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Hashim H, Tarcan T, Acar O, Malde S, Wein A, Abrams P. Evaluation of new treatments for benign prostatic obstruction: ICI-RS 2023. Neurourol Urodyn 2024; 43:1409-1419. [PMID: 38078704 DOI: 10.1002/nau.25345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 07/03/2024]
Abstract
AIMS To address how invasive therapies for benign prostatic obstruction (BPO) have been evaluated, what their effect is on BPO, if they can prevent progression to BPO and how new therapies need to be evaluated before implementation into clinical practice. METHODS The think tank conducted a literature review and looked at the previous and current American Urological Association, European Association of Urology and the International Consultation on Urological Diseases guidelines to see what procedures have been used to treat BPO. They then assessed whether trials have been conducted before implementation of the procedures and whether they have been compared to a "gold" standard treatment. The use of urodynamics has also been addressed in the think tank in relation the clinical trials as well as terminology. RESULTS Guidelines vary in the use of terminology when it comes to BPO with some continuing to use the term benign prostatic hyperplasia (BPH). There are several procedures for example, TUNA, which have become obsolete although continues to be mentioned in the guidelines until recently. Majority of procedures have been introduced without comparing to "gold" standard treatment and without any long-term data. There continues to be many unknowns with regard to the success of some of the BPO procedures and why some of the adverse events develop. CONCLUSION There needs to be more robust long-term clinical trials conducted of new BPO therapies, with men who have both lower urinary tract symptoms and urinary retention, before introduction into clinical practice.
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Affiliation(s)
| | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Omer Acar
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sachin Malde
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alan Wein
- Desai Sethi Institute of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Shin SH, Lee KS, Koo KC, Cho KS, Hong CH, Chung BH, Ryoo HS, Ryu JH, Kim YB, Yang SO, Lee JK, Jung TY, Yoo JW. Effects of resection volume on postoperative micturition symptoms and retreatment after transurethral resection of the prostate. World J Urol 2023; 41:3065-3074. [PMID: 37787942 PMCID: PMC10632267 DOI: 10.1007/s00345-023-04628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE Despite advances in technology, such as advent of laser enucleation and minimally invasive surgical therapies, transurethral resection of the prostate (TURP) remains the most widely performed surgical technique for benign prostatic hyperplasia (BPH). We evaluated resection volume (RV)-derived parameters and analyzed the effect of RV on post-TURP outcomes. METHODS This observational study used data from patients who underwent TURP at two institutions between January 2011 and December 2021 Data from patients with previous BPH surgical treatment, incomplete data, and underlying disease affecting voiding function were excluded. The collected data included age, prostate-specific antigen, transrectal ultrasound (TRUS)- and uroflowmetry-derived parameters, RV, perioperative laboratory values, perioperative International Prostatic Symptom Score (IPSS), follow-up period, retreatment requirements and interval between the first TURP and retreatment. RESULTS In 268 patients without prior BPH medication, there were no differences in prostate volume (PV), transitional zone volume (TZV), or RV according to IPSS. A total of 60 patients started retreatment, including medical or surgical treatment, within the follow-up period. There was a significant difference in RV/PV between the groups without and with retreatment respectively (0.56 and 0.37; p = 0.008). However, preoperative TRUS- and uroflowmetry-derived parameters did not differ between the two groups. Multiple linear regression analysis showed that RV (p = 0.003) and RV/TZV (p = 0.006) were significantly associated with differences in perioperative IPSS. In the multivariate logistic regression analysis, only RV/PV was correlated with retreatment (p = 0.010). CONCLUSION Maximal TURP leads to improved postoperative outcomes and reduced retreatment rate, it may gradually become a requirement rather than an option.
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Affiliation(s)
- Seung Han Shin
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Hee Hong
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Soo Ryoo
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Jae Hyun Ryu
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Yun Beom Kim
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Seung Ok Yang
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Jeong Kee Lee
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea
| | - Jeong Woo Yoo
- Department of Urology, Veterans Health Service Medical Center, 53 Jinhwangdo-Ro 61-Gil, Gangdong-Gu, Seoul, 05368, Republic of Korea.
