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Marchioni M, Primiceri G, Veccia A, Di Nicola M, Carbonara U, Crocerossa F, Falagario U, Rizzoli A, Autorino R, Schips L. Transurethral prostate surgery in prostate cancer patients: A population-based comparative analysis of complication and mortality rates. Asian J Urol 2024; 11:48-54. [PMID: 38312810 PMCID: PMC10837658 DOI: 10.1016/j.ajur.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Prostate cancer (PCa) patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia (BPH). Some of them might be treated for their lower urinary tract symptoms instead of PCa. We aimed to test the effect of PCa versus BPH on surgical outcomes after transurethral prostate surgery, namely complication and mortality rates. Methods Within the American College of Surgeons National Surgical Quality Improvement Program database (2011-2016), we identified patients who underwent transurethral resection of the prostate, photoselective vaporization, or laser enucleation. Patients were stratified according to postoperative diagnosis (PCa vs. BPH). Univariable and multivariable logistic regression models evaluated the predictors of perioperative morbidity and mortality. A formal test of interaction between diagnosis and surgical technique used was performed. Results Overall, 34 542 patients were included. Of all, 2008 (5.8%) had a diagnosis of PCa. The multivariable logistic regression model failed to show statistically significant higher rates of postoperative complications in PCa patients (odds ratio: 0.9, 95% confidence interval: 0.7-1.1; p=0.252). Moreover, similar rates of perioperative mortality (p=0.255), major acute cardiovascular events (p=0.581), transfusions (p=0.933), and length of stay of more than or equal to 30 days (p=0.174) were found. Additionally, all tests failed to show an interaction between post-operative diagnosis and surgical technique used. Conclusion Patients diagnosed with PCa do not experience higher perioperative morbidity or mortality after transurethral prostate surgery when compared to their BPH counterparts. Moreover, the diagnosis seems to not influence surgical technique outcomes.
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Affiliation(s)
- Michele Marchioni
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University of Chieti, Chieti, Italy
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University of Chieti, Chieti, Italy
| | - Giulia Primiceri
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University of Chieti, Chieti, Italy
| | | | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University of Chieti, Chieti, Italy
| | | | | | | | - Ambra Rizzoli
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University of Chieti, Chieti, Italy
| | | | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University of Chieti, Chieti, Italy
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Post-voided residual urine ratio as a predictor of bladder outlet obstruction in men with lower urinary tract symptoms: development of a clinical nomogram. World J Urol 2023; 41:521-527. [PMID: 36527471 DOI: 10.1007/s00345-022-04259-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To confirm the correlation between post-void residual urine ratio (PVR-R) and BOO diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS) and to develop a clinical nomogram. METHODS A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment for BOO including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies, suprapubic ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BTW). PVR-R was defined as follows: PVR-R = (PVR/total Bladder Volume [BV]) × 100). Logistic regression analysis was used to investigate predictors of pathological bladder emptying (BOO) defined as Schafer > II. A nomogram to predict BOO based on the multivariable logistic regression model was then developed. RESULTS Overall 335 patients were enrolled. Overall, 131/335 (40%) presented BOO on PFS. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 2.21 per mm; 95% confidence interval [CI], 1.57-3.09; p = 0.001), PVR-R (OR: 1.02 per %; 95% CI, 1.01-1.03; p = 0.034) and prostate volume (OR: 0.97 per mL; 95% CI, 0.95-0.98; p = 0.001) were significant predictors for BOO. The model presented an accuracy of 0.82 and a clinical net benefit in the range of 10-90%. CONCLUSIONS The present study confirms the important role of PVR-ratio in the prediction of BOO. For the first time, we present a clinical nomogram including PVR-ratio for the prediction of BOO.
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Wymer KM, Narang G, Slade A, Sharma V, Thao V, Borah BJ, Rivera M, Cheney S, Humphreys MR. Evaluation of the Cost-Effectiveness of Surgical Treatment Options for Benign Prostatic Hyperplasia. Urology 2023; 171:96-102. [PMID: 36270339 DOI: 10.1016/j.urology.2022.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the cost-effectiveness of surgical interventions for BPH. METHODS Using a Markov model, a cost-utility analysis was performed comparing HoLEP, B-TURP, WVTT, and PUL for prostate size <80cc (index patient 1) and HoLEP and SP for prostate size >80cc (index patient 2). Model probabilities and utility values were drawn from the literature. Analysis was performed at a 5-year time horizon with extrapolation to a lifetime horizon. Primary outcomes included quality-adjusted life years (QALYs), 2021 Medicare costs, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY. Univariate and probabilistic sensitivity analyses were performed. RESULTS At 5 years, costs per patient for index patient 1 were $3292 (WVTT), $6532 (HoLEP), $6670 (B-TURP), and $10,257 (PUL). HoLEP resulted in the highest QALYs (4.66), followed by B-TURP (4.60), PUL (4.38), and WVTT (4.38). This translated to HoLEP being most cost-effective (ICER $11,847). For index patient 2, HoLEP was less costly ($6,585 vs $15,404) and more effective (4.654 vs 4.650) relative to SP. On sensitivity analysis for index patient 1, B-TURP became most cost-effective if cost of HoLEP increased two-fold or chronic stress incontinence following HoLEP increased ten-fold. When follow-up time was varied, WVTT was preferred at very short follow up (<1 year), and HoLEP became more strongly preferred with longer follow up. CONCLUSION At 5 years follow up, HoLEP is a cost-effective surgical treatment for BPH- independent of gland size.
