2019 American Urological Association assessment of BPH surgical procedures
Posted , 8 users are following.
If you cut and paste the following into google it shows the current status of American Urological Association recommendations. The paper also states when surgery should be considered.
Benign Prostatic Hyperplasia: Surgical Management of Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms (2018, amended 2019)
The different surgeries get either a B or C "evidence level" recommendation. PAE is not recommended, probably because the urologists can't do it.
We can only hope that someday there will be an "A" rating.
2 likes, 17 replies
lester90053 doug04815
Posted
No report is shown.
doug04815 lester90053
Posted
https://www.auanet.org/guidelines/benign-prostatic-hyperplasia-(bph)-guideline
doug04815 lester90053
Posted
I put the link in the above reply.
john53959 doug04815
Posted
Here is the link I used Bing not Google.....
https://www.auanet.org/guidelines/benign-prostatic-hyperplasia-(bph)-guideline
kenneth1955 doug04815
Posted
Hey Doug
It is a very good Report. I did not have to cut and paste. I just did a search I put in "" American Urological Association Recommendations for 2019 "" It was the first on the page.
I did go over it but I have to read it again. I really did not see any of Grade A. Then do talk about it some Did see a lot of Grade B & C and some with no grades when it came to surgery's.
Boy do they sure love the Turp. It is all in this article. To me they are pushing it because it is the gold standard. That is a matter of opinion. I would never do that with all the other procedures out there.
Another thing that I do not like is they have a way of saying no matter what the side effects you have you should still have the procedure so you can pee better. Everything else does not matter.
I feel this way because of what I read about Sexual Function and the Surgical Therapy. This is from the report.
Data on sexual side effects of BPH surgery's can be difficult to ascertain as many studies are not primarily designed to answer these questions. As such many studies evaluate sexual side effects by looking at reported adverse events only, rather then specifically assessing sexual functions.
This is why we have to do as much research we can before we have a procedure. Doctor are suppose to tell you everything about the procedures but there are some that just tell you enough to have the procedure. They also say that this because most doctor's feel that after 50 we should not be that interested in sex.
But after our kids are gone and you and you wife or partner are alone. This is when you can let your hair down and have fun and enjoy life together.
Well this is all I have to say for now. I get carried away with some of this.
All the best....Ken
Thanks again Doug. All men should read this article.....................................
steven05114 kenneth1955
Posted
Hi Ken,
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I downloaded and read the report too. You did not see any A's because there is probably not a BPH procedure that can get an A due to the morbidity and complications associated with any prostate surgery.
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Yes it looks like they still love TURP which they gave a B rating and has been around forever but still has the highest morbidity, highest percentage of complications, longest hospital stay, and longest recovery time when compared to newer and less invasive procedures.
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The report gives the newer procedures a C rating but that is because there is a lot less data (i.e evidence level) on the newer procedures than TURP. Many urologists stopped doing TURP 10 to 15 years ago when laser technologies came out but many are still doing TURP.
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You and I chose 2 new but different procedures because we were concerned about the negative complications of TURP. When looking for a urologist, I recommend choosing one who is concerned about our concerns about the negative complications of any BPH surgery.
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The moral of the story is to careful choose your urologist before considering any BPH surgery.
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Steve
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PS: Ken, in the last 2 weeks, my PVR's have dropped below 100 several times, so my bladder is showing signs of slowly recovering.
steven05114
Posted
PS: It is interesting that the report did not recommend Prostate Artery Embolization (PAE), which is a procedure that is not done by urologists.
kenneth1955 steven05114
Posted
Hey Steve
In a few days I'm going to print it up not enough ink Maybe I will save it on a file on the computer for now. Yes did go through it but I want to sit and read it slowly.
Yes I did see that PAE was not given a grade and is not recommended maybe it is because there is data but not enough.
Like you and I try to tell the men to make sure you do your research and research the doctor. Read his reviews and if he rushes you through just move on and find another.
All the best to everyone....Ken
steven05114 kenneth1955
Posted
Ken,
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Written like a true wize man "do your research and research the doctor. Read his reviews and if he rushes you through just move on and find another." Note that the urologist that I finally chose to do my Rezum was a 'her". She was concerned about my guy concerns and took precautions accordingly.
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Steve
kenneth1955 steven05114
Posted
Steven
Yes we do all have to do that to get the best results from a doctor. They need to listen to our concerns to.
Yes I know that you had a women Urologist and a few of the other guys. That is all I have to say on that subject.
Ken
n2506 doug04815
Posted
I dont think moderator allows.posting report. if you could summarize the report for everyone who does not have access to the report, it would be grateful.
steven05114 n2506
Posted
The problem is in posting links. The solution is to post what is necessary to search for the report, i.e. the name of the report. It would be a lot of work for any of us to post a summary of this report as it reviews several BPH procedures and lists their pros and cons.
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S
kenneth1955 steven05114
Posted
Good evening All
I sent a PM to him the way I found it. Yes that would be a lot to post. 33 pages
Ken
doug04815 n2506
Posted
A quick summary is that the URA gives the following grades:
TURP, TUIP, TUVP (an upgraded TURP procedure) , PVP (another TURP upgrade?), Laser Enuc leation (HoLEP): B
Simple Prostatectomy, PUL (UroLift), TUMT, Water Vapor Thermal Energy (Rezum?), Aquablation: C
TUNA and PAE are not recommended.
Looks like TURP and TURP variants, except for HoLEP get a B and some of the newer techniques like UroLift and Rezum get a C.
There are many caveats in the article related to prostate size and co-existing medical conditions.
I'm thinking there is a huge human factor which could only be ascertained by researching the surgeon. I.e. someone who is really good with a Grade C procedure might produce a better result than a novice using a Grade B procedure.
Also, as someone else mentioned, the article tends to minimize sexual side effects, except they do say for PUL (UroLift):
"15. PUL may be offered to eligible patients concerned with erectile and ejaculatory function for the treatment of with LUTS attributed to BPH. "
I imagine that pertains to a lot of people!
steven05114 doug04815
Posted
It is important for everyone to understand that the grade rating as written in the Methodology section is as follows:
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"the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low)".
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This has nothing to do with the morbidity (the medical problems caused by a treatment) and the complications (such as RE and ED) of the procedure, but instead is about how much data is available on the procedure.
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Newer procedures or procedures that are not widely used will have a lower grade, while TURP which has been around forever will have a higher grade, despite the fact that it has the highest morbidity, highest incident of complications, longest hospital stay, and longest recovery time.
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So the grading system avoids the question that we are all asking, "if I have a certain procedure, then what will be my sexual functioning afterwards". The report does give recommendations for some procedure as follows:
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"...may be offered to eligible patients who desire preservation of erectile and ejaculatory function."
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The first urologist that I saw, was very much like this report. He only gave a high score to TURP because that is what he had done forever and totally avoided answering my very direct question on the morbidity and complications of TURP. I decided to find another urologist.
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While this report does provide some useful information, the grade rating in the report is avoiding answering our question of "if I have a certain procedure, then what will be my sexual functioning afterwards".
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Steve
john53959 steven05114
Posted
This info just reminds we have to educate ourselves on all the ins & outs of this medical issues as others, as it appears the medical profs (some not all) miss the mark in so many ways. Would like to find info on Urologists that have gone thru these proceedures that had BPH.!!