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Helman TA, Browne BM. Advances in Outpatient Therapies and Treatment of Benign Prostatic Hyperplasia: A Comprehensive Review for Men's Health. Med Clin North Am 2024; 108:981-991. [PMID: 39084845 DOI: 10.1016/j.mcna.2024.03.009] [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] [Indexed: 08/02/2024]
Abstract
Benign prostate hyperplasia (BPH) affects a large number of men and can be treated with behavioral, medical, or surgical treatments. The newest addition to medical therapy is β3-agonists for overactive lower urinary tract symptoms. Multiple new surgical treatments have become available in the past decade, including several clinic-based minimally invasive surgical techniques (eg, UroLift, Rezum, Optilume BPH), OR treatments (eg, Aquablation, single port robotics), and prostate artery embolization. The growth of options allows providers to better tailor BPH treatment to the specific disease factors and patient preferences.
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Affiliation(s)
- Talia A Helman
- Division of Urology, Department of Surgery, Emory University, 1365 Clifton Road NorthEast, Building B 1st Floor, Suite 1400, Atlanta, GA 30322, USA.
| | - Brendan M Browne
- Division of Urology, Department of Surgery, Emory University, 1365 Clifton Road NorthEast, Building B 1st Floor, Suite 1400, Atlanta, GA 30322, USA
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Heiman J, Snead WM, DiBianco JM. Persistent Lower Urinary Tract Symptoms After BPH Surgery. Curr Urol Rep 2024; 25:125-131. [PMID: 38578550 DOI: 10.1007/s11934-024-01202-y] [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] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE OF REVIEW Lower urinary tract symptoms (LUTS) after surgical management for BPH pose a significant clinical challenge for urologists. Despite high success rates in relieving LUTS, there is a subset of patients who experience persistent symptoms after intervention. In this review article, we describe the management of patients with new or persistent LUTS after endoscopic bladder outlet surgery. RECENT FINDINGS Previously, the goal for BPH management was to remove as much adenomatous tissue as possible. While potentially effective, this may lead to unwanted side effects. There has been a recent paradigm shift for new minimally invasive surgical therapies (MIST) that strategically treat adenomatous tissue, adding potential complexity in managing patients with new or residual symptoms in the postoperative setting. There is a paucity of literature to guide optimal workup and care of patients with persistent LUTS after surgical management. We characterize patients into distinct groups, defined by types of symptoms, irritative versus obstructive, and timing of the symptomatology, short term versus long term. By embracing this patient-centered approach with shared decision management, clinicians can optimize outcomes efficiently improving their patients' quality of life.
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Affiliation(s)
- Joshua Heiman
- Department of Urology, Indiana University, Indianapolis, IN, USA.
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Lee HY, Wang CS, Juan YS. Detrusor Underactivity in Men with Bladder Outlet Obstruction. Biomedicines 2022; 10:biomedicines10112954. [PMID: 36428522 PMCID: PMC9687129 DOI: 10.3390/biomedicines10112954] [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: 09/23/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Detrusor underactivity (DU) and bladder outlet obstruction (BOO) are both common troublesome causes of lower urinary tract symptoms (LUTS) and often impact on quality of life simultaneously in men. This article aims to focus on DU with BOO in male patients. METHODS Original articles concerning DU with BOO were identified through literature research from PubMed and EMBASE database. We selected 38 articles in our review, including those concerning pathophysiology, evaluation, treatment and predictors for a successful BOO surgery for DU. RESULTS DU from BOO can result from several pathophysiological mechanisms. Although urodynamic study (UDS) is considered as a precise method to diagnose DU and BOO, there are some previous studies which proposed a non-invasive method to identify DU related to BOO. The treatment goal of DU is restoring bladder contractility using medication or surgery. Releasing outlet obstruction and resistance is the main strategy to restore bladder contractility when medication to directly increase bladder contractility has had limited efficacy. CONCLUSIONS DU from BOO is poorly understood and is largely under-researched. The etiology and pathophysiology still need to be evaluated. Effective and safe medication to restore bladder contractility is also lacking. It remains valuable to perform further research to reveal the unknown aspects of DU.