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Affiliation(s)
- Kevin M Wymer
- Department of Urology, Mayo Clinic, Phoenix, AZ; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - Austen Slade
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Viengneesee Thao
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Bijan J Borah
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Barbosa ÁRG, Takemura LS, Amaral BS, Wroclawski ML, Alfer W, Gil AO, Monteiro J, Lourenço DB, Cha JD, Apezzato M, Barbosa JABA, Bianco B, Lemos GC, Carneiro A. Benign prostatic hyperplasia surgical treatment trends in the Public Health System in São Paulo, Brazil. EINSTEIN-SAO PAULO 2022; 20:eAO6880. [PMID: 35730806 PMCID: PMC9239570 DOI: 10.31744/einstein_journal/2022ao6880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022] Open
Abstract
Objective To describe and compare the number of surgeries, mortality rate, length of hospital stay, and costs of transurethral resection of the prostate and open prostatectomy for the treatment of benign prostatic hyperplasia, between 2008 and 2018, in the Public Health System in São Paulo, Brazil. Methods Ecological and retrospective study using data from the informatics department of the Brazilian Public Health System database. Procedure codes were “open prostatectomy” and “transurethral resection of the prostate.” The outcomes analyzed were compared between transurethral resection of the prostate and open prostatectomy according to the hospital surgical volume and presence or absence of a residency program. Results A total of 18,874 surgeries were analyzed (77% transurethral resection of the prostate) and overall mortality was not statistically different between procedures. Intermediate and high-volume centers had shorter length of hospital stay than low-volume centers for transurethral resection of the prostate (3.28, 3.02, and 6.58 days, respectively, p=0.01 and p=0.004). Length of hospital stay was also shorter for open prostatectomy in high-volume compared to low-volume centers (4.86 versus 10.76 days, p=0.036). Intrahospital mortality was inversely associated with surgical volume for transurethral resection of the prostate. Centers with residency program had shorter length of hospital stay considering open prostatectomy and less mortality regarding transurethral resection of the prostate. Open prostatectomy was 64% more expensive than transurethral resection of the prostate. Conclusion The findings suggest the importance of investing in specialized centers, which could be potential referral centers for surgical cases.
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A Review of Aging and the Lower Urinary Tract: The Future of Urology. Int Neurourol J 2022; 25:273-284. [PMID: 34991304 PMCID: PMC8748297 DOI: 10.5213/inj.2142042.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are common among elderly people, with significant effects on individuals, caregivers, and the wider health care system. As the elderly population with multiple comorbidities is increasing, the burden of LUTS will increase. This review describes the demographic trends in the aging society, changes in lower urinary tract function with aging, and deterioration of physical and cognitive function in aging, as well as what has been done regarding geriatric urology and what urologists should do to meet the health care needs of the aging population. Frailty and dementia are unmissable factors in the evaluation of elderly patients. Numerous reports have described associations between LUTS and frailty and between LUTS and dementia. Urologists must be aware of the multiplex physical, cognitive, and social characteristics of elderly people. Maintaining a geriatric viewpoint in the diagnosis, treatment, and management of elderly individuals with LUTS will fulfill the unmet needs of elderly people. It is also essential to discuss the treatment and management goals of LUTS with patients and caregivers. Active case identification, appropriate evaluations of LUTS and comorbidities, and a multidisciplinary approach with other health-care professionals are recommended for better treatment and management.
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Lombardo R, Zarraonandia Andraca A, Tema G, Cancrini F, Carrion Valencia A, González-Dacal JA, Rodríguez Núñez H, Plaza Alonso C, Giulianelli R, DE Nunzio C, Tubaro A, Ruibal Moldes M. How many procedures are needed to achieve learning curve of Millin simple laparoscopic prostatectomy. Minerva Urol Nephrol 2021; 74:225-232. [PMID: 33769017 DOI: 10.23736/s2724-6051.21.04114-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aim of our study was to evaluate learning curve of the Millin simple prostatectomy analysing three expert laparoscopic surgeons. METHODS Learning curve of 3 expert laparoscopic surgeons with excellent radical prostatectomy training was evaluated. Surgeon 1 had more than 20 years of experience, while other surgeons had 10 years of experience. The first 45 procedures of the surgeons were considered for analysis. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted to analyse learning curves. The variables included to evaluate learning curve of the surgeons were: operative time (OT), hospitalisation (HO) and complication rate. RESULTS Overall 135 patients were included in the analysis. Median age was 68 (64/74), median prostate volume was 83 (75/97), median Qmax 9 ml/s (6/11) and median IPSS 20 (18/22). Complications included: 9/135 (7%) transfusion, 4/135 (3%) Urinary retention, 3/135 (2%) fever, 1/35 (<1%) reintervention and 1/135 (<1%) conversion. Surgeon 1 presented a lower median operative time when compared to surgeon 2 and 3. No significant differences were recorded in terms of hospitalisation, blood loss and transfusion rate as well as postoperative outcomes. According to the CUSUM analysis the number of procedures needed to achieve a plateau in surgical time is 10/15 procedures (fig 1). CONCLUSIONS In conclusion, according to our results 15 procedures are needed to reach a plateau in surgical time for trained laparoscopic surgeons.
