[Show abstract][Hide abstract] ABSTRACT: Many men with benign prostatic hyperplasia (BPH) forego therapy because they are dissatisfied with current treatment options. While surgical resection and ablation using many different forms of energy remain the reference standard for BPH treatment, many men seek a less invasive technique that will improve symptoms but not risk the complications associated with tissue removal. The Prostatic Urethral Lift opens the prostatic urethra with UroLift (NeoTract Inc., Pleasanton, CA, USA) permanent implants that are delivered under cystoscopic visualization. The implants literally "hold open" the lateral prostatic lobes creating a passage through the obstructed prostatic urethra. Voiding and symptoms are significantly improved without the morbidity or possible complications following prostate resection. The entire procedure can be readily performed using local anesthesia. As with all new implant procedures, the technique has evolved with experience. The objective of this article is to describe the most current technique for the delivery of the UroLift implant in order to achieve maximal impact on symptom relief.
The Canadian Journal of Urology 04/2012; 19(2):6217-22. · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Benign prostatic hyperplasia (BPH), and its clinical manifestation as lower urinary tract symptoms (LUTS), is a major health concern for aging men. There have been significant advances in the diagnosis and treatment of BPH in recent years. There has been a renewed interest in medical therapies and less invasive surgical techniques. As a consequence, the treatment needs of men with mild to moderate LUTS without evidence of prostate cancer can now be accomplished in a primary care setting. There are differences in the way urologists and primary care physicians approach the evaluation and management of LUTS due to BPH, which is not reflected in Canadian Urological Association (CUA) and American Urological Association (AUA) guidelines. A "shared care" approach involving urologists and primary care physicians represents a reasonable and viable model for the care of men suffering from LUTS. The essence of the model centres around educating and communicating effectively with the patient on BPH. This article provides primary care physicians with an overview of the diagnostic and management strategies outlined in recent CUA and AUA guidelines so that they may be better positioned to effectively deal with this patient population. It is now apparent that we must move away from the urologist as the first-line physician, and allow primary care physicians to accept a new role in the diagnosis and management of BPH.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada 07/2009; 3(3 Suppl 2):S92-S100. · 1.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Testosterone replacement therapy (TRT) can have significant beneficial effects in the appropriate hypogonadal male patient. Testosterone deficiency is common in primary care practice and recognition of the signs and symptoms of this abnormality will allow physicians to choose appropriate interventions. The symptoms of clinical hypogonadism include muscle weakness, fatigue, mood changes and a reduced libido. Signs include a reduced muscle mass, osteoporosis, anemia and increased adiposity. While routine screening for testosterone deficiency, determination of testosterone levels in high risk populations, including obesity and diabetes, will help the clinician direct TRT to the patients most likely to benefit from therapy. In this article the syndrome of male hypogonadism is discussed, together with therapeutic choices available to the primary care physician.
The Canadian Journal of Urology 09/2008; 15 Suppl 1:71-7; discussion 77. · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Studies evaluating the effect of education on treatment success with phosphodiesterase type 5 (PDE5) inhibitor therapy in men with erectile dysfunction (ED) are limited. Additional education of the primary care physician (PCP) and the patient are thought to optimize the treatment of ED.
To assess the impact of education of the PCP or of the patient in the treatment of ED with vardenafil relative to usual care.
In this 12-week, open-label, multicenter, factorial-designed, cluster-randomized Canadian study, 1,029 patients with ED were enrolled into four different education groups: usual care, patient education, PCP education, and both PCP and patient education. All groups started on vardenafil 10 mg, with the option to titrate at weeks 4 and 8.
The primary efficacy measure was the difference at week 4 last observation carried forward (LOCF) in the overall improvement in erectile function (EF) as measured by the Global Assessment Question (GAQ), while on background vardenafil, between those receiving education vs. those who did not. Other secondary assessments included responses to diary questions regarding penetration (sexual encounter profile, SEP2) and erection maintenance (SEP3), and to questionnaires regarding treatment satisfaction (Erectile Dysfunction Inventory of Treatment Satisfaction [EDITS]).
A total of 956 patients were included in the intent-to-treat population. Mean baseline International Index of Erectile Function-EF domain score was 13. GAQ response rates at week 4 LOCF were high (>80%) for all groups, regardless of the education given. Mean per patient SEP2 and SEP3 rates at week 12 LOCF were 86-89% and 79-83%, respectively. In an exploratory analysis, a positive relationship between GAQ responses and EDITS scores was observed (P < or = 0.0007). Vardenafil was generally well tolerated.
In men with moderate ED, vardenafil led to high success rates and satisfaction regardless of the education given. The benefits of education for PCP and patients in Canada were possibly masked by a ceiling effect in this study population.
Journal of Sexual Medicine 04/2008; 5(3):705-15. DOI:10.1111/j.1743-6109.2007.00716.x · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While the efficacy of sildenafil for the management of erectile dysfunction (ED) has been demonstrated in randomized clinical trials, few data exist on its effectiveness in a real-life setting.