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Affiliation(s)
- Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 800-852, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 800-852, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 800-852, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 800-852, Taiwan
| | - Chien-Sheng Wang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 800-852, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 800-852, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 800-852, Taiwan
- Correspondence: or ; Tel.: +886-7312-1101; Fax: +886-7213-8405
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Elterman D, Aubé-Peterkin M, Evans H, Elmansy H, Meskawi M, Zorn KC, Bhojani N. UPDATE - Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J 2022; 16:245-256. [PMID: 35905485 PMCID: PMC9343161 DOI: 10.5489/cuaj.7906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Howard Evans
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Division of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Malek Meskawi
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Kevin C. Zorn
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Université de Montréal, Montreal, QC, Canada
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Significance of a decrease in the proportion of detrusor muscle to bladder wall for non-invasive diagnosis of detrusor underactivity in men with lower urinary tract symptoms. Sci Rep 2022; 12:5237. [PMID: 35347204 PMCID: PMC8960773 DOI: 10.1038/s41598-022-09302-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
To investigate the significance of detrusor muscle thickness (DMT) to bladder wall thickness (BWT) ratio as a detrusor-sarcopenia and a consistently applicable factor for noninvasive diagnosis of detrusor underactivity (DU). We prospectively performed a urodynamic study of 100 male with medical refractory lower-urinary-tract-symptoms during 2017–2019. The DMT, BWT and DMT/BWT ratio were measured by ultrasonography every 50 mL during bladder filling, and were analyzed for non-invasive diagnosis of DU and prediction of prostate surgery outcome with questionnaire and the maximum-flow-rate. Of the 94 patients, DU was urodynamically diagnosed in 24 (25.5%). The DMT/BWT ratio was maintained in all patients until the 50% of the maximum cystometric capacity (MCC), and then rapidly decreased. At 20% of the MCC, the DMT/BWT ratio was significantly lower in the DU group (44.0 ± 4.9% vs. 49.4 ± 6.7%, p = 0.008). The DMT/BWT ratio of less than 47.5% at 20% of the MCC showed the ideal accuracy for diagnosing DU (AUC = 0.763), and was a predictor of failure at 12 months after prostate surgery (OR 8.78, p = 0.024). A DMT/BWT ratio of less than 47.5% at 20% of the MCC is a consistently applicable factor for non-invasive diagnosis of DU and could also be considered detrusor-sarcopenia.
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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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Abuelnaga M, Sharaf A, Armitage J. Efficacy of Holmium laser enucleation of the prostate in men with impaired bladder contractility: A review. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211062468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Since Holmium laser enucleation of the prostate (HoLEP) was introduced in the 1990s as an endoscopic deobstructing modality for benign prostatic hyperplasia (BPH), several reports have concluded that HoLEP has compared favourably to transurethral resection of prostate (TURP) in relieving Bladder Outlet Obstruction (BOO). However, there has been no consensus regarding the efficacy of surgical management of men with Detrusor Underactivity (DU) and BOO. Methods: We performed a literature search of PubMed, Google Scholar, Scopus, and Web of Science databases. All studies that provided data on the effectiveness of HoLEP in men with BOO and DU were assessed. Data collected included the number of patients, median follow-up, International Prostate Symptom Score (IPSS), Qmax, post-void residual (PVR) and catheter dependency pre- and post-intervention. Results: Nine studies were identified in the literature with a follow-up range between 6 and 60 months. Only one prospective study was identified where investigators performed urodynamic studies (UDSs) before and after the intervention. In addition to a significant improvement of voiding parameters, they reported partial recovery of detrusor muscle contractility in approximately 80% of patients. Furthermore, all other studies reported an improvement in all outcome parameters and proved the efficacy of HoLEP in patients with DU and BOO. Conclusion: The current literature underpins the efficacy of HoLEP in patients with impaired bladder contractility. However, current research is limited and the majority of the published data are retrospective in nature. Therefore, more well-conducted prospective randomised studies are needed to reinforce high-level evidence for this hypothesis. Level of evidence: Not applicable.
