This story about a relatively new surgical technique called prostatic urethral lift did a good job talking to patients and physicians familiar with the procedure. However, since all the anecdotes and commentary were overwhelmingly positive, it may not be reflective of the true patient experience. We also think the story would have been more useful if it had provided more information on the various treatment options and how they compare and contrast–particularly as the evidence shows, and not just patient anecdotes.
Frequent urination can be terribly inconvenient so if a simple, safe, and effective new treatment can be offered, it is likely to be very popular. Readers of this story need to know that there are alternatives, both surgical and non-surgical to the minimally-invasive prostatic urethral lift described here, and all carry pros and cons, risks and benefits.
Cost is mentioned, but somewhat indirectly. Stating that “insurers generally reimburse about $5,000 for the procedure,” is vague when ti comes to real costs. Learning that “Medicare covers it, though some private insurers do not,” also is not that useful for men who might have to pay out of pocket for the procedure. Still, the cost information is more than what we typically see.
There is insufficient detail about the benefits and how long they last. We learn that at least one urologist who has become a convert to the procedure is “unsure how long the improvement will last.” The link to a study abstract adds a bit more detail, but its not discussed much in the story. We learn that the manufacturer-funded trial found “peak urinary flow have lasted so far for five years,” but no details on how this compares to controls. It is useful to know that “one in 10 patients ended up needing surgery anyway.”
The minimally invasive surgery seems safer than other kinds of surgery, but without any specific details on the potential for harms, we can’t be sure. We are told that most patients experienced more frequent urination after the procedure, but that the improvements may take four weeks or so to be seen.
The procedure was studied in a prospective, 5-year randomized trial but those details were not included in the story.
The story did not disease monger. But it would have been stronger if it had reminded readers that some men with enlarged prostates may have no symptoms or don’t find them bothersome enough for a procedure.
The story included at least one independent source, and we didn’t detect any conflicts of interest that should have been disclosed. The story was heavy on positive patient anecdotes, which may not be reflective of the typical patient experience.
There are alternatives to prostatic urethral lift yet only one was discussed with enough detail to be useful. We learn that the lift “does not improve flow as much as surgery,” but the “lift procedure and recovery are much quicker, with no hospital stay and fewer complications.” Those who might not be adequately served by the urethral lift can always “come back for surgery later.”
We learn that “the first patients were treated in Australia by the end of 2005. Initial clearance from the U.S. Food and Drug Administration did not come until 2013, but now more than half of the 30,000 patients treated to date are in this country,” according to the manufacturer’s chief executive officer Dave Amerson.
The story would have been stronger if it had discussed how many urologists can do the procedure.
The story provides a lot of detail on how the device was invented and what sets it apart from other treatment options. However, we’re not sure why the story was written now–what’s the news here?
The story does not appear to rely on a news release, though positive anecdotal testimonials predominated the piece.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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