Robotic Surgery Unit, S. Chiara Hospital, 38122 Trento, Italy.
Department of Urology, S. Chiara Hospital, 38122 Trento, Italy.
Int J Environ Res Public Health. 2022 Aug 8;19(15):9738. doi: 10.3390/ijerph19159738.
Objectives: The aim of this study was to establish a tool to identify patients at risk for pharmaceutical and surgical interventions for benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) over a 10 year follow-up. Methods: The data of patients with mild to moderate male LUTS undergoing phytotherapy from January to December 2010 were reviewed. Patients were followed for 10 years through medical visits and telephone consultations. The outcomes were (1) treatment switch from phytotherapy or no therapy to alpha-blockers or 5α-reductase inhibitors (5-ARI), and (2) clinical progression (acute urinary retention or need for surgery). Two calibrated nomograms (one for each outcome) were constructed on significant predictors at multivariate analysis. Results: A total of 107 patients with a median age of 55 years at presentation were included; 47% stopped or continued phytotherapy, while 53% switched to alpha-blockers and/or 5-ARI after a median time of 24 months. One-third in the second group experienced clinical progression after a median time of 54 months. Age, symptom score, peak flow rate (Qmax), prostate-specific antigen (PSA), and post-void residual volume were significantly associated with the outcomes. According to our nomograms, patients switching therapy or progressing clinically had average scores of 75% and 40% in the dedicated nomograms, respectively, as compared to 25% and <5% in patients who did not reach any outcome. Conclusions: We developed a nomogram to predict the risk of pharmaceutical or surgical interventions for BPH-related LUTS at 10 years from presentation. On the basis of our models, thresholds of >75% and >40% for high risk and <25% and <5% for low risk of pharmaceutical or surgical interventions, respectively, can be proposed.
本研究旨在建立一种工具，以识别患有轻度至中度男性下尿路症状（LUTS）并接受植物疗法治疗的患者，在 10 年的随访中存在发生与良性前列腺增生（BPH）相关的下尿路症状（LUTS）药物和手术干预的风险。方法：回顾 2010 年 1 月至 12 月期间接受植物疗法治疗的轻度至中度男性 LUTS 患者的数据。通过门诊和电话咨询对患者进行了 10 年的随访。结局为（1）从植物疗法或不治疗转为α受体阻滞剂或 5α-还原酶抑制剂（5-ARI）的治疗转换，（2）临床进展（急性尿潴留或需要手术）。在多变量分析中，对显著预测因子构建了两个校准的列线图（每个结局一个）。结果：共纳入 107 例中位年龄为 55 岁的患者；47%的患者停止或继续接受植物疗法，而 53%的患者在中位时间为 24 个月后转为α受体阻滞剂和/或 5-ARI。第二组中有三分之一的患者在中位时间为 54 个月后出现临床进展。年龄、症状评分、最大尿流率（Qmax）、前列腺特异性抗原（PSA）和残余尿量与结局显著相关。根据我们的列线图，与未达到任何结局的患者相比，转换治疗或出现临床进展的患者在专用列线图中的平均评分分别为 75%和 40%，而分别为 25%和<5%。结论：我们开发了一种列线图，以预测从就诊到 10 年时发生与 BPH 相关的 LUTS 的药物或手术干预的风险。基于我们的模型，可以提出>75%和>40%为药物或手术干预的高风险阈值，<25%和<5%为低风险阈值。