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Costa Silva A, Abreu-Mendes P, Morgado A, Dinis P, Martins Silva C. Analysis of benign prostatic obstruction surgery: A long-term evaluation in a real-life context. Arch Ital Urol Androl 2022; 94:295-299. [DOI: 10.4081/aiua.2022.3.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: Surgery is the treatment for male lower urinary tract symptoms (LUTS) relat-ed to benign prostatic obstruction (BPO) refractory to pharma-cological treatment or with complications. This study aimed to assess factors associated with the need for surgical reinterven-tion and/or continuation of pharmacological treatment. Materials and methods: A retrospective analysis of patients who underwent prostatic surgery for male LUTS associated with BPO between 1 May 2015 and 1 May 2016, with a minimum follow-up of five years, in an academic tertiary hospital. The type of surgery, preoperative, postoperative and follow-up analysis were collected in a database. Results: A total of 212 patients were included with a mean age of 70 ± 8.66 years at five years follow-up. At 5 years, a total of 86.9% of patients do not need pharmacological treatment and 12% required surgical reintervention. Of the preoperative parameters, it was found a relationship between prior prostatitis and the need for second surgery with an odds ratio of 4.6.
Conclusions: Patients should be informed of the potential need for pharmacological treatment following surgery, or even of the need for reintervention. History of prostatitis seems to be a risk factor for reintervention.
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ERGÜN KE, KALEMCİ S, BAHÇECİ T, KIZILAY F, ÖZYURT MC. Investigation of parameters related to treatment efficiency in patients undergoing transurethral prostate resection for benign prostatic hyperplasia. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1168246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Evaluation of the postoperative benefit rates and various parameters that may be associated with the postoperative benefit in patients who underwent transurethral resection of the prostate due to benign prostate enlargement and the treatment efficacy of transurethral resection of the prostate and to investigate whether the parameters that can predict this can be achieved. Materials and Methods: 100 patients who underwent transurethral resection of the prostate in our clinic between 2015-2016 July were evaluated retrospectively. Preoperative estimated prostate weight, international prostate symptom score , maximum flow rate, postvoid residual urine volume , and resected prostate tissue weights were recorded. In the postoperative six weeks to six months, the data of the patients were re-recorded and statistical analyzes were performed.
Results: It was determined that the decrease in IPSS was 11.40 (53.4%), the increase in Qmax was 11.10 ml/s (110%) and the decrease in PVR was 59.60 ml (59%). The decrease in IPSS was found to be statistically significantly higher in those with preoperative IPSS ≥ 20, preoperative Qmax ≤ 10 ml/sec, and PVR >100 ml (p100 ml (p=0.012, p 50 g and RDA / TPA ≤ 0.3 (p=0.027 and p=0.008, respectively). Conclusion: We think that obtaining clearer data that may be related to the efficacy of transurethral resection of the prostate can guide clinicians in patient follow-up and treatment selection, and more studies are needed on this subject.
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Affiliation(s)
- Kasım Emre ERGÜN
- Ege Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı, İzmir, Türkiye
| | - Serdar KALEMCİ
- Ege Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı, İzmir, Türkiye
| | - Tuncer BAHÇECİ
- Ege Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı, İzmir, Türkiye
| | - Fuat KIZILAY
- Ege Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı, İzmir, Türkiye
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Lopes F, Pereira E Silva R, Fernandes M, Palmela Leitão T, Palma Dos Reis J. Prostate resection weight matters in severely obstructed men undergoing transurethral resection of the prostate. Arch Ital Urol Androl 2022; 94:169-173. [PMID: 35775341 DOI: 10.4081/aiua.2022.2.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Transurethral resection of the prostate (TURP) remains one of the goldstandard surgical treatments for benign prostatic hyperplasia/lower urinary tract symptoms. The usefulness of a complete adenoma resection is questionable, with studies reporting no impact of the amount of resected tissue on surgical outcomes, irrespective of prostate volume. The aim of this study was to assess whether in less obstructed patients a less extensive TURP may be considered. MATERIALS AND METHODS Retrospective analysis of 185 men undergoing TURP in one university hospital. Retrieved data included pre-operative prostate volume and Qmax, as well as resected prostate weight and post-operative Qmax. Patients were divided in two groups according to pre-operative Qmax < 10mL/s and ≥ 10 mL/s. RESULTS A correlation was found between absolute resected prostate weight and post-operative Qmax in the group of patients with pre-operative Qmax < 10 mL/s (r2 = 0.038, p = 0.032), independently of the pre-operative prostate volume. This association was neither observed in the group of patients with pre-operative Qmax ≥ 10 mL/s (r2 = -0.033, p = 0.796) nor in whole population analysis (r2 = 0.019, p = 0.064). Likewise, in the group of patients with pre-operative Qmax < 10 mL/s, the improvement in Qmax was correlated with absolute resected weight and percentage of prostate resected weight (r2 = 0.036, p = 0.037 and r2 = 0.040, p = 0.029, respectively). None of these correlations was found in the group of patients with pre-operative Qmax ≥ 10 mL/s (r2 = 0.009, p = 0.463 and r2 = -0.018, p = 0.294, respectively). CONCLUSIONS Patients with pre-operative Qmax ≥ 10 mL/s may do well with less profound prostate resections, whereas patients with lower pre-operative Qmax seem to benefit from a complete adenoma resection.