The objective of this study was to examine the treatment satisfaction and effectiveness with sildenafil in a real-life setting in Canada.
A multicenter, prospective study, using an educational program aimed at optimizing sildenafil treatment, was conducted at 231 primary care sites across Canada. Patients who received their first prescription of sildenafil for ED within the usual practice of medicine were invited to participate in the study. Data were collected through patient self-administered questionnaires.
The Sexual Health Inventory for Men (SHIM) questionnaire was used to determine the erectile function at baseline, month 3 and month 6. Treatment satisfaction at months 3 and 6 was assessed using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire.
The intent-to-treat population consisted of 2,573 patients. The mean age was 55 years (18 to 92 years). At baseline, the mean SHIM score was 11.9 with 21.7% of men having severe ED, 22.9% moderate ED, 36.5% mild-to-moderate ED, and 16.9% mild ED. At month 3, the mean SHIM score improved significantly to 18.0 (P < 0.0001) and 33.3% of patients had a SHIM score above 21 (no ED). At 6 months, the mean SHIM score was 18.7. At both months 3 and 6, approximately 89% of patients were satisfied with their treatment (i.e., EDITS score >or= 50), suggesting no attenuation of the satisfaction over the 6 months of use.
The effectiveness of sildenafil in the management of ED was demonstrated in a large cohort of men treated in a primary care setting in this Canadian real-life study. Persistence with therapy and lack of attenuation over time among the vast majority of men was shown.
Journal of Sexual Medicine 10/2007; 4(5):1414-21. DOI:10.1111/j.1743-6109.2007.00555.x · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Erectile dysfunction (ED) is a complex condition, which is variously influenced by physical, emotional, societal, and relationship factors. ED has serious implications for the quality of life (QoL) enjoyed by an affected male and his partner. It is very important, therefore, to understand the impact of ED on the QoL of those affected by it. Our objective was to determine if the eight-question Patient Reported Erectile Function Assessment (PREFA) could act as an independent, comprehensive disease-specific instrument in the assessment of QoL as it is impacted by ED.
During the development and validation of the Erectile Function-Visual Analog Scale (EF-VAS) (14), a new ED-specific preference-based instrument, a series of questions were included at the beginning of the assessment that would act as a way to encourage respondents to focus on their own experience with ED. Upon analysis of the EF-VAS data, it became apparent that the eight-question "warm up" section might act as a stand-alone assessment. Accordingly, the eight questions were named PREFA, and a validation analysis was undertaken to determine their consistency, feasibility, reliability, validity, and responsiveness.
The PREFA questionnaire was found to be feasible and simple to complete, reliable, and valid, with excellent responsiveness. Overall, the PREFA has demonstrated that it can perform as a stand alone, validated assessment of the impact of ED on QoL, assessing areas of QoL not previously captured in existing instruments.
The PREFA is suitable for use in clinical and research settings as a disease-specific QoL assessment tool.
International Journal of Technology Assessment in Health Care 02/2006; 22(3):372-8. DOI:10.1017/S0266462306051270 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A novel slow release formulation of alfuzosin should improve compliance by reducing dosing to one 10 mg tablet per day. The current study examined efficacy, at 9 days and 3 months, and safety of this formulation of alfuzosin in BPH patients.
ALF-X was a 3-month, non-comparative, observational study of 353 BPH patients from 39 Canadian Urology centres.
At baseline (BL), mean age was 63.1+/-9.01 years, 92.6% of patients were Caucasian, 3.4% had a history of acute urinary retention, mean duration of the micturition disorder was 48.6+/-54.15 months, and mean PSA was 3.3+/-6.65 ng/mL. Mean total International Prostate Symptom Score (I-PSS) decreased from 17.5 at BL to 10.4 at M3--an improvement of 7.1+/-6.82 points (40.6%, p < 0.001), mostly occurring (27.0%, p < 0.001)) during the first 9 days. Mean Quality of Life Assessment Index improved by 0.7+/-1.39 points between BL and D9 (17.5%, p < 0.001), and by 1.5+/-1.52 points between BL and M3 (37.5%, p < 0.001). The proportion of 'mild' I-PSS patients increased from 11.8% (BL) to 29.7% (D9) to 39.0% (M3); those with 'severe' I-PSS decreased from 37.8% (BL) to 14.5% (D9) to 9.4% (M3). Of 144 patients with nocturia (>2 nightly voidings) at D1, 51.4% improved to < or = 2 nightly voidings at D9, and 60.4% at M3. Adverse events related to alfuzosin occurred in 7.8% of patients; 2.0% experienced serious adverse events. There were no vasodilatory events related to alfuzosin or deaths.
In routine clinical practice, slow-release alfuzosin is associated with a significant improvement in LUTS, and frequency of nocturia, and an excellent safety profile.
The Canadian Journal of Urology 08/2005; 12(4):2745-54. · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To perform a Canadian multicenter randomized placebo-controlled trial to evaluate the safety and efficacy of 6 weeks of levofloxacin therapy compared with placebo in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Uncontrolled studies have supported the use of antibiotics in CP/CPPS.
