BACKGROUND: Previous studies noted varied adherence to clinical practice guidelines (CPGs), but studies are yet to quantify adherence to American Urological Association BPH guidelines. We studied guideline adherence in the context of a new quality improvement collaborative (QIC).
METHODS: Data were collected as part of a statewide QIC. Medical records for patients undergoing select CPT codes from January 2020 to May 2022 were retrospectively reviewed for adherence to selected BPH guidelines.
RESULTS: Most men were treated with transurethral resection of the prostate. Notably, 53.3% of men completed an IPSS and 52.3% had a urinalysis. 4.7% were counseled on behavioral modifications, 15.0% on medical therapy, and 100% on procedural options. For management, 79.4% were taking alpha-blockers and 59.8% were taking a 5-ARI. For evaluation, 57% had a PVR, 63.6% had prostate size measurement, 37.4% had uroflowmetry, and 12.3% were counseled about treatment failure. Postoperatively, 51.6% completed an IPSS, 57% had a PVR, 6.50% had uroflowmetry, 50.6% stopped their alpha-blocker, and 75.0% stopped their 5-ARI.
CONCLUSIONS: There was adherence to preoperative testing recommendations, but patient counseling was lacking in the initial work-up and preoperative evaluation. We will convey the data to key stakeholders, expand data collection to other institutions, and devise an improvement implementation plan.

UNASSIGNED: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method.
UNASSIGNED: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized.
UNASSIGNED: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations.
UNASSIGNED: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Benign prostatic hyperplasia (BPH) is the most common disease of the lower urinary tract in men. The prevalence increases continuously with increasing age and a chronic progressive course is to be expected. In order to reduce the morbidity of affected patients and to improve their quality of life, the expert panel Benign Prostatic Hyperplasia (BPH) of the German Society of Urology (DGU) has written a new version of the evidence-based \"S2e guideline on the diagnosis and treatment of BPH\". Using a current patient case, the contents of the new S2e guideline are illustrated, from diagnosis to the decision-making process for a suitable treatment choice. The case presented here shows the possible complexity and difficulty that can arise in the diagnosis of BPH, the need for further diagnostic steps and the finding of a suitable therapy in order to fulfill the patient\'s wishes, if possible.
UNASSIGNED: Das benigne Prostatasyndrom (BPS) ist die häufigste Erkrankung des unteren Harntraktes beim Mann. Die Prävalenz steigt kontinuierlich mit zunehmendem Lebensalter an und ein chronisch progredienter Verlauf ist zu erwarten. Um die Morbidität betroffener Patienten zu senken und die Lebensqualität zu verbessern, hat der Arbeitskreis Benignes Prostatasyndrom (BPS) der Deutschen Gesellschaft für Urologie e. V. (DGU) eine Neufassung der evidenzbasierten „S2e-Leitlinie Diagnostik und Therapie des BPS“ verfasst. Anhand eines aktuellen Patientenfalls werden hier die Inhalte der neuen S2e-Leitlinie von der Diagnostik bis zur Entscheidungsfindung einer passenden Therapiewahl anschaulich dargestellt. Im hier vorgestellten Fall zeigen sich die mögliche Komplexität und Schwierigkeit, die bei der Diagnose eines BPS auftreten können, die Notwendigkeit weiterführender Diagnostik und die Findung einer passenden Therapie, um auch vorliegende Patientenwünsche, wenn möglich, zu erfüllen.

