Surgical management of bph: current practice patterns and attitudes in europe



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SURGICAL MANAGEMENT OF BPH: CURRENT PRACTICE PATTERNS AND ATTITUDES IN EUROPE
De Nunzio C.1, Sosnowski R.2, Thiruchelvam N.3, Ahyai S.4, Autorino R.5, Bachmann A.6, Briganti A. 7, Novara G.8, EAU Young Academic Urologists BPH Group, Arnhem, The Netherlands
1Sant' Andrea Hospital "La Sapienza", Dept. of Urology, Rome, Italy.

2M. Sklodowska-Curie Memorial Cancer Center, Dept. of Urology, Warsaw, Poland.

3Addenbrookes Hospital, Dept. of Urology, Cambridge, United Kingdom.

4University Medical Centre Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany.

5Urology Unit, Second University of Naples, Naples, Italy.

6 UniversitätsspitalBasel, Dept. of Urology, Basel, Switzerland.

7Vita-Salute University San Raffaele, Dept. of Urology, Milan, Italy.

8Department of Oncological and Surgical Sciences, University of Padua, Urology Clinic, Padua, Italy.
Introduction and Objectives

Management of Benign Prostatic Hyperplasia (BPH) related Lower Urinary Tract Symptoms (LUTS) is variable throughout Europe. The aim of the present survey was to evaluate the current practice patterns and attitudes of urologists across Europe in the management of BPH/LUTS.



Material& Methods

A purpose-built questionnaire (28 questions) was developed by the Young Academic Urologist BPH group and distributed via a free online tool (Survey Monkey)using the monthly EAU Newsletter (received by 2000 EAU members). The questionnaire included 5 questions on the urological setting; 7 questions on diagnosis and medical management, and 16 questions on surgical management of BPH/LUTS.



Results

637 urologists replied. 77% were younger than 50 years. 44% worked in Academic Hospitals and 17% in private clinics. 55% reported that 20-50% of their patients have BPH/LUTS. On first presentation, 29% of thoseare treatment-naïve. 74% of all urologists considered history taking, IPSS, uroflowmetry, PVR measurement and PSA testing mandatory prior to any surgical intervention. In the majority (79%), first line management was an alpha-blocker and second line the addition of a 5-alpha reductase inhibitor (49%). No response (65%) to or progression (71%) on medical treatment and urinary retention (66%) were the most important indications for surgical treatment. 93% uses prophylactic antibiotics for surgery.




procedures used by urologists

(B)TURP

TUIP

TUMT

TUNA

HoLEP

HoLRP

‘green lasers’

120W HPS or

180W XPS


Open prostatectomy

Prostatic stent

Intra-prostatic injection

Patient’s preference

% of overall number (multiple answers possible)

69%


48%


22%


21%


34%


22%


37%


63%


24%


21%


19%

Safety was deemed the major advantage of laser prostatectomy (39%) with cost as the major disadvantage (57%). 43% have experience in performing laser prostatectomy and considered the best laser treatment:Holmium:YAG (44%) , KTP:YAG (24% ), Thulium:YAG (18% ), and others (13%). Efficacy of surgical treatment was measured most frequently by IPSS (80%), uroflowmetry (80%) and PVR (68%). UTI (12%) and dysuria (26%) were the most common short-term complications, and UTI (9%) and retrograde ejaculation (67%) the most common long-term complications. 7% of all surgically treated patients required re-treatment with secondary TURP (86%), urethrotomy (79%) or bladder neck incision (77%).


Discussion

Most urologists recommend medical alpha-blocker therapy as first-line treatment. The most popular surgical procedure remains TURP. Open prostatectomy still has an established role. Laser procedures are used by a significant but still minor group of practising urologists. Importantly, the EAU members asked seem mostly to investigate and treat male LUTS patients in concordance with current EAU guidelines.


Conclusions

This survey provides a description of how European urologists diagnose and manage BPH/LUTS.
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