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Achalu P, Okene M, Mirheydar H. Iatrogenic injuries to reservoirs of inflatable penile prosthesis during urologic surgery: a scoping review and case report. Sex Med Rev 2024; 12:513-518. [PMID: 38705874 DOI: 10.1093/sxmrev/qeae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION First-line treatment options for patients with erectile dysfunction whose medical management has failed include the inflatable penile prosthesis (IPP). Many patients with an IPP require subsequent urologic surgery, during which the reservoir of the IPP can be injured. OBJECTIVES This review aims to present a summary of current literature related to iatrogenic injuries to the IPP sustained during urologic surgery. METHODS Two reviewers independently performed a systematic search on PubMed using standardized search terms to identify pertinent articles. After preliminary review, relevant studies were analyzed to identify the presence of perioperative complications resulting in IPP reservoir injury. Results were categorized by surgical procedures. RESULTS Among 13 articles included, all were based on urologic surgery. Four studies identified IPP reservoir injury as a result of surgical injury. Of these, injuries occurred during radical prostatectomy (n = 3) and prostatic urethral lift surgery (UroLift, n = 1). Most radical prostatectomy studies without IPP reservoir injuries also described intentional surgical techniques that were employed to prevent reservoir damage, including modulation of reservoir inflation-deflation (n = 3), temporary reservoir repositioning (n = 1), or reservoir capsule dissection to improve visualization (n = 1). Findings from an additional novel case report on IPP injury during a UroLift procedure are presented in this review. CONCLUSION Approximately one-third of studies identified intraoperative IPP reservoir injury as a significant complication of urologic surgery, particularly during radical prostatectomy. Novel case report findings also contribute the only other case of IPP reservoir damage sustained from delivery of UroLift implants. Findings are used to create a standardized surgical checklist that guides perioperative planning measures prior to pursuing surgery in adjacent spaces.
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Affiliation(s)
- Priyanka Achalu
- Department of Clinical Science, Kaiser Permanente School of Medicine, Pasadena, CA 91101, United States
| | - Michael Okene
- Department of Clinical Science, Kaiser Permanente School of Medicine, Pasadena, CA 91101, United States
| | - Hossein Mirheydar
- Department of Clinical Science, Kaiser Permanente School of Medicine, Pasadena, CA 91101, United States
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Chan ASW, Chan SWH, Estivalet AG, Man Leung L, Tam HL, Ho JMC, Hsu WL, Tang PMK, Yan E. Mitigating Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Ameliorating Sexual Function and Psychological Well-Being in Older Men. Am J Mens Health 2023; 17:15579883231205521. [PMID: 38093710 PMCID: PMC10722946 DOI: 10.1177/15579883231205521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 12/17/2023] Open
Abstract
This study aimed to investigate the prevalence of lower urinary tract symptoms (LUTS) in older men (N= 3056) with benign prostatic hyperplasia (BPH) and its effects on their sexual function and mental health. Descriptive, correlation, and regression analyses were used to explore the relationships between prostate and lower urinary tract health and psychological well-being. Better prostate and lower urinary tract health positively affected psychological well-being, and sexual function also had a positive influence. LUTS have an adverse impact on sexual function and mental health. Early intervention is crucial for mitigating the negative impact of LUTS on the quality of life in older men. Addressing prostate and lower urinary tract health issues through appropriate interventions may improve psychological well-being. Health care professionals must consider the adverse effects of BPH and LUTS on sexual function and mental health, and implement interventions to enhance the overall quality of life in older men.
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Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | | | | | - Lok Man Leung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Hon Lon Tam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jacqueline Mei Chi Ho
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Wing Leung Hsu
- Department of Pharmacy, Faculty of Health and Well-Being, University of Sunderland, UK
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Elsie Yan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
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De la Cuadra-Grande A, Rioja-Zuazu J, Domínguez-Esteban M, Torres E, Blissett R, Woodward E, Oyagüez I, Fernández-Arjona M. Budget impact analysis of transurethral water vapor therapy for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia in the Spanish national healthcare system. Expert Rev Pharmacoecon Outcomes Res 2023; 23:499-510. [PMID: 36897833 DOI: 10.1080/14737167.2023.2189591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Several surgical treatments are available for managing lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Water vapor thermal therapy (WVTT) is a new minimally invasive therapy. This study estimates the budget impact of introducing WVTT for LUTS/BPH into the Spanish health care system. METHODS A model simulated the evolution of men over 45 years of age with moderate-severe LUTS/BPH after surgical treatment, over a 4-year time horizon, from the Spanish public health care service´s perspective. The technologies in scope included those most used in Spain: WVTT, transurethral resection (TURP), photoselective laser vapourization (PVP) and holmium laser enucleation (HoLEP). Transition probabilities, adverse events and costs were identified from the scientific literature and validated by a panel of experts. Sensitivity analyses were performed by varying the most uncertain parameters. RESULTS Per intervention, WVTT resulted in savings of €3,317, €1,933 and €2,661 compared to TURP, PVP and HoLEP. Over a 4-year time horizon, when performed in 10% of the cohort of 109,603 Spanish males with LUTS/BPH, WVTT saved €28,770,125 against the scenario without WVTT availability. CONCLUSIONS WVTT could reduce the cost of managing LUTS/BPH, increase the quality of health care and reduce the length of procedure and hospital stay.
