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Yu XD, Yan SS, Liu RJ, Zhang YS. Apparent differences in prostate zones: susceptibility to prostate cancer, benign prostatic hyperplasia and prostatitis. Int Urol Nephrol 2024; 56:2451-2458. [PMID: 38528290 DOI: 10.1007/s11255-024-04012-w] [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: 01/14/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
Men are inevitably plagued by prostate disease throughout their lives. However, the understanding of the pathogenesis of prostate diseases is still limited. In the 1960s, McNeal proposed the theory of prostate zones: the prostate was divided into three main zones: transition zone, central zone, and peripheral zone. Over the past 50 years, significant differences between different prostate zones have been gradually revealed. We summarized the most significant differences in different zones of the prostate. For the first time, we proposed the "apparent difference in prostate zones" concept. This new concept has been proposed to understand the different zones of the prostate better. It also provided new ideas for exploring the susceptibility of lesions in different prostate zones. Despite the reported differences between zones, the treatment of prostate-related diseases remains partition agnostic. Therefore, we also discussed the clinical significance of the "apparent difference in the prostate zone" and emphasized the necessity of prostate zones.
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Affiliation(s)
- Xu-Dong Yu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing Tumour Minimally Invasive Medical Center of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | - Shao-Shuai Yan
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Rui-Jia Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yao-Sheng Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
- Beijing Tumour Minimally Invasive Medical Center of Integrated Traditional Chinese and Western Medicine, Beijing, China.
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Dieudonne ZOJ, Nedjim SA, Kifle AT, Gebreselassie KH, Gnimdou B, Mahamat MA, Emmanuel M, Noel C, Khassim NA, Khalid A, John L, Brahima K, Adama O, Aristide KF. Surgical Advances in Treating Benign Prostatic Hyperplasia in Africa: What About the Endoscopic Approach? Urology 2024; 189:80-86. [PMID: 38653385 DOI: 10.1016/j.urology.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To assess the practices, trends, and challenges associated with the use of endoscopic techniques in Africa related to the surgical treatment of benign prostatic hyperplasia METHODS: The questionnaire, which was based on Google Forms, assessed several points related to the surgical management of benign prostatic hyperplasia. RESULTS In 67.4% of the centers, BPH was the primary pathology requiring surgical management. In all 43 centers, approximately 1/3 of the urologists (n = 41) are able to perform an endoscopic procedure for the management of prostatic hypertrophy. Of the 43 centers, 30 had a block equipped with endourology equipment, and 56.6% (n = 17) performed endourological surgery exclusively for the surgical management of BPH. TURP is the most widely used endoscopic technique. Open prostatectomy was the only surgical technique used in 14 centers (32.5%). In the remaining centers, both procedures (endoscopy and open surgery) were used depending on the surgeon's skills. Twenty-six (60.5%) centers expressed the need for training in endoscopic management of BPH. CONCLUSION The main challenges encountered relate to the lack of competent personnel, the unavailability of equipment and materials, and the high cost to patients. It is essential to develop modern urology in Africa, particularly in terms of endourological practices.
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Affiliation(s)
| | - Saleh Abdelkerim Nedjim
- Modern Urology For Africa Association; University Teaching Hospital Ibn Rochd, Casablanca, Morocco; University Teaching Hospital, la Référence Nationale, N'Djamena, Chad
| | | | | | - Botcho Gnimdou
- University of Kara, Urology Department at the Regional Hospital Center of Sokodé, Togo
| | | | | | - Coulibaly Noel
- University Teaching Hospital of Treichville, Abidjan, Ivory Coast
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Carvalho BRG, Gabrich PN, de Marins RL, Damião R, Oliveira RV. Same-day Catheter Removal and Hospital Discharge After Holmium Laser Enucleation of the Prostate: A Prospective Study. Urology 2024:S0090-4295(24)00446-1. [PMID: 38871305 DOI: 10.1016/j.urology.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/21/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To assess the feasibility, safety, and predictive factors for the success of holmium laser enucleation of the prostate (HoLEP) with catheter removal and hospital discharge on the same day of the procedure. METHODS This prospective study included 34 patients who underwent HoLEP using a 60-W holmium laser device and the Wolf Piranha morcellation system. Surgeries began at 10:30 am and the patients were expected to be discharged by 5 pm on the same day. The patients underwent a voiding trial to remove the urinary catheter before hospital discharge. Functional outcomes were assessed 90 days after the procedure. RESULTS Mean (range) age, prostate-specific antigen value, and prostate weight were as follows: 63.4 (50-80) years, 4.81 (0.19-14) ng/mL, and 89.3 (33-258) g, respectively. The mean (range) enucleation and morcellation times were 56.2 (29-91) minutes and 14.67 (3-45) minutes, respectively. Thirty-one patients (91.1%) were discharged on the same day of the procedure after urinary catheter removal. CONCLUSION The performance of HoLEP is safe on an outpatient basis. Same-day catheter removal is feasible and does not affect hospital discharge.
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Affiliation(s)
| | | | | | - Ronaldo Damião
- University of the State of Rio de Janeiro, Rio de Janeiro
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Kaplan SA, Moss JL, Freedman SJ. Two-year long-term follow-up of treatment with the Optilume BPH catheter system in a randomized controlled trial for benign prostatic hyperplasia (The PINNACLE Study). Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00833-z. [PMID: 38684918 DOI: 10.1038/s41391-024-00833-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Patient outcomes were assessed 2 years after treatment with the Optilume BPH Catheter System, a minimally invasive surgical therapy for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). METHODS One-hundred forty-eight adult males with symptomatic BPH were enrolled and randomized in a 2:1 fashion to Optilume BPH or Sham (100 Optilume BPH; 48 Sham). Long-term measures include International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), Post-Void Residual Urine (PVR), quality of life measures and sexual function. Follow-up beyond one year was limited to those treated with Optilume BPH. RESULTS At 2 years, 67.5% (56/83 CI 56.3%, 77.4%) of participants in the Optilume BPH arm were symptomatic responders as defined by ≥30% improvement in IPSS without medical or surgical retreatment. IPSS significantly improved from 23.4 ± 5.5 (n = 100) to 11.0 ± 7.0 (n = 74). Qmax improved by 116.8.% (8.9 ± 2.2 (n = 97) to 19.0 ± 16.3 (n = 65)), while PVR showed a slight reduction (83.7 ± 70.3 (n = 99) to 65.9 ± 74.5 (n = 65)). Improvement in uroflowmetry measures was consistent across all prostate volumes. BPH-II improved from 7.0 ± 2.9 (n = 98) to 2.3 ± 2.5 at 1 year (n = 89) and remained consistent at 2.3 ± 2.9 at the 2-years (n = 74), representing a 53.9% improvement. IPSS QoL also improved from 4.6 ± 1.3 (n = 100) at baseline to 2.2 ± 1.5 (n = 74). The most common adverse events reported in the Optilume BPH arm were hematuria and urinary tract infection (UTI). No device and/or treatment related serious adverse events were reported occurring beyond 12 months post-procedure. There was no impact to sexual function. CONCLUSIONS In the PINNACLE study, participants treated with the Optilume BPH Catheter System demonstrated continued and durable results at 2 years, affirming tolerability, safety, and the enduring effectiveness. The Optilume BPH Catheter System provides lasting results that are comparable to the more invasive therapies, while preserving the advantages with being a minimally invasive therapy. REGISTRATION ClinicalTrials.gov NCT04131907.
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Affiliation(s)
- Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
| | - Jared L Moss
- Department of Urology, Ochsner-LSU Health Shreveport, Shreveport, LA, USA
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Ini’ C, Vasile T, Foti PV, Timpanaro C, Castiglione DG, Libra F, Falsaperla D, Tiralongo F, Giurazza F, Mosconi C, David E, Palmucci S, Lavalle S, Venturini M, Basile A. Prostate Artery Embolization as Minimally Invasive Treatment for Benign Prostatic Hyperplasia: An Updated Systematic Review. J Clin Med 2024; 13:2530. [PMID: 38731058 PMCID: PMC11085005 DOI: 10.3390/jcm13092530] [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: 03/10/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Benign prostatic hyperplasia (BPH) has a significant impact on the quality of life of symptomatic patients. In patients manifesting lower urinary tract symptoms (LUTS), prostatic arterial embolization (PAE) has become a topic of interest in recent years. The purpose of this systematic review is to analyze and review techniques and clinical outcomes of patients who underwent endovascular treatment of BPH, with a special focus on the comparison of surgical and endovascular procedures. Methods: Through the major scientific databases, 1225 articles were selected from the initial research utilizing specific keywords and medical subject headings. Based on the inclusion and exclusion criteria established for selecting relevant studies for our purposes, the systematic analysis of the literature was conducted on a total of seven articles. Results: We collected data on 718 male patients (408 patients underwent PAE and 310 received TURP). The technical success rate varied from 86% to 100% for TAE and was 100% for TURP. During a 12-month follow-up period, both PAE and TURP were comparable on the reduction in IPSS and QoL questionnaire, while TURP showed significant improvements in Qmax and in the reduction in prostate volume. Length and cost of hospitalization were lower for PAE. Complication and adverse events rates were higher in the TURP group rather than in the PAE group (60.6% vs. 35.5%). Conclusions: Prostatic artery embolization represents an emerging minimally invasive procedure for BPH. According to previously released clinical studies, quality-of-life and urological symptom scores of the PAE group were comparable to those of the TURP group. Our research strengthens the evidence supporting the effectiveness and safety of PAE as a therapy for LUTS related to BPH.
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Affiliation(s)
- Corrado Ini’
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Tiziana Vasile
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
- NANOMED-Research Centre for Nanomedicine and Pharmaceutical Nanotechnology, University of Catania, 95125 Catania, Italy
- Centro di Ricerca Multidisciplinare “Chirurgia delle Sindromi Malformative Complesse della Transizione e dell’Età Adulta” (ChiSMaCoTA), Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy
| | - Concetta Timpanaro
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Davide Giuseppe Castiglione
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Federica Libra
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Daniele Falsaperla
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Francesco Tiralongo
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy;
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy;
| | - Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Salvatore Lavalle
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Enna “Kore” Cittadella Universitaria, 94100 Enna, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
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Omar M, Abdullah MM, Moustafa A, Sultan S. Thirty versus 60-Watt thulium laser enucleation of prostate: Toward the development of low-power anatomical enucleation of the prostate. Urol Ann 2024; 16:129-132. [PMID: 38818432 PMCID: PMC11135353 DOI: 10.4103/ua.ua_159_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/20/2023] [Indexed: 06/01/2024] Open
Abstract
Introduction We aimed to study whether using 30 W versus 60 W thulium enucleation of the prostate (ThuLEP) would affect postoperative outcomes in patients with benign prostatic hyperplasia (BPH). Materials and Methods We prospectively identified male patients with moderate or severe lower urinary tract symptoms due to BPH. We randomized patients into 30 W (Group 1) or 60 W (Group 2) thulium yag laser with a 550 μm laser fiber and a 26 Fr continuous flow resectoscope. We collected data related to prostate size, enucleation time, morcellation time, laser time, perioperative complications, and 1-year functional outcomes. Results A total of 120 patients were included, with a mean age of 67 years and a mean prostate size of 105 g. The preoperative characteristics were similar across both groups. The mean operative time was shorter in the 60 W group, 74 ± 27 vs. 91 ± 33 min in the 30 W group (P = 0.001), and the mean laser time was 55 ± 20 in 60 W versus 71 ± 25 in 30 W (P = 0.0001). The mean hospital stay was 1 day in both groups and at 1-year follow-up; there was a similar improvement in mean Qmax and International Prostate Symptom Score symptom scores. Discussion/Conclusion Both 30 and 60 W ThuLEP provided a safe and comparable outcome with a relatively shorter operative time for the 60 W groups. Perhaps using a 30-W setting would be beneficial in the early learning curve or cases with more bleeding capsular perforators; besides, the financial benefit of manufacturing low-cost low-power devices that may help in the widespread of AEEP.