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Aho T, Finch W, Jefferson P, Suraparaju L, Georgiades F. HoLEP for acute and non-neurogenic chronic urinary retention: how effective is it? World J Urol 2021; 39:2355-2361. [PMID: 33763730 DOI: 10.1007/s00345-021-03657-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/06/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine catheter status within 3 months of holmium laser enucleation of the prostate (HoLEP) for acute and non-neurogenic chronic urinary retention (AUR and NNCUR), to compare short-term outcomes of HoLEP for urinary retention (UR) versus lower urinary tract symptoms (LUTS), and to report long-term serum creatinine (SC) after HoLEP for high-pressure chronic urinary retention (HPCUR). METHODS A prospectively maintained database of the first 500 consecutive HoLEP cases performed under the care of a single surgeon was analysed retrospectively. Urodynamic studies (UDS) did not play a role in the decision making process for those with UR. NNCUR was defined as painless, with post-void residual volume (PVR) greater than 300 ml in men able to void and initial catheter drainage > 1000 ml in men unable to void. RESULTS 280/500 (56%) were in UR: AUR (195), and NNCUR (85) including 22 with HPCUR. The UR cohort were older with higher enucleated tissue weight [median (IQR); 72 years (66-79 year) and 56 g (29.8-86.3 g)], than the LUTS cohort [70 years (64-75 year) and 38 g (18-67 g)] (p < 0.001). 98.9% with AUR and 98.8% with NNCUR were catheter-free 3 months after HoLEP. There were no significant differences in transfusion rates, hospital stay, or time to first trial without catheter (TWOC) between the LUTS and UR cohorts, nor in international prostate symptom score and quality of life scores, maximum urinary flow rate, post void residual volume or urinary incontinence at 3 months. Patients with NNCUR were less likely to pass their first TWOC (58.8%) than those with AUR (84.6%) or LUTS (87.7%), p < 0.001. None with HPCUR had a clinically significant deterioration in SC at a median of 60 months (IQR 36-82 months). CONCLUSION HoLEP has 3-month catheter-free rates in excess of 98.5% for AUR and NNCUR in patients not pre-selected by UDS. First TWOC is significantly more likely to fail after HoLEP for NNCUR than AUR or LUTS. HoLEP is a durable treatment for HPCUR and there is no need to monitor renal function to detect recurrence.
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Affiliation(s)
- Tevita Aho
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - William Finch
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Plata M, Santander J, Trujillo CG, Bravo-Balado A, Robledo D, Higuera T, Caicedo JI. Impact of detrusor underactivity on the postoperative outcomes after benign prostatic enlargement surgery. Neurourol Urodyn 2021; 40:868-875. [PMID: 33645847 DOI: 10.1002/nau.24637] [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] [Received: 08/22/2020] [Revised: 10/06/2020] [Accepted: 01/04/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION AND OBJECTIVE Previous studies suggest that men with detrusor underactivity (DUA) have less symptomatic improvement after prostate surgery than those with normal contractility, but the available data is controversial. We aim to determine the differences in functional outcomes of patients with or without DUA who underwent photovaporization of the prostate (PVP) with GreenLight™180 W XPS. METHODS A cohort of patients with lower urinary tract symptoms (LUTS) who underwent PVP between 2012 and 2019 was evaluated. Patients were stratified according to bladder contractility index (BCI). DUA was defined as BCI < 100. Those with normal contractility (BCI = 100-150) were included in Group 1, and those with DUA (BCI < 100) in Group 2. Primary outcomes were symptomatic improvement defined as a reduction ≥ 4 points in the international prostate symptom score (IPSS) and a reduction of at least 1 point in the quality of life (IPSS-QoL). Complications according to the Clavien-Dindo classification were also recorded. RESULTS A total of 271 patients who underwent PVP with GreenLight™ and met the inclusion criteria were assessed. Group 1 included 158 patients, while Group 2 included 113 patients. Mean follow-up was 24 months. Patients with normal contractility had a median reduction of 11 points (18.9 ± 8.0 to 7.1 ± 7.0) while patients with DUA had a median reduction of 10 points (19.3 ± 6.9 to 8.6 ± 8.4) in IPSS score; these differences were not statistically significant (p = .20). Patients in Group 1 had a 1.92 higher chance of QoL improvement (OR, 1.92; 90% CI, 1.10-3.37), compared to those in Group 2. Failure to void after PVP was most frequently reported in DUA patients (OR, 2.36; 90% CI, 1.26-4.43). Sociodemographic characteristics, intraoperative complications, conversion rates, hospital stay, and urinary catheterization time were similar between groups. CONCLUSIONS Patients with LUTS, regardless of their BCI, improved their symptoms after PVP according to the IPSS. However, patients with DUA were more likely not to improve their QoL after the procedure and had a higher chance of failure to void in the immediate postoperative period. An appropriate counseling process with the patient discussing possible outcomes based on these findings should be encouraged.