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Affiliation(s)
- Filipe Lopes
- Urology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon.
| | - Ricardo Pereira E Silva
- Urology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon; Urology University Clinic, Faculty of Medicine, University of Lisbon.
| | - Miguel Fernandes
- Urology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon.
| | - Tito Palmela Leitão
- Urology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon; Urology University Clinic, Faculty of Medicine, University of Lisbon.
| | - José Palma Dos Reis
- Urology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon; Urology University Clinic, Faculty of Medicine, University of Lisbon.
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Liu H, Tian Y, Luo G, Su Z, Ban Y, Wang Z, Sun Z. Modified bladder outlet obstruction index for powerful efficacy prediction of transurethral resection of prostate with benign prostatic hyperplasia. BMC Urol 2021; 21:170. [PMID: 34872539 PMCID: PMC8650302 DOI: 10.1186/s12894-021-00937-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background The correlation between modified bladder outlet obstruction index (MBOOI) and surgical efficacy still remains unknown. The purpose of the study was to investigate the clinical value of the MBOOI and its use in predicting surgical efficacy in men receiving transurethral resection of the prostate (TURP).
Methods A total of 403 patients with benign prostate hyperplasia (BPH) were included in this study. The International Prostate Symptom Score (IPSS), quality of life (QoL) index, transrectal ultrasonography, and pressure flow study were conducted for all patients. The bladder outlet obstruction index (BOOI) (PdetQmax–2Qmax) and MBOOI (Pves–2Qmax) were calculated. All patients underwent TURP, and surgical efficacy was accessed by the improvements in IPSS, QoL, and Qmax 6 months after surgery. The association between surgical efficacy and baseline factors was statistically analyzed. Results A comparison of effective and ineffective groups based on the overall efficacy showed that significant differences were observed in PSA, Pves, PdetQmax, Pabd, BOOI, MBOOI, TZV, TZI, IPSS-t, IPSS-v, IPSS-s, Qmax, and PVR at baseline (p < 0.05). Binary logistic regression analysis suggested that MBOOI was the only baseline parameter correlated with the improvements in IPSS, QoL, Qmax, and the overall efficacy. Additionally, the ROC analysis further verified that MBOOI was more optimal than BOOI, TZV and TZI in predicting the surgical efficacy. Conclusion Although both MBOOI and BOOI can predict the clinical symptoms and surgical efficacy of BPH patients to a certain extent, however, compared to BOOI, MBOOI may be a more useful factor that can be used to predict the surgical efficacy of TURP. Trial registration retrospectively registered.
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Affiliation(s)
- Hongming Liu
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ye Tian
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China.
| | - Guangheng Luo
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Zhiyong Su
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yong Ban
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Zhen Wang
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Zhaolin Sun
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
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Khorrami MH, Gholipour F, Zargham M, Mohammadi Sichani M, Izadpanahi MH, Alizadeh F, Khorrami F. Electrocoagulation Accounts for a Significant Portion of Discrepancy Between Preoperative Ultrasonography Prostate Size Estimation and Resected Tissue Weight. J Endourol 2020; 34:671-675. [PMID: 32204614 DOI: 10.1089/end.2020.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives: Transurethral resection of the prostate (TURP) is considered to be the gold standard surgical procedure for medium-sized prostates. However, there is a drastic difference between the weight of resected tissue reported by the pathologist and the sonographic estimate of prostate weight before the operation. The present study investigates the role of electrocoagulation in tissue loss during monopolar (M-) and bipolar (B-) TURP. Methods: In this experimental in vitro study, 33 prostate glands removed from patients by open suprapubic prostatectomy were roughly divided in half and the weight of each half was recorded precisely. One half of the specimen was resected using a monopolar resectoscope and the other half was resected by bipolar resectoscope in an out-of-body simulated condition. The weight of obtained chips was measured and the amount of lost tissue was calculated. Data from prostates with final pathologic diagnosis of benign prostatic hyperplasia were included in the analysis. The mean difference of prostate weight before and after out-of-body resection and also the proportion of tissue loss between M-TURP and B-TURP were compared using t-test. Results: Data from 62 prostate halves were included in the final analysis. The mean weight of samples after M-TURP was considerably lower than before resection (38.0 ± 6.9 and 48.7 ± 9.0, respectively, p < 0.001). Similarly, the mean weight of prostate samples after B-TURP was lower than the weight before resection (36.2 ± 7.3 and 48.4 ± 9.1, respectively, p < 0.001). However, the ratio of tissue loss in B-TURP (25.3% ± 2.5%) was significantly higher than in M-TURP (21.3% ± 3.7%) (p < 0.001). Conclusion: Prostate resection using electrocoagulation leads to a significant prostate tissue loss due to heat effect. Furthermore, tissue loss in B-TURP is slightly more than M-TURP.