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Affiliation(s)
| | - Jorge Rioja-Zuazu
- Urology Department, Clínica Universitaria de Navarra, Navarra, Spain
| | | | - Esperanza Torres
- Health Economics & Market Access, Boston Scientific Inc, Madrid, Spain
| | - Rob Blissett
- Health Economics & Economic Evaluation, MedTech Economics Ltd, Winchester, UK
| | - Emily Woodward
- Health Economics & Market Access, Boston Scientific AG, Solothurn, Switzerland
| | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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UroLift implants as surrogate fiducial markers for cone-beam CT-based prostate image-guided radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396923000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Introduction:
UroLift implants are a novel treatment for the obstructive lower urinary tract symptoms arising from benign prostatic hyperplasia. This case study aimed to assess their effectiveness as fiducial marker (FM) surrogates in prostate image-guided radiotherapy (IGRT).
Method:
Cone-beam CT images from a patient receiving prostate radiation therapy underwent manual alignment using UroLift implants and also prostate soft-tissue matching by five experienced therapeutic radiographers. The match values of both methods were compared using Bland–Altman analysis. All five observers were also asked to score the ease of matching using both approaches.
Results:
The 95% mean level of agreement for the UroLift matches were within a 2-mm threshold in all dimensions. Comparison of UroLift and prostate matches had 95% limit of agreement values of −0·98 to 1·78, −0·58 to 0·49 and −1·83 to 1·04 mm in the vertical, longitudinal and lateral planes, respectively. All of the UroLift matches were rated as ‘very easy’ or ‘possible with little difficulty’ by the five observers.
Conclusion:
A small difference between the CBCT UroLift and CBCT prostate match was found. It has been shown that IGRT to the prostate with the aid of the UroLift system implants and CBCT is feasible and can eliminate the need for FM implants. Wider evaluation in a large cohort is recommended.
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Tung JY, Aslim EJ, Ho HS, Chen C. A cost-effectiveness analysis of pharmacotherapy versus prostatic urethral lift as initial therapy for patients with moderate benign prostatic hyperplasia. Expert Rev Pharmacoecon Outcomes Res 2023; 23:63-68. [PMID: 36342223 DOI: 10.1080/14737167.2023.2144237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM The objective of this study was to evaluate the cost-effectiveness of an upfront minimally invasive surgical procedure, the prostatic urethral lift (PUL), as an initial treatment for patients with moderate benign prostatic hyperplasia (BPH), against current first-line pharmacotherapy with combination medical therapy. METHOD A micro-simulation model was developed using TreeAge Pro to compare two treatment strategies - initial treatment with combination medical therapy (alpha-blocker + 5-ARI) versus an upfront prostatic urethral lift procedure. The impact on disease progression, costs, and quality-adjusted life-years (QALYs) was analyzed. A Markov model and probabilistic sensitivity analysis were used to estimate the costs and effects of the different strategies. The cost-effectiveness of the strategies at different willingness-to-pay (WTP) thresholds was then examined. RESULTS Incremental costs (versus no prostatic urethral lift) were S$13,600 (1 year) and S$8,700 (5 years). Incremental QALYs were 0.07 (1 year) and 0.22 (5 years). An upfront PUL procedure was more expensive but also more effective than pharmacotherapy, with an incremental cost per QALY gain of approximately S$39,400. It is a cost-effective treatment option at the willingness-to-pay threshold of S$50,000. CONCLUSION Prostatic urethral lift is a cost-effective initial treatment option for men with moderate symptoms of benign prostatic hyperplasia.
