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2012 THE RECOMMENDATORY USE OF NOMOGRAM PREDICTING THERAPEUTIC EFFECTS ON NOCTURIA BY TRANSURETHRAL RESECTION OF THE PROSTATE (TUR-P) FOR PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA (BPH) IN SELECTING TREATMENT OPTIONS INCLUDING TUR-P
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THE JOURNAL OF UROLOGY姞
Vol. 187, No. 4S, Supplement, Wednesday, May 23, 2012
CONCLUSIONS: This study validates for the first time the role of the PGI-I as a global index of symptomatic response to surgery for bladder outlet obstruction and in this case with PVP. Its failure to correlate with improvement in urinary flow rate may be consistent with increased patient bother with storage compared to voiding symptoms. Further correlations with subgroups of componens of the IPSS will of further research interest. The PGI-I may potentially be used to assess other surgical therapies for BPH and may prove to be a valuable addition as a tool to measure outcomes in clinical trials evaluating surgical interventions for BPH.
Source of Funding: American Medical Systems provided assistance with statistical analysis
2012 THE RECOMMENDATORY USE OF NOMOGRAM PREDICTING THERAPEUTIC EFFECTS ON NOCTURIA BY TRANSURETHRAL RESECTION OF THE PROSTATE (TUR-P) FOR PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA (BPH) IN SELECTING TREATMENT OPTIONS INCLUDING TUR-P Munekado Kojima*, Yasufumi Yada, Yosimasa Hayase, Nagoya, Japan
Source of Funding: The LeBaron Foundation Concord Hospital Trust
2011 VALIDATION OF PATIENT GLOBAL IMPRESSION OF IMPROVEMENT (PGI-I) TO ASSESS THE EFFECTIVENESS OF SURGERY FOR BLADDER OUTFLOW OBSTRUCTION. Spencer Murray*, Henry Woo, Sydney, Australia INTRODUCTION AND OBJECTIVES: The Patient Global Impression of Improvement (PGI-I) is an instrument used to assess patient satisfaction following treatment for a given condition and the seven point scale rates outcomes from 1⫽very much better to 7⫽ very much worse. The PGI-I is widely used in the area of incontinence surgery and lends itself well for the use in other areas of surgery. The objective of this study was to validate for the first time the PGI-I against improvement outcomes following surgery for bladder outlet obstruction due to benign prostatic hyperplasia. METHODS: Consecutive men with lower urinary tract symptoms undergoing 120W lithium triborate photoselective vaporisation of the prostate (PVP) were assessed pre and post operatively with the International Prostate Symptom Score (IPSS), Quality of Life Index (QL), peak urinary flow (Qmax) and ultrasound measured post void residual (PVR). The PGI-I was correlated with improvements in IPSS, QL, Qmax and PVR at 3 months following surgery. RESULTS: There was excellent test-retest reliability and correlation between PGI-I and other outcome measures with significant correlation. These are summarised in Table 1. Correlations with improvement in IPSS and QL as well as actual IPSS and QL at 3 months was highly statistically significant. There was also statistically significant correlation with improvement in PVR but not Qmax.
INTRODUCTION AND OBJECTIVES: Although TUR-P is a gold standard still now in the treatment of BPH, it occasionally fails to improve lower urinary tract symptoms, particularly nocturia. The present study was conducted to reveal therapeutic effects on nocturia by TUR-P and additionally to recommend the use of nomogram predicting the change in nocturia after TUR-P. METHODS: A total of 834 patients with BPH treated by TUR-P, who reported pre-operatively nocturia at least one time, were subjects for this study. Pre-operative parameters including age, prostate volume, urinary flow rate, postvoid residual urine and the International Prostate Symptom Score (IPSS) were compared with the change in nocturia reported 3 months following TUR-P. When post-operative score of nocturia (Q7 in IPSS) was 50% of less compared to preoperative score of Q7, patients were classified as responders and the others as non-responders in terms of therapeutic effects on nocturia. RESULTS: Out of 834 patients, 346 (41%) were classified as responders. Multiple regression analyses demonstrated that age, postvoid residual urine, scores of frequency (Q2 in IPSS), uegency (Q4) and nocturia (Q7) were independent predictors of the improvement rate of nocturia (post-operative/pre-operative Q7 scores). In addition, logistic regression analyses revealed that age, postvoid residual urine, the scores of urgency (Q4) and nocturia (Q7) were independent predictors of responders (R2⫽0.068). CONCLUSIONS: The present study demonstrated that therapeutic effects on nocturia by TUR-P were limited and their prediction was also difficult in clinical settings. In this situation, a nomogram predicting therapeutic effects on nocturia would be of clinical use particularly for patients in whom nocturia is the most bothersome symptom and TUR-P is one of treatment options for BPH. Nomogram predicting therapeutic effects on nocturne 3M following TUR-P Pre-TURP nocturnal frequency 1
Post-TURP nocturnal frequency 0 14%
Post-TURP nocturnal frequency 1 61%
Post-TURP nocturnal frequency 2 22%
2
5%
44%
42%
3
1%
32%
39%
4
2%
22%
37%
5 or more
7%
11%
32%
Values are percent probability
Source of Funding: None
Post-TURP nocturnal frequency 3 3%
Post-TURP nocturnal frequency 4 0%
Post-TURP nocturnal frequency 5 or more 0%
total 100%
7&
1%
1%
100%
22%
5%
1%
100%
29%
8%
2%
100%
33%
10%
7%
100%
THE JOURNAL OF UROLOGY姞
Vol. 187, No. 4S, Supplement, Wednesday, May 23, 2012
CONCLUSIONS: This study validates for the first time the role of the PGI-I as a global index of symptomatic response to surgery for bladder outlet obstruction and in this case with PVP. Its failure to correlate with improvement in urinary flow rate may be consistent with increased patient bother with storage compared to voiding symptoms. Further correlations with subgroups of componens of the IPSS will of further research interest. The PGI-I may potentially be used to assess other surgical therapies for BPH and may prove to be a valuable addition as a tool to measure outcomes in clinical trials evaluating surgical interventions for BPH.
