Successes and Failures of Evidence-Based Urology

The document discussed the application of an evidence-based approach in urology, highlighting both successes and challenges. It emphasized the shift from using death statistics to focusing on symptomatic disease and quality of life in conditions like benign prostatic hyperplasia (BPH), erectile dysfunction, and incontinence. The research led to the development of questionnaire-based evaluations for urological conditions and identified the prevalence of these conditions in aging populations. A significant finding was that treatment for BPH evolved from surgical to pharmacologic options, with finasteride proving effective for men with enlarged prostates by inhibiting 5-alpha reductase. The research also demonstrated that serum PSA levels could indicate prostate volume, aiding in identifying suitable candidates for finasteride, which reduced the risk of acute urinary retention (AUR) more effectively than alpha-blockers. Additionally, phase III trials of dutasteride confirmed similar benefits, and a method was developed to predict individual AUR risk in men with BPH.