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Affiliation(s)
- Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Distrito Capital, Colombia
| | - Jessica Santander
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Distrito Capital, Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Distrito Capital, Colombia
| | - Alejandra Bravo-Balado
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Distrito Capital, Colombia
| | - Daniela Robledo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Distrito Capital, Colombia
| | - Tatiana Higuera
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Distrito Capital, Colombia
| | - Juan Ignacio Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Distrito Capital, Colombia
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Success of endoscopic prostatic surgery in patients with DUA: a prospective observational and analytic study. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415821993604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Detrusor underactivity (DUA) is a highly prevalent and poorly understood disease in urology practice. Conservative treatment in the form of clean intermittent catheterization (CIC) and pharmacotherapy are in use for DUA without good results. Endoscopic prostate surgery was initially considered ineffective in such patients. But a recent series of retrospective studies showed promising results of surgery in DUA. Therefore, we conducted this prospective study to evaluate success of endoscopic prostatic surgery in a patient with DUA. Materials and methods: This is prospective observational study of 50 patients, satisfying the inclusion criteria, at Ruby Hall Clinic, Pune, conducted between March 2017 and March 2019. Inclusion criteria are that the patients are male, aged > 50 years; urodynamically diagnosed with DUA; a bladder contractility index < 90 with associated bladder outlet obstruction index (BOOI) between 20–40 (equivocal) or > 40 (obstruction), who presented with lower urinary tract symptoms and poor flow ( Qmax < 10 ml/s in a voided volume of >150 ml. Patients were excluded from the study if they had DUA due to neurological causes or spinal trauma, an acontractile detrusor, and were < 50 years. Results: The follow-up period for each patient was 12 months. The mean international prostate specific score reduced from 24.82 ± 2.74 preoperatively to 4.4 ± 1.85 postoperatively. Mean quality of life score reduced from 4.06 ± 0.68 to 0.82 ± 0.62. Mean Qmax increased from 6.26 ±1.46 ml/s to 12.22 ±1.6 ml/s. Mean post-void residual urine volume reduced form 241.9 ±74.9 to 77.3 ±20.75. All of these were statistically significant with a p value < 0.00001. Conclusion: Transurethral resection of the prostate (monopolar/laser) to reduce BOO should be considered as an alternative, viable treatment option in men with DUA. Preoperative counselling and postoperative follow-up are crucial in the management of such patients. Level of evidence:
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Tsuboi I, Maruyama Y, Sadahira T, Ando N, Nishiyama Y, Araki M, Kurashige T, Ichikawa T, Arata R, Ono N, Watanabe T, Hayata S, Shiina H, Nasu Y. Efficacy of holmium laser enucleation in patients with a small (less than 30 mL) prostate volume. Investig Clin Urol 2021; 62:298-304. [PMID: 33943050 PMCID: PMC8100012 DOI: 10.4111/icu.20200450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) in patients with a small prostate volume (≤30 mL). Materials and Methods We retrospectively evaluated 1,135 patients who underwent HoLEP at two institutions between July 2007 and March 2020. Patients who were not evaluated for the International Prostate Symptom Score (IPSS) before or after HoLEP were excluded. We divided patients into two groups according to estimated prostate volume (ePV): ≤30 (n=198) and >30 mL (n=539). The patient characteristics, IPSS, peak urinary flow rate (Qmax), postvoid residual urine volume (PVR), and other data were compared before and after surgery in each group and between the two groups. Multivariate analysis was performed to identify the factors associated with the efficacy of HoLEP in the group with ePV ≤30 mL. Results A total of 737 patients were included in this retrospective study. ePV (23.4 mL vs. 50 mL; p<0.001) and PVR differed significantly between the two groups. The IPSS, IPSS-quality of life, PVR, and Qmax significantly improved after HoLEP in both groups. Improvements in the IPSS, IPSS-quality of life, Qmax, and PVR were greater in the >30 mL group (p<0.001), whereas operation time and morcellation time were significantly shorter in the ≤30 mL group. In the multivariate analysis, age <70 years was independently associated with improvement by HoLEP. Conclusions HoLEP is an effective treatment for patients with a small prostate, even though the extent of improvement after HoLEP was greater in those with a larger prostate.