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Affiliation(s)
- Mohamed Omar
- Department of Urology, Menoufia University, Shebeen El Kom, Menoufia, Egypt
| | | | - Ahmed Moustafa
- Department of Urology, Menoufia University, Shebeen El Kom, Menoufia, Egypt
| | - Sultan Sultan
- Department of Urology, Menoufia University, Shebeen El Kom, Menoufia, Egypt
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Bhatia A, Porto JG, Maini A, Langade D, Herrmann TRW, Shah HN, Bhatia S. One-year outcomes after prostate artery embolization versus laser enucleation: A network meta-analysis. BJUI COMPASS 2024; 5:189-206. [PMID: 38371212 PMCID: PMC10869668 DOI: 10.1002/bco2.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 02/20/2024] Open
Abstract
Background Although holmium laser enucleation (HoLEP) is considered a size-independent procedure for treatment of an enlarged prostate, prostate artery embolization (PAE) is emerging as an alternative modality to treat moderate and large benign prostatic hyperplasia. This study aims to compare the early post-operative and short-term efficacy of PAE and HoLEP. Methods PubMed, Cochrane Library and EMBASE databases were searched. Network meta-analysis was performed following PRISMA-N-guidelines. Post-operative parameters analysed include international prostate symptom score (IPSS), quality of life (QOL), post-void residual urine (PVR), maximal uroflow rate (Qmax) and serious adverse events (SAE). Random effects model calculated weighted mean differences (WMD). If 95%CI crossed the line of no effect (WMD = 0), evidence indicated no statistically significant difference between treatments compared. Results Qualitative and quantitative syntheses included 20 and 18 studies with 1991 and 1606 patients, respectively. At 3 months, there was no statistically significant difference between PAE and HoLEP in IPSS score improvement [WMD: -2.21: 95%CI: (-10.20, 5.78), favouring PAE], QoL score improvement [WMD: -0.22:95%CI: (-1.75, 1.32), favouring PAE] and PVR improvement [WMD: 26.97: 95%CI: (-59.53, 113.48), favouring HoLEP]. However, PAE was found inferior to HoLEP for Qmax improvement [WMD: 8.47, 95%CI: (2.89, 14.05), favouring HoLEP]. At 1-year follow-up, there was no statistically significant was found between PAE and HoLEP for IPSS score improvement [WMD:6.03, 95%CI: (-1.30, 13.35)], QoL score improvement [WMD: 0.03, 95%CI: (-1.19, 1.25)], PVR improvement [WMD:4.11, 95%CI: (-32.31, 40.53)] and Qmax improvement [WMD:2.60, 95%CI: (-2.20, 7.41)] with all differences favouring HoLEP. PAE was superior to HoLEP for SAE [PAE vs. HoLEP-OR: 0.68, 95%CI: (0.25, 1.37)]. Conclusion HoLEP was superior to PAE at 3 months for Qmax improvement. There was no significant difference in IPSS, QoL, PVR and Qmax improvement at 1 year between PAE and HoLEP. PAE was also associated with lesser SAE compared to HoLEP. Studies on the long-term outcome of PAE are needed to establish the durability of early outcomes after PAE.
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Affiliation(s)
- Ansh Bhatia
- Department of Interventional Radiology, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
- Seth GS Medical College and KEM HospitalMumbaiIndia
| | | | - Aneesha Maini
- School of MedicineGeorgetown UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Thomas R. W. Herrmann
- Department of UrologySwitzerland Urology Spital Thurgau AG (STGAG)FrauenfeldSwitzerland
| | - Hemendra Navinchandra Shah
- Department of Urology, Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Shivank Bhatia
- Department of Interventional Radiology, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
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Franco A, Ditonno F, Manfredi C, Pellegrino AA, Licari LC, Bologna E, Feng C, Antonelli A, De Sio M, De Nunzio C, Porpiglia F, Cherullo EE, Kaouk J, Crivellaro S, Autorino R. Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00787-2. [PMID: 38263281 DOI: 10.1038/s41391-024-00787-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Aim of our study was to review the current evidence on single port robot-assisted radical prostatectomy (SP-RARP) and SP robot-assisted simple prostatectomy (SP-RASP) procedures. METHODS A comprehensive bibliographic search on multiple databases was conducted in July 2023. Studies were included if they assessed patients with non-metastatic prostate cancer or candidate for benign prostatic hyperplasia surgery (P) who underwent SP-RARP or SP-RASP, respectively, (I), compared or not with other surgical techniques (C), evaluating perioperative, oncological, or functional outcomes (O). Prospective and retrospective original articles were included (S). A meta-analysis of comparative studies between SP-RARP and MP-RARP was performed. RESULTS A total of 21 studies investigating 1400 patients were included in our systematic review, 18 were related to SP-RARP while 3 to SP-RASP. Only 8 comparative studies were eligible for meta-analysis. Mean follow-up was 8.1 (±5.8) months. Similar outcomes were observed for SP-RARP and MP-RARP in terms of operative time, catheterization time, pain score, complications rate, continence and potency rates, positive surgical margin, and biochemical recurrence. Length of hospital stay was shorter in the SP group after sensitivity analysis (WMD -0.58, 95% IC -1.17 to -0.9, p < 0.05). Subgroup analysis by extraperitoneal approach did not show any statistical difference, except for a lower positive margins rate in the SP extraperitoneal technique compared to MP-RARP. Overall, SP-RASP exhibited shorter hospital stay and lower rate of de novo urinary incontinence when compared to other techniques, while no differences were reported in terms of postoperative International Prostate Symptom Score, post void residual and maximum flow. CONCLUSIONS Overall comparable oncological, functional, and perioperative outcomes can be achieved with SP platform. Subgroup analysis by different approaches did not reveal significant variations in outcomes. However, the retrospective nature of the studies, the limited follow-up, and the relatively small sample size of selected Centers may impact these results.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | | | - Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Carol Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | | | - Marco De Sio
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Jihad Kaouk
- Department of Urology, Glickman Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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Kaltsas A, Kratiras Z, Zachariou A, Dimitriadis F, Sofikitis N, Chrisofos M. Evaluating the Impact of Benign Prostatic Hyperplasia Surgical Treatments on Sexual Health. Biomedicines 2024; 12:110. [PMID: 38255215 PMCID: PMC10813562 DOI: 10.3390/biomedicines12010110] [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: 12/15/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Benign prostatic hyperplasia (BPH), a prevalent condition in older men, is often managed through various surgical interventions. This narrative review aims to explore the impact of these surgical treatments on sexual function, a critical aspect of patient quality of life often overlooked in BPH management. The methodology encompassed a thorough review of contemporary surgical techniques for BPH, including prostate resection, enucleation, vaporization, and minimally invasive therapies such as UroLift, Rezum, and Aquablation. Additionally, the focus was on patient-centered outcomes, with a special emphasis on sexual health following surgery. Findings reveal that, while surgical interventions effectively alleviate BPH symptoms, they often have significant repercussions in sexual function, including erectile and ejaculatory dysfunction. However, emerging techniques demonstrate potential in preserving sexual function, underscoring the need for patient-centric treatment approaches. The study highlights the complex interplay between BPH surgery and sexual health, with minimally invasive treatments showing promise in balancing symptom relief and sexual function preservation. In conclusion, the study advocates for an integrated, interdisciplinary approach to BPH treatment, emphasizing the importance of considering sexual health in therapeutic decision-making. This narrative review suggests a paradigm shift towards minimally invasive techniques could optimize patient outcomes, marrying symptom relief with quality-of-life considerations. The need for further research in this domain is evident, particularly in understanding long-term sexual health outcomes following different surgical interventions for BPH.
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Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
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Anezaki H, Endo F, Swan G, Takashima K, Rojanasarot S. Cost-effectiveness analysis of minimally invasive surgical treatments for benign prostatic hyperplasia: implications for Japan's public healthcare system. J Med Econ 2024; 27:554-565. [PMID: 38466193 DOI: 10.1080/13696998.2024.2327920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/29/2024] [Indexed: 03/12/2024]
Abstract
AIMS Benign prostatic hyperplasia (BPH) represents a significant public health issue in Japan. This study evaluated the lifetime cost-effectiveness of water vapor energy therapy (WAVE) versus prostatic urethral lift (PUL) for men with moderate-to-severe BPH from a public healthcare payer's perspective in Japan. MATERIALS AND METHODS A decision analytic model compared WAVE to PUL among males in Japan. Clinical effectiveness and adverse event (AE) inputs were obtained from a systematic literature review. Resource utilization and cost inputs were derived from the Medical Data Vision database and medical service fee national data in Japan. Experts reviewed and validated model input parameters. One-way and probabilistic sensitivity analyses were conducted to determine how changes in the values of uncertain parameters affect the model results. RESULTS Throughout patients' lifetimes, WAVE was associated with higher quality-adjusted life years (0.920 vs. 0.911 year 1; 15.564 vs. 15.388 lifetime) and lower total costs (¥734,134 vs. ¥888,110 year 1; ¥961,595 vs. ¥1,429,458 lifetime) compared to PUL, indicating that WAVE is a more effective and less costly (i.e. dominant) treatment strategy across all time horizons. Lifetime cost-savings for the Japanese healthcare system per patient treated with WAVE instead of PUL were ¥467,863. The 32.7% cost difference between WAVE and PUL was predominantly driven by lower WAVE surgical retreatment rates (4.9% vs. 19.2% for WAVE vs PUL, respectively, at 5 years) and AE rates (hematuria 11.8% vs. 25.7%, dysuria 16.9% vs. 34.3%, pelvic pain 2.9% vs. 17.9%, and urinary incontinence 0.4% vs. 1.3% for WAVE vs PUL, respectively, at 3 months). Model findings were robust to changes in parameter input values. LIMITATIONS The model represents a simplification of complex factors involved in resource allocation decision-making. CONCLUSIONS Driven by lower retreatment and AE rates, WAVE was a cost-effective and cost-saving treatment for moderate-to-severe BPH in Japan compared to PUL, providing better outcomes at lower costs to the healthcare system.
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Affiliation(s)
- Hisataka Anezaki
- Field of Artificial Intelligence and Digital Health Science, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | - Georgia Swan
- Boston Scientific, Asia Pacific, Singapore, Singapore
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11
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Busetto GM, Checchia A, Recchia M, Tocci E, Falagario UG, Annunziata G, Annese P, d’Altilia N, Mancini V, Ferro M, Crocetto F, Tataru OS, Gianfrancesco LD, Porreca A, Giudice FD, Berardinis ED, Bettocchi C, Cormio L, Carrieri G. Minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS): promise or panacea? Asian J Androl 2023; 26:00129336-990000000-00138. [PMID: 37921510 PMCID: PMC10919430 DOI: 10.4103/aja202357] [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: 06/29/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
ABSTRACT The increasing importance of treatment of lower urinary tract symptoms (LUTS), while avoiding side effects and maintaining sexual function, has allowed for the development of minimally invasive surgical therapies (MISTs). Recently, the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia (BPH) to the management of nonneurogenic male LUTS. The aim of the present review was to evaluate the efficacy and safety of the most commonly used MISTs: ablative techniques such as aquablation, prostatic artery embolization, water vapor energy, and transperineal prostate laser ablation, and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device (iTIND). MISTs are becoming a new promise, even if clinical trials with longer follow-up are still lacking. Most of them are still under investigation and, to date, only a few options have been given as a recommendation for use. They cannot be considered as standard of care and are not suitable for all patients. Advantages and disadvantages should be underlined, without forgetting our objective: treatment of LUTS and re-treatment avoidance.