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Affiliation(s)
- Riccardo Lombardo
- Ospedale Sant'Andrea, Rome, Italy - .,Nuova Villa Claudia, Rome, Italy -
| | | | - Giorgia Tema
- Ospedale Sant'Andrea, Rome, Italy.,Nuova Villa Claudia, Rome, Italy
| | - Fabiana Cancrini
- Ospedale Sant'Andrea, Rome, Italy.,Nuova Villa Claudia, Rome, Italy
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De Nunzio C, Franco A, Lombardo R, Baldassarri V, Borghesi A, Li Marzi V, Trucchi A, Agrò EF, Tubaro A. Phamacological treatment of persistant lower urinary tract symptoms after a transurethral resection of the prostate is predictive of a new surgical treatment: 10 years follow-up study. Neurourol Urodyn 2021; 40:722-727. [PMID: 33508153 DOI: 10.1002/nau.24616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/30/2020] [Accepted: 01/16/2021] [Indexed: 01/25/2023]
Abstract
AIM To evaluate possible risk factors of re intervention in patients with benign prostatic enlargement (BPE) undergoing transurethral resection of the prostate (TURP). MATERIALS AND METHODS A consecutive series of patients with LUTS and BPE underwent TURP in our center in 2004 and 2005 and they were then followed up to September 2016. Patients were assessed at baseline, 3-, 6-month postoperatively and yearly thereafter with medical history, international prostate symptom score, prostate specific antigen, maximal urinary flow rate, post void residual urine. Reoperation was defined as the requirement of a new TURP to relieve bothersome LUTS. Cox regression was used to determine covariates associated with reoperation rate and the Kaplan-Meier curve assessed the time to reoperation. RESULTS Overall, 92 patients were enrolled. Median follow up was 142 months. 13 patients underwent a second TURP during the follow-up period (reoperation rate was 14%); out of them 9/13 (69%) received medical treatment for persistent LUTS (p = .001). The need of LUTS/BPE pharmacological treatment after TURP is an independent risk factor for a second surgical procedure (odds ratio 9,3; p = .001). Out of the 13 patients treated with a re-TURP, 12 (92%) underwent surgery within 5 years of follow-up. CONCLUSION In our single center study, the need of LUTS/BPE pharmacological treatment was a predictive factor of a re-TURP. Considering that more than 90% of re-TURP were performed during the first 5 years of follow-up, it is assumable that a follow-up longer than 5 years is not needed in these patients.
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Affiliation(s)
- Cosimo De Nunzio
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
| | - Antonio Franco
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
| | | | | | | | - Vincenzo Li Marzi
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alberto Trucchi
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
| | | | - Andrea Tubaro
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
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8
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Joshi H, Sali G, Paramore L, Jones R, Lazarowicz H, Kujawa ML, Pandit A, David R, Wilson K, Bates C, Shergill I, Gan C, El-Husseiny T, Mukhtar B, Appanna T, Veeratterapillay R, Harding C, Crockett M, Dawson C, Simpson R, Zelhof B, Starmer B, Mukherjee R, Bourdoumis A, Jelski J, Hashim H, McCabe J, Shaw G, Chow K, Betts C. Current process and outcomes of the surgical management of LUTS due to benign prostatic enlargement: how consistent are we? - results from the multi-institutional audit of surgical management of BPE (AuSuM BPE) in the United Kingdom. Scott Med J 2021; 66:58-65. [PMID: 33459189 DOI: 10.1177/0036933020977295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE In view of changing landscape of surgical treatment for LUTS secondary to BPE, this audit was undertaken to assess key aspects of the processes and outcomes of the current interventional treatments for BPE, across different units in the UK. MATERIALS AND METHOD A multi-institutional snapshot audit was conducted for patients undergoing interventions for LUTS/BPE over 8-week period. Using Delphi process two-part proforma was designed to capture data. RESULTS 529 patients were included across 20 NHS trusts in England and Wales. Median age was 73 years. Indications for surgery were acute retention (47%) and LUTS (45%). 80% of patients had prior medical therapy. TURP formed the commonest procedure. 27% patients had <23 hour hospital stay. Immediate (21%) and delayed (18%) complications were Clavien-Dindo <2 category. High proportion of patients reported residual symptoms. Type and indication of surgery were significant predictor of complications, length of stay and failure of TWOC outcomes, on multivariate analyses. There were variations in departmental processes, 50% centres used PROMs. CONCLUSION Monopolar TURP still remains the commonest intervention for BPE. Most departments are adopting newer technologies. The audit identified opportunities for development of consistent, effective and patient centric practices as well as need for large-scale focused studies.
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Affiliation(s)
- Hrishi Joshi
- Consultant Urological Surgeon and Honorary lecturer, Department of Urology, University Hospital of Wales, UK
| | - Gaurav Sali
- Clinical Fellow in Urology, Department of Urology, University Hospital of Wales, UK
| | - Louise Paramore
- Specialist Registrar in Urology, Department of Urology, University Hospital of Wales, UK
| | - Richard Jones
- Specialist Registrar in Urology, Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - Henry Lazarowicz
- Consultant Urological Surgeon, Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - Magda Lucia Kujawa
- Consultant Urological Surgeon, Department of Urology, Stepping Hill Hospital, UK
| | - Amol Pandit
- Consultant Urological Surgeon, Department of Urology, Morriston Hospital, UK
| | - Rotimi David
- Clinical Fellow in Urology , Department of Urology, Morriston Hospital, UK
| | - Katherine Wilson
- Specialist Registrar in Urology, Department of Urology, Royal Gwent Hospital, UK
| | - Christopher Bates
- Consultant Urological Surgeon, Department of Urology, Royal Gwent Hospital, UK
| | - I Shergill
- Consultant Urological Surgeon, Department of Urology, Wrexham Maelor Hospital, UK
| | - Christine Gan
- Consultant Urological Surgeon, Department of Urology, Charing Cross Hospital - Imperial College Healthcare NHS Trust, UK
| | - Tamer El-Husseiny
- Consultant Urological Surgeon, Department of Urology, Charing Cross Hospital - Imperial College Healthcare NHS Trust, UK
| | - Bashir Mukhtar
- Specialist Registrar in Urology, Department of Urology, Cwm Taf Morgannwg Health Board Royal Glamorgan Hospital, UK
| | - Timson Appanna
- Consultant Urological Surgeon, Department of Urology, Cwm Taf Morgannwg Health Board Royal Glamorgan Hospital, UK
