Recent Trends in the Diagnostic and Surgical Management of Benign Prostatic Hyperplasia in the U.S. from 2004 to 2017: Annual Changes in the Selection of Treatment Options and Medical Costs
Francesco Del GiudiceJin Kyu OhSatvir BasranEdouard NicaisePhil Hyun SongWansuk KimSang Youn KimGyeong Eun MinKoo Han YooHyuk Jin ChoSinyeong LeeAlessandro SciarraStefano SalcicciaEttore De BerardinisVincenzo AseroCarlo Maria ScornajenghiBenjamin PradèreWojciech KrajewskiAndrea GallioliMatteo FerroFelice CrocettoSavio Domenico PandolfoRiccardo AutorinoFederico BelladelliAndrea MariGian Maria BusettoShufeng LiSimone CrivellaroBenjamin I. Chung
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Background: Transurethral resection of the prostate (TURP) is the gold-standard treatment for benign prostatic hyperplasia (BPH). However, laser surgery techniques (e.g., photoselective vaporization of the prostate (PVP), holmium laser, thulium laser enucleation of the prostate (HoLEP or ThuLEP)), and minimally invasive treatment options (e.g., UroLift) are increasingly replacing TURP. This study seeks to report the annual incidence, management trends, and costs of BPH procedures in the U.S. Methods: Data analyses of U.S. health insurance claims from 2004 to 2017, collected from the de-identified Optum Clinformatics Claims Database, were performed to determine the number of BPH patients and the treatment selected. Results: A total of 51,448 patients underwent BPH procedures from 2004 to 2017. There was a significant increase in the annual rate from 770 in 2004 to 6571 in 2017. The mean patient age (±SD) increased from 67.6 years old (±8.4) in 2004 to 73.4 years old (±8.4) in 2017. More than 60% of patients underwent cystourethroscopy and a post-void residual urine check for workup prior to surgical management. TURP was the most-common, and PVP was the second-most-common BPH procedure. Medical and total treatment costs increased, while the detection rate of prostate cancer after BPH surgery gradually decreased from 19.87% in 2004 to 5.78% in 2017. Conclusions: Our study demonstrates a recent trend in BPH management that replaces the traditional TURP technique with alternative methods. Due to rising costs, future studies should assess whether these newer methods are cost effective over the long term.Keywords:
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【Objective】To investigate the main factors that cause the enucleation of eyeball in clinical setting. 【Methods】We retrospectively reviewed all the patients with enucleation of eyeballs in our hospital from January 2003 to November 2010.【Results】The most common cause of destructive procedure was trauma(34.4%), followed by neoplasms(29.5%), and infection(27.5%). Regarding neoplasms, females were more likely to be enucleated while the reverse was so for traumas and infection(all P 0.05). 【Conclusions】The most common reason to cause the enucleation of eyeballs was trauma. Men were much frequently involved in the eyeball enucleation with reasons of trauma and infection, while in the cases with neoplasms, their amount was less than women's. The key points of reducing the occurrence rate of enucleation are to increase the awareness of family accident and improve the early diagnosis of ocular neoplasms.
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Lasers have been used in the management of benign prostatic hyperplasia for the last two decades. To be comparable, they should reduce or avoid the immediate and long-term complications of transurethral resection of the prostate (TURP) or open prostatectomy (OP), especially bleeding and need for blood transfusion. Although Holmium laser treatment of the prostate was compared frequently in terms of cardiovascular safety with TURP or OP, photoselective vaporisation of the prostate (PVP) was not largely evaluated. In this article we analyzed the current literature to see if there is convincing data to support the observation of some authors that use of PVP is associated with increased safety in patients on anticoagulants with cardiovascular comorbidities. With this purpose a Medline search between January 2004 to March 2013 was performed using evidence obtained from randomised trials, well-designed controlled studies without randomisation, individual cohort studies, individual case control studies and case reportsIn the last 10 years, several case-control and cohort studies have demonstrated the efficacy of PVP as well as its safety in patients with cardiovascular comorbidities using anticoagulants. The results confirmed the overall lower perioperative and postoperative morbidity of PVP, whereas the efficacy was comparable to TURP in the short term, despite a higher reoperation rate.Although it is still developing, PVP with KTP or LBO seems to be a promising alternative to both TURP and OP in terms of cardiovascular safety and in patients using anticoagulants.
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Values for radioactive phosphorus uptake from 23 eyes with malignant melanomas of the choroid were compared before and after enucleation. In all but two eyes, the percentage increase in 32P uptake was higher immediately after enucleation than before enucleation. In 11 eyes, the variation was more than 100%. In one eye, the percentage increase of 32P uptake was 68% before enucleation and 137% after enucleation. The clinical importance of our findings is that pressure on the globe by the detector probe before enucleation may locally decrease choroidal blood volume thereby causing an increase in the calculated 32P uptake.
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Oocytes of Yanbian Yellow Cattle were enucleated by methods of squeezing enucleation,blind enucleation and point-hitting enucleation,then compared in operating time,achievement rate,enucleation rate and proportion of reconstituted embryos.The results showed that blind enucleation was lower than the other two ways in enucleation rate.Higher success rate were obtained using squeezing enucleation and point-hitting enucleation.The shorter time-consuming methods were squeezing enucleation and blind enucleation;there is no significant difference in cleavage rate and blastocyst rate.Therefore,the methods of squeezing enucleation was a practical enucleation method of Yanbian Yellow Cattle oocytes.
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To date, the parameters for evaluating enucleation efficiency have only considered enucleation time, although operators simultaneously consume both time and energy during holmium laser enucleation of the prostate. This study was undertaken to find a better way of assessing enucleation skills, considering both enucleation time and consumed energy.One hundred (n=100) consecutive patients who underwent holmium laser enucleation of the prostate from April 2012 to April 2014 by a single surgeon were enrolled. Ten groups of 10 consecutive cases were used to analyze the parameters of enucleation efficiency.The mean enucleation time, consumed energy, and enucleated weight were 41.3±19.2 minutes, 66.2±36.0 kJ, and 26.6±21.8 g, respectively. Concerning learning curves, like enucleation time-efficacy (=enucleated weight/enucleation time), enucleation energy-efficacy (=enucleated weight/consumed energy) also had an increasing tendency. Enucleation ratio efficacy (=enucleated weight/transitional zone volume/enucleation time) plateaued after 30 cases. However, enucleation time-energy-efficacy (=enucleated weight/enucleation time/consumed energy) continued to increase after 30 cases and plateaued at 61 to 70 cases. Furthermore, one-way analysis of variance showed that group means for enucleation time-energy-efficacy (F=3.560, p=0.001) were significantly different, but that those of enucleation ratio efficacy (F=1.931, p=0.057) were not.When both time and energy were considered, enucleation skills continued to improve even after 30 cases and plateaued at 61 to 70 cases. Therefore, we propose that enucleation time-energy-efficacy should be used as a more appropriate parameter than enucleation ratio efficacy for evaluating enucleation skills.
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