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Affiliation(s)
- Mohammad-Hatef Khorrami
- Department of Urology, Isfahan Research Center for Kidney Transplantation, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farshad Gholipour
- Department of Urology, Isfahan Research Center for Kidney Transplantation, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahtab Zargham
- Department of Urology, Isfahan Research Center for Kidney Transplantation, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Mohammadi Sichani
- Department of Urology, Isfahan Research Center for Kidney Transplantation, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad-Hossein Izadpanahi
- Department of Urology, Isfahan Research Center for Kidney Transplantation, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farshid Alizadeh
- Department of Urology, Isfahan Research Center for Kidney Transplantation, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farbod Khorrami
- Department of Neuroscience, University of Toronto, Toronto, Canada
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Abstract
BACKGROUND Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is the fourth most common and the fifth most costly disease in men aged 50 years or older. Despite the high prevalence of LUTS/BPH in clinical practice and evidence-based guideline recommendations, there are still plenty of misconceptions on the terminology and pathophysiology of the disease, leading to false assumptions and malpractice. OBJECTIVES Listing of commonly used false assumptions and clarification of the correct terminology and pathophysiology. MATERIALS AND METHODS Critical reflection of 12 selected fake news based on PubMed search. RESULTS Average prostate weight in healthy men is 20 g but varies between 8-40 g. The BPH-disease does not progress in stages; therefore, the BPH-classifications according Alken or Vahlensieck should not be used anymore. There is only a weak and inconsistent relationship between bladder outlet obstruction (BOO) and prostate size, diverticula/pseudo-diverticula, postvoid residual, urinary retention or renal insufficiency, which is too unreliable for BOO-diagnosis in the individual patient. Urethro-cystoscopy with grading of the degrees of occlusion of the prostatic urethra and bladder trabeculation is insufficient for BOO-diagnosis. There is no clinically relevant reduction of BOO with licensed BPH-drugs and no convincing data that prostate resection (TURP) has to be complete until the surgical capsule in order to obtain optimal results. CONCLUSIONS The reasons for the persistent use of wrong terminology and pathophysiology are diverse. One reason is lack of implementation of evidence-based guidelines into clinical practice due to lack of knowledge, individual beliefs, costs, availability and reimbursement policies. Another reason is the increasing focus on oncology, coupled with underrepresented education and training on BPH.
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Lavan L, Kyriazis G, Mbiabjeu D, Gormley R, Hall S, Robinson R, Hodgson D. Day-case surgery is possible in the majority of men undergoing transurethral resection of the prostate – a report on over 1000 cases. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818786667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We describe our experience of performing bipolar transurethral resection in saline (Olympus Medical) as a day-case procedure over an initial five-year period. Patients and methods: All procedures coded as transurethral resection of the prostate over a 60-month period were analysed to determine whether the procedure was planned as a day-case or as an inpatient admission, and whether post-operative discharge proceeded as intended. Re-admission rates, reasons for re-admission and transfusion rates were also recorded. Results: Of the 1035 operations, 689 (66.57%) were planned as a day-case procedure (mean age 70.5 years) with 176 (25.5%) requiring inpatient admission, and 346 (33.43%) were planned for inpatient admission (mean age 73.6) but 58 (16.8%) were discharged the same day. Overall 571 (55.17%) procedures were performed as day cases. Readmission rates for day-case and inpatient procedures were 7.4%, and 6.3% respectively ( p=0.48). Transfusion rates were lower in the day-case group (0.7% vs 3.7%, p<0.05). Day-case rates improved from 48.70% in 2011 to 75.22% in 2016. Conversion from day case to inpatient fell from 34.6% in 2011 to 14.8% in 2016. Conclusions: Our experience indicates that day-case transurethral resection of the prostate can be performed safely in appropriately selected patients, without increased rates of re-admission or complications. Level of evidence: 4 (Oxford Centre for Evidence-Based Medicine (CEBM)).