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Affiliation(s)
- Gian Maria Busetto
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Andrea Checchia
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Marco Recchia
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Edoardo Tocci
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | | | | | - Pasquale Annese
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Nicola d’Altilia
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Matteo Ferro
- Urology Unit, European Institute of Oncology (IEO) IRCCS, Milan 20141, Italy
| | | | - Octavian Sabin Tataru
- G. E. Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures 540142, Romania
| | - Luca Di Gianfrancesco
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35128, Italy
| | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35128, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Roma 00161, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Roma 00161, Italy
| | - Carlo Bettocchi
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Luigi Cormio
- University of Foggia, Foggia 71122, Italy
- Urology Unit, “L. Bonomo” Hospital, Andria 76123, Italy
| | - Giuseppe Carrieri
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
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12
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Weinstein IC, Wu X, Arenas-Gallo C, Zhu A, Brant A, Al Awamlh BAH, Gaffney C, Lee R, Zell M, Jaeger I, Ponsky L, Shoag J. Adoption and Outcomes of Holmium Laser Enucleation of the Prostate in the United States. Urology 2023; 179:106-111. [PMID: 37328009 DOI: 10.1016/j.urology.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate the utilization of holmium laser enucleation of the prostate (HoLEP) using a large real-world cohort. We compare the safety, readmission, and retreatment rates of HoLEP to other widely used endoscopic surgical interventions for benign prostatic hyperplasia (BPH) including transurethral resection of the prostate (TURP), photoselective vaporization of the prostate, and prostatic urethral lift. METHODS Men who underwent endoscopic treatments for BPH from 2000 to 2019 were identified in the Premier Healthcare Database (n = 218,793). We compared the relative proportion of each procedure performed and annual physician volume data to identify trends in adoption and utilization. Readmission and retreatment rates were determined at both 30- and 90-days postoperation. Multivariable logistic regression was used to assess the association between procedure type and outcomes. RESULTS HoLEP accounted for 3.2% (n = 6967) of all the BPH procedures performed between 2000 and 2019 and increased from 1.1% of the procedures in 2008 to 4% in 2019. Patients undergoing HoLEP had lower odds of 90-days readmission compared to TURP (Odds ratio (OR) 0.87, p = 0.025). HoLEP had similar odds of retreatment compared to TURP at both 1-year (OR 0.96, p = 0.7) and 2-years (OR 0.98, p = 0.9), while patients undergoing photoselective vaporization of the prostate and prostatic urethral lift were more likely to retreat within 2-years (OR 1.20, P < 0.001; OR 1.87, P < 0.001). CONCLUSION HoLEP is a safe therapy for BPH with lower readmission and comparable retreatment rates to the gold standard TURP. Despite this, the utilization of HoLEP has lagged behind other endoscopic procedures and remains low.
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Affiliation(s)
- Ilon C Weinstein
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Xian Wu
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Camilo Arenas-Gallo
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Alec Zhu
- Department of Urology, New York, Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Aaron Brant
- Department of Urology, New York, Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | | | | | - Richard Lee
- Department of Urology, New York, Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Michael Zell
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Irina Jaeger
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lee Ponsky
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jonathan Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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Iqbal J, Mashkoor Y, Nadeem A, Tah S, Sharifa M, Ghani S, Thugu TR, Patel H, Bonner-Reid FT, Shrestha J, Hassen BA. Shifting Trends in Prostate Treatment: A Systematic Review Comparing Transurethral Resection of the Prostate and Holmium Laser Enucleation of the Prostate. Cureus 2023; 15:e46173. [PMID: 37905244 PMCID: PMC10613322 DOI: 10.7759/cureus.46173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Our systematic review aimed to assess the effectiveness and suitability of holmium laser enucleation of the prostate (HoLEP) as a treatment for benign prostatic hyperplasia (BPH) in comparison to transurethral resection of the prostate (TURP). We analyzed 12 studies involving male participants aged 45-85 years, all of whom had BPH. In our analysis, we compared HoLEP and TURP, with a focus on several primary outcomes, including postoperative International Prostate Symptom Score (IPSS), postvoid residual (PVR) volume, maximum flow rate (Qmax), and changes in sexual function post-treatment. HoLEP demonstrated advantages in certain aspects when compared to TURP. HoLEP generally resulted in an improved postoperative IPSS in some studies, but not all studies showed a significant difference when compared to TURP. HoLEP was associated with improved Qmax in most studies, but one study found no significant difference between HoLEP and TURP. Patients who underwent HoLEP showed improvement in the PVR volume in some studies, while others found no significant change in the PVR volume with either HoLEP or TURP. Some studies reported a reduction in orgasm and ejaculatory scores following TURP, while no significant changes were observed in erectile function, intercourse satisfaction, and overall satisfaction scores. It is worth noting that previous reviews and meta-analyses had limited data on the effects of HoLEP and TURP on sexual dysfunction. TURP is associated with a higher risk of morbidity and mortality, which has led to its replacement with HoLEP as the gold standard for treating BPH, particularly due to its size-independent applicability. HoLEP also demonstrated greater efficacy in the postoperative period.
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Affiliation(s)
- Javed Iqbal
- Department of Neurosurgery, Mayo Hospital, Lahore, PAK
| | - Yusra Mashkoor
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Abdullah Nadeem
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sunanda Tah
- Department of Internal Medicine, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Saroosh Ghani
- Department of Medicine and Allied Sciences, Isra University, Hyderabad, PAK
| | - Thanmai Reddy Thugu
- Department of Internal Medicine, Sri Padmavathi Medical College for Women, Tirupati, IND
| | - Harshkumar Patel
- Department of Internal Medicine, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Felicia T Bonner-Reid
- Department of Internal Medicine, Universidad de Ciencias Médicas de Granma, Manzanillo, CUB
| | - Jeena Shrestha
- Department of Internal Medicine, Jalalabad Ragib-Rabeya Medical College, Sylhet, BGD
| | - Buure A Hassen
- Department of Internal Medicine, Hayat Medical College, Addis Ababa, ETH
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14
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Nazarko L. A guide to diagnosing and treating benign prostatic hypertrophy. Br J Community Nurs 2023; 28:344-350. [PMID: 37369440 DOI: 10.12968/bjcn.2023.28.7.344] [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: 06/29/2023]
Abstract
Benign prostatic hypertrophy (BPH) is a condition where the prostate becomes enlarged. It affects all men and is part of the ageing process. Globally, the incidence rates of BPH have risen by 70% between 2000-2019. When left untreated, it can lead to acute urinary retention, impaired bladder emptying, urinary tract infections, bladder stones, kidney failure or gross haematuria. In this article, Linda Nazarko describes the causes and consequences of BPH along with treatment options that are available for it.
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15
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Capdevila F, Insausti I, San Miguel R, Sanchez-Iriso E, Montesino M. Cost-Utility Analysis of Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03443-9. [PMID: 37142802 DOI: 10.1007/s00270-023-03443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/05/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To perform a post hoc cost-utility analysis of a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS We conducted a cost-utility analysis over a 5-year period to compare PAE versus TURP from a Spanish National Health System perspective. Data were collected from a randomized clinical trial performed at a single institution. Effectiveness was measured as quality-adjusted life years (QALYs), and an incremental cost-effectiveness ratio (ICER) was derived from the cost and QALY values associated with these treatments. Further sensitivity analysis was performed to account for the impact of reintervention on the cost-effectiveness of both procedures. RESULTS At the 1-year follow-up, PAE resulted in mean cost per patient of €2904.68 and outcome of 0.975 QALYs per treatment. In comparison, TURP had cost €3846.72 per patient and its outcome was 0.953 QALYs per treatment. At 5 years, the cost for PAE and TURP were €4117.13 and €4297.58, and the mean QALY outcome was 4.572 and 4.487, respectively. Analysis revealed an ICER of €2121.15 saved per QALY gained when comparing PAE to TURP at long-term follow-up. Reintervention rate for PAE and TURP was 12% and 0%, respectively. CONCLUSIONS Compared to TURP, in short term, PAE could be considered a cost-effective strategy within the Spanish healthcare system for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, in long term, the superiority is less apparent due to higher reintervention rates.
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Affiliation(s)
- Ferran Capdevila
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain.
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain.
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain.
| | - Iñigo Insausti
- Department of Radiology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Ramon San Miguel
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Eduardo Sanchez-Iriso
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Manuel Montesino
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Department of Urology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
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16
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Soyster ME, Agarwal D, Slade A, Sahm E, Large T, Rivera M. Impact of American Society of Anesthesiologists score on postoperative holmium enucleation of the prostate outcomes and complications. Prostate 2023; 83:316-322. [PMID: 36415930 DOI: 10.1002/pros.24463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTIONS The American Society of Anesthesiologists Physical Status Classification System (ASA) is a validated risk stratification method for patients undergoing surgery. There is an increased prevalence of benign prostatic hyperplasia and comorbidities in our aging population. The role of ASA related to postoperative complications in patients undergoing holmium laser enucleation of the prostate (HoLEP) has not been described. METHODS A review of our database was performed for patients who underwent HoLEP from July 2018 to December 2020. Patients were stratified based on ASA score. Preoperative, perioperative, and complication data were analyzed using SAS analytics software. RESULTS Of 472 patients undergoing HoLEP, 320 (67.8%) were ASA 3-4 patients. There was a statistically significant difference found in age (72.3 ± 9.8 vs. 69.1 ± 9.0 years, p < 0.001), body mass index (BMI) (29.0 ± 5.9 vs. 27.3 ± 4.2, p = 0.004), and use of antiplatelet/anticoagulant medications (14.6% vs. 2.6%, p < 0.001) in the ASA 3-4 group. There was no significant difference between prostate volume (p = 0.158) or catheter-dependent urinary retention (p = 0.376). No difference was found in enucleation time (52.76 ± 24.8 vs. 54.16 ± 23.7 min, p = 0.587), OR specimen weight (70.24 ± 58.5 vs. 81.53 ± 65.9, p = 0.094). or intraoperative complications (2.8% vs. 1.3%, p = 0.330). There were higher postoperative complications in the ASA 3-4 group (12.8% vs. 7.9%, p = 0.03), but no difference in Clavien ≥3 complications (p = 0.068). ASA 3-4 patients had similar postoperative international prostate symptom score (p = 0.159). CONCLUSION HoLEP is feasible and effective in patients who are ASA 3-4. The high-risk cohort had an increased rate of low-grade complications. Patients with an ASA score of 3-4 should be counseled regarding a higher rate of low-grade complications.
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Affiliation(s)
- Mary E Soyster
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Deepak Agarwal
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Austen Slade
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Erica Sahm
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
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17
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Khalil IA, Aldeeb M, Mohammed A, Awad K, Ibrahim T, Al-Zoubi RM, Aboumarzouk OM, Al-Rumaihi K. The role of Rezum in the management of refractory urinary retention due to benign prostate hyperplasia: A literature review. Arab J Urol 2023; 21:185-189. [PMID: 37521455 PMCID: PMC10373601 DOI: 10.1080/2090598x.2023.2178104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/04/2023] [Indexed: 02/26/2023] Open
Abstract
Background Benign prostatic hyperplasia is the most common cause of urinary retention in men (BPH). The gold standard surgical treatment is transurethral resection of the prostate (TURP). However, due to the morbidity and mortality associated with TURP, more minimally invasive treatments, such as vaporizing the prostate with the Rezum system, have been introduced. We investigated the efficacy of Rezum in the treatment of refractory urinary retention due to BPH in this review. Methodology and materials To conduct this review, the Cochrane methodology for systematic reviews was used. All studies that used Rezum to treat catheter-dependent patients with enlarged prostates were included. The literature search showed 111 studies, 84 of which were excluded due to non-relevance based on titles and 18 due to lack of relevance based on abstract review. Full manuscripts were reviewed in nine studies, three of which were excluded because they did not meet the inclusion criteria. Results This review included 301 patients in total. The rate of a successful trial of voiding post Rezum therapy was 85%. The complication rated between 3.8 and 4.3% all of which were mild and self-limited. As there was no major complication of Rezum (clavien dindo >2), the procedure-related morbidity is negligible. Conclusion In this review, Rezum was found to be an efficacious and safe alternative in the treatment of refractory retention with mild complications and minimal morbidity.