| | - Rajan Veeratterapillay
- Consultant Urological Surgeon, Department of Urology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - Christopher Harding
- Consultant Urological Surgeon, Department of Urology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - Matthew Crockett
- Specialist Registrar in Urology, Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, UK
| | - Christopher Dawson
- Consultant Urological Surgeon, Department of Urology, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Richard Simpson
- Specialist Registrar in Urology, Department of Urology, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - Bachar Zelhof
- Consultant Urological Surgeon, Department of Urology, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - B Starmer
- Consultant Urological Surgeon, Department of Urology, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, UK
| | - Rono Mukherjee
- Consultant Urological Surgeon, Department of Urology, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, UK
| | - Andreas Bourdoumis
- Consultant Urological Surgeon, Department of Urology, Penine Acute Hospitals NHS Trust, The Royal Oldham Hospital, UK
| | - Joseph Jelski
- Specialist Registrar, Department of Urology, Southmead Hospital, North Bristol NHS Trust, UK
| | - H Hashim
- Specialist Registrar, Department of Urology, Southmead Hospital, North Bristol NHS Trust, UK
| | - John McCabe
- Consultant Urological Surgeon, Department of Urology, St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - Greg Shaw
- Consultant Urological Surgeon, Department of Urology, University College London Hospitals NHS Foundation Trust, UK
| | - Karyee Chow
- Consultant Urological Surgeon, Department of Urology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK
| | - Christopher Betts
- Consultant Urological Surgeon, Department of Urology, Salford Royal NHS Foundation Trust, UK
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Castellucci R, Marchioni M, Fasolis G, Varvello F, Ditonno P, Di Rienzo G, Greco F, Altieri VM, Frattini A, Ferrari G, Schips L, Cindolo L. The safety and feasibility of the simultaneous use of 180-W GreenLight laser for prostate vaporization during concomitant surgery. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348957 DOI: 10.4081/aiua.2020.4.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To explore the safety and feasibility of photo-selective vaporization of the prostate (PVP) with GreenLight XPS 180 Watt laser (GL-180- W XPS) combined with other surgical procedures. MATERIAL AND METHODS Data on patients in whom GL-180-W XPS was performed to relieve lower urinary tract symptoms/ benign prostatic hyperplasia (LUTS/BPH) symptoms were extracted from a multi-institutional database (2011-2016). Patients were stratified into two groups. In the first all patients who had GL-180-W XPS with a concomitant procedure during the same surgical session were included as cases while those who underwent GL-180-W XPS PVP only were included as control. RESULTS A total of 487 patients were included. Fifty-eight (11.9%) patients underwent concomitant procedures. Multivariable linear regression models failed to find an association between concomitant procedures and longer laser time (p = 0.4). Similarly, multivariable linear regression models failed to find an association between concomitant procedures and laser time even when the analyses were repeated and stratified into endoscopic (p = 0.6) and open/laparoscopic (p = 0.4) procedures. Multivariable logistic regression models failed to demonstrate any association between concomitant procedures and early complications (OR:1.39, CI: 0.379-2.44, p = 0.2), late complications (OR:1.84, CI:0.78-3.98; p = 0.1) and acute urinary retention (OR:1.84, CI:0.78-3.98; p = 0.1). When the analyses were repeated and the concomitant procedures stratified into endoscopic and open/laparoscopic ones, they yielded virtually the same results. CONCLUSIONS GL-180-W XPS PVP could be safely performed in concomitant endoscopic or open/laparoscopic surgery. These results should be taken into consideration in the counseling of the patient who might choose to undergo simultaneous procedures.
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Affiliation(s)
| | - Michele Marchioni
- Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University, Chieti.
| | | | | | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari.
| | - Gaetano Di Rienzo
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari.
| | | | | | - Antonio Frattini
- Department of Urology, "Ercole Franchini" Hospital, Montecchio Emilia.
| | | | - Luigi Schips
- Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University, Chieti.
| | - Luca Cindolo
- Department of Urology, Private Hospital Villa Stuart, Rome.
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10
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Lombardo R, Zarraonandia Andraca A, Plaza Alonso C, González-Dacal JA, Rodríguez Núñez H, Barreiro Mallo A, Gentile BC, Tema G, Albanesi L, Mavilla L, Baldassarri V, De Nunzio C, Tubaro A, Ruibal Moldes M, Giulianelli R. Laparoscopic simple prostatectomy vs bipolar plasma enucleation of the prostate in large benign prostatic hyperplasia: a two-center 3-year comparison. World J Urol 2020; 39:2613-2619. [PMID: 33175211 PMCID: PMC8332603 DOI: 10.1007/s00345-020-03512-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/24/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To compare surgery outcomes and safety of button bipolar enucleation of the prostate vs laparoscopic simple prostatectomy in patients with large prostates (> 80 g) in a two-center cohort study. METHODS All patients with lower urinary tract symptoms due to benign prostatic enlargement (Prostate volume > 80 cc) undergoing button bipolar enucleation of the prostate (BTUEP) or laparoscopic simple prostatectomy (LSP) in two centers were enrolled. Data on clinical history, physical examination, urinary symptoms, uroflowmetry and prostate volume were collected at 0, 1, 3 6, 12, 24 and 36 months. Early and long-term complications were recorded. RESULTS Overall, 296 patients were enrolled. Out of them, 167/296 (56%) performed a LSP and 129/296 (44%) performed a BTUEP. In terms of efficacy both procedures showed durable results at three years with a reintervention rate of 8% in the LSP group and of 5% in the BTUEP group. In terms of safety, BTUEP and LSP presented similar safety profiles with a 9% of transfusion rate and no major complications. CONCLUSION LSP and BTUEP are safe and effective in treating large-volume adenomas with durable results at three years when performed in experienced centers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Valeria Baldassarri
- Azienda Ospedaliera Sant'Andrea Roma, 'Sapienza' University, Rome, Italy. .,Department of Urology, University "La Sapienza", Rome, Italy.
