literature search January 1990 until June 2016 was performed by combining the following MESH terms: Lower Urinary Tract Symptoms, Benign Prostatic Hyperplasia, male, medical treatment surgical treatment, deferred/postponed treatment/intervention, early intervention/treatment. Each article title and abstract was reviewed for relevance and appropriateness with regards to the topic of this review.
EVIDENCE SYNTHESIS: The pharmacological treatment of LUTS is undoubtedly a successful story in the field of urology. In the last two decades the introduction of novel pharmaceutical agents have dramatically decreased the rate of benign prostatic hyperplasia (BPH) surgery all over the world. Thus nowadays patients, who undergo surgery, may be generally older, with more severe comorbidities and with larger prostates, requiring theoretically more challenging interventions. Nevertheless the advance in surgical techniques and instruments may have counterbalanced this unfavourable scenario and generally a non-pejorative trend has been observed in peri-/post-operative complications. On the other hand some evidence from “pre-medical” era suggested that immediate BPH surgery may be the best option for patients at risk of severe BPH progression, however currently there are no established criteria to accurately discriminate these patients. In conclusion, the evidence summarized in our review support the need of prospective comparative studies evaluating long-term LUTS/BPH pharmacological treatment versus an early surgical intervention, particularly using the emerging laser technologies.
CONCLUSIONS: Several questions remain open on how medical treatment has changed the natural history of BPH and surprisingly rare good quality studies are available on this topic. The evidence summarized in our review support the need of prospective comparative studies evaluating long-term LUTS/BPH pharmacological treatment versus an early surgical intervention, particularly using the emerging laser technologies.