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    BPH/LUTS: OTC alpha-blocker use feasible

    • A Cochrane review and meta-analysis comparing desmopressin to other interventions for nocturia in men with LUTS found desmopressin was associated with a decrease in nocturnal voids of approximately one per night, and similar reductions were seen with alpha-blockers. The quality of evidence overall was low.
    • In patients with BPH and overactive bladder, silodosin (Rapaflo), 8 mg, plus fesoterodine (Toviaz), 4 mg, and silodosin plus mirabegron (Myrbetriq), 50 mg, showed similar improvements in symptom scores at 12 weeks, but on urodynamics, the fesoterodine group had greater improvements in detrusor overactivity incidence.
    • A visual analog scale may be a good option to the IPSS in patients with low literacy. While 42% of patients needed help filling out the IPSS, only 10% needed help filling out the visual analog scale.
    • Metformin appears to inhibit proliferation of epithelial cells by suppressing expression of the IGF-1 receptor and may be protective against proliferation.
    • Study findings suggest a potential role for periprostatic fat pro-inflammatory secretome in BPH pathogenesis.
    • In men with moderate to severe BPH, the robot-assisted waterjet ablation system (Aquablation) appears to be superior to TURP in the treatment of large prostates as well as in preventing anejaculation events.
    • Outpatient radiofrequency thermal therapy using the RezÅ«m System showed very good improvements in IPSS, Qmax, and quality of life at 2 years and no new erectile dysfunction. Median lobe treatments can also be performed and were done in 31% of patients.
    • Men with prostate volume of 30-80 cc undergoing the prostatic urethral lift (UroLift) procedure experienced symptom improvement by 1 month, and improvements were durable to 5 years. Sexual function, including ejaculatory function, was preserved.
    • At 13-year follow-up, holmium laser enucleation of the prostate continued to be safe and effective with very few early or late complications.
    • Robotic simple prostatectomy appears safe and effective for the treatment of BPH, with good functional outcomes and low morbidity. Significant improvements were seen in IPSS, PVR, and Qmax at 7 months.
    • Photovaporization using the 180-watt GreenLight XPS laser appears to be an acceptable technique in patients with very large prostates (>200 grams). However, OR times, energy density, PSA drop at 2 years, and LUTS are a concern, and careful counseling is recommended.

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