| | - Cosimo De Nunzio
- Azienda Ospedaliera Sant'Andrea Roma, 'Sapienza' University, Rome, Italy
| | - Andrea Tubaro
- Azienda Ospedaliera Sant'Andrea Roma, 'Sapienza' University, Rome, Italy
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De Nunzio C, Cantiello F, Fiori C, Crocerossa F, Tognoni P, Amparore D, Baldassarri V, Elbers JR, Sancha FG, Porpiglia F. Urinary and sexual function after treatment with temporary implantable nitinol device (iTind) in men with LUTS: 6-month interim results of the MT-06-study. World J Urol 2020; 39:2037-2042. [PMID: 32851439 DOI: 10.1007/s00345-020-03418-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the functional outcomes as they relate to the preservation of urinary continence and sexual function after treatment with the temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Israel); a novel minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). METHODS Men with symptomatic BPH (IPSS ≥ 10, Qmax < 12 ml/s, and prostate volume (PV) < 120 ml) were invited to participate in this single-arm, prospective multicenter study (MT06). Patients were not washed out of BPH medications before the procedure. The iTind was implanted through a 22F rigid cystoscope under intravenous sedation and was removed 5-7 days later through a 22F Foley catheter under local anesthesia. Post-operative VAS and complications (Clavien Dindo-Grading System) were recorded. Preservation of urinary continence and erectile and ejaculatory function were assessed according to ISI, MSHQ-EjD and SHIM questionnaires. Post-operative IPSS, QoL, Qmax and PVR were also assessed at 1, 3, and 6 months post-operatively. RESULTS This interim report includes data out to 6 months on the first 70 patients enrolled in the study. The median age was 62.31 years, and the mean prostate volume was 37.68 ml (15-80 ml). Baseline and follow-up data are reported in Table 1. No intraoperative complications were observed, the average post-operative VAS score was 3.24 ± 2.56. On average patients returned to daily life after 4.3 days following the retrieval procedure. Sexual function and urinary continence were preserved in all subjects according to the ISI, SHIM and MSHQ-EjD questionnaires and significant improvements (p < 0.0001) from baseline levels were recorded in IPSS, QoL and peak flow. CONCLUSION iTind is a well-tolerated, minimally invasive treatment for BPH-related LUTS which preserves sexual function and urinary continence, offers a rapid recovery and return to daily life, and a significant improvement of symptoms and urinary flow at 6-month follow-up.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, La Sapienza University, Rome, Italy.
| | - Francesco Cantiello
- Azienda Ospedaliero-Universitaria Mater Domini, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Cristian Fiori
- San Luigi Gonzaga di Orbassano University Hospital, Orbassano, Italy
| | - Fabio Crocerossa
- Azienda Ospedaliero-Universitaria Mater Domini, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Daniele Amparore
- San Luigi Gonzaga di Orbassano University Hospital, Orbassano, Italy
| | - Valeria Baldassarri
- Department of Urology, Ospedale Sant'Andrea, La Sapienza University, Rome, Italy
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Giulianelli R, Gentile BC, Mirabile G, Tema G, Nacchia A, Albanesi L, Tariciotti P, Mavilla L, Bellangino M, Lopes Mendes L, Rizzo G, Aloisi P, Vincenti G, Lombardo R. Bipolar Plasma Enucleation of the Prostate: 5 Years Outcomes. J Endourol 2020; 33:396-399. [PMID: 30816063 DOI: 10.1089/end.2019.0050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Aim of our study is to assess outcomes and safety of button bipola transurethral enucleation of the prostate (B-TUEP) in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE) in a single-center cohort study. Materials and Methods: All patients with LUTS caused by BPE undergoing button B-TUEP between May 2012 and December 2013 were prospectively enrolled in our study. Data on clinical history, physical examination, urinary symptoms, erectile function, uroflowmetry, and prostate volume were collected at 0, 1, 3, 6, 12, 24, 36, 48, and 60 months. Early and long-term complications were recorded. Results: Overall 50 patients were enrolled at baseline. Nine patients were excluded during the 5 years. All patients completed the procedure without severe complications. In terms of outcomes, improvement in International Prostate Symptom Score (IPSS) were sustained for all 5 years and mean difference from baseline at 5 years was 17 points. As well, improvements in Qmax (maximum urinary flow rate) were sustained for all 5 years and mean improvement at 5 years was 16 mL/second. Erectile function was slightly improved after surgery and maintained for the following 5 years. Conclusions: Our single-center study suggests that B-TUEP may have excellent outcomes at 5 years with no recurrence. Further multicentre studies should confirm our results.
