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Parsons J.K.,University of California at San Diego | Parsons J.K.,Urologic | Parsons J.K.,San Diego Veterans Affairs Medical Center
Current Opinion in Urology | Year: 2011

PURPOSE OF REVIEW: Although age, genetics, and sex steroid hormones play prominent roles in the cause of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), recent epidemiological studies suggest that modifiable lifestyle factors also contribute substantially to the pathogenesis of these conditions. RECENT FINDINGS: Lifestyle and metabolic factors associated with significantly increased risks of benign prostatic hyperplasia and lower urinary tract symptoms include obesity, diabetes, and meat and fat consumption. Factors associated with decreased risks include physical activity, moderate alcohol intake, and vegetable consumption. Factors for which no clear risk patterns have emerged include lipids and smoking. Randomized clinical trials of lifestyle alterations - such as weight loss, exercise, and diet - for the prevention or treatment of benign prostatic hyperplasia and lower urinary tract symptoms have yet to be performed. SUMMARY: Lifestyle factors present a novel opportunity for the prevention and treatment of benign prostatic hyperplasia and lower urinary tract symptoms. Although clinical trials of lifestyle modifications have not yet been undertaken, promotion of healthy lifestyle alternatives within the context of standard benign prostatic hyperplasia and lower urinary tract symptoms treatment algorithms is potentially beneficial. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Parsons J.K.,University of California at San Diego | Parsons J.K.,Urologic | Parsons J.K.,San Diego Veterans Affairs Medical Center | Messer K.,University of California at San Diego | And 4 more authors.
European Urology | Year: 2011

Background: Two potential targets for preventing chronic lower urinary tract symptoms (LUTS) in older men are obesity and physical activity. Objective: To examine associations of adiposity and physical activity with incident LUTS in community-dwelling older men. Design, setting, and participants: The Osteoporotic Fractures in Men Study (MrOS) is a prospective cohort of men ≥65 yr of age. MrOS participants without LUTS and a history of LUTS treatment at baseline were included in this analysis. Measurements: Adiposity was measured with body mass index (BMI), physical activity with the Physical Activity Scale for the Elderly (PASE) and self-report of daily walking, and LUTS with the American Urological Association Symptom Index. Results and limitations: The mean age (standard deviation [SD]) of the 1695 participants was 72 (5) yr at baseline. At a mean (SD) follow-up of 4.6 (0.5) yr, 524 (31%) of men reported incident LUTS. In multivariate analyses, compared with men of normal weight at baseline (BMI <25 kg/m 2), overweight (BMI: 25.0-29.9 kg/m 2) and obese (≥30 kg/m 2)men were 29% (adjusted odds ratio [OR adj]: 1.29; 95% confidence interval [CI], 1.00-1.68) and 41% (OR adj: 1.41; 95% CI, 1.03-1.93) more likely to develop LUTS, respectively. Men in the highest quartile of physical activity were 29% (OR adj: 0.71; 95% CI, 0.53-0.97) and those who walked daily 20% (OR adj: 0.80; 95% CI, 0.65-0.98) less likely than their sedentary peers to develop LUTS, adjusting for BMI. The homogeneous composition of MrOS potentially diminishes the external validity of these results. Conclusions: In older men, obesity and higher physical activity are associated with increased and decreased risks of incident LUTS, respectively. Prevention of chronic urinary symptoms represents another potential health benefit of exercise in elderly men. © 2011 European Association of Urology. Source

Allen R.T.,University of California at San Diego | Allen R.T.,San Diego Veterans Affairs Medical Center | Garfin S.R.,University of California at San Diego
Spine | Year: 2010