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Affiliation(s)
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mohammed
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Awad
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Tarek Ibrahim
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Raed M. Al-Zoubi
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar M Aboumarzouk
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Veterinary and Life Science, The University of Medicine, University of Glasgow, Scotland, UK
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18
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Khosla L, Lee P, Farooq M, Rychik K, Daniel R, Vizgan G, Prishtina L, Bushman W, Weiss JP, Blaivas JG. The role of the bladder diary in phenotyping men with LUTS. Neurourol Urodyn 2023; 42:718-724. [PMID: 36825401 DOI: 10.1002/nau.25164] [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: 06/26/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
AIMS The aim of this study was to compare the clinical characteristics of men with lower urinary tract symptoms (LUTS) grouped by 24-h urine output determined from a bladder voiding diary. METHODS An online database was queried to identify men who completed a 24-hour bladder diary (24HBD), and the Lower Urinary Tract Symptom Score (LUTSS) questionnaire from 2015 to 2019 using a mobile app. Data from the bladder diary and questionnaire were contemporaneously matched within a 2-week period. Additional data, including maximum uroflow (Qmax ) and postvoid residual urine (PVR), were obtained from the electronic medical record (EMR). The cohort was divided into three groups: normal, oliguria, and polyuria based on their 24-hour voided volume (24HVV). The LUTSS, 24HVV, maximum voided volume (MVV), maximum flow rate (Qmax ), and PVR were compared between those with oliguria and polyuria. RESULTS A total of 327 men (mean age 62, SD: 19) completed the LUTSS questionnaire and contemporaneous 24HBD. Of these, 61% had a normal 24HVV, 13% had oliguria, and 26% had polyuria. A total of 147 patients from the study cohort had contemporaneous Qmax and PVR abstracted from the EMR. There was no difference in symptom severity, bother, or PVR among the three patient groups. However, several objective metrics were significantly correlated with urine output. Men with oliguria, as compared to men with polyuria were older (65 vs. 55 years) and had lower MVV (260 vs. 470 mL), fewer voids/24 h (8 vs. 13), and lower Qmax (8.5 vs. 18.3 mL/s). CONCLUSIONS These observations suggest that men with oliguria or polyuria and LUTS constitute easily distinguished phenotypes that might require different diagnostic and therapeutic algorithms. Those with oliguria were older, and had lower MVVs and much lower uroflows, suggesting that they are more likely to have underlying disorders such as bladder outlet obstruction and detrusor underactivity or may be patients with overactive bladder who reduced fluid intake to improve symptoms.
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Affiliation(s)
- Lakshay Khosla
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Philip Lee
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Muhammad Farooq
- Institute for Bladder and Prostate Research, New York City, New York, USA
| | - Kevin Rychik
- Institute for Bladder and Prostate Research, New York City, New York, USA.,Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Roby Daniel
- Institute for Bladder and Prostate Research, New York City, New York, USA
| | - Gabriel Vizgan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Institute for Bladder and Prostate Research, New York City, New York, USA
| | - Learta Prishtina
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Institute for Bladder and Prostate Research, New York City, New York, USA
| | - Wade Bushman
- Department of Urology, University of Wisconsin, Madison, Wisconsin, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jerry G Blaivas
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Institute for Bladder and Prostate Research, New York City, New York, USA.,Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Pathak RA, Krol BC, Crain NA, Hemal AK. Robot-Assisted Simple Prostatectomy: A Comparison of Primary Simple Prostatectomy Versus Salvage Simple Prostatectomy in Treatment of Lower Urinary Tract Symptoms. J Endourol 2023; 37:414-421. [PMID: 36680760 DOI: 10.1089/end.2022.0588] [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: 01/22/2023] Open
Abstract
Purpose: Simple prostatectomy is indicated in patients with enlarged glands (>80 g) who present with lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia. Salvage robotic simple prostatectomy (SSP) is defined as simple prostatectomy after failed transurethral procedure. The aim of this study is to evaluate the efficacy of primary robotic simple prostatectomy (PSP) vs SSP in ameliorating LUTS. Materials and Methods: We retrospectively reviewed 124 patients who underwent RSP between 2013 and 2021. Indications for surgery were enlarged prostate, bothersome LUTS, or symptoms refractory to medical management and/or previous prostate surgery. PSP and SSP preoperative, perioperative, and postoperative variables were recorded. The severity of LUTS was assessed using the International Prostate Symptoms Score (IPSS). Two-tailed t-tests were performed to compare primary vs salvage RSP cohorts at a p-value of 0.05. Results: Of 124 patients who underwent RSP, 98 were primary and 26 were in the salvage setting with 19 patients undergoing prior transurethral resection of the prostate, 3 status post-transurethral microwave therapy, 1 status post-transurethral needle ablation of the prostate, and 3 status post-UroLIFT. Mean length of stay following RSP was 1.87 (days). At mean follow-up of ∼12 months, no patient required reoperation for LUTS. Preoperative IPSS for primary and salvage RSP was 18.56 and 16.25, respectively (p = 0.36), and postoperative IPSS for primary and salvage RSP was 5.33 and 8.00, respectively (p = 0.38). Conclusion: Regardless of primary or salvage indication, RSP remains a highly efficient and durable procedure for improvement in LUTS. RSP performed in the salvage setting greatly improved urinary function outcomes in patients after failure of previous transurethral procedures.
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Affiliation(s)
- Ram A Pathak
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Bridget C Krol
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nikhil A Crain
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ashok K Hemal
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
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Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database. World J Urol 2023; 41:529-536. [PMID: 36534154 DOI: 10.1007/s00345-022-04260-4] [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: 07/17/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80 cc) vs. small prostates (< 80 cc). METHODS Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe. RESULTS 3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12 months (p = 0.005). There were no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28). CONCLUSIONS Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80 cc, with durable outcomes relatively independent from prostate size.
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21
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The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. THE LANCET. HEALTHY LONGEVITY 2022; 3:e754-e776. [PMID: 36273485 PMCID: PMC9640930 DOI: 10.1016/s2666-7568(22)00213-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia is a common urological disease affecting older men worldwide, but comprehensive data about the global, regional, and national burden of benign prostatic hyperplasia and its trends over time are scarce. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated global trends in, and prevalence of, benign prostatic hyperplasia and disability-adjusted life-years (DALYs) due to benign prostatic hyperplasia, in 21 regions and 204 countries and territories from 2000 to 2019. METHODS This study was conducted with GBD 2019 analytical and modelling strategies. Primary prevalence data came from claims from three countries and from hospital inpatient encounters from 45 locations. A Bayesian meta-regression modelling tool, DisMod-MR version 2.1, was used to estimate the age-specific, location-specific, and year-specific prevalence of benign prostatic hyperplasia. Age-standardised prevalence was calculated by the direct method using the GBD reference population. Years lived with disability (YLDs) due to benign prostatic hyperplasia were estimated by multiplying the disability weight by the symptomatic proportion of the prevalence of benign prostatic hyperplasia. Because we did not estimate years of life lost associated with benign prostatic hyperplasia, disability-adjusted life-years (DALYs) equalled YLDs. The final estimates were compared across Socio-demographic Index (SDI) quintiles. The 95% uncertainty intervals (UIs) were estimated as the 25th and 975th of 1000 ordered draws from a bootstrap distribution. FINDINGS Globally, there were 94·0 million (95% UI 73·2 to 118) prevalent cases of benign prostatic hyperplasia in 2019, compared with 51·1 million (43·1 to 69·3) cases in 2000. The age-standardised prevalence of benign prostatic hyperplasia was 2480 (1940 to 3090) per 100 000 people. Although the global number of prevalent cases increased by 70·5% (68·6 to 72·7) between 2000 and 2019, the global age-standardised prevalence remained stable (-0·770% [-1·56 to 0·0912]). The age-standardised prevalence in 2019 ranged from 6480 (5130 to 8080) per 100 000 in eastern Europe to 987 (732 to 1320) per 100 000 in north Africa and the Middle East. All five SDI quintiles observed an increase in the absolute DALY burden between 2000 and 2019. The most rapid increases in the absolute DALY burden were seen in the middle SDI quintile (94·7% [91·8 to 97·6]), the low-middle SDI quintile (77·3% [74·1 to 81·2]), and the low SDI quintile (77·7% [72·9 to 83·2]). Between 2000 and 2019, age-standardised DALY rates changed less, but the three lower SDI quintiles (low, low-middle, and middle) saw small increases, and the two higher SDI quintiles (high and high-middle SDI) saw small decreases. INTERPRETATION The absolute burden of benign prostatic hyperplasia is rising at an alarming rate in most of the world, particularly in low-income and middle-income countries that are currently undergoing rapid demographic and epidemiological changes. As more people are living longer worldwide, the absolute burden of benign prostatic hyperplasia is expected to continue to rise in the coming years, highlighting the importance of monitoring and planning for future health system strain. FUNDING Bill & Melinda Gates Foundation. TRANSLATION For the Amharic translation of the abstract see Supplementary Materials section.
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22
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Laparoscopic simple prostatectomy versus robot-assisted simple prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of comparative trials. J Robot Surg 2022; 17:351-364. [PMID: 36272059 DOI: 10.1007/s11701-022-01460-3] [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: 08/16/2022] [Accepted: 10/02/2022] [Indexed: 10/24/2022]
Abstract
Laparoscopic simple prostatectomy (LSP) and robot-assisted simple prostatectomy (RASP) are important approaches for large benign prostatic hyperplasia (BPH), though it is still unclear which is superior. This study aimed to perform a pooled analysis to compare the safety and efficacy profiles of LSP and RASP. We systematically searched the databases of Science, PubMed, Embase, Web of Science, and Cochrane Library database for randomized controlled trials (RCTs) and non-RCTs, comparing LSP to RASP. The principal outcomes included perioperative, functional and complications variables. The results are presented as odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals (CI) of dichotomous and continuous variables. Five comparative trials involving 1928 patients were included. RASP demonstrated a shorter length of hospital stay compared to LSP (WMD 1.20 days, 95% CI 0.09, 2.32; p = 0.03). However, there was no difference between the two groups regarding operative time, estimated blood loss, catheterization time and complications. Moreover, RASP had a higher maximum flow rate (Qmax) (WMD - 2.15 mL/s, 95% CI - 3.75, - 0.55; p = 0.0009) and comparable international prostate symptom score (IPSS) and sexual health inventory (SHIM) in men with LSP. The results of this study demonstrated that RASP offered comparable efficacy and safety to LSP, while maintaining a superior perioperative and functional profile. However, treatment selection should also be based on the availability and experience of the operator.
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23
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Robotic versus open simple prostatectomy for benign prostatic hyperplasia in large glands: single-centre study. World J Urol 2022; 40:3001-3006. [PMID: 36239808 DOI: 10.1007/s00345-022-04176-z] [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: 11/22/2021] [Accepted: 09/28/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Robot-assisted simple prostatectomy (RASP) for benign prostatic hyperplasia (BPH) is a recently described surgical approach, but comparison with open simple prostatectomy (OSP) lack in the literature. We compared perioperative outcomes of OSP versus RASP. METHODS Patients who underwent simple prostatectomy between 2017 and 2020 were included in this retrospective study. OSP was performed by the transvesical technique and RASP was performed with a DaVinci Xi robot, using the transvesical extraperitoneal approach. Perioperative and postoperative data were compared and complications risk factors for complications were identified. RESULTS and limitations. Overall, 103 patients were included (median age 72 years [IQR = 67-76]). Forty-seven underwent RASP and 56 OSP. The median volume of the prostate gland was 130 mL [IQR = 100-180] in the RASP group and 126 mL [IQR = 100-160] in the OSP group. RASP was associated with a significant reduction in blood loss (median 200 vs. 400 mL; p < 0.001), shorter hospital stay (5 vs. 10 days; p < 0.001) and median catheterisation time (4 vs. 9 days; p < 0.001). In the RASP group, there were fewer grade ≥ 2 complications (2 (4.3%) vs. 13 (23.2%); p = 0.005) and less need for transfusions (0 vs. 6 (11%), p = 0.005). Preoperative prostate volume was a risk factor for complications (OR = 1.2 [95% CI 1.1-1.5]; p = 0.01) while robot-assisted surgery was a protective factor (OR 0.3 [95% CI 0.05-0.9]; p = 0.05). Functional outcomes between the two groups were identical at 12 months follow up. CONCLUSION RASP is a safe and effective procedure. When compared with OSP, RASP was associated with decreased morbidity as well as reduced hospital stay and catheterisation time. Functional outcomes were comparable to the open approach.
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Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study. J Clin Med 2022; 11:jcm11195662. [PMID: 36233530 PMCID: PMC9570762 DOI: 10.3390/jcm11195662] [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: 08/30/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The postoperative bleeding complications associated with laser surgery of the prostate and transurethral resection of the prostate (TURP) were compared. Methods: We used the Taiwan National Health Insurance Research Database to conduct an observational population-based cohort study. All eligible patients who received transurethral procedures between January 2015 and September 2018 were enrolled. Patients who received laser surgery or TURP were matched at a ratio of 1:1 by using propensity score matching, and the association of these procedures with bleeding events was evaluated. Results: A total of 3302 patients who underwent elective transurethral procedures were included. The multivariable Cox regression analysis revealed that diode laser enucleation of the prostate (DiLEP) resulted in significantly higher emergency room risks within 90 days after surgery due to clot retention than the Monopolar transurethral resection of the prostate (M-TURP) (Hazard Ratio: 1.52; 95% Confidence Interval [CI], 1.06–2.16, p = 0.022). Moreover, GreenLight photovaporization of the prostate (PVP) (0.61; 95% CI, 0.38–1.00 p = 0.050) and thulium laser vaporesection of the prostate (ThuVARP) (0.67; 95% CI, 0.47–0.95, p = 0.024) resulted in significantly fewer rehospitalization due to clot retention than did M-TURP. No significant increase in blood clots were observed in patients using comedications and those with different demographic characteristics and comorbidities. Conclusions: Among the investigated six transurethral procedures for Benign prostatic hyperplasia, PVP and ThuVARP were safer than M-TURP because bleeding events and clot retention were less likely to occur, even in patients receiving anticoagulant or antiplatelet therapy. However, DiLEP and holmium laser enucleation of the prostate (HoLEP) did not result in fewer bleeding events than M-TURP.