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Affiliation(s)
- L Lavan
- Department of Urology, Queen Alexandra Hospital, UK
| | - G Kyriazis
- Department of Urology, Queen Alexandra Hospital, UK
| | - D Mbiabjeu
- Department of Urology, Queen Alexandra Hospital, UK
| | - R Gormley
- Department of Urology, Queen Alexandra Hospital, UK
| | - S Hall
- Department of Urology, Queen Alexandra Hospital, UK
| | - R Robinson
- Department of Urology, Queen Alexandra Hospital, UK
| | - D Hodgson
- Department of Urology, Queen Alexandra Hospital, UK
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10
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Bailey K, Abrams P, Blair PS, Chapple C, Glazener C, Horwood J, Lane JA, McGrath J, Noble S, Pickard R, Taylor G, Young GJ, Drake MJ, Lewis AL. Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) for diagnosis and management of bladder outlet obstruction in men: study protocol for a randomised controlled trial. Trials 2015; 16:567. [PMID: 26651344 PMCID: PMC4676182 DOI: 10.1186/s13063-015-1087-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) comprise storage symptoms, voiding symptoms and post-voiding symptoms. Prevalence and severity of LUTS increase with age and the progressive increase in the aged population group has emphasised the importance to our society of appropriate and effective management of male LUTS. Identification of causal mechanisms is needed to optimise treatment and uroflowmetry is the simplest non-invasive test of voiding function. Invasive urodynamics can evaluate storage function and voiding function; however, there is currently insufficient evidence to support urodynamics becoming part of routine practice in the clinical evaluation of male LUTS. DESIGN A 2-arm trial, set in urology departments of at least 26 National Health Service (NHS) hospitals in the United Kingdom (UK), randomising men with bothersome LUTS for whom surgeons would consider offering surgery, between a care pathway based on urodynamic tests with invasive multichannel cystometry and a care pathway based on non-invasive routine tests. The aim of the trial is to determine whether a care pathway not including invasive urodynamics is no worse for men in terms of symptom outcome than one in which it is included, at 18 months after randomisation. This primary clinical outcome will be measured with the International Prostate Symptom Score (IPSS). We will also establish whether inclusion of invasive urodynamics reduces rates of bladder outlet surgery as a main secondary outcome. DISCUSSION The general population has an increased life-expectancy and, as men get older, their prostates enlarge and potentially cause benign prostatic obstruction (BPO) which often requires surgery. Furthermore, voiding symptoms become increasingly prevalent, some of which may not be due to BPO. Therefore, as the population ages, more operations will be considered to relieve BPO, some of which may not actually be appropriate. Hence, there is sustained interest in the diagnostic pathway and this trial could improve the chances of an accurate diagnosis and reduce overall numbers of surgical interventions for BPO in the NHS. The morbidity, and therapy costs, of testing must be weighed against the cost saving of surgery reduction. TRIAL REGISTRATION Controlled-trials.com - ISRCTN56164274 (confirmed registration: 8 April 2014).
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Affiliation(s)
- K Bailey
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - P Abrams
- North Bristol NHS Trust, Bristol Urological Institute, Level 3, Learning and Research Building, Southmead Hospital, Bristol, BS10 5N, UK.
| | - P S Blair
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration, University of Bristol, St. Michael's Hospital, Level D, Southwell Street, Bristol, UK.
| | - C Chapple
- Sheffield Teaching Hospitals NHS Trust, Room H26, H-Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
| | - C Glazener
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
| | - J Horwood
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - J A Lane
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - J McGrath
- Exeter Surgical Health Services Research Unit - Urology, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK.
| | - S Noble
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - R Pickard
- Institute of Cellular Medicine, University of Newcastle, 3rd Floor, William Leech Building, Newcastle upon Tyne, NE2 4HH, UK.
| | - G Taylor
- University of Plymouth, Plymouth, Devon, PL4 8AA, UK.
| | - G J Young
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - M J Drake
- North Bristol NHS Trust, Bristol Urological Institute, Level 3, Learning and Research Building, Southmead Hospital, Bristol, BS10 5N, UK.