Study design.: Review of the literature. Objective.: To summarize current cost and clinical efficacy data in minimally invasive spine (MIS) surgery. Summary of background data.: Cost effectiveness (CE), using cost per quality-adjusted life-years gained, has been shown for lumbar discectomy, decompressive laminectomy, and for instrumented and noninstrumented lumbar fusions in several high-quality studies using conventional, open surgical procedures. Currently, comparisons of costs and clinical outcomes of MIS surgery to open (or nonoperative) approaches are rare and of lesser quality, but suggest that a potential for cost benefits exist using less-invasive surgical approaches. Methods.: A literature review was performed using the database of the National Center for Biotechnology Information (NCBI), PUBMED/Medline. Results.: Reports of clinical results of MIS approaches are far more common than economic evaluations. MIS techniques can be classified as endoscopic or nonendoscopic. Although endoscopic approaches decrease some approach morbidities, the high cost of instrumentation, steep learning curves, and new complication profiles introduced have prevented widespread adoption. Additionally, the high costs have not been shown to be justified by superior clinical benefits. Nonendoscopic MIS approaches, such as percutaneous posterior or lateral, and mini-open lateral and anterior approaches, use direct visualization, standard operative techniques, and report lower complication rates, reduced length of stay, and faster recovery time. For newer MIS and mini-open techniques, significantly lower acute and subacute costs were observed compared with open techniques, mainly due to lower rates of complications, shorter length of stay, and less blood loss, as well as fewer discharges to rehab. Although this suggests that certain MIS procedures produce early cost benefits, the quality of the existing data are low. Conclusion.: Although the CE of MIS surgery is yet to be carefully studied, the few economic studies that do exist suggest that MIS has the potential to be a cost-effective intervention, but only if improved clinical outcomes are maintained (durable). Longer follow-up and better outcome and cost data are needed to determine if incremental CE exists with MIS techniques, versus open or nonsurgical interventions. © 2010, Lippincott Williams & Wilkins. Source

Silberstein J.L.,University of California at San Diego | Parsons J.K.,University of California at San Diego | Parsons J.K.,San Diego Veterans Affairs Medical Center
Urology | Year: 2010

Bladder cancer presents a substantial challenge to public health. Dietary factors influence the risk of bladder cancer incidence and recurrence and may offer innovative therapies for prevention. Agents associated with decreased risk of bladder cancer include carrots, selenium, cruciferous vegetables, and fruits. Dietary components associated with increased bladder cancer risk include pork, barbecued meats, fat, soy, and excessive coffee consumption. Although definitive clinical trials have yet to be performed, promotion of healthy lifestyle interventions based on dietary factors-increased vegetable and fruit intakes, decreased meat and fat intakes-should be considered in the care of patients with bladder cancer. © 2010 Elsevier Inc. All rights reserved. Source

Anderson J.E.,University of California at San Diego | Chang D.C.,University of California at San Diego | Parsons J.K.,University of California at San Diego | Parsons J.K.,Urologic | And 2 more authors.
Journal of the American College of Surgeons | Year: 2012

BACKGROUND: There are few population-based data describing outcomes of robotic-assisted surgery. We compared outcomes of robotic-assisted, laparoscopic, and open surgery in a nationally representative population database. STUDY DESIGN: A retrospective analysis of the Nationwide Inpatient Sample database from October 2008 to December 2009 was performed. We identified the most common robotic procedures by ICD-9 procedure codes and grouped them into categories by procedure type. Multivariate analyses examined mortality, length of stay (LOS), and total hospital charges, adjusting for age, race, sex, Charlson comorbidity index, and teaching hospital status. RESULTS: A total of 368,239 patients were identified. On adjusted analysis, compared with open, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.2; p < 0.001), decreased mean LOS (-2.4 days; 95% CI, -2.5 to 2.3; p < 0.001), and increased mean total charges in all procedures (range $3,852 to $15,329) except coronary artery bypass grafting (-$17,318; 95% CI, -34,492 to -143; p = 0.048) and valvuloplasty (not statistically significant). Compared with laparoscopic, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.6; p = 0.008), decreased LOS overall (-0.6 days; 95% CI, -0.7 to -0.5; p < 0.001), but increased LOS in prostatectomy and other kidney/bladder procedures (0.3 days; 95% CI, 0.1-0.4; p = 0.006; 0.8 days; 95% CI, 0.0-1.6; p = 0.049), and increased total charges ($1,309; 95% CI, 519-2,099; p = 0.001). CONCLUSIONS: Data suggest that, compared with open surgery, robotic-assisted surgery results in decreased LOS and diminished likelihood of death. However, these benefits are not as apparent when comparing robotic-assisted laparoscopic with nonrobotic laparoscopic procedures. © 2012 American College of Surgeons. Source

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