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Garbens A, Kominsky H, Dai J, Steinberg RL, Trivedi H, Kusin S, Roehrborn C, Gahan J. Evaluating Surgical Outcomes of Robot Assisted Simple Prostatectomy in the Retreatment Setting. Urology 2022; 170:111-116. [PMID: 35988733 DOI: 10.1016/j.urology.2022.07.044] [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: 03/08/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To report perioperative and postoperative outcomes in men who undergo salvage RASP (sRASP) following some other endoscopic outlet procedure for benign prostate enlargement (BPE) compared to those undergoing RASP for primary treatment (pRASP). METHODS A prospectively maintained database consisting of all RASP surgeries (December 2014 - October 2019) performed at our institution by three different urologists was used. Patients who had received an endoscopic procedure for BPE prior to their RASP (sRASP) were compared to those who had not had a prior outlet procedure (pRASP). RESULTS In total, 310 men underwent RASP during the study period. Of those, 30 (9.7%) had undergone an endoscopic procedure prior to surgery. There were no significant differences in age, race, ASA, BMI, prostate volume, PSA or rates of preoperative retention (p>0.05 for all). Men who were treatment-naive had significantly higher preoperative International Prostate Symptom Scores (IPSS) than men who had a prior procedure (18.3 ±7.7 vs. 13.6 ±6.2, p=0.008). However, there were no significant differences in functional or quality of life outcomes between the two groups (p>0.05 for all). There were no significant differences in perioperative or post-operative outcomes between the two groups. Furthermore, rates of post-operative complications and incontinence were similar between groups (11% vs. 10%, p=0.9 and 2% vs. 0%, p=1 respectively). CONCLUSION Performing a RASP after prior endoscopic procedure for BPE was found to be safe and effective. Success and complication rates were similar to patients with no prior procedures.
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Affiliation(s)
- Alaina Garbens
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Hal Kominsky
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Jessica Dai
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Ryan L Steinberg
- University of Iowa, Department of Urology, Iowa City, Iowa, USA.
| | - Hersh Trivedi
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Sam Kusin
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Claus Roehrborn
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Jeffrey Gahan
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
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Frandon J, Belaouni A, Pellerin O, Thiounn N, Serrand C, Droupy S, Petitpierre F, Vernhet-Kovacsik H, Murez T, Vidal V, Ghelfi J, Pagnoux G, Codas R, de Forges H, Beregi JP, Sapoval M. Efficacy and safety of prostate artery embolization for patients with lower urinary tract symptoms and indwelling urinary catheter: A retrospective multicenter study. Diagn Interv Imaging 2022; 103:601-606. [PMID: 35963778 DOI: 10.1016/j.diii.2022.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this multicenter study was to evaluate the clinical success at three months of prostate artery embolization (PAE), assess PAE safety in centers with various experiences and identify factors associated with PAE success. PATIENTS AND METHODS This multicenter, retrospective study included patients who underwent PAE for lower urinary tract symptoms (LUTS) including those with indwelling urinary catheter. PAE clinical success was defined as either 25% improvement of the International Prostate Symptom Score (IPSS) or 1-point improvement of quality of life (QoL) score, or catheter removal at three months. Multivariable analyses were performed using a logistic regression adjusted on patient variables, technical parameters and center experience in PAE. RESULTS A total of 383 men (mean age, 68.4 ± 9.7 [standard deviation] years; range: 46-94) with LUTS, including 99 (25.8%) patients with indwelling urinary catheter, were included in seven centers from January 2017 to March 2019. Five patients reported major complications (1.3%), three (0.8%) penile ulceration, three (0.8%) acute urinary retention, one (0.3%) prostatic abscess, and 56 (14.6%) minor complications. Follow up data were available for 271 patients (center 1: n = 159; other centers: n = 112). Clinical success was reported in 232 patients (85.6%). In multivariable analyses, presence of cardiovascular comorbidities (diabetes, stroke history, myocardial infarction and lower limb artery disease) was the single independent variable inversely associated with PAE clinical success (odds ratio = 0.396; 95% confidence interval: 0.17-0.91; P = 0.029). There was no center effect. CONCLUSION Our results show that PAE is safe and effective in centers with various PAE experiences. Cardiovascular comorbidity is the single independent variable associated with PAE failure.
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Affiliation(s)
- Julien Frandon
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France.
| | - Asmaa Belaouni
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France
| | - Olivier Pellerin
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, INSERM U970, Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Nicolas Thiounn
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 75006 Paris, France
| | - Chris Serrand
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (BESPIM), CHU Nîmes, 30029 Nîmes France
| | - Stéphane Droupy
- Department of Urology, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
| | - François Petitpierre
- Department of Diagnostic and Interventional Imaging, Groupe Hospitalier Pellegrin, 33000 Bordeaux, France
| | - Hélène Vernhet-Kovacsik
- Department of Radiology, CHU de Montpellier, Arnaud de Villeneuve Hospital, University of Montpellier, 34090 Montpellier, France
| | - Thibaut Murez
- Department of Urology, CHU de Montpellier, Lapeyronie Hospital, University of Montpellier, 34295 Montpellier, France
| | - Vincent Vidal
- Department of Diagnostic and Interventional Imaging, AP-HM, Hôpital de La Timone; Université Aix-Marseille, CERIMED, Faculté de Médecine, EA 4264, Laboratoire d'Imagerie Interventionnelle Expérimentale, 13005 Marseille, France
| | - Julien Ghelfi
- Department of Diagnostic and Interventional Imaging, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U 1209, 38700 La Tronche, France
| | - Gaele Pagnoux
- Service d'Imagerie Urinaire et Vasculaire, Hospices Civils de Lyon; Faculté de Médecine Lyon Est, 69002 Lyon, France
| | - Ricardo Codas
- Service d'Urologie et Chirurgie de la Transplantation, Hospices Civils de Lyon; Faculté de Médecine Lyon Est, 69002 Lyon, France
| | - Hélène de Forges
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France
| | - Marc Sapoval
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP, INSERM U970, Université Paris Cité, Faculté de Médecine, 75006 Paris, France
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Heiman J, Agarwal D, Komanapalli S, Nottingham C, Large T, Krambeck A, Rivera M. Outcomes of octogenarians undergoing holmium laser enucleation of prostate. World J Urol 2022; 40:1751-1754. [PMID: 35633402 DOI: 10.1007/s00345-022-04053-9] [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: 01/23/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Holmium laser enucleation of prostate (HoLEP) is an effective surgical procedure in men with BPH. Due to the increase in the use of medical therapy for BPH related lower urinary symptoms more octogenarians are presenting in a delayed fashion with significant symptoms and urinary retention. We evaluate the feasibility and safety of octogenarians undergoing HoLEP. METHODS We performed a retrospective review of HoLEPs at our institution from July 2018 to December 2019. Patients were stratified into two groups based on age: < 80 and ≥ 80. RESULTS A total of 458 patients were identified, with 74 (16.2%) ≥ 80. In patients ≥ 80, prostate volume was higher (p < 0.0005), there was a higher rate of antiplatelet/anticoagulation (p = 0.029) use, and a lower rate of alpha-blocker use (p = 0.0016). As expected, ASA scores which correlate with increasing number of concomitant diseases were greater in the ≥ 80 cohort (p = 0.016). There was no significant difference in intraoperative complications (p = 0.14), 90 day complication (p = 0.34), readmission rates (p = 0.425) or emergency room visits between groups (p = 0.15). CONCLUSIONS Despite higher medical comorbidities and increased rates of anticoagulation in octogenarians, there is no increase in operative or postoperative complication rates. Age alone should not be used as exclusion criteria for HoLEP.
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Affiliation(s)
- Joshua Heiman
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA.
| | - Deepak Agarwal
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Sarah Komanapalli
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Charles Nottingham
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Amy Krambeck
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
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Jones JM, Gannett C, Jones M, Winata E, Zhu M, Buckley L, Lazar J, Hedges JC, McCarthy SJ, Xie H. Development of a Hemostatic Urinary Catheter for Transurethral Prostatic Surgical Applications. Urology 2022; 165:359-365. [PMID: 35461919 PMCID: PMC10860670 DOI: 10.1016/j.urology.2022.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate a novel transurethral hemostatic catheter device with an integrated chitosan endoluminal hemostatic dressing (CEHD). Development and implementation of this technology may help address bleeding following surgery such as transurethral resection of prostate (TURP). Bleeding remains the most common complication following TURP, leading to increased morbidity and hospitalization. METHODS Investigation of hemostasis, delivery, safety and efficacy of the CEHD device is conducted using Female Yorkshire swine (N = 23). Hemostatic efficacy of the CEHD (N = 12) is investigated against a control of gauze (N = 12) in a splenic injury model (3 swine). The delivery, safety, and efficacy of the CEHD device (N = 10) are investigated against Foley-catheter control (N = 10) for 7 days using a swine bladder-neck-injury model. RESULTS In the splenic injury study, 9/12 CEHD dressings successfully achieved hemostasis within 150 seconds (mean 83 seconds) vs success of 6/12 (mean 150 seconds) for gauze (P = .04). In the 7-day study, the CEHD was successfully deployed in 10/10 animals and all dressings were tolerated without histologic or clinical adverse effect. Hemostasis of the CEHD device was found to be noninferior to control catheters. Noninferiority is attributed to low bleeding rates in the swine bladder neck injury model. CONCLUSION This investigation successfully demonstrated the feasibility of transurethral deployment of the CEHD in vivo. Routine use of safe and slowly dissolvable CEHDs could reduce the rate of complications and hospitalizations associated with bleeding and blood loss in TURP procedures. Further investigation is warranted.
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Affiliation(s)
- James M Jones
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | | | | | | | - Meihua Zhu
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | - Lisa Buckley
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | - Jack Lazar
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | - Jason C Hedges
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR; Department of Urology, Oregon Health & Science University, Portland, OR
| | | | - Hua Xie
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR; Department of Surgery, Oregon Health & Science University, Portland, OR.
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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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Bridgeman MB, Brunetti L. Part
II
: Interactive case: Combination therapies in benign prostatic hyperplasia. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lichy I, Law K, Tholomier C, Nguyen DD, Sadri I, Bouhadana D, Couture F, Zakaria AS, Bhojani N, Zorn KC, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Reimann M, Cash H. Global experience and progress in GreenLight-XPS 180-Watt photoselective vaporization of the prostate. World J Urol 2022; 40:1513-1522. [PMID: 35499590 PMCID: PMC9166849 DOI: 10.1007/s00345-022-03997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate changes in global perioperative data of GreenLight-XPS 180-Watt photo-selective vaporization of the prostate (GL-XPS) of the Global Greenlight Group (GGG) database. METHODS 3441 men, who underwent GL-XPS for symptomatic BPH between 2011 and 2019 at seven high volume international centers, were included. Primary outcome measurements were operative time (OT; min), effective laser time (LT; min of OT), as well as intraoperative and postoperative adverse events (AEs), all analyzed by year of surgery (2011-2019) and prostate volume (PV) group (< 80 ml vs. 80-150 ml vs. > 150 ml). RESULTS The median age was 70 years (interquartile range 64-77), the median PV was 64 ml (IQR 47-90). The OT and LT slightly increased but stayed highly efficient all in all. Median OT was 60 min (IQR 45-83) and LT was 33 min (IQR 23-46). Median energy use was 253 kJ (IQR 170-375) with an energy density of 3.94 kJ/ml (IQR 2.94-5.02). The relative probability of perioperative AEs decreased by 17% each year (p < 0.001). The relative probability of perioperative transfusion dropped significantly from 2% in 2011 to 0% in 2019 (p = 0.007). The early postoperative complications (within 30 days after surgery) decreased significantly from 48.8% (n = 106) in 2011 to 24.7% (n = 20) in 2019 (p > 0.001). CONCLUSION These findings from the GGG demonstrate significant improvement secondary to growing experience with GL-XPS between 2011 and 2019 in intraoperative AEs, including transfusions, and postoperative AEs. While staying highly efficient in OT and LT of GL-XPS within a 9-year period of experience.