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Affiliation(s)
- Joshua Ym Tung
- Department of Urology, Singapore General Hospital, Singapore
| | - Edwin J Aslim
- Department of Urology, Singapore General Hospital, Singapore
| | - Henry Ss Ho
- Department of Urology, Singapore General Hospital, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Knight L, Dale M, Cleves A, Pelekanou C, Morris R. UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:669-680. [PMID: 35843995 PMCID: PMC9385790 DOI: 10.1007/s40258-022-00735-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 05/15/2023]
Abstract
Lower urinary tract symptoms (LUTS) commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), or prostatic urethral lift using the UroLift system. The UroLift system implants to pull excess prostatic tissue away so that it does not narrow or block the urethra. In this way, the device is designed to relieve symptoms of urinary outflow obstruction without cutting or removing tissue. National guidance recommending the use of UroLift in the UK NHS was first issued in 2015 by the National Institute for Health and Care Excellence (NICE MTG26). We now report on the process to update the economic evaluation of UroLift, leading to updated NICE guidance published in May 2021 (NICE MTG58). The conclusions of the available clinical evidence were mixed and suggested that whilst UroLift improves symptoms over time, this improvement is smaller than that of TURP for symptom severity (IPSS) and urological outcomes. However, UroLift appears to be superior to Rezum for symptom severity and measures of erectile dysfunction and ejaculatory dysfunction. The updated economic model estimated that using UroLift as a day-case procedure for people with prostate of volume 30-80 mL creates a saving of £981 per person compared with bipolar TURP, £1242 compared with monopolar TURP, and £1230 compared with HoLEP.
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Affiliation(s)
- Laura Knight
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | - Megan Dale
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | - Andrew Cleves
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | - Charlotte Pelekanou
- National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT UK
| | - Rhys Morris
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
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7
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Chidurala S, Bheemarasetti M. Unusual Presentation of Infective Endocarditis Following a Prostatic Urethral Lift. Cureus 2022; 14:e26919. [PMID: 35983389 PMCID: PMC9377382 DOI: 10.7759/cureus.26919] [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] [Accepted: 07/16/2022] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis is a serious inflammation of the inner lining of the heart. It is caused by pathogens entering the bloodstream and infecting the endocardium. We demonstrate a unique presentation of infective endocarditis following a prostatic urethral lift. The low index of suspicion and atypical symptoms prevented early diagnosis of the disease, leading to life-threatening complications and valve replacement surgery. Understanding unusual presentations of infective endocarditis can increase the index of suspicion in outpatient settings, leading to early diagnosis and preventing fatal complications.
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8
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Erazo J, Suso D, Sejnaui J, Aluma L, Mendoza L, Ramirez G, Morales C, Usubillaga F, Mendoza S, Rivera F, Mendoza A, Usubillaga MC, Erazo S, Chavarriaga J. Outpatient 180 W XPS GreenLight™ Laser Photoselective Vaporization of the Prostate: Seven Year Experience. J Endourol 2021; 36:548-553. [PMID: 34779677 DOI: 10.1089/end.2021.0618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE GreenLight XPS Laser System (GL-XPS) photoselective vaporization of the prostate (PVP) is not only non-inferior to Transurethral resection of the prostate (TURP), but with shorter rates of hospital stay and length of catheterization. Scarce literature has been published about the feasibility and safety of performing GL-XPS PVP in an outpatient setting. Our aim is to report our seven-year experience with outpatient GL-XPS PVP. METHODS Medical charts of all patients that underwent GL-XPS PVP between 2013 and 2020 were reviewed. Patients were discharged after careful monitoring in the recovery room and the catheter was removed either at home or at a schedule hospital visit. We used the Shapiro-Wilk test to assess for normal distribution, and the evaluation of homoscedasticity was performed with the SD Test. For qualitative variables, the comparison between groups was carried using the Chi-Square test and for the quantitative variables we used the non-parametric Mann Whitney U test. RESULTS A total of 537 patients were treated, 517 in an outpatient basis. Median age was 68 years (IQR 62-76), median prostate volume 50 cc (IQR 40-70). 22.8% were on anticoagulants or antiplatelet therapy. Median operative time was 100 minutes (IQR 75-125), length of hospital stay 5 hours (IQR 4-6.45), mean length of catheterization 48 hours (SD 14.92). Readmission rate within 90 days of surgery was 11.7%, 58 (10.8%) for surgical-related complications. Median time for readmission was 4 days (IQR 2-24). Immediate readmission (within 10 days) was recorded in 7.6% of patients, urinary retention was the main cause. No significant differences were found trying to find perioperative predictors for readmission. CONCLUSIONS Our experience suggests that outpatient GL-XPS PVP could be performed safely with a predefined outpatient pathway. With a low readmission and complication rate.
