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Conservative Treatment for Benign Prostatic Hyperplasia in Patients With Bladder Stones

      Objective

      To determine whether conservative management of benign prostatic hyperplasia (BPH) is an appropriate option for patients with bladder stones.

      Methods

      The study cohort comprised 34 men who underwent endoscopic bladder stone removal with subsequent conservative management of BPH, including watchful waiting and medical therapy (alpha-blocker ± dutasteride), between April 2006 and January 2014. We recorded BPH-related complications after stone removal and compared International Prostate Symptom Scores, quality of life scores, and postvoid residual urine volume before and after treatment. Cumulative BPH-related complication-free survival and the preoperative parameters associated with the occurrence of BPH-related complications were also analyzed.

      Results

      Twenty-six patients (76.5%) treated with conservative management had no BPH-related complications, during a mean follow-up of 52.6 ± 30.9 months. Mean International Prostate Symptom Scores fell from 13.5 ± 7.1 before treatment to 9.7 ± 6.3 after treatment (P = .025). One of the 34 patients (2.9%) experienced recurrent urinary infections, 2 (5.9%) had urinary retention, and 6 (17.6%) developed recurrent bladder stones. The cumulative BPH-related complication-free survival was 97.0% at 1 year, 81.8% at 3 years, and 70.5% at 5 years. Six of the men (17.6%) underwent invasive intervention for BPH after occurrence of these complications. Prostate volume was the only preoperative parameter associated with the occurrence of complications after stone removal (P = .035).

      Conclusion

      Conservative management of BPH can be an appropriate treatment option in men with bladder stones and concurrent mild-to-moderate lower urinary tract symptoms.
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      References

        • Schwartz B.F.
        • Stoller M.L.
        The vesical calculus.
        Urol Clin North Am. 2000; 27: 333-346
        • Philippou P.
        • Moraitis K.
        • Masood J.
        • et al.
        The management of bladder lithiasis in the modern era of endourology.
        Urology. 2012; 79: 980-986
        • Douenias R.
        • Rich M.
        • Badlani G.
        • et al.
        Predisposing factors in bladder calculi. Review of 100 cases.
        Urology. 1991; 37: 240-243
        • Mebust W.K.
        • Holtgrewe H.L.
        • Cockett A.T.
        • Peters P.C.
        Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients.
        J Urol. 1989; 141: 243-247
        • Millán-Rodríguez F.
        • Errando-Smet C.
        • Rousaud-Barón F.
        • et al.
        Urodynamic findings before and after noninvasive management of bladder calculi.
        BJU Int. 2004; 93: 1267-1270
        • Malaeb B.S.
        • Yu X.
        • McBean A.M.
        • Elliott S.P.
        National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008).
        Urology. 2012; 79: 1111-1116
        • Gratzke C.
        • Bachmann A.
        • Descazeaud A.
        • et al.
        EAU Guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction.
        Eur Urol. 2015; 19
        • McVary K.T.
        • Roehrborn C.G.
        • Avins A.L.
        • et al.
        Update on AUA guideline on the management of benign prostatic hyperplasia.
        J Urol. 2011; 185: 1793-1803
        • Millán-Rodríguez F.
        • Izquierdo-Latorre F.
        • Montlleó-González M.
        • et al.
        Treatment of bladder stones without associated prostate surgery: results of a prospective study.
        Urology. 2005; 66: 505-509
        • Netto N.R.
        • de Lima M.L.
        • Netto M.R.
        • D'Ancona C.A.
        Evaluation of patients with bladder outlet obstruction and mild international prostate symptom score followed up by watchful waiting.
        Urology. 1999; 53: 314-316
        • Flanigan R.C.
        • Reda D.J.
        • Wasson J.H.
        • et al.
        5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study.
        J Urol. 1998; 160 (discussion 16-17): 12-16
        • Chapple C.R.
        • Montorsi F.
        • Tammela T.L.
        • et al.
        Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe.
        Urologiia. 2012; (38-42, 44-45)
        • Jardin A.
        • Bensadoun H.
        • Delauche-Cavallier M.C.
        • Attali P.
        Alfuzosin for treatment of benign prostatic hypertrophy. The BPH-ALF Group.
        Lancet. 1991; 337: 1457-1461
        • Kirby R.S.
        • Andersen M.
        • Gratzke P.
        • et al.
        A combined analysis of double-blind trials of the efficacy and tolerability of doxazosin-gastrointestinal therapeutic system, doxazosin standard and placebo in patients with benign prostatic hyperplasia.
        BJU Int. 2001; 87: 192-200
        • McConnell J.D.
        • Roehrborn C.G.
        • Bautista O.M.
        • et al.
        The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia.
        N Engl J Med. 2003; 349: 2387-2398
        • Roehrborn C.G.
        • Siami P.
        • Barkin J.
        • et al.
        The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study.
        Eur Urol. 2010; 57: 123-131
        • O'Connor R.C.
        • Laven B.A.
        • Bales G.T.
        • Gerber G.S.
        Nonsurgical management of benign prostatic hyperplasia in men with bladder calculi.
        Urology. 2002; 60: 288-291
        • Tzortzis V.
        • Aravantinos E.
        • Karatzas A.
        • et al.
        Percutaneous suprapubic cystolithotripsy under local anesthesia.
        Urology. 2006; 68: 38-41
        • Philippou P.
        • Volanis D.
        • Kariotis I.
        • et al.
        Prospective comparative study of endoscopic management of bladder lithiasis: is prostate surgery a necessary adjunct?.
        Urology. 2011; 78: 43-47