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Affiliation(s)
- Isabel Lichy
- Department of Urology, Charité–University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Kyle Law
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Côme Tholomier
- Division of Urology, Department of Surgery, McGill University, Montreal, QC Canada
| | - David-Dan Nguyen
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Iman Sadri
- Division of Urology, Department of Surgery, McGill University, Montreal, QC Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Félix Couture
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Ahmed S. Zakaria
- Division of Urology, Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, ON Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Kevin C. Zorn
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, Midi-Pyrenees France
| | - Dean Elterman
- Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, ON Canada
| | - Maximilian Reimann
- Department of Urology, Charité–University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Hannes Cash
- Prouro, Urology Berlin, Berlin, Germany
- Department of Urology, University of Magdeburg, Magdeburg, Germany
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
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Gerberding S, Golzarian J. Prostate Artery Embolization for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia- Radiology In Training. Radiology 2022; 304:31-37. [PMID: 35348376 DOI: 10.1148/radiol.212419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 71-year-old man was evaluated and treated with prostate artery embolization (PAE) for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Appropriate patient selection, workup, and expected treatment outcomes for PAE are discussed.
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Affiliation(s)
- Shannon Gerberding
- From the Department of Radiology, University of Minnesota, 420 Delaware St SE, MMC 292, Minneapolis, MN 55455
| | - Jafar Golzarian
- From the Department of Radiology, University of Minnesota, 420 Delaware St SE, MMC 292, Minneapolis, MN 55455
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Welliver C, Feinstein L, Ward JB, Kirkali Z, Martinez-Miller EE, Matlaga BR, McVary K. Poor clinical guideline adherence and inappropriate testing for incident lower urinary tract symptoms associated with benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 2022; 25:269-273. [PMID: 34545201 PMCID: PMC8934314 DOI: 10.1038/s41391-021-00435-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The American Urological Association makes recommendations for evaluation and testing for lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) to help primary care providers and specialists identify LUTS/BPH and harmful related conditions including urinary retention and prostate or bladder cancer. Our understanding of provider adherence to these Guidelines is limited to single-site or nonrepresentative settings. METHODS We analyzed two insurance claims databases: the Optum® de-identified Clinformatics® Data Mart database for privately insured males aged 40-64 years (N ≈ 1,650,900 annually) and the Medicare 5% Sample for males aged ≥65 years (N ≈ 546,000 annually). We calculated the annual prevalence of LUTS/BPH and comorbid bladder cancer and bladder stones from 2004 to 2013. We additionally examined LUTS/BPH incidence and adherence to testing guidelines in a cohort of men newly diagnosed with LUTS/BPH in 2009. RESULTS While LUTS/BPH prevalence and incidence increased with increasing age, evaluation testing became less common. Urinalysis was the most common testing type but was performed in <60% of incident patients. Serum prostate-specific antigen (PSA) was the second most common test across age groups (range: 15-34%). Prevalence of comorbid bladder cancer (range: 0-4%), but not bladder stones (range: 1-2%), increased with increasing age. CONCLUSIONS Although older men were at greater risk of LUTS/BPH than younger men, they were less likely to undergo testing at diagnosis. Recommended testing with urinalysis was poor despite higher prevalence of bladder cancer in older men and a standard recommendation for urinalysis since 1994. Providers should be more cognizant of AUA Guidelines when assessing LUTS/BPH patients.
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Affiliation(s)
| | - Lydia Feinstein
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, USA. .,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Julia B. Ward
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Erline E. Martinez-Miller
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brian R. Matlaga
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin McVary
- Loyola University Medical Center, Center for Male Health, Maywood, IL
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Oerther B, Sigle A, Franiel T, Teichgräber U, Bamberg F, Gratzke C, Benndorf M. More Than Detection of Adenocarcinoma - Indications and Findings in Prostate MRI in Benign Prostatic Disorders. ROFO-FORTSCHR RONTG 2022; 194:481-490. [PMID: 35081650 DOI: 10.1055/a-1719-1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Multiparametric MRI of the prostate has become a fundamental tool in the diagnostic pathway for prostate cancer and is recommended before (or after negative) biopsy to guide biopsy and increase accuracy, as a staging examination (high-risk setting), and prior to inclusion into active surveillance. Despite this main field of application, prostate MRI can be utilized to obtain information in a variety of benign disorders of the prostate. METHODS Systematic bibliographical research with extraction of studies, national (German) as well as international guidelines (EAU, AUA), and consensus reports on MRI of benign disorders of the prostate was performed. Indications and imaging findings of prostate MRI were identified for a) imaging the enlarged prostate, b) prostate MRI in prostatic artery embolization, c) imaging in prostatitis and d) imaging in congenital anomalies. RESULTS AND CONCLUSIONS Different phenotypes of the enlarged prostate that partly correlate with severity of symptoms are discussed. We provide an overview of the different types of prostatitis and possible imaging findings, highlighting abscesses as a severe complication. The most common congenital anomalies of the prostate are utricular cysts, whereas anomalies like aplasia, hypoplasia, and ectopia are rare disorders. Knowledge of indications for imaging and imaging appearance of these conditions may improve patient care and enhance differential diagnosis. KEY POINTS · Current guidelines do not implement indications for mpMRI apart from prostate carcinoma.. · MRI can distinguish different anatomical phenotypes of prostatic enlargement.. · Prostatic artery embolization represents a valuable treatment option in cases of symptomatic benign prostatic enlargement.. · Different forms of prostatitis exist and may mimic prostate carcinoma in MRI.. · MRI can be used to evaluate anatomical prostate anomalies.. CITATION FORMAT · Oerther B, Sigle A, Franiel T et al. More Than Detection of Adenocarcinoma - Indications and Findings in Prostate MRI in Benign Prostatic Disorders. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1719-1463.
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Affiliation(s)
- Benedict Oerther
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - August Sigle
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Tobias Franiel
- Department of Diagnostic and Interventional Radiology, University Hospital Jena, Germany
| | - Ulf Teichgräber
- Department of Diagnostic and Interventional Radiology, University Hospital Jena, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Matthias Benndorf
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Huffman PJ, Yin E, Cohen AJ. Evaluating Patient Preferences in Benign Prostatic Hyperplasia Treatment Using Conjoint Analysis. Urology 2022; 164:211-217. [PMID: 35063462 DOI: 10.1016/j.urology.2022.01.012] [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: 10/25/2021] [Revised: 12/17/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To quantify BPH patient preferences to promote guidelines-compliant, patient-centered care. Discordance between patient and urologist priorities for the treatment of benign prostatic hyperplasia (BPH) hinders patient-centered care. Physician assumptions regarding patient preferences lead to dissatisfied patients; a poor outcome in any quality of life surgery. American Urologic Association guidelines urge urologists to consider patient preferences when recommending a BPH treatment. METHODS In this cross-sectional, online survey study using researchmatch.org, participants were required to decide between theoretical BPH treatments in a balanced, choice-based conjoint analysis. The treatments had varying levels of four attributes: efficacy, recovery difficulty, risk of complications (Clavien-Dindo 2+), and risk of de novo ejaculatory dysfunction. Demographic information and International Prostate Symptom Score (IPSS) were collected and analyzed using comparative statistics. Each attribute was analyzed using a conditional logit model, and attribute importance (range in utility between attribute-levels) was calculated. RESULTS Out of 1235 recruited participants, 812 (66%) completed the study. Median IPSS and age was 6 (IQR 3-12) and 56 (IQR 38-67), respectively. Complication risk was the most important attribute, followed by efficacy, recovery difficulty, and risk of ejaculatory dysfunction. In a subgroup analysis of age quartiles, participants age <38 and >67 held efficacy (31%) and complication risk (47%) to the highest relative importance, respectively. CONCLUSIONS Males valued BPH treatments that minimize complication risks, while ejaculatory dysfunction was least impactful. Variation in results between age subgroups emphasizes the need for individualized care to maximize patient satisfaction.
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Affiliation(s)
- Phillip J Huffman
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Edward Yin
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrew J Cohen
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Mian A, Balzano FL, Pachorek M, Sam AP, Ruel N, Warner JN. Complications Based on Prostate Size After Plasmakinetic Enucleation of the Prostate. J Endourol 2022; 36:969-976. [PMID: 35018807 DOI: 10.1089/end.2021.0911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms among adult men can significantly impact quality of life. We evaluated complications based on prostate size following plasma kinetic enucleation of the prostate. METHODS Patients were grouped into small prostate group (SPG) <75 grams, and large prostate group (LPG) >75 grams based on preoperative imaging. Patient demographics, comorbidities, preoperative international prostate symptoms score (IPSS), bother index (BI), prostate specific antigen (PSA) if indicated, post void residual volume (PVR), indwelling catheter or self-catheterization status, and any prior surgical intervention were evaluated. Postoperatively IPSS, BI, and PVR was assessed at 6 weeks, 4 months, and yearly. Post-operative urge urinary incontinence (UUI), stress urinary incontinence (SUI) and pad use was assessed. RESULTS Between September 2015 and December 2020, 296 bipolar enucleation with minimum 4 month follow-up were evaluated. All postoperative IPSS, BI, PVR and PSA timepoints were significantly decreased compared to pre-operative values (p <0.05). There was no significant difference in the complications between groups. Univariable and multivariable analysis found size <75 grams was predictive of stricture formation and bladder neck contracture. UUI was more common at 6 weeks in the SPG, and SUI was more common at 6 weeks in the LPG, but no difference was noted at the 4 month and 1 year time point. Pad use was equal between the two groups at all time points. CONCLUSIONS PKEP provides an effective treatment option for all prostate sizes, however, prostates <75 grams have a higher rate of BNC and urethral strictures compared to those >75 grams.
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Affiliation(s)
- Abrar Mian
- Midwestern University Chicago College of Osteopathic Medicine, 70050, 555 31st Street, Downers Grove, Downers Grove, Illinois, United States, 60515-1235;
| | | | - Mark Pachorek
- Pasadena City College , Pasadena , California, United States;
| | - Andre-Philippe Sam
- University of California Riverside, 8790, Riverside, California, United States;
| | - Nora Ruel
- City of Hope Medical Center, Biostatistics, 1500 East Duarte Rd, Duarte, California, United States, 91010;
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Kocjancic E, Chung E, Garzon JA, Haylen B, Iacovelli V, Jaunarena J, Locke J, Millman A, Nahon I, Ohlander S, Pang R, Plata M, Acar O. International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction. Neurourol Urodyn 2022; 41:140-165. [PMID: 34989425 DOI: 10.1002/nau.24846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research. METHODS This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent. RESULTS A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated. CONCLUSION A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.