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Affiliation(s)
- Juan Erazo
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Daniel Suso
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Jorge Sejnaui
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Luis Aluma
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Lupi Mendoza
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - German Ramirez
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Carlos Morales
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | | | - Sergio Mendoza
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Fabio Rivera
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Alexandra Mendoza
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Maria C Usubillaga
- Pontificia Universidad Javeriana Facultad de Medicina, 89654, Urology, Bogota, Colombia;
| | - Santiago Erazo
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Julian Chavarriaga
- Pontificia Universidad Javeriana Facultad de Medicina, 89654, Urology, Bogota, Colombia.,Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
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9
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Weiss JK, Santucci NM, Sajadi KP, Chouhan JD. Post-Surgical Complications After Bladder Outlet Reducing Surgery: An Analysis of The FDA Manufacturer and User Facility Device Experience (MAUDE) Database. Urology 2021; 156:211-215. [PMID: 33971189 DOI: 10.1016/j.urology.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/05/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine voluntary reports in the Food & Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, categorize complications and assign device-related causality with transurethral resection of the prostate (TURP), prostatic urethral lift (PUL), and transurethral water vapor therapy (TWVT). METHODS A review was performed using the terms "Urolift," "Rezum," and "transurethral resection of the prostate" between 01/01/2015 and 12/31/2019. Duplicate and incomplete reports were excluded. The Gupta system was used to report complications and device related causality.1 Pearson's Chi-square analysis was performed to compare minor (Level 1) versus major (Levels 2-4) complications. RESULTS A total of 548 events were examined. After removal of duplicates (n = 60), irrelevant reports (n=65), and incomplete information (n = 14), we included 409 events (74.6%). Of the 409 events, 214 were for TURP, 112 for TWVT, and 83 for PUL. In aggregate, 39.4% of events were minor/Level 1 (n=161/409). The proportion of subjects with Level 2-4 complications versus Level 1 complications was significantly higher for PUL than TURP or TWVT [X2 (2, N = 408) = 41.4023, P < .00001]. Device causality was attributable to device malfunction in 60.4% of cases (n=247/409). CONCLUSION Device malfunction was noted in all groups and 39.4% of these were minor (Level 1). However, the majority of PUL reports noted a Level 3 or 4 complication (50.6%, 42/83), primarily bleeding related. Previous studies have not revealed significant risk of bleeding and suggests a discrepancy between study data and real-world experience that may alter patient counseling practices.
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Affiliation(s)
- Jason K Weiss
- School of Medicine, Oregon Health & Science University
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10
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Ewing B, Alavi-Dunn N, Hamann H, Danforth T. Large pelvic hematoma following UroLift procedure causing renal failure requiring dialysis. Urol Case Rep 2020; 34:101514. [PMID: 33318939 PMCID: PMC7726674 DOI: 10.1016/j.eucr.2020.101514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 11/03/2022] Open
Abstract
The prostatic urethral lift procedure is a minimally invasive treatment option for lower urinary tract symptoms due to benign prostatic hyperplasia, with reported benefit of less adverse effects than traditional treatments. While complications are usually minimal, our patient developed a large pelvic hematoma and the first case of organ failure after prostatic urethral lift. He required temporary dialysis during his extended postoperative admission, and his chronic kidney disease permanently progressed from stage III to stage IV. This case highlights the need for research into the safest preoperative and operative approach for prostatic urethral lift procedures in patients with comorbidities.