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Affiliation(s)
| | | | | | - Giorgia Tema
- 2 Department of Urology, University "La Sapienza," Rome, Italy
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13
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Campobasso D, Marchioni M, Altieri V, Greco F, De Nunzio C, Destefanis P, Ricciardulli S, Bergamaschi F, Fasolis G, Varvello F, Voce S, Palmieri F, Divan C, Malossini G, Oriti R, Tuccio A, Ruggera L, Tubaro A, Delicato G, Laganà A, Dadone C, De Rienzo G, Frattini A, Pucci L, Carrino M, Montefiore F, Germani S, Miano R, Schips L, Rabito S, Ferrari G, Cindolo L. GreenLight Photoselective Vaporization of the Prostate: One Laser for Different Prostate Sizes. J Endourol 2020; 34:54-62. [DOI: 10.1089/end.2019.0478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Davide Campobasso
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, “G. D'Annunzio” University of Chieti, Chieti, Italy
| | | | | | - Cosimo De Nunzio
- Department of Urology, “Sant'Andrea” Hospital, Sapienza University, Roma, Italy
| | - Paolo Destefanis
- Department of Urology, Azienda Ospedaliera Città della Salute e della Scienza di Torino—Sede Molinette, Torino, Italy
| | | | - Franco Bergamaschi
- Department of Urology, “Arcispedale Santa Maria Nuova,” Reggio Emilia, Italy
| | | | | | - Salvatore Voce
- Department of Urology, “Santa Maria delle Croci Hospital,” Ravenna, Italy
| | - Fabiano Palmieri
- Department of Urology, “Santa Maria delle Croci Hospital,” Ravenna, Italy
| | - Claudio Divan
- Department of Urology, “Rovereto Hospital,” Rovereto, Italy
| | | | - Rino Oriti
- Department of Urology, “Ulivella e Glicini Clinic,” Florence, Italy
| | - Agostino Tuccio
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Lorenzo Ruggera
- Department of Urology, Clinica urologica azienda ospedaliera, University of Padova, Padova, Italy
| | - Andrea Tubaro
- Department of Urology, “Sant'Andrea” Hospital, Sapienza University, Roma, Italy
| | - Giampaolo Delicato
- Department of Urology, “S. Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Antonino Laganà
- Department of Urology, “S. Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Claudio Dadone
- Department of Urology, “Santa Croce e Carle” Hospital, Cuneo, Italy
| | - Gaetano De Rienzo
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | - Antonio Frattini
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy
| | - Lugi Pucci
- Department of Urology, AORN “Antonio Cardarelli,” Naples, Italy
| | | | | | - Stefano Germani
- UOSD Urologia, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Roberto Miano
- UOSD Urologia, Dipartimento di Scienze Chirurgiche, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Luigi Schips
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | | | | | - Luca Cindolo
- Department of Urology, “Villa Stuart” Private Hospital, Rome, Italy
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14
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De Nunzio C, Tema G, Lombardo R, Cicione A, Nacchia A, D'Annunzio S, Sarchi L, Proietti F, Brassetti A, Tubaro A. Metabolic syndrome and smoking are associated with persistence of nocturia after transurethral resection of the prostate. Neurourol Urodyn 2019; 38:1692-1699. [PMID: 31107572 DOI: 10.1002/nau.24041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
Abstract
AIMS The aim of our study was to evaluate the relationship between smoking, metabolic syndrome (MetS) and persistence of nocturia in patients with moderate/severe nocturia (nocturia episodes ≥2), lower urinary tract symptoms (LUTSs), and benign prostatic enlargement (BPE) undergoing transurethral resection of the prostate (TURP). METHODS From 2015 onward, a consecutive series of patients with moderate/severe nocturia (nocturia episodes ≥2), LUTS, and BPE undergoing TURP were prospectively enrolled. Medical history, physical examination, and smoking status were recorded. MetS was defined according to Adult Treatment Panel III. Moderate/severe persistent nocturia after TURP was defined as nocturia episodes ≥2. Binary logistic regression analysis was used to evaluate the risk of persisting nocturia. RESULTS One hundred two patients were enrolled with a median age of 70 years (interquartile range: 65/73). After TURP, moderate/severe nocturia was reported in 43 of 102 (42%) of the patients. Overall 40 of 102 (39%) patients presented a MetS, and out of them, 23 of 40 (58%) presented a moderate/severe persistent nocturia after TURP ( P = .001). Overall 62 of 102 (61%) patients were smokers, and out of them, 32 of 62 (52%) presented moderate/severe persistent nocturia after TURP ( P = .034). On multivariate analysis, prostate volume, MetS, and smoking were independent risk factors for moderate/severe persistent nocturia after TURP. CONCLUSION In our single-center study, MetS and smoking increased the risk of moderate/severe persistent nocturia after TURP in patients with LUTS-BPE. Although these results should be confirmed, and the pathophysiology is yet to be completely understood, counseling smokers and MetS patients about the risk of postoperative persistent nocturia is warranted.