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Affiliation(s)
- Ervin Kocjancic
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Eric Chung
- Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | | | - Bernard Haylen
- Department of Gynaecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Valerio Iacovelli
- Department of Urology, San Carlo di Nancy General Hospital-GVM Care and Research, Tor Vergata University of Rome, Rome, Italy
| | - Jorge Jaunarena
- Division of Urology, Centro de Urologia CDU, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Jennifer Locke
- Department of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Alexandra Millman
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Irmina Nahon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Samuel Ohlander
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ran Pang
- Department of Urology, Guang An Men Hospital, Beijing, China
| | - Mauricio Plata
- Department of Urology, Universidad de los Andes School of Medicine, Fundación Santa fe de Bogotá University, Bogotá, Colombia
| | - Omer Acar
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Rojanasarot S, Cutone B, Bhattacharyya S, DeRouen K, Miller LE. Long-Term Risk of Surgery Following First Diagnosis of Benign Prostatic Hyperplasia in Middle-Aged Men. Cureus 2022; 14:e20961. [PMID: 35154940 PMCID: PMC8815443 DOI: 10.7759/cureus.20961] [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: 01/05/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Pharmacotherapy is often used to relieve lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), yet surgery may be indicated for persistent bothersome symptoms. BPH is common among older men, yet the burden of BPH among middle-aged men may be under-recognized. This study examined the 5-year risk of BPH surgery among middle-aged men following the first BPH diagnosis. Methods Using the IBM MarketScan Commercial Claims and Encounters Database, males aged 35 to 64 years with a first-time primary diagnosis of BPH who were prescribed oral medication for LUTS were identified. The primary outcome was the risk of BPH surgery within five years of the first BPH diagnosis, which was analyzed using Kaplan-Meier methods. The influence of patient demographics, comorbidities, and medication use on the risk of BPH surgery was explored using a Cox proportional hazards model. Results Four thousand five hundred ten eligible men, 460 underwent BPH surgery within five years of BPH diagnosis. The most common surgical procedures were transurethral resection of the prostate and laser enucleation. The risk of BPH surgery over five years following BPH diagnosis was 10.2% (95% CI: 9.4% to 11.1%). In a multivariable Cox proportional hazards regression analysis, patient age was the primary factor associated with higher surgery risk. Compared to men aged 35 to 44 years, the hazard ratio for BPH surgery was 3.9 (95% CI: 1.9 to 8.4; p<0.001) among men aged 45 to 54 years, and 5.0 (95% CI: 2.4 to 10.6; p<0.001) among men aged 55 to 64 years. Conclusions In middle-aged men prescribed oral medication for LUTS secondary to BPH, the risk of BPH surgery was 10.2% over five years. This risk may be underappreciated and highlights the clinical need for surgical procedures with favorable risk-to-benefit profiles.
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Wang YB, Yan SY, Xu XF, Huang X, Luo LS, Deng YQ, Li XH, Huang Q, Wang YY, Huang J, Jin YH, Zeng XT. Comparison on the Efficacy and Safety of Different Surgical Treatments for Benign Prostatic Hyperplasia With Volume >60 mL: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials. Am J Mens Health 2021; 15:15579883211067086. [PMID: 34939514 PMCID: PMC8721735 DOI: 10.1177/15579883211067086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to compare the efficacy and safety of 10 different surgical treatments for benign prostatic hyperplasia (BPH) with volume >60 mL. A systematic literature review and network meta-analysis of randomized controlled trials (RCTs) within a Bayesian framework was performed. A total of 52 parallel-group RCTs included, reporting on 6,947 participants, comparing open prostatectomy (OP), monopolar/bipolar transurethral resection of prostate (monopolar/ bipolar TURP), thulium, holmium and diode laser enucleation of prostate (LEP), bipolar enucleation of prostate, potassium titanyl phosphate laser vaporization of prostate (KTP LVP), bipolar vaporization of prostate (bipolar VP), and laparoscopic simple prostatectomy (laparoscope SP). Compared with OP, laparoscope SP identified better maximal flow rate (Qmax; mean differences [MDs] = 2.89 mL/s) at the 24th month, but bipolar VP demonstrated worse Qmax (MD = −3.20 mL/s) and International Prostate Symptom Score (IPSS; MD = 2.60) at the 12th month. Holmium LEP (MD = 1.37) demonstrated better International Index of Erectile Function–5 at the 12th month compared with OP. However, compared with OP, KTP LVP demonstrated worse postvoid residual volume (PVR) at the sixth (MD = 10.42 mL) and 12th month (MD = 5.89 mL) and monopolar TURP (MD = 6.9 mL) demonstrated worse PVR at the 12th month. Eight new surgical methods for BPH with volume >60 mL appeared to be superior in safety compared with OP and monopolar TURP due to fewer complications. Bipolar VP and KTP LVP maybe not suitable for prostates more than 60 mL due to short- and middle-term worse Qmax, IPSS, and PVR than OP.
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Affiliation(s)
- Yong-Bo Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Si-Yu Yan
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiao-Feng Xu
- Department of Urology, Xianyang Central Hospital, Xianyang, China
| | - Xing Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Li-Sha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu-Qing Deng
- Department of Urology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Lulic Z, Son H, Yoo SB, Cunnington M, Kapse P, Miller D, Cortes V, Park S, Bhak RH, Duh MS. Free combination of dutasteride plus tamsulosin for the treatment of benign prostatic hyperplasia in South Korea: analysis of drug utilization and adverse events using the National Health Insurance Review and Assessment Service database. BMC Urol 2021; 21:178. [PMID: 34933674 PMCID: PMC8691067 DOI: 10.1186/s12894-021-00941-1] [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: 08/10/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To assess the use and safety of free combination therapy (dutasteride and tamsulosin), dutasteride monotherapy, or tamsulosin monotherapy in patients with benign prostatic hyperplasia (BPH). Methods This non-interventional retrospective cohort study used claims data from the Korea Health Insurance Review and Assessment-National Patient Sample database. Patients with BPH ≥ 40 years of age receiving combination therapy (dutasteride 0.5 mg and tamsulosin 0.4 mg daily) or dutasteride 0.5 mg, or tamsulosin 0.4 mg daily dose between 2012 and 2017 were included. The frequency, duration of treatment and risk of any adverse event (AE) or serious AE (SAE) was compared for combination therapy versus each monotherapy using non-inferiority testing. Results Of 14,755 eligible patients, 1529 (10.4%) received combination therapy, 6660 (45.1%) dutasteride monotherapy, and 6566 (44.5%) tamsulosin monotherapy. The proportion of patients treated with combination therapy exceeded the pre-specified 3% threshold for ‘frequent’ use. Safety results indicated a similar risk of any AE and SAE irrespective of treatment group. The adjusted relative risk for any AE over the treatment observation period comparing combination therapy with dutasteride monotherapy was 1.07 (95% confidence interval [CI] 1.03, 1.12), and with tamsulosin monotherapy was 0.98 (95% CI 0.95, 1.02) demonstrating non-inferiority. The adjusted relative risk for any SAE was 1.07 (95% CI 0.66, 1.74) and 0.90 (95% CI 0.56, 1.45), compared with dutasteride and tamsulosin monotherapy, respectively. Although the SAE results did not statistically demonstrate non-inferiority of combination therapy based on pre-specified margins, the 95% CI for the risk ratio estimates included the null with a lower limit below the non-inferiority margins, indicating no meaningful differences in SAE risk between groups. Absolute SAE risks were low. Conclusion Combination therapy with dutasteride and tamsulosin is frequently used in real-world practice in South Korea for treatment of BPH and demonstrates a safety profile similar to either monotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00941-1.
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Affiliation(s)
| | - Hwancheol Son
- Department of Urology, Seoul National University College of Medicine, Boramae Hospital, Seoul, Korea
| | | | | | | | | | | | - Suna Park
- Analysis Group, Inc., Boston, MA, USA
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Gürlen G, Karkin K. Does Holmium laser enucleation of the prostate (HoLEP) still have a steep learning curve? Our experience of 100 consecutive cases from Turkey. Arch Ital Urol Androl 2021; 93:412-417. [PMID: 34933536 DOI: 10.4081/aiua.2021.4.412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
AIM The aim of our study is to examine the learning curve of HoLEP and to discuss our results in the light of the literature. METHODS 100 patients who had LUTS resistant to medical treatment and complicated BPH to whom HoLEP procedure had been administered regardless of the size of the prostate in the last 1 year were analysed retrospectively. To evaluate the learning curve, the patients were classified into 4 main groups of 25 consecutively operated patients beginning from the first case. The 4 main groups were divided into 2 subgroups including patients who had prostate volume below or above 80 grams. RESULTS The mean age of the 100 patients who had HoLEP was 64.5 years. The mean prostate volume was 99.1 cc (45-281 cc). When those with prostate smaller than 80 g are examined, Enucleation efficiency was 0.76 g/min (0.46-0.97 g/min) and Morcellation efficiency was 3.07 g/min (3.34-4 g/min). When those with prostates larger than 80 g are examined, Enucleation efficiency was 0.89 g/min (0.66-1.04 g/min) and Morcellation efficiency was 4.01 g/min (3.93-4.25 g/min). These two parameters were statistically and significantly different in all the 4 groups (p < 0.05). CONCLUSIONS HoLEP still has a steep learning curve. It is necessary to reach the number of cases of 25-50 to reach fundamental experience.
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Affiliation(s)
- Güçlü Gürlen
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana.
| | - Kadir Karkin
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana.
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Taratkin M, Shpikina A, Morozov A, Novikov A, Fokin I, Petov V, Rw Herrmann T, Misrai V, Lusuardi L, Teoh JY, McFARLAND J, Kozlov V, Enikeev D. Enucleation vs vaporization of benign prostatic hyperplasia: a head-to-head comparison of the various outcomes and complications. A systematic review and meta-analysis. Minerva Urol Nephrol 2021; 74:559-569. [PMID: 34791865 DOI: 10.23736/s2724-6051.21.04639-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Vaporization of the prostate (VP) and endoscopic enucleation of the prostate (EEP) are reliable and frequently used methods for BPO relief. Both surgeries utilize lasers and EAU recommends them in similar patient cohorts. Our objective was to compare intra- and perioperative results of patients who had undergone VP and EEP. EVIDENCE ACQUISITION A systematic literature search was performed in three databases (MEDLINE, Web of Science and Scopus). The detailed search strategy is available at Prospero, CRD42020204739. Primary outcomes were functional results (IPSS, QoL, PVR, Qmax), and secondary outcomes were intraoperative results, postoperative PSA and prostate volume, complications, and recurrence rate. EVIDENCE SYNTHESIS VP required less operative time compared to EEP, mean difference=-5.51 (95%CI -7.52; -3.50). IPSS and Qmax for VP were worse after 12-month follow-up, mean difference=0.89 (95%CI 0.52; 1.27) and -3.7 (95%CI -4.56; -2.85), respectively, while QoL did not differ significantly. Postoperative PSA level was higher in the VP group, mean difference=2.28 (95%CI 2.00; 2.55). VP was associated with reduced Clavien-Dindo grade I (OR=4.16; 95%CI 2.96; 5.84) and grade II (OR=3.79; 95%CI 2.25; 6.39) complication rate, especially in terms of the percentage of blood transfusion and transient urinary incontinence. The rate of complications grade IIIa and higher was similar (3 - 6%). Reoperation rate was only estimated in one study and was significantly higher in the PVP group at 60 months of follow-up, 2.7% vs 0%, p<0.05. CONCLUSIONS EEP and VP share the efficacy and safety in BPH management. Our meta-analysis shows comparable complication rate in Clavien-Dindo III, VP superiority in operation time, and EEP superiority in long-term functional outcomes and PSA reduction.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Anastasia Shpikina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Alexey Novikov
- Moscow state clinical hospital named after Yudin, Moscow, Russia
| | - Igor Fokin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Thomas Rw Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.,Department of Urology, Hannover Medical School, Hannover, Germany
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jeremy Y Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jonathan McFARLAND
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia.,Faculty of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Vasiliy Kozlov
- Department of Public Health and Healthcare, Sechenov University, Moscow, Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia -
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Lucas MI, Diaz P, Escobedo FJ, Limbrick BJ, Scotland KB. Online engagement with surgical treatments for benign prostatic hyperplasia: Are Minimally Invasive Surgical Therapies outpacing the gold standard? J Endourol 2021; 36:554-561. [PMID: 34779667 DOI: 10.1089/end.2021.0741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients suffering from progressive symptoms of benign prostatic hyperplasia (BPH) increasingly turn to the internet for information on invasive and minimally invasive surgical therapies (MIST). This study aimed to identify online articles accessed by patients seeking guidance on said options and to evaluate the quality and readability of their content. METHODS Social media analytics tool Buzzumo was used to identify the most shared articles on Facebook, Twitter, Reddit, and Pinterest related to BPH surgical treatments from 2016 to 2021. The content quality was graded using the DISCERN tool; a questionnaire that assesses the quality of written information on treatment choices for a health problem. An online Automatic Readability Checker was used to evaluate the readability of the written transcripts. Google Trends data was used to evaluate search term popularity for BPH procedures from 2016 to 2021. Google trends data and DISCERN ratings were analyzed with ANOVA and paired t-test, respectively. RESULTS Thirty-nine percent of identified articles were rated as low quality, 39% as moderate quality, and 22% as high quality using the DISCERN tool, with no significant difference among reviewer ratings (p = 0.0561). The median reading level of all articles was 12th grade. Google Trends data illustrated a rising popularity of MIST such as Rezūm and Urolift, exceeding interest in more invasive procedures like Holmium laser enucleation of the prostate (HoLEP) and laser surgery. Transurethral resection of the prostate (TURP) remained popular with no significant difference between MIST and TURP on Google Trends (p = 3.46). CONCLUSIONS The most accessed articles on BPH treatments have important shortcomings including risks of treatment and other available options for treatment. Article transcripts exceed the reading level of the average adult patient. TURP has remained a popular procedure online, but there is a notable rising interest in MIST, especially Urolift.