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Affiliation(s)
- Brandon Ewing
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Urology, 100 High St, Buffalo, NY, 14203, USA
| | - Nicole Alavi-Dunn
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Urology, 100 High St, Buffalo, NY, 14203, USA
| | - Harold Hamann
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Urology, 100 High St, Buffalo, NY, 14203, USA
| | - Teresa Danforth
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Urology, 100 High St, Buffalo, NY, 14203, USA
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11
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Xiang P, Wang M, Guan D, Liu D, Wang Y, Hao Y, Li S, Liu Y, Ping H. A Systematic Review and Meta-analysis of Prostatic Urethral Lift for Male Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. EUR UROL SUPPL 2020; 19:3-15. [PMID: 34337448 PMCID: PMC8317884 DOI: 10.1016/j.euros.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 02/03/2023] Open
Abstract
CONTEXT Recently, prostatic urethral lift (PUL) is being used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Although preliminary clinical studies on PUL are increasing, the long-term efficacy and safety of this procedure are still not well evaluated. OBJECTIVE The objective of our study is to synthesize the existing literature evidence, and make a comprehensive and long-term systematic review for the PUL procedure. EVIDENCE ACQUISITION A systematic search was performed from the electronic databases including PubMed, Embase, and OVID. The search period was up to January 1, 2020. Comprehensive retrospective and prospective studies on PUL were collected in accordance with specific inclusion and exclusion criteria. Pooled prostatic symptom scores, sexual health scores, and functional outcomes were calculated by using a fixed or random-effect model. EVIDENCE SYNTHESIS Nineteen articles meet our determined inclusion and exclusion criteria, and 11 independent patient series were included in the final analysis. Meta-analysis results indicated improvement after the PUL procedure, including International Prostate Symptom Score improvement of 9.73-12.16 points, BPH Impact Index improvement of 3.74-4.50 points, maximum flow rate improvement of 3.44-4.26 ml/s, and quality of life improvement of 2.20-2.55 points. Postvoid residual volume at most of the intervals was not significantly variable. Data regarding sexual function remained stable or improved slightly during the 24-mo follow-up period. Pooled estimates were largely heterogeneous except for sexual function. CONCLUSIONS PUL can continue to relieve prostatic symptoms for 24 mo without causing serious complications. The extremely important advantage of the PUL procedure is that it can preserve or slightly improve sexual function. Longer-term and more comprehensive clinical trials are still needed to further clarify the functional outcomes and cost effectiveness of PUL. PATIENT SUMMARY Prostatic urethral lift is an attractive option for selected patients who seek rapid and durable relief of lower urinary tract symptoms with complete preservation of sexual function.
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Affiliation(s)
- Peng Xiang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mingdong Wang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Di Guan
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dan Liu
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yonghui Wang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yongxiu Hao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shuang Li
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuexin Liu
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hao Ping
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Ullah R, Wazir J, Hossain MA, Diallo MT, Khan FU, Ihsan AU, Zhou X. A glimpse into the efficacy of alternative therapies in the management of benign prostatic hyperplasia. Wien Klin Wochenschr 2020; 133:153-162. [PMID: 32533441 DOI: 10.1007/s00508-020-01692-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/26/2020] [Indexed: 12/28/2022]
Abstract
Benign prostatic hyperplasia (BPH) is a common disease that can cause uncomfortable lower urinary tract symptoms. The occurrence of symptomatic BPH develops after the age of 40 years and increases gradually with age to reach more than 50% at the age of 60 years and severely disturbs the quality of life of the patients. Alpha-blockers and 5‑alpha reductase inhibitors are first-line agents used for the treatment of BPH. Due to the adverse effects of these conventional therapies, many patients turn to phytotherapy and other alternative therapies. This review covers alternative therapies, i.e., phytotherapy (cernilton, eviprostat, quercetin, saw palmetto and pumpkin seed) and physical therapy (acupuncture, aquablation, pulsed electromagnetic field, prostate urethral lift, radial extracorporeal shock wave therapy, thermobalancing therapy, and transurethral needle ablation) commonly used in the management of BPH.
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Affiliation(s)
- Rahat Ullah
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Junaid Wazir
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Md Amir Hossain
- Center for New Drug Safety Evaluation and Research, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Maladho Tanta Diallo
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Farhan Ullah Khan
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Awais Ullah Ihsan
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Xiaohui Zhou
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China.
- Department of Surgery, Nanjing Shuiximen Hospital, 211198, Nanjing, Jiangsu, China.
- Zhongda Hospital, Affiliated with Southeast University, 211198, Nanjing, Jiangsu, China.
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13
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Sountoulides P, Karatzas A, Gravas S. Current and emerging mechanical minimally invasive therapies for benign prostatic obstruction. Ther Adv Urol 2019; 11:1756287219828971. [PMID: 30792821 PMCID: PMC6376539 DOI: 10.1177/1756287219828971] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022] Open
Abstract
Transurethral resection of the prostate (TURP) is considered the ‘gold standard’ for the surgical management of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). However, during recent years TURP has been challenged by several minimally invasive therapies (MITs). The reasons for the development of these MITs are the need for anesthesia and the rather unchanged morbidity of TURP, including ejaculation disorders. Mechanical MITs may represent an attractive option for treating LUTS/BPO by using mechanical forces to maintain urethral patency without cutting, ablating, heating or removing prostatic tissue. The present paper provides an update on currently available mechanical devices for the treatment of LUTS/BPO including the prostatic urethral lift (PUL), the temporary implantable nitinol device, and new intraprostatic implants. It analyzes the evidence for their safety, tolerability, and efficacy in clinical practice and aims to define those subpopulations of patients who will benefit from these MITs. It is obvious that there is a wide variation in the degree of mature of the available mechanical MITs. Time and high-quality long-term studies will decide which of these therapies will be accepted by patients and urologists. At the moment, PUL is claiming its position in the armamentarium of BPO treatment.