暂无摘要。

BACKGROUND: Lower urinary tract symptoms suggestive for benign prostatic obstruction (LUTS/BPO) are one of the most frequent diseases in men and can have a significant impact on quality of life. Instrumental therapies are common, and many patients seek minimally invasive treatment options.
OBJECTIVE: Presentation and evidence-based evaluation of the minimally invasive therapy for benign prostatic syndrome.
METHODS: Summary and overview of chapters 11-13 on minimally invasive therapies for LUTS/BPO of the current long version of the German S2e guideline.
RESULTS: In case of absolute indication for surgery or after unsatisfactory or undesired medical therapy, minimally invasive treatments such as UroLift® (Neotract Inc., Pleasanton, CA, USA), Rezῡm™ (Boston Scientific, Malborough, MA, USA), iTIND™ (Olympus America Inc., Westborough, MA, USA), and prostatic artery embolization (PAE) can be considered. These indirect/delayed ablative therapies offer lower morbidity and the possibility of performing them under local anesthesia, but they are inferior to direct ablative/resective techniques in terms of effectiveness and sustainability.
CONCLUSIONS: The updated German S2e guideline summarizes evidence-based recommendations for new minimally invasive therapies for LUTS/BPO, which present alternative treatment options for selected patients.
UNASSIGNED: HINTERGRUND: Das benigne Prostatasyndrom (BPS) ist die häufigste Erkrankung des unteren Harntrakts beim Mann und kann großen Einfluss auf die Lebensqualität der Betroffenen nehmen. Instrumentelle Therapien sind häufig, und viele Patienten streben mittlerweile eine operative Therapie mit weniger Morbidität als bei den klassischen Prostataoperationen an.
UNASSIGNED: Es handelt sich um die Darstellung und evidenzbasierte Bewertung der minimalinvasiven Therapie (MIT) des BPS.
METHODS: Der Artikel liefert eine Zusammenfassung und Übersicht der Kapitel 11–13 zur MIT des BPS der aktuellen Langfassung der deutschen S2e-Leitlinie.
UNASSIGNED: Bei absoluten Operationsindikationen oder nach unzufriedenstellender oder abgelehnter medikamentöser Therapie können MIT, wie UroLift® (Neotract Inc., Pleasanton, CA, USA), Rezῡm™ (Boston Scientific, Malborough, MA, USA), iTIND™ (Olympus America Inc., Westborough, MA, USA) sowie die Prostata-Arterien-Embolisation (PAE) in Betracht gezogen werden. Diese indirekt/verzögert ablativen Therapien weisen eine geringe Morbidität auf und können auch in Lokalanästhesie durchgeführt werden. MIT sind jedoch den klassischen Prostataoperationen (mit unmittelbarer Gewebeablation) hinsichtlich Effektivität und Nachhaltigkeit unterlegen.
UNASSIGNED: Die aktualisierte deutsche S2e-Leitlinie erfasst und bewertet die neuen MIT des BPS, welche Alternativen bei einem selektionierten Patientenklientel darstellen.

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暂无摘要。

Background: Holmium laser enucleation of the prostate (HoLEP) has emerged as a new gold standard for treatment of benign prostatic hyperplasia; however, its steep learning curve hinders generalization of this technique. Therefore, there is a need for a benchtop HoLEP simulator to reduce this learning curve and provide training. We have developed a nonbiohazardous HoLEP simulator using modern education theory and validated it in a multicenter study. Materials and Methods: Six experts established key components for a HoLEP simulator through a Delphi consensus over three rounds including 250 questions. After consensus, a digital design was created and approved by experts, then used to fabricate a physical prototype using three-dimensional printing and hydrogel molding. After a process of iterative prototype testing, experts completed a survey assessing the simulator with a 5-point Likert scale for final approval. The approved model was validated with 56 expert and novice participants at seven institutions using subjective and objective performance metrics. Results: Consensus was reached on 85 of 250 questions, and experts found the physical model to adequately replicate 82.5% of required features. Objective metrics were statistically significant (p < 0.0001) when comparing experts and novices for enucleation time (37.4 ± 8.2 vs 16.7 ± 6.8 minutes), adenoma weight (79.6 ± 20.4 vs 36.2 ± 9.9 g), and complications (6 vs 22), respectively. Conclusion: We have effectively completed a multicenter study to develop and validate a nonbiohazardous benchtop simulator for HoLEP through modern education theory. A training curriculum including this simulator is currently under development.

BACKGROUND: Lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) are one of the most common diagnoses in clinical practice. Bothersome LUTS impact considerably quality of life of men and may cause severe complications without treatment. According to the diagnostic assessment every patient should be treated with an adequate therapy. Management comprises a conservative approach, medication, novel minimally invasive options, and surgical procedures with the aim to remove the obstructing adenoma. The German guideline panel has updated the German guidelines on diagnostic evaluation and management of LUTS due to BPO.
OBJECTIVE: Evidence-based recommendations of surgical treatment options of LUTS due to BPO are evaluated.
METHODS: Chapters 11.1.1 and 11.2 of the updated German S2e guideline on the management of LUTS due to BPO are summarized as a review article.
RESULTS: A treatment algorithm based on current evidence has been proposed. It is considered to provide guidance for the selection of the best procedure according to the needs of the patient. Anatomic features of the prostate, the patients\' morbidity, and the preservation of ejaculatory function are taken into account for the choice of the best procedures. These surgical options can be divided into techniques with direct, delayed or no removal of the adenoma, procedures with suprapubic access, and embolizing approaches.
CONCLUSIONS: The updated German S2e guideline on the management of LUTS due to BPO provides evidence-based recommendations for the selection of the best procedure according to the needs of the individual patient.
UNASSIGNED: HINTERGRUND: Das benigne Prostatasyndrom (BPS) ist eines der häufigsten Behandlungsanlässe in der urologischen Praxis. Es beeinflusst die Lebensqualität betroffener Männer und kann, wenn nicht adäquat behandelt, zu schwerwiegenden Komplikationen führen. Nach diagnostischer Abklärung wird dem Patienten ein Behandlungskonzept entsprechend seiner Symptomatik angeboten. Neben konservativen, medikamentösen, neueren minimalinvasiven Therapieoptionen steht ein Spektrum aus direkt ablativen Verfahren zur Verfügung mit dem Ziel, den ursächlichen Blasenauslasswiderstand möglichst vollständig zu reduzieren. Der Arbeitskreis BPS hat diese ablativen Verfahren einer eingehenden Prüfung und Bewertung anhand aktueller Evidenz unterzogen.
UNASSIGNED: Es werden die evidenzbasierten Bewertungen der direkt ablativen Operationsverfahren zur Behandlung des BPS vorgestellt.
METHODS: Die Kapitel 11.1.1 und 11.2 der aktuellen Langfassung der deutschen S2e-Leitlinie zur Diagnostik und Therapie des BPS wurden als Übersichtsartikel zusammengefasst.
UNASSIGNED: Ein differenzierter Therapiealgorithmus wurde definiert. Als Leitfaden dient er der Auswahl eines geeigneten Verfahrens zur operativen Behandlung des BPS. Anhand von bestimmten Charakteristika der Prostata, des Patienten und des Patientenwunsches nach Erhalt der ejakulatorischen Funktion ergibt sich eine Selektion geeigneter Verfahren. Diese Verfahren lassen sich nach Techniken mit direkt/indirekt/fehlendem ablativen Wirkmechanismus, suprapubischem Zugang und embolisierenden Verfahren einteilen.
UNASSIGNED: Die aktuelle Fassung der deutschen S2e-Leitlinie zur Diagnostik und Therapie des BPS bietet eine evidenzbasierte Grundlage zur Auswahl eines geeigneten Verfahrens, das auf die Bedürfnisse des individuellen Patienten abgestimmt wurde.