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Affiliation(s)
- Ichiro Tsuboi
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Yuki Maruyama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan.
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Nobuyoshi Ando
- Department of Urology, Kagawa Rosai Hospital, Kagawa, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Yasuhiro Nishiyama
- Department of Urology, Kochi Health Sciences Center, Kochi, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Takushi Kurashige
- Department of Urology, Tottori Municipal Hospital, Tottori, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Takaharu Ichikawa
- Department of Urology, National Hospital Organization Okayama Medical Center, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Ryoji Arata
- Department of Urology, Kochi Health Sciences Center, Kochi, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Noriaki Ono
- Department of Urology, Kochi Health Sciences Center, Kochi, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Syunji Hayata
- Department of Urology, Tottori Municipal Hospital, Tottori, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Hiroaki Shiina
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
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The Evidence For and Against Prostate-Reducing Procedures for Men with Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00615-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Madersbacher S, Oelke M, Häcker A, Bschleipfer T. [Sophisticated surgical management of distinctive patients with benign prostatic hyperplasia (BPH)]. Urologe A 2020; 59:1168-1176. [PMID: 32845346 DOI: 10.1007/s00120-020-01310-w] [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: 12/30/2022]
Abstract
Herein we describe four clinical scenarios. For the standard patient (prostate volume 30-80 ml, life expectancy >10 years) transurethral resection of the prostate (TURP) remains the standard of care, while endoscopic enucleation is a valuable alternative. Patients with a relevant middle lobe profit most from TURP, endourological enucleation procedures, or laser vaporization. In the case of the absence or a moderate-sized middle lobe and the absence of severe bladder outlet obstruction (BOO), minimally invasive procedures such as Rezūm®, UroLift® or prostate artery embolization (PAE) can be offered. Patients have to be informed that long-term data on this specific indication are lacking. Particularly younger men requiring BPH surgery are interested in preserving ejaculatory function. In the presence of severe BOO, ejaculatory-protective TURP or endoscopic enucleation by preserving the pericollicular region or aquablation are the methods of choice providing an antegrade ejaculation in 60-90% of cases. Rezūm®, AquaBeam®, and UroLift® enable preservation of ejaculation in almost 100%; data on PAE with this respect are more controversial. For patients with a small prostate and significant post void residual, a thorough preoperative work-up, including urodynamics and bladder/detrusor wall thickness measurement, is of great importance. Desobstructive surgery provides satisfactory short- and midterm outcome, yet the long-term outcome is disappointing and remains to be determined in greater detail. The broad spectrum of therapeutic options enables today an individualized minimally invasive or surgical management of BPH considering patient wishes, anatomical factors or urodynamic factors. The time of a "one therapy fits all" strategy is definitely history.
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Affiliation(s)
- S Madersbacher
- Abteilung für Urologie, Klinikum Favoriten, Kundratstraße 3, 1100, Wien, Österreich. .,Sigmund Freud Privatuniversität, Wien, Österreich.
| | - M Oelke
- Klinik für Urologie, St. Antonius-Hospital, Gronau, Deutschland
| | - A Häcker
- Marienhaus Klinikum Hetzelstift, Akademisches Lehrkrankenhaus der Johannes, Gutenberg-Universität Mainz, Stiftstraße 10, 67434, Neustadt a.d. Weinstraße, Deutschland
| | - T Bschleipfer
- Klinik für Urologie, Klinikum Weiden/Kliniken Nordoberpfalz, Weiden, Deutschland
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Méndez-Rubio S, López-Pérez E, Laso-Martín S, Vírseda-Chamorro M, Salinas-Casado J, Esteban-Fuertes M, Moreno-Sierra J. The role of clean intermittent catheterization in the treatment for detrusor underactivity. Actas Urol Esp 2020; 44:233-238. [PMID: 32151472 DOI: 10.1016/j.acuro.2019.11.002] [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: 08/05/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU). MATERIAL AND METHODS A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test. RESULTS The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time. CONCLUSIONS CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor.