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Affiliation(s)
| | - Giorgia Tema
- Department of Urology, Ospedale Sant'Andrea, Rome, Italy
| | | | | | | | | | - Luca Sarchi
- Department of Urology, Ospedale Sant'Andrea, Rome, Italy
| | | | - Aldo Brassetti
- Department of Urology, Ospedale Sant'Andrea, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea, Rome, Italy
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15
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Lombardo R, Andersson KE, Tubaro A, De Nunzio C. Intraprostatic injections for lower urinary tract symptoms/benign prostatic enlargement treatment. MINERVA UROL NEFROL 2018; 70:570-578. [PMID: 30298711 DOI: 10.23736/s0393-2249.18.03233-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endoscopic surgical treatment represents the gold standard in patients with lower urinary tract symptoms (LUTS) when medical treatment fails. In the past years there has been a growing interest in intraprostatic injections which represent a minimally invasive alternative for those patients not suitable for surgery. Aim of our study is to systematically review all the available data on intraprostatic injections for the treatment of LUTS patients with benign prostatic enlargement (BPE). EVIDENCE ACQUISITION A systematic review of the literature using the Medline, Scopus and Web of Science databases for relevant articles published until June 2018 was performed using both the Medical Subjects Heading and free test protocols. The MeSH search was conducted by combining the following terms: "Intraprostatic Injections," "Botulinum Toxin A," "Onabotulinum," "Ethanol," "Lower Urinary tract Symptoms," "Benign prostatic enlargement," "Benign Prostatic Hyperplasia," "NX1207," "PRX302." Each article's title and abstract were reviewed for their appropriateness and their relevance with regards to the relationship to intraprostatic injections. EVIDENCE SYNTHESIS Intraprostatic injections for the treatment of LUTS/BPE patients may be performed using different products as: ethanol, onabotulinum toxin A, NX1207 and PRX 302. Ethanol, the first agent for intraprostatic use, showed promising results in prospective trials, however, the rare but serious adverse events associated with extraprostatic diffusion of ethanol stopped its use. Many studies on onabotulinum toxin A (BotoxR) have been performed, however, two large randomized clinical trials showed no differences in terms of symptoms improvements and flow improvements when compared to placebo. Two new promising drugs NX 1207 and PRX 302 have been developped in the past years. NX 1207 showed lack of efficacy in the two large European phase III RCT. PRX 302 showed promising results in phase I and II studies, however, definitive results from a large phase III randomized controlled trial (RCT) are awaited before drawing any definitive conclusions. CONCLUSIONS Intraprostatic injections are still to be considered investigational for the minimally invasive management of LUTS/BPE patients. Emerging data suggest a possible role of new agents in the near future when definitive data of ongoing RCTs will be available.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Karl-Erik Andersson
- Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.,Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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16
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Cindolo L, De Nunzio C, Greco F, Destefanis P, Bergamaschi F, Ferrari G, Fasolis G, Palmieri F, Divan C, Oriti R, Ruggera L, Tubaro A, Dadone C, De Rienzo G, Frattini A, Mirone V, Schips L. Standard vs. anatomical 180-W GreenLight laser photoselective vaporization of the prostate: a propensity score analysis. World J Urol 2017; 36:91-97. [DOI: 10.1007/s00345-017-2106-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022] Open
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17
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Evrard PL, Mongiat-Artus P, Desgrandchamps F. [Morbi-mortality of transurethral resection of the prostate in patients aged 75 and over]. Prog Urol 2017; 27:312-318. [PMID: 28377079 DOI: 10.1016/j.purol.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Monopolar transurethral resection of the prostate is one of standard surgical treatment of benign prostatic hyperplasia. The objective of this study was to evaluate early postoperative complications in patients aged 75 years old and more using a standardized classification. MATERIAL AND METHODS We included all patients aged at least 75 on the day of surgery between 1 January 2008 and 31 December 2013. The reporting of complications was carried from the Clavien-Dindo classification. RESULTS One hundred and seventy-six patients were included in this study. A total of 47.2% of patients experienced at least one complication. The majority of patients (79.5%) had complications grade 1 or 2 according to Clavien-Dindo classification. One patient died postoperatively at day 27. Most complications were urological (55%). A high Charlson score and low plasma hemoglobin levels have been identified as a risk factor for complications. CONCLUSION Monopolar transurethral resection of the prostate is followed by significant morbidity in older patients, higher than in the general population. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- P-L Evrard
- Service urologie, hôpital Saint-Louis, 1, avenue Claude-Velfaux, 75010 Paris, France.
| | - P Mongiat-Artus
- Service urologie, hôpital Saint-Louis, 1, avenue Claude-Velfaux, 75010 Paris, France
| | - F Desgrandchamps
- Service urologie, hôpital Saint-Louis, 1, avenue Claude-Velfaux, 75010 Paris, France
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18
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Bagcioglu M, Karadag MA, Kocaaslan R, Sarikas CM, Gok M, Arslan OE. It Suddenly Occurred: Extensive Subcutaneous Emphysema after Bipolar Transurethral Resection of Prostate. Case Rep Urol 2015; 2015:134651. [PMID: 26491598 PMCID: PMC4600862 DOI: 10.1155/2015/134651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/30/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022] Open
Abstract
Subcutaneous emphysema is a very rare and good-natured complication after transurethral resection of prostate (TURP). It has been reported as colon perforation, diverticulitis, and bladder perforation associated complication previously. We report the first case of a wide subcutaneous emphysema due to microperforations of prostatic capsule, without a bladder perforation after TURP. Any sign of clinic situation should lead to ceasing of the procedure immediately; otherwise, it can cause a life-threatening problem of abdominal compartment syndrome.