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Affiliation(s)
- Petros Sountoulides
- Aristotle University of Thessaloniki, Department of Urology, Thessaloniki, Greece
| | - Anastasios Karatzas
- University of Thessaly, Faculty of Medicine, Department of Urology, Larissa, Greece
| | - Stavros Gravas
- University of Thessaly, Faculty of Medicine, Department of Urology, Feidiou 6-8, 41221, Larissa, Greece
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14
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Abstract
PURPOSE OF REVIEW To review the costs associated with benign prostatic hyperplasia (BPH) management. Specifically, to compare the costs of medical therapy, office-based procedures, and surgical management from a payer perspective. RECENT FINDINGS The American Urological Association released updated guidelines in 2018 for the surgical management of BPH. Over recent years, analyses investigating the cost-effectiveness of the modalities included in these guidelines have been completed. These show relatively newer, minimally-invasive office-based therapies can provide cost-effective alternatives to medical therapy. Likewise, surgical therapies provide a cost-effective means of BPH management, if performed well with low complication rates. However, comparisons of these studies are limited by the biases they contain. Minimally-invasive office-based therapies and well performed surgical therapies for BPH can achieve cost equivalence to combination medical therapy within a few years. Factors such as age, gland size, patient compliance, and surgeon skill should be considered when personalizing treatment recommendations for each patient.
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15
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Ray AF, Powell J, Speakman MJ, Longford NT, DasGupta R, Bryant T, Modi S, Dyer J, Harris M, Carolan-Rees G, Hacking N. Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study). BJU Int 2018; 122:270-282. [DOI: 10.1111/bju.14249] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Alistair F. Ray
- Cedar; Cardiff University/Cardiff and Vale University Health Board; Cardiff UK
| | - John Powell
- Centre for Health Technology Evaluation; National Institute for Health and Care Excellence; London UK
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - Mark J. Speakman
- Department of Urology; Taunton and Somerset NHS Trust; Taunton UK
| | - Nicholas T. Longford
- SNTL Statistics Research and Consulting; Department of Medicine; Imperial College London; London UK
| | - Ranan DasGupta
- Department of Urology; St. Mary’s Hospital; Imperial College Healthcare NHS Trust; London UK
| | - Timothy Bryant
- Department of Interventional Radiology; Southampton General Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Sachin Modi
- Department of Interventional Radiology; Southampton General Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Jonathan Dyer
- Department of Urology; Southampton General Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Mark Harris
- Department of Urology; Southampton General Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Grace Carolan-Rees
- Cedar; Cardiff University/Cardiff and Vale University Health Board; Cardiff UK
| | - Nigel Hacking
- Department of Interventional Radiology; Southampton General Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
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16
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Su XJ, Zeng XT, Fang C, Liu TZ, Wang XH. Genetic association between PSA-158G/A polymorphism and the susceptibility of benign prostatic hyperplasia: a meta-analysis. Oncotarget 2018; 8:33953-33960. [PMID: 28430620 PMCID: PMC5464925 DOI: 10.18632/oncotarget.15424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/08/2017] [Indexed: 12/16/2022] Open
Abstract
Inconsistency between reported findings on the association of prostate specific antigen (PSA) gene -158G/A polymorphism with benign prostatic hyperplasia (BPH) susceptibility need a meta-analysis to obtain a more accurate conclusion. A systematic search was conducted in electronic databases for the collection of eligible studies on PSA -158G/A polymorphism and BPH susceptibility. Pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were then calculated. 7 case-control studies with 758 cases and 752 controls were included into the present meta-analysis. The analysis results showed no significant relationship between PSA -158G/A polymorphism and BPH susceptibility in total analysis. Interestingly, after subgroup analyses based on ethnicity and source of control, the polymorphism reduced the susceptibility of BPH in Caucasian group (AA vs. GG: OR=0.47, 95% CI=0.25-0.89; allele A vs. allele G: OR=0.68, 95% CI=0.49-0.93), but it increased the disease susceptibility in Asian (AA vs. GG: OR=1.63, 95% CI=1.02-2.60; allele A vs. allele G: OR=1.37, 95% CI=1.03-1.83) and population-based (AA vs. GG: OR=2.39, 95% CI=1.07-5.38; allele A vs. allele G: OR=1.83, 95% CI=1.26-2.65) groups. PSA-158G/A polymorphism may be an inhibitor to the incidence of BPH in Caucasians, but it is likely to be a susceptible factor in Asians.