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Creta M, Collà Ruvolo C, Longo N, Mangiapia F, Arcaniolo D, DE Sio M, DE Nunzio C, Imbimbo C, Mirone V, Fusco F. Detrusor overactivity and underactivity: implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment. Minerva Urol Nephrol 2020; 73:59-71. [PMID: 32026666 DOI: 10.23736/s2724-6051.20.03678-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Detrusor underactivity (DUA) and detrusor overactivity (DO) have potential impact on the outcomes of surgery for lower urinary tract symptoms related to benign prostate hyperplasia (LUTS/BPH). EVIDENCE ACQUISITION We performed a literature search including studies on humans enrolling patients with preoperative urodynamic evidence of DO and/or DUA undergoing LUTS/BPH surgery. Factors that may influence the outcomes of surgery in these patients were evaluated. EVIDENCE SYNTHESIS In patients with DUA mean bladder contractility index improved from +4 to +44.6, mean total International Prostate Symptom Score (IPSS) improved from -3 to -19.5 points, mean maximum urinary flow (Q<inf>max</inf>) improved from +1.4 to +11.7 mL/s, and mean postvoid residual volume (PVR) improved from -16.5 to -736 mL. Older age, lack of obstruction, concomitant DO, lower detrusor contractility and use of transurethral resection of the prostate (TURP) or photovaporization (PV) instead of Holmium laser enucleation of the prostate (HoLEP) were associated with worse outcomes. In patients with DO, the percentage of DO resolution ranged from 57.1% to 83.3%. Mean total IPSS, Q<inf>max</inf>, and PVR variations ranged from +0.9 to -15.7 points, from -0.2 mL/s to +14 mL/s, and from -19.6 to -202.5 mL, respectively. Older age, lack of obstruction, terminal DO, low maximum cystometric capacity, early and high amplitude DO, and use of transurethral prostate incision instead of TURP or open adenomectomy were associated with worse outcomes. CONCLUSIONS In patients with DUA or DO, surgery for LUTS/BPH provides overall good results. However, a number of factors can affect these outcomes.
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Affiliation(s)
- Massimiliano Creta
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Claudia Collà Ruvolo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Nicola Longo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Francesco Mangiapia
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Davide Arcaniolo
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Marco DE Sio
- Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Ciro Imbimbo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Vincenzo Mirone
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy
| | - Ferdinando Fusco
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy -
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Parikh KA, Ivey JA, Hodge DO, Spiegel MR, Dora CD. Factors Predisposing to Catheter Reinsertion Following Holmium Laser Enucleation of the Prostate. Urology 2020; 138:125-128. [PMID: 31978525 DOI: 10.1016/j.urology.2020.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine if preoperative catheter dependence or specimen weight is associated with failed trial without catheter (TWOC) following holmium laser enucleation of the prostate (HoLEP). MATERIAL AND METHODS The study population consisted of 143 consecutive men who underwent HoLEP by a single surgeon over 10 months. Ten were excluded from analysis because they did not have a TWOC on the morning following surgery. Preoperative catheter dependence and specimen weight as well as catheter reinsertions were analyzed. RESULTS Of 133 men included in analysis, 23 (17.3%) required catheter reinsertion. Of the 23 requiring catheter reinsertion, 6 were catheter dependent preoperatively and 17 were not. Men who were catheter dependent had a lower overall rate of failed TWOC compared to those who were not catheter dependent (15.0% vs 18.3%, P = .647). Mean specimen weight for men requiring catheter reinsertion was significantly lower than men who passed their TWOC (49.9 gm vs 73.1 gm, P = .013). CONCLUSION Very few studies exist on factors associated with short-term catheter reinsertion following HoLEP or other prostatic hyperplasia procedures. We hypothesized that preoperative catheter dependence and small specimen weight would predispose to catheter reinsertion. Specimen weight was inversely related to risk of catheter reinsertion after HoLEP and preoperative catheter dependence was not associated with catheter reinsertion. In men with small prostates, consideration should be given to delayed TWOC to allow resolution of capsular edema and accumulation of clot in the prostatic fossa. Transition zone volume below which delayed TWOC should be considered is the subject of future studies.