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Affiliation(s)
- Murat Bagcioglu
- Urology Department, Faculty of Medicine, Kafkas University, 36000 Kars, Turkey
| | - Mert Ali Karadag
- Urology Department, Faculty of Medicine, Kafkas University, 36000 Kars, Turkey
| | - Ramazan Kocaaslan
- Urology Department, Faculty of Medicine, Kafkas University, 36000 Kars, Turkey
| | - Cafer Mutlu Sarikas
- Anesthesiology and Reanimation Department, Faculty of Medicine, Kafkas University, 36000 Kars, Turkey
| | - Mustafa Gok
- Radiology Department, Faculty of Medicine, Kafkas University, 36000 Kars, Turkey
| | - Omer Erkam Arslan
- Urology Department, Faculty of Medicine, Kafkas University, 36000 Kars, Turkey
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19
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De Nunzio C, Brassetti A, Gacci M, Finazzi Agrò E, Carini M, Presicce F, Tubaro A. Patients With Prostatic Inflammation Undergoing Transurethral Prostatic Resection Have a Larger Early Improvement of Storage Symptoms. Urology 2015; 86:359-65. [PMID: 26194294 DOI: 10.1016/j.urology.2015.04.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/01/2015] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the association between prostate inflammation, metabolic syndrome (MetS), and postoperative lower urinary tract symptoms in patients treated with transurethral resection of the prostate (TURP). METHODS From April 2011, a consecutive series of patients treated with TURP were prospectively included in this observational study. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. Patients were evaluated at baseline and 1 month postoperative with the International Prostate Symptom Score (IPSS), including the storage IPSS (sIPSS) and voiding IPSS (vIPSS) subscores, the Overactive Bladder questionnaire (OAB-q), and uroflowmetry. Prostate volume was evaluated at baseline. Complications were classified using the modified Clavien system. TURP specimens were examined to define grade, location, and extent of the inflammatory infiltrate according to the standardized classification system of chronic prostatitis and/or chronic pelvic pain syndrome. RESULTS One hundred and thirty-one subjects were enrolled, in which 54 patients (41.3%) presented with MetS. No differences were observed in terms of preoperative prostate-specific antigen, OAB score, IPSS, vIPSS, sIPSS, Qmax, post void residual, and prostate volume in subjects with and without MetS. An incidence of postoperative complications of 10.6% was recorded: 79% were classified as Clavien type I or II; 21% Clavien IIIb. Of 131 subjects, 97 (74.1%) presented with an inflammatory infiltrate. Patients with MetS presented a high proportion of inflammatory infiltrates compared to patients without MetS (45 of 54; 83% vs 52 of 77; 67%, P = .01). Patients with prostate inflammation presented a 50% risk reduction of postoperative storage urinary symptoms. CONCLUSION We confirmed the association between MetS and prostate inflammation.Patients with inflammatory infiltrates mostly benefit from TURP, particularly regarding storage symptoms.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, University "La Sapienza", Roma, Italy.
| | - Aldo Brassetti
- Department of Urology, Ospedale Sant'Andrea, University "La Sapienza", Roma, Italy
| | - Mauro Gacci
- Department of Urology, Careggi Hospital, University of Florence, Firenze, Italy
| | - Enrico Finazzi Agrò
- Department of Urology, Policlinico Tor Vergata, "Tor Vergata" University, Roma, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Firenze, Italy
| | - Fabrizio Presicce
- Department of Urology, Ospedale Sant'Andrea, University "La Sapienza", Roma, Italy
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea, University "La Sapienza", Roma, Italy
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20
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Simone G, De Nunzio C, Leonardo C, Gallucci M. Editorial comment. Urology 2015; 85:559-60. [PMID: 25733266 DOI: 10.1016/j.urology.2014.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Giuseppe Simone
- Department of Urology, San Giovanni Bosco Hospital, Turin, Italy
| | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University of Rome, Rome, Italy
| | - Costantino Leonardo
- Department of Urology, "La Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Michele Gallucci
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
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21
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The role of the bipolar plasmakinetic TURP over 100 g prostate in the elderly patients. Int Urol Nephrol 2014; 46:2071-7. [PMID: 25134941 DOI: 10.1007/s11255-014-0803-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Bipolar plasma kinetic (BP) transurethral resection of prostate (TURP) has been proved to be a safe and effective treatment for benign prostatic enlargement (BPE). However, the role of bipolar TURP on large prostates over 100 g compared with open suprapubic prostatectomy (SP) in elderly patients (>65 years) has not ever been studied before. PATIENTS AND METHODS A retrospective analysis of patients' medical records between 2007 and 2012 was performed. A total of 102 patients who underwent SP (n = 44) or BP-TURP [Gyrus Plasma Kinetic™ (Gyrus ACMI, USA)] (n = 58) for obstructive lower urinary tract symptoms due to BPE were included in this retrospective study. Inclusion criteria were age ≥65 years, prostate volume ≥100 g, International Prostate Symptom Score (IPSS) ≥18, and peak urinary flow rate (PFR) ≤15 ml/s. Exclusion criteria were urethral stricture, known history of neurogenic bladder due to neural disorders, previous prostate and/or urethral surgery, bladder stone, bladder cancer, and known prostate cancer. Operation time, hospitalization, and catheter removal times were noted. Patients were re-evaluated at postoperative 3rd and 12th months. Evaluated parameters were IPSS, quality of life (QoL), simplified International Index of Erectile Function-5 (IIEF-5), PFR, post-voiding residual urinary volume (PVR). Statistical significance was set at 0.05 and all tests were two-tailed. RESULTS Preoperative IPSS, PVR, IIEF-5, QoL, and prostate volume were not statistically significantly different between two groups except for PFR. Mean follow-up for BP-TURP and SP groups were 15.0 ± 5.8 (R: 11-38), 22.1 ± 11.2 (R: 11-59) months, respectively (p < 0.001). When compared with SP, mean catheter removal time (p < 0.001) and median hospitalization time (p < 0.001) were significantly shorter in BP-TURP group. However, mean operative time was significantly (p < 0.001) longer than SP group and also median resected material weight was significantly lower in the BP-TURP group (p < 0.001). IPSS, QoL, PFR, PVR, and IIEF-5 scores at postoperative 3rd and 12th month were not significantly different between the two groups (p > 0.05). Thirty-three patients had perioperative complications according to the modified Clavien-Dindo system. Thirteen patients (22.4 %) in BP-TURP group and 20 patients (45.4 %) in SP group had complications. In 12th month follow-up visit, four patients presented with urethral stricture, three patients (5.1 %) were in BP-TURP group, and one patient (2.3 %) in SP group (p = 0.455). All strictures were treated with internal urethrotomy. CONCLUSIONS BP-TURP is a safe and highly effective treatment modality for BPE in the elderly patients with prostate glands over 100 g. Clinical efficacy and postoperative 12th month's results were similar to SP. Larger studies with longer follow-up are needed in order to confirm our findings.
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