Men with a National Institutes of Health (NIH) diagnosis of CP/CPPS (specifically, no infection localized to the prostate) were randomized to levofloxacin (500 mg/day) or placebo for 6 weeks in 11 Canadian centers. Patients were assessed at baseline and at 3, 6, and 12 weeks with the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and global patient assessments (subjective global assessment and patient assessment questionnaire).
Eighty men (average age 56.0 years, range 36 to 78; duration of symptoms 6.5 years, range 0.6 to 32) were randomized to receive levofloxacin (n = 45) or placebo (n = 35). All were evaluated in an intent-to-treat analysis. Both groups experienced progressive improvement in symptoms as measured by the NIH-CPSI. However, the difference in response was not statistically or clinically significant at end of treatment (6 weeks) or at the end of the follow-up visits (12 weeks). No patients withdrew because of adverse events. One patient withdrew before the 6-week assessment. Adverse events (all mild) were reported in 20% of the levofloxacin group and 17% of the placebo group.
This pilot placebo-controlled study showed that 6 weeks of levofloxacin therapy in men diagnosed with CP/CPPS resulted in symptom improvement that was not significantly different from that with placebo at end of treatment or follow-up. The clinical ramifications of these findings need to be addressed.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: High Intensity Focused Ultrasound (HIFU) ablates benign prostatic tissue in a minimally invasive manner with low morbidity. The safety and effectiveness of treating of benign prostatic hypertrophy (BPH) with HIFU using 3 different protocols are reported. METHODS: Forty six male patients with a mean age of 65 (range 47-84) were treated using the Sonablate HIFU device (Focus Surgery, Indianapolis IN) with 3 different protocols at 3 centres (LDS n=20, PJP n=12, RWC n=14). Baseline and outcome measures included AUA symptom score, peak urinary flow rate (Qmax) and quality of life (QOL) score. Early and long term complications were recorded. RESULTS: At 12 months post-HIFU, patients showed improvements in AUA symptom scores of 35% (LDS), 43% (PJP) and 59% (RWC). Qmax improved by 30% (LDS), 37% (PJP) and 63% (RWC). QOL scores improved by 63% (LDS) and 58% (RWC). Minor complications included hematospermia (13%), mild to moderate hematuria (9%), acute retention (4%), perineal pain (11%) and epididymitis (9%). Recatheterization occurred in up to 16% of patients. Eleven patients in the LDS and PJP series required a transurethral resection of the prostate (TURP) for symptoms of urinary obstruction after HIFU treatment. There were no TURP's following HIFU in the RWC series. CONCLUSIONS: HIFU is safe, produces acceptable complications and effectively relieves BPH symptoms.
The Canadian Journal of Urology 07/1999; 6(3):799-805. · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: To determine the minimum clinically important difference with respect to the different outcome measures used in benign prostatic hyperplasia (BPH) research. MATERIALS AND METHODS: Forty-two patients diagnosed with symptomatic BPH were prospectively recruited from community urology clinics. Patients were asked at follow-up visits to rate their improvement using a self-administrated questionnaire. The improvement score was then compared to the changes from baseline in each of the outcome measures. RESULTS: Maximum and mean flow-rates did not correlate significantly with the patient's improvement measure. The Boyarsky score correlated best with the patient's grading of overall improvement (R=.507, p<.001). The mean change in Boyarsky symptom score for patients with a small improvement was 3.23 (sd=3.52).
The Canadian Journal of Urology 02/1997; 4(2):377-380. · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives. This study was designed to evaluate the safety and efficacy of the selective alpha(1)-adrenoceptor blocker terazosin in the treatment of benign prostatic hyperplasia (BPH). Methods. Two hundred twenty-four patients aged 50 to 80 years, who had a diagnosis of BPH based on medical history, physical examination, and digital palpation, were recruited from 11 different sites between January 1992 and January 1994. The study consisted of a screening phase, a placebo phase, a double-blind dose-titration phase, and a double-blind maintenance phase. Results. Of the patients recruited, 164 entered the double-blind phase and of these 134 were evaluable. Only 11 patients withdrew because of an adverse event, 7 in the terazosin and 4 in the placebo group. Compared to placebo, terazosin significantly increased peak and mean urine flow rates without significantly affecting voided volume or postvoid residual volume. It significantly improved both the obstructive and irritative symptoms associated with BPH. Fifty-one patients from the terazosin group reported a total of 120 adverse events compared with 83 reported by 42 patients in the placebo group. The majority of these events were mild to moderate. Seventeen terazosin-treated patients reported hypotension-related adverse events and 4 withdrew from the study. However, concurrent treatment with antihypertensive agents did not affect the blood pressure response of the terazosin group. Conclusions. Overall, this study showed terazosin to be safe and effective in relieving the signs and symptoms of BPH and should be considered as a treatment alternative.