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Affiliation(s)
- Kevin A Parikh
- Department of Urology, Mayo Clinic Florida, Jacksonville, FL
| | - Joseph A Ivey
- Department of Urology, Mayo Clinic Florida, Jacksonville, FL
| | - David O Hodge
- Department of Biomedical Statistics and Informatics, Mayo Clinic Florida, Jacksonville, FL
| | - Matthew R Spiegel
- Department of Biomedical Statistics and Informatics, Mayo Clinic Florida, Jacksonville, FL
| | - Chandler D Dora
- Department of Urology, Mayo Clinic Florida, Jacksonville, FL.
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17
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Abstract
PURPOSE OF REVIEW Holmium laser enucleation of the prostate (HoLEP) has been a mainstay therapy for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) for nearly 20 years. We briefly review current and sentinel publications that provide outcomes data after HoLEP. RECENT FINDINGS Current literature continues to support HoLEP as a versatile and durable surgical option for men with LUTS secondary to BPH. Despite evidence supporting durable symptom relief beyond 10 years even in large prostate glands, HoLEP is still not widely available to all patients. Concerns surrounding the learning curve of the procedure, high rates of retrograde ejaculation, and transient urinary incontinence seem to persist and limit the adoption of HoLEP by established urologists and residency training programs. SUMMARY Recent publications continue to show excellent short-term and long-term outcomes after HoLEP, in the categories of voiding function and patient satisfaction. Continued attempts to demonstrate equivalent outcomes of alternate-BPH surgical techniques are being met with renewed efforts by those performing HoLEP to demonstrate equivalent outcomes and patient safety during the learning phase of HoLEP for both mentored and self-directed surgical training.
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18
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Holmium Laser Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia: a Safe and Effective Treatment Option in our Elderly Patients. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-0281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Cho MC, Yoo S, Park J, Cho SY, Son H, Oh SJ, Paick JS. Effect of preoperative detrusor underactivity on long-term surgical outcomes of photovaporization and holmium laser enucleation in men with benign prostatic hyperplasia: a lesson from 5-year serial follow-up data. BJU Int 2019; 123:E34-E42. [PMID: 30582661 DOI: 10.1111/bju.14661] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To investigate the impact of preoperative detrusor underactivity (DU) on serial treatment outcomes over the course of 5 years after photovaporization (PV) or holmium laser enucleation (HoLEP) in patients with benign prostatic hyperplasia (BPH), to compare its impact after PV vs HoLEP, and to identify predictors of long-term lower urinary tract symptoms (LUTS) improvement. MATERIALS AND METHODS This study involved 245 patients with BPH who had complete 5-year follow-up data (PV using 120W-HPS, n = 143, HoLEP, n = 102), grouped as follows: PV-HPS-DU(+), n = 114; PV-HPS-DU(-), n = 29; HoLEP-DU(+), n = 56; and HoLEP-DU(-), n = 46. Bladder contractility index (BCI) < 100 was regarded as DU. Serial treatment outcomes for the International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry and serum PSA level at 6 months, and at 1, 2, 3, 4 and 5 years after surgery, were compared among the groups. LUTS improvement was defined as a reduction in total IPSS of ≥50% relative to baseline. RESULTS Improvement in total IPSS, quality of life (QoL) index and post-void residual urine volume (PVR) in the PV-HPS-DU(+) and PV-HPS-DU(-) groups were maintained up to 5 years after PV, except for maximum urinary flow rate (Qmax ) and bladder voiding efficiency. In the HoLEP-DU(+) and HoLEP-DU(-) groups, improvements in all outcome variables were maintained up to 5 years after HoLEP. Deteriorations in subtotal voiding symptom score, total IPSS and Qmax with time during the long-term period after surgery were more pronounced in the PV-HPS-DU(+) and HoLEP-DU(+) groups than in the PV-HPS-DU(-) and HoLEP-DU(-) groups. Reductions in subtotal voiding symptom score, total IPSS, QoL index, and serum PSA were greater in the HoLEP-DU(+) group than in the PV-HPS-DU(+) group throughout follow-up. The type of surgery (HoLEP vs PV) and higher baseline BCI were independent predictors of LUTS improvement at 5 years after surgery. CONCLUSION Generally, improvement of micturition symptoms, QoL and PVR in patients with DU appears to be maintained