Letter to the Editor
Towards a change of model in the management of benign prostatic hyperplasia: the importance of an individualized approach
Hacia un cambio de modelo en el manejo de la hiperplasia benigna de próstata: Importancia de un enfoque individualizado
A. Alcántara Montero
Corresponding author
Centro de Salud Trujillo, Consultorios de Herguijuela/Conquista de la Sierra Cáceres, Cáceres, Spain
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Alcántara Montero" "autores" => array:1 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Alcántara Montero" "email" => array:1 [ 0 => "a.alcantara.montero@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro de Salud Trujillo, Consultorios de Herguijuela/Conquista de la Sierra Cáceres, Cáceres, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hacia un cambio de modelo en el manejo de la hiperplasia benigna de próstata: Importancia de un enfoque individualizado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 907 "Ancho" => 1450 "Tamanyo" => 106426 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conceptualization of LUTS/BPH.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BPH: Benign prostatic hyperplasia; LUTS: Lower urinary tract symptoms.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Following a detailed examination of the consensus on the clinical application of the UroLift® System in Spain for the treatment of lower urinary tract symptoms (LUTS) associated with urinary flow obstruction and secondary to benign prostatic hyperplasia (BPH),<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> I would like to present some reflections.</p><p id="par0010" class="elsevierStylePara elsevierViewall">As stated in the latest guidelines of the European Association of Urology, there is currently a large therapeutic armamentarium available for the management of BPH, including both pharmacological and surgical treatment options.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> For this reason, patients must be informed of the different treatment options, including the associated risks and benefits, which will enable them to make an informed decision and increase their participation in choosing the most appropriate option.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In most cases, the presence of filling symptoms is indicative of bladder dysfunction, such as detrusor overactivity, and has the greatest impact on quality of life.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is important to note that the majority of studies on male LUTS secondary to prostatic obstruction classify severity using the International Prostate Symptom Score (IPSS), which is based on the assessment of symptoms. Information related to other aspects such as prostate size and flowmetry contributes to the diagnosis, but the classification of clinical severity is determined by the score of the IPSS. The prevailing initial assumption among clinicians is that benign prostatic hyperplasia (BPH) results in prostatic enlargement, which in turn causes bladder outlet obstruction and ultimately acute urinary retention. This is a well-established, valid hypothesis; however, it does not fully account for the natural history of male LUTS. This is a much more complex scenario; not all men with lower urinary tract symptoms (LUTS) follow this timeline. Hence, these concepts do not behave as concentric circles. It is known that not all men over the age of 40 with BPH will experience LUTS. Furthermore, the presence of BPH does not necessarily imply gland enlargement or obstruction, and the presence of LUTS may occur in the absence of these factors. (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This paradigm shift has helped to establish symptomatic improvement and treatment satisfaction, both measured in a reliable way, as health goals to be achieved. Notwithstanding this, there is a need to enhance our comprehension of the underlying physiopathology of LUTS/BPH. As the field of male LUTS has evolved, clinicians have come to recognize the necessity for dependable and validated data, both for diagnostic purposes and for outcome assessment. To this end, patients represent the primary source of information. Consequently, the introduction of more reliable assessment tools, and greater patient awareness of their condition, will result in improved overall health outcomes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">The author declares that no funding has been received.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-09-23" "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 907 "Ancho" => 1450 "Tamanyo" => 106426 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conceptualization of LUTS/BPH.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BPH: Benign prostatic hyperplasia; LUTS: Lower urinary tract symptoms.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aplicación clínica del sistema de liberación uretral UroLift® en España: consenso sobre el tratamiento de los síntomas del tracto urinario inferior asociados a la obstrucción del flujo urinario por hiperplasia benigna de próstata" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Fernández Arjona" 1 => "L. López Martín" 2 => "L.M. Herranz Fernández" 3 => "B. Sinues Ojas" 4 => "J.M. Campá Bortoló" 5 => "J. Extramiana Cameno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2024.06.003" "Revista" => array:2 [ "tituloSerie" => "Actas Urol Esp." "fecha" => "2024" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EAU Guidelines on Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.N. Cornu" 1 => "M. Gacci" 2 => "H. Hashim" 3 => "T.R.W. Herrmann" 4 => "S. Malde" 5 => "C. Netsch" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2024" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Non-Neurogenic-Male-LUTS-2024.pdf" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perfil de síntomas del tracto urinario inferior en el varón y su impacto en la calidad de vida" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Cambronero" 1 => "S. Arlandis" 2 => "C. Errando" 3 => "A.M. Mora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2012.11.011" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp." "fecha" => "2013" "volumen" => "37" "paginaInicial" => "401" "paginaFinal" => "407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23411069" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/unassign/S2173578624001148/v1_202411040359/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735786/unassign/S2173578624001148/v1_202411040359/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578624001148?idApp=UINPBA00004N" ]