BACKGROUND: Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH, in German guidelines: benign prostatic syndrome [BPS]) is considered the most common disease of the lower urinary tract in men and can have a tremendous impact on the quality-of-life of affected patients. Conservative and pharmacological therapy of this disease are of great importance, both in improving LUTS and reducing progression-related complications.
OBJECTIVE: Presentation of the conservative and pharmacological treatment options according to the current German S2e guideline on BPS.
METHODS: Summary and overview of chapters 9 and 10 of the current German S2e guideline on BPS.
RESULTS: In addition to a controlled watchful waiting for BPS patients without an absolute indication for prostate surgery, a variety of phytopharmacological formulations and synthetic drugs according to the symptomatology and clinical progress are available. Phytotherapy should, due to inconsistent study data, only be considered for mild to moderate symptoms. Synthetic drugs include alpha-blockers, 5α-reductase inhibitors, phosphodiesterase inhibitors, antimuscarinics and, more recently, the β3-agonist mirabegron in the current guideline. In addition, various combination therapies are listed and evaluated according to their indications, effects and side effects.
CONCLUSIONS: The current German S2e guideline on the diagnosis and treatment of BPS provides an evidence-based foundation for finding the best possible and most effective medication.
UNASSIGNED: HINTERGRUND: Das benigne Prostatasyndrom (BPS) gilt als häufigste Erkrankung des unteren Harntrakts beim Mann und kann enormen Einfluss auf die Lebensqualität der betroffenen Patienten nehmen. Der konservativen und medikamentösen Therapie dieser Erkrankung wird dabei ein großer Stellenwert zugeschrieben, sowohl bei Verbesserung der Symptomatik als auch bei der Reduktion progressionsbedingter Komplikationen.
UNASSIGNED: Es handelt sich um die Darstellung der konservativen und medikamentösen Therapieoptionen entsprechend der aktuellen deutschen S2e-Leitlinie zur Diagnostik und Therapie des BPS.
METHODS: Der Artikel fasst die Kapitel 9 und 10 der aktuellen deutschen S2e-Leitlinie zusammen.
UNASSIGNED: Neben einem kontrollierten Zuwarten steht BPS-Patienten ohne absolute Indikation zur Prostataoperation eine Vielzahl an phytopharmakologischen Präparaten und synthetischen Medikamenten entsprechend der Symptomatik und dem klinischen Verlauf zur Verfügung. Pflanzliche Produkte sollten aufgrund inkonsistenter Studiendaten lediglich bei leichten oder moderaten Symptomen in Erwägung gezogen werden. Als synthetische Medikamente kommen Alpha-Blocker, 5α-Reduktasehemmer, Phosphodiesterasehemmer und Antimuskarinika in Frage; der β3-Agonist Mirabegron wurde neu in die Leitlinie aufgenommen. Zudem sind verschiedene Kombinationstherapien aufgeführt, die entsprechend ihrer Indikation, ihren Wirkungen und Nebenwirkungen bewertet wurden.
UNASSIGNED: Die aktuelle deutsche S2e-Leitlinie zur Diagnostik und Therapie des BPS bietet eine evidenzbasierte Grundlage zur Findung der bestmöglichen und effektivsten Medikation.