Successes and failures of evidence based urology

Boyle, Peter (2005) Successes and failures of evidence based urology. DSc thesis, University of Glasgow.

Abstract

I have conceived, undertaken and published a body of work in Urology which has applied an evidence-based approach to different aspects with widely varying success in modifying the impact on treatment choices and outcome. On the positive side, the research work I have led has demonstrated that the era when death statistics could be used to the occurrence of benign prostatic hyperplasia was gone and that we had moved to an epoch where symptomatic disease and quality of life were the key issues. I have worked on the creation of the questionnaire-based approach necessary for evaluating the presence of various urological conditions for use in different populations clearly identified and quantified the extent and inter-relationships between the various benign urological conditions in communities. This work has made it quite clear that such benign conditions as benign prostatic hyperplasia, erectile dysfunction, incontinence, prostatitis and cystitis are remarkably common conditions world-wide in ageing populations. Since 1990, treatment options for men and symptomatic BPH have moved from an essentially surgical approach to an increasing introduction of pharmacologic options and less invasive approaches to disease management. The meta-analysis of the Phase III clinical trials of finasteride which I undertook, demonstrated that this drug was effective only in men with enlarged prostates and justified the biological approach taken in the development of this drug which was an inhibitor of 5-alpha reductase, the enzyme which converts Testosterone (T) to Dihydrotestosterone (DHT) the metabolite which made the prostate hyperplastic. I then demonstrated that serum PSA was a good indicator of prostate volume thus making identification of men who would most likely respond to this drug easily identifiable. Using this same dataset, I was able to demonstrate that finasteride reduced the risk of Acute Urinary Retention (AUR) and that it was superior to alpha-blockers, the other major class of drugs used to treat symptomatic BPH, in this regard. I designed the phase III trials of dutasteride, a new five-alpha reductase inhibitor, and the findings lay on the regression line demonstrated in the meta-analysis of finasteride and also had the identical effect on reducing the risk of AUR. I was able to develop a method of predicting individual risk of AUR in men who were diagnosed with benign prostatic hyperplasia.

• Item Type: Thesis (DSc)
• Qualification Level: Doctoral
• Colleges/Schools: College of Medical Veterinary and Life Sciences
• Supervisor's Name: known, Not supervisor
• Date of Award: 2005
• Depositing User: Mrs Monika Milewska-Fiertek
• Unique ID: glathesis:2005-30972
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 31 Oct 2018 14:50
• Last Modified: 13 May 2022 09:31
• URI: https://theses.gla.ac.uk/id/eprint/30972

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