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Affiliation(s)
- Mayra I Lucas
- University of California Los Angeles David Geffen School of Medicine, 12222, 10833 Le Conte Ave, Los Angeles, California, United States, 90095;
| | - Parris Diaz
- Charles Drew University of Medicine and Science, 5140, Los Angeles, California, United States;
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Unwala DJ. EDITORIAL COMMENT. Urology 2021; 156:223. [PMID: 34758560 DOI: 10.1016/j.urology.2021.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Darius J Unwala
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
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AUTHOR REPLY. Urology 2021; 156:224. [PMID: 34758561 DOI: 10.1016/j.urology.2021.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022]
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46
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Bauer SR, Walter LC, Ensrud KE, Suskind AM, Newman JC, Ricke WA, Liu TT, McVary KT, Covinsky K. Assessment of Frailty and Association With Progression of Benign Prostatic Hyperplasia Symptoms and Serious Adverse Events Among Men Using Drug Therapy. JAMA Netw Open 2021; 4:e2134427. [PMID: 34817584 PMCID: PMC8613596 DOI: 10.1001/jamanetworkopen.2021.34427] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Benign prostatic hyperplasia (BPH) in older men can cause lower urinary tract symptoms (LUTS), which are increasingly managed with medications. Frailty may contribute to both symptom progression and serious adverse events (SAEs), shifting the balance of benefits and harms of drug therapy. OBJECTIVE To assess the association between a deficit accumulation frailty index and clinical BPH progression or SAE. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Medical Therapy of Prostatic Symptoms trial, which compared placebo, doxazosin, finasteride, and combination therapy in men with moderate-to-severe LUTS, reduced urinary flow rate, and no prior BPH interventions, hypotension, or elevated prostate-specific antigen. Enrollment was from 1995 to 1998, and follow-up was through 2001. Data were assessed in February 2021. EXPOSURES A frailty index (score range, 0-1) using 68 potential deficits collected at baseline was used to categorized men as robust (score ≤0.1), prefrail (score 0.1 to <0.25), or frail (score ≥0.25). MAIN OUTCOMES AND MEASURES Primary outcomes were time to clinical BPH progression and time to SAE, as defined in the parent trial. Adjusted hazard ratios (AHRs) were estimated using Cox proportional hazards regressions adjusted for demographic variables, treatment group, measures of obstruction, and comorbidities. RESULTS Among 3047 men (mean [SD] age, 62.6 [7.3] years; range, 50-89 years) in this analysis, 745 (24%) were robust, 1824 (60%) were prefrail, and 478 (16%) were frail at baseline. Compared with robust men, frail men were older (age ≥75 years, 12 men [2%] vs 62 men [13%]), less likely to be White (646 men [87%] vs 344 men [72%]), less likely to be married (599 men [80%] vs 342 men [72%]), and less likely to have 16 years or more of education (471 men [63%] vs 150 men [31%]). During mean (SD) follow-up of 4.0 (1.5) years, the incidence rate of clinical BPH progression was 2.2 events per 100 person-years among robust men, 2.9 events per 100 person-years among prefrail men (AHR, 1.36; 95% CI, 1.02-1.83), and 4.0 events per 100 person-years among frail men (AHR, 1.82; 95% CI, 1.24-2.67; linear P = .005). Larger point estimates were seen among men who received doxazosin or combination therapy, although the test for interaction between frailty index and treatment group did not reach statistical significance (P for interaction = .06). Risk of SAE was higher among prefrail and frail men (prefrail vs robust AHR, 1.81; 95% CI, 1.48-2.23; frail vs robust AHR, 2.86; 95% CI, 2.21-3.69; linear P < .001); this association was similar across treatment groups (P for interaction = .76). CONCLUSIONS AND RELEVANCE These findings suggest that frailty is independently associated with greater risk of both clinical BPH progression and SAEs. Older frail men with BPH considering initiation of drug therapy should be counseled regarding their higher risk of progression despite combination therapy and their likelihood of experiencing SAEs regardless of treatment choice.
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Affiliation(s)
- Scott R. Bauer
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
- Department of Urology, University of California, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Louise C. Walter
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Kristine E. Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Anne M. Suskind
- Department of Urology, University of California, San Francisco
| | - John C. Newman
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Buck Institute for Research on Aging, Novato, California
| | - William A. Ricke
- George M. O’Brien Center of Research Excellence, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Teresa T. Liu
- George M. O’Brien Center of Research Excellence, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Kevin T. McVary
- Department of Urology and Center for Male Health, Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois
| | - Kenneth Covinsky
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
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Prostate Artery Embolization-Review of Indications, Patient Selection, Techniques and Results. J Clin Med 2021; 10:jcm10215139. [PMID: 34768659 PMCID: PMC8584630 DOI: 10.3390/jcm10215139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) are a very common problem in men ranging from mild urinary symptoms to recurrent urinary tract infections or renal failure. Numerous treatment options are available ranging from conservative medical therapies to more invasive surgical options. Prostate artery embolization (PAE) has emerged as a novel treatment option for this common problem with clinical efficacy comparable to the current surgical gold standard, transurethral resection of the prostate (TURP). PAE offers fewer complications and side effects without a need for general anesthesia or hospitalization. This review discusses the indications for prostate artery embolization in addition to LUTS, patient evaluation in patients with LUTS, PAE technique and clinical results, with an emphasis on efficacy and safety.
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Xiong Y, Zhang F, Wu C, Zhang Y, Huang X, Qin F, Yuan J. The Circadian Syndrome Predicts Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia Better Than Metabolic Syndrome in Aging Males: A 4-Year Follow-Up Study. Front Med (Lausanne) 2021; 8:715830. [PMID: 34621761 PMCID: PMC8490706 DOI: 10.3389/fmed.2021.715830] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/20/2021] [Indexed: 02/05/2023] Open
Abstract
Background: The prevalence of lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (BPH) increases in men. Although several risk factors, including metabolic syndrome (MetS) and depression, were identified, the underlying etiological factor remains unclear. Recently, circadian syndrome (CircS) was proposed as a novel risk cluster based on MetS. To compare the predictive power of the CircS and MetS for LUTS/BPH, this study was performed. Materials and Methods: In the baseline survey, 4,390 men older than 40 years from the China Health and Retirement Longitudinal Study were enrolled. Of them, 3,658 men were followed in the 2015 survey. Logistic regression was adopted to examine the relationships between CircS, MetS, and LUTS/BPH. To further verify the association, propensity score matching was used for sensitivity analyses. Moreover, the participants who had LUTS/BPH at the baseline were excluded to test the longitudinal relationships between CircS, MetS, and LUTS/BPH. In addition, we employed the receiver operating characteristic (ROC) curve analysis to compare the predictive power using the number of components of CircS and MetS. The DeLong test was used to test the disparities of area under the curves (AUCs). Results: The prevalence of CircS and MetS in aging men was 30.23 and 38.36%, respectively. The odds ratios for prevalent LUTS/BPH were 1.61 (95% CI = 1.29–2.00, P < 0.001) and 1.34 (95% CI = 1.08–1.66, P < 0.01), respectively, in aging men. This increased risk was also observed in incident LUTS/BPH. The prevalence of LUTS/BPH in normal, CircS alone, MetS alone, and both CircS and MetS groups was 6.96, 8.77, 7.83, and 10.77%, respectively. The AUCs for CircS predicting prevalent and incident LUTS/BPH were higher than those for MetS (0.582 vs. 0.556 for incident LUTS/BPH, P < 0.001; 0.574 vs. 0.561 for prevalent LUTS/BPH, P < 0.05). Conclusions: The CircS predicts both incident and prevalent LUTS/BPH better than MetS.
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Affiliation(s)
- Yang Xiong
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Fuxun Zhang
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Changjing Wu
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Yangchang Zhang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiaoyingzi Huang
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Qin
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuhong Yuan
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Bassily D, Wong V, Phillips JL, Fraiman M, Bauer R, Dixon CM, Wong NC. Rezūm for retention-retrospective review of water vaporization therapy in the management of urinary retention in men with benign prostatic hyperplasia. Prostate 2021; 81:1049-1054. [PMID: 34287992 DOI: 10.1002/pros.24201] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/03/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rezūm vapor ablation is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for tissue ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30 and ≤80 ml, it is unclear how effective Rezūm is for men in urinary retention. We sought to determine whether Rezūm is effective in the treatment of catheter-dependent urinary retention secondary to BPH. METHODS A retrospective chart review was conducted on consecutive patients who presented for urinary retention and subsequently treated with Rezūm. We evaluated procedural details and examined variables pre- and post-Rezūm (at 6 months) including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Qmax ), post void residual volume (PVR), prostate specific antigen, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI). RESULTS Of the 49 patients included in this study, median age of was 73 years, median prostate volume was 73cc (Interquartile range [IQR]: 50, 103) and a median lobe was present in 80% of patients. All patients were in urinary retention before treatment with a median PVR of 900 ml (IQR: 566, 1146). Following Rezum, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved at 6 months (p < 0.01). Qmax increased from 3 to 6 ml/s (p = 0.03) and PVR decreased from 900 to 78 ml (p < 0.01). Only 17/38 patients taking alpha-blockers and 7/15 patients on 5ARIs continued therapy at 6 months following Rezūm (p < 0.01). Of the 49 patients treated, 10 (20.4%) remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months (12.2%) even after further surgical therapies for BPH (p < 0.01). CONCLUSION Rezūm is a safe and effective therapy for treating catheter dependent urinary retention in patients with BPH, including those with median lobes. As a minimally invasive therapy, it is a promising option in patient, particularly those who are not suitable for prolonged anesthesia.
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Affiliation(s)
- Daniel Bassily
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Vincent Wong
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
| | - John L Phillips
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
| | - Mitchell Fraiman
- Department of Urology, Good Samaritan Hospital, Suffern, New York, USA
| | - Ross Bauer
- Department of Urology, Good Samaritan Hospital, Suffern, New York, USA
| | | | - Nathan C Wong
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
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da Silva MHA, Estrada JHD, Gregório BM, Sampaio FJB, de Souza DB. Does treatment with dutasteride or finasteride has impact on renal morphology? Experimental study. Acta Cir Bras 2021; 36:e360703. [PMID: 34550196 PMCID: PMC8448540 DOI: 10.1590/acb360703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate whether renal modifications occur following treatment with dutasteride or finasteride. METHODS Twenty-four male rats were divided into three groups: control (that received distilled water), dutasteride (0.5 mg/kg/day), and finasteride (5 mg/kg/day) groups. All administrations were given by gavage for 40 consecutive days. After inducing euthanasia, blood was collected for urea and creatinine analyses, and both the kidneys were collected for stereological analyses of kidney morphology. RESULTS Serum urea and creatinine levels were increased in both the finasteride and the dutasteride groups compared with those in the control group. In addition, kidney weight, kidney volume, cortical volume, glomerular volumetric density, and mean glomerular volume were reduced in both treatment groups. Finally, the number of glomeruli per kidney was reduced by 26.8% in the finasteride group and by 51.6% in the dutasteride group compared with that in the control group. CONCLUSIONS The 5-ARIs finasteride and dutasteride promoted morphological and functional damages in rat kidneys. In addition, rats in the dutasteride group showed more severe renal modifications than those in the finasteride group.
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Affiliation(s)
| | - João Henrique Duque Estrada
- MD. Urogenital Research Unit – Universidade do Estado do Rio de
Janeiro (UERJ) - Rio de Janeiro (RJ), Brazil
| | - Bianca Martins Gregório
- PhD. Urogenital Research Unit – Universidade do Estado do Rio de
Janeiro (UERJ) - Rio de Janeiro (RJ), Brazil
| | | | - Diogo Benchimol de Souza
- PhD. Urogenital Research Unit – Universidade do Estado do Rio de
Janeiro (UERJ) - Rio de Janeiro (RJ), Brazil
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