Source of Funding: American Medical Systems provided assistance with statistical analysis
2012 THE RECOMMENDATORY USE OF NOMOGRAM PREDICTING THERAPEUTIC EFFECTS ON NOCTURIA BY TRANSURETHRAL RESECTION OF THE PROSTATE (TUR-P) FOR PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA (BPH) IN SELECTING TREATMENT OPTIONS INCLUDING TUR-P Munekado Kojima*, Yasufumi Yada, Yosimasa Hayase, Nagoya, Japan
Source of Funding: The LeBaron Foundation Concord Hospital Trust
2011 VALIDATION OF PATIENT GLOBAL IMPRESSION OF IMPROVEMENT (PGI-I) TO ASSESS THE EFFECTIVENESS OF SURGERY FOR BLADDER OUTFLOW OBSTRUCTION. Spencer Murray*, Henry Woo, Sydney, Australia INTRODUCTION AND OBJECTIVES: The Patient Global Impression of Improvement (PGI-I) is an instrument used to assess patient satisfaction following treatment for a given condition and the seven point scale rates outcomes from 1⫽very much better to 7⫽ very much worse. The PGI-I is widely used in the area of incontinence surgery and lends itself well for the use in other areas of surgery. The objective of this study was to validate for the first time the PGI-I against improvement outcomes following surgery for bladder outlet obstruction due to benign prostatic hyperplasia. METHODS: Consecutive men with lower urinary tract symptoms undergoing 120W lithium triborate photoselective vaporisation of the prostate (PVP) were assessed pre and post operatively with the International Prostate Symptom Score (IPSS), Quality of Life Index (QL), peak urinary flow (Qmax) and ultrasound measured post void residual (PVR). The PGI-I was correlated with improvements in IPSS, QL, Qmax and PVR at 3 months following surgery. RESULTS: There was excellent test-retest reliability and correlation between PGI-I and other outcome measures with significant correlation. These are summarised in Table 1. Correlations with improvement in IPSS and QL as well as actual IPSS and QL at 3 months was highly statistically significant. There was also statistically significant correlation with improvement in PVR but not Qmax.
INTRODUCTION AND OBJECTIVES: Although TUR-P is a gold standard still now in the treatment of BPH, it occasionally fails to improve lower urinary tract symptoms, particularly nocturia. The present study was conducted to reveal therapeutic effects on nocturia by TUR-P and additionally to recommend the use of nomogram predicting the change in nocturia after TUR-P. METHODS: A total of 834 patients with BPH treated by TUR-P, who reported pre-operatively nocturia at least one time, were subjects for this study. Pre-operative parameters including age, prostate volume, urinary flow rate, postvoid residual urine and the International Prostate Symptom Score (IPSS) were compared with the change in nocturia reported 3 months following TUR-P. When post-operative score of nocturia (Q7 in IPSS) was 50% of less compared to preoperative score of Q7, patients were classified as responders and the others as non-responders in terms of therapeutic effects on nocturia. RESULTS: Out of 834 patients, 346 (41%) were classified as responders. Multiple regression analyses demonstrated that age, postvoid residual urine, scores of frequency (Q2 in IPSS), uegency (Q4) and nocturia (Q7) were independent predictors of the improvement rate of nocturia (post-operative/pre-operative Q7 scores). In addition, logistic regression analyses revealed that age, postvoid residual urine, the scores of urgency (Q4) and nocturia (Q7) were independent predictors of responders (R2⫽0.068). CONCLUSIONS: The present study demonstrated that therapeutic effects on nocturia by TUR-P were limited and their prediction was also difficult in clinical settings. In this situation, a nomogram predicting therapeutic effects on nocturia would be of clinical use particularly for patients in whom nocturia is the most bothersome symptom and TUR-P is one of treatment options for BPH. Nomogram predicting therapeutic effects on nocturne 3M following TUR-P Pre-TURP nocturnal frequency 1
Post-TURP nocturnal frequency 0 14%
Post-TURP nocturnal frequency 1 61%
Post-TURP nocturnal frequency 2 22%
2
5%
44%
42%
3
1%
32%
39%
4
2%
22%
37%
5 or more
7%
11%
32%
Values are percent probability
Source of Funding: None
Post-TURP nocturnal frequency 3 3%
Post-TURP nocturnal frequency 4 0%
Post-TURP nocturnal frequency 5 or more 0%
total 100%
7&
1%
1%
100%
22%
5%
1%
100%
29%
8%
2%
100%
33%
10%
7%
100%