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Affiliation(s)
- Xin-Jun Su
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xian-Tao Zeng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College, Wuhan University, Wuhan, China
| | - Cheng Fang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tong-Zu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College, Wuhan University, Wuhan, China
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17
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Van Bruwaene S, Namdarian B, Challacombe B, Eddy B, Billiet I. Introducing new technology safely into urological practice. World J Urol 2018; 36:543-548. [PMID: 29327248 DOI: 10.1007/s00345-018-2173-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Surgical innovation is necessary to ensure continued improvement in patient care. However, several challenges unique to the surgical craft are encountered during the development and validation of such new technology. This article highlights some of these challenges and gives an overview of existing solutions. METHODS A Pubmed review was performed about the "introduction of new technology" to identify challenges. Cross-referencing was used to explore the possible solutions per challenge. RESULTS Several characteristics of the surgical craft itself limit our ability to establish randomised controlled trials and hence provide clear categorical evidence. Existing certification bodies for new technology often use unstructured regulations and allow fast-track bypassing systems. Consequently the IDEAL framework (innovation, development, exploration, assessment, long-term follow-up) proposes an objective scientific approach whilst defining stakeholder responsibilities. The selection of which new modality to implement is heavily influenced by third parties unrelated to the best patient outcomes and thus professional organisations can aid in this decision-making. Appropriate training of surgeons and their teams until proficiency is achieved is essential prior to credentialling. Finally long-term surveillance of outcomes in the form of registries is an increasing responsibility of the urological community to maintain our role in directing the adoption or rejection of these innovations. CONCLUSION Urological innovation is a dynamic and challenging process. Increasing efforts are identified within the urological community to render the process more reliable and transparent.
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Affiliation(s)
| | | | - Ben Challacombe
- Guy's Hospital, Guy's and St Thomas' Trust (GSTT), London, UK
| | - Ben Eddy
- Kent and Canterbury Hospital, East Kent Hospital Trust (EKHUFT), Canterbury, UK
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18
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Nunes RLV, Antunes AA, Constantin DS. Contemporary surgical treatment of benign prostatic hyperplasia. Rev Assoc Med Bras (1992) 2017; 63:711-716. [PMID: 28977110 DOI: 10.1590/1806-9282.63.08.711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are several options available today in the therapeutic armamentarium. Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the last decade, but it still needs to dodge the trade barrier. Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market.
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Affiliation(s)
- Ricardo Luís Vita Nunes
- Head of the Benign Prostatic Hyperplasia Department, Sociedade Brasileira de Urologia (SBU). Assistant Physician, Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Head of the Urology Clinic, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
| | - Alberto Azoubel Antunes
- Associate Professor, Division of Urology, Head of the Urology Graduate Program, and Coordinator of the Prostate Sector, Division of Urology, FMUSP, São Paulo, SP, Brazil
| | - Davi Souza Constantin
- Preceptor of Urology, Centro de Referência do Homem do Hospital de Transplantes Euryclides de Jesus Zerbini. MD, Urologist, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
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19
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Maclean D, Maher B, Modi S, Harris M, Dyer J, Somani B, Hacking N, Bryant T. Prostate artery embolization: a new, minimally invasive treatment for lower urinary tract symptoms secondary to prostate enlargement. Ther Adv Urol 2017; 9:209-216. [PMID: 29662545 DOI: 10.1177/1756287217717889] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/07/2017] [Indexed: 01/12/2023] Open
Abstract
Prostate artery embolization (PAE) is emerging as a safe and efficacious treatment which approaches benign prostatic obstruction (BPO) from a unique perspective. This brings with it distinct advantages and solutions, which we discuss along with cost, evidence, complications and disadvantages.
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Affiliation(s)
- Drew Maclean
- University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Ben Maher
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
| | - Sachin Modi
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
| | - Mark Harris
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Jonathan Dyer
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Nigel Hacking
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
| | - Timothy Bryant
- Department of Interventional Radiology, University Hospital Southampton, Southampton, UK
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20
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Chung AS, Woo HH. Update on minimally invasive surgery and benign prostatic hyperplasia. Asian J Urol 2017; 5:22-27. [PMID: 29379732 PMCID: PMC5780286 DOI: 10.1016/j.ajur.2017.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 02/28/2017] [Accepted: 03/13/2017] [Indexed: 01/24/2023] Open
Abstract
Transurethral resection of the prostate (TURP) became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy. TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options. Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard. Over recent years, there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift (PUL; UroLift System), convective WAter Vapor Energy (WAVE; Rezum System), Aquablation (AQUABEAM System), Histotripsy (Vortx Rx System) and temporary implantable nitinol device (TIND). Intraprostatic injections (NX-1207, PRX-302, botulinum toxin A, ethanol) have mostly been used with limited efficacy, but may be suitable for selected patients. This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.