- School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, BS2 8DZ, Bristol, UK.
| | - A L Lewis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Milonas D, Verikaite J, Jievaltas M. The effect of complete transurethral resection of the prostate on symptoms, quality of life, and voiding function improvement. Cent European J Urol 2015; 68:169-74. [PMID: 26251736 PMCID: PMC4526604 DOI: 10.5173/ceju.2015.507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/31/2014] [Accepted: 01/04/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Transurethral resection of the prostate (TURP) still remains the most popular surgical treatment for patients with lower urinary tract symptoms. However, in some patients, the improvement of symptoms after TURP is insufficient. The aim of our study was to evaluate the impact of the resected prostate tissue weight (RPTW) on the improvement of symptoms (IPSS), quality of life (QoL), and voiding function after TURP. Material and methods The study included 89 men who had undergone TURP in our institution. IPSS, QoL, post–voiding residual urine volume (PVR) and Qmax were recorded before the operation and six months after TURP. The total prostate volume (TPV) and transition zone volume (TZV) were measured before the operation by transrectal ultrasound. The impact of RPTW, RPTW/TZV ratio, and RPTW/TPV ratio were analyzed according to the efficacy of TURP. Results The mean Qmax after TURP increased by 10.15 mL/s, IPSS decreased by 16.7 points, QoL increased by 3.57 points, and PVR decreased by 95.3 mL. According to Qmax, the treatment was effective in 74.2%, according to IPSS, in 91%, and according to QoL, in 74.2% of patients. The ROC analysis demonstrated that RPTW/TZV and RPTW/TPV ratios were the most significant predictors of obtaining favorable results. Survival analysis (life table) shows that in order to achieve 50% improvement on Qmax, QoL, and IPSS, more than 30–35% of TPV and more than 60% of the TZV should be removed. Conclusions The efficacy of the TURP at short term follow-up depends on the completeness of the resection.
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Affiliation(s)
- Daimantas Milonas
- Department of Urology, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania
| | - Jone Verikaite
- Department of Urology, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania
| | - Mindaugas Jievaltas
- Department of Urology, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania
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Reply by the authors. Urology 2014; 85:275-6. [PMID: 25530401 DOI: 10.1016/j.urology.2014.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 11/21/2022]
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Harraz AM, El-Assmy A, Tharwat M, Elshal AM, El-Nahas AR, Barakat TS, Elsaadany MM, El-Halwagy S, Ibrahiem EHI. Predicting the resected tissue weight from a digital rectal examination and total prostate specific antigen level before transurethral resection of the prostate. Arab J Urol 2014; 12:256-61. [PMID: 26019959 PMCID: PMC4434800 DOI: 10.1016/j.aju.2014.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/29/2014] [Accepted: 09/18/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To determine the use of the prostate specific antigen (PSA) level and digital rectal examination (DRE) findings to estimate the resected tissue weight (RTW) before transurethral resection of the prostate (TURP). PATIENTS AND METHODS We retrospectively analysed 983 patients who underwent TURP between December 2006 and December 2012. The primary outcome was the RTW required for clinical improvement, and was not associated with re-intervention. Age, PSA level, body mass index (BMI) and DRE findings were correlated and modelled with the RTW. The DRE result was defined as DREa (small vs. large) or DREb (small vs. moderate vs. large) according to the surgeon's report. Equations to calculate RTW were developed and tested using receiver operating characteristic (ROC) curve analyses. RESULTS There were significant correlations between PSA level (r = 0.4, P < 0.001) and RTW, whilst BMI and age showed weak correlations. The median (range) RTW was 45 (7-60) vs. 15 (6-60) g for small vs. large prostates (DREa) (P < 0.001), respectively. Similarly, the median (range) RTW was 11 (6-59) vs. 26.2 (6-60) vs. 42 (7-60) g in small vs. moderate vs. large prostates (DREb) (P < 0.001), respectively. Using PSA level and DREb (model 3) there was a significantly better ability to estimate RTW than using PSA and DREa (model 2) or PSA alone (model 1) based on ROC curve analyses. The equation developed by model 3 (RTW = 1.2 + (1.13 × PSA) + (DREb × 9.5)) had a sensitivity and specificity of 82% and 71% for estimating a RTW of >30 g, and 84% and 63% for estimating a RTW of >40 g, respectively. CONCLUSIONS The PSA level and DRE findings can be used to predict the RTW before TURP.
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Affiliation(s)
| | - Ahmed El-Assmy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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