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Affiliation(s)
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, NSW, Australia
- Corresponding author.
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21
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Affiliation(s)
- Peter J. Gilling
- Bay of Plenty District Health Board Clinical School; Tauranga New Zealand
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22
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Pushkaran A, Stainer V, Muir G, Shergill IS. Urolift – minimally invasive surgical BPH management. Expert Rev Med Devices 2017; 14:223-228. [PMID: 28270016 DOI: 10.1080/17434440.2017.1296762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anish Pushkaran
- The Alan de Bolla Urology Unit, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Victoria Stainer
- The Alan de Bolla Urology Unit, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Gordon Muir
- The Department of Urology, Kings College, London, UK
| | - Iqbal S. Shergill
- The Alan de Bolla Urology Unit, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
- The North Wales and North West Urological Research Centre, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
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23
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Brewster S, Biers S, Challacombe B, Cresswell J, Sinclair A, Smith D. Advances in urology 2015–2016. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415816681238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has become customary that a session is held at the British Association of Urological Surgeons (BAUS) annual meeting wherein the most important advances in the major urological sub-specialities are summarised by British opinion leaders for the benefit of the core urologist. It gives us pleasure to present in this paper (to which the six authors contributed equally) the topics covered at the Liverpool BAUS meeting in June 2016.
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Affiliation(s)
| | | | | | - Jo Cresswell
- James Cook University Hospital, Middlesbrough, UK
| | | | - Daron Smith
- Institute of Urology, University College Hospital, London, UK
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24
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Keehn A, Fram E, Garg M, Maria P. UroLift in Place of Fiducial Markers for Patients With Benign Prostatic Hyperplasia Undergoing External Beam Radiation Therapy. Urology 2016; 104:230-234. [PMID: 27988266 DOI: 10.1016/j.urology.2016.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/06/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate if using a novel treatment for obstructive benign prostatic hyperplasia (UroLift) to relive lower urinary tract symptoms (LUTS) prior to external beam radiotherapy (EBRT) could also supplant the use of fiducial markers obviating the need for a second transrectal procedure while facilitating symptom-free voiding during and after EBRT a series of patients are reported on. METHODS The medical records of 7 consecutive patients who underwent placement of UroLift for simultaneous treatment of obstructive LUTS due to benign prostatic hyperplasia and targeting of EBRT for treatment of prostate cancer between September and December of 2015 were reviewed. RESULTS The UroLift clips were sufficiently radiopaque to make targeting possible for EBRT. All patients were able to complete a full course of radiotherapy without placement of fiducial markers. No patient experienced complications that could be attributed to the UroLift implants or procedure during their course of radiotherapy. None of the patients required additional alpha-blockers during radiation therapy. CONCLUSION The UroLift system can serve as fiducial markers in patients undergoing EBRT. Although the current clip utilized in the UroLift system is generally radiopaque, it does not project well on the sagittal plane and would be significantly enhanced if a more strongly opaque substance was incorporated. It remains to be proven if the UroLift system can significantly reduce the symptoms of LUTS during and post EBRT.
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Affiliation(s)
- Aryeh Keehn
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Ethan Fram
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Madhur Garg
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Pedro Maria
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
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25
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Jones P, Rai BP, Aboumarzouk O, Somani BK. UroLift: a new minimally-invasive treatment for benign prostatic hyperplasia. Ther Adv Urol 2016; 8:372-376. [PMID: 27904652 DOI: 10.1177/1756287216671497] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
'UroLift' has emerged as a new minimally-invasive nonablative surgical technique for benign prostatic hyperplasia (BPH). We discuss the procedure, cost, evidence, advantages and disadvantages of this procedure. It is a novel technology suitable for a selected group of patients that allows for a bespoke treatment for men with BPH.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Blackpool Victoria Hospital, Blackpool, UK
| | - Bhavan P Rai
- James Cook University Hospital, South Tees Hospital NHS Foundation Trust, UK
| | - Omar Aboumarzouk
- Department of Urology, Bristol Urological Institute, Bristol, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK
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26
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Urolift: a New Face of Minimally Invasive Surgical Technique for Benign Prostatic Hyperplasia? Curr Urol Rep 2016; 17:63. [DOI: 10.1007/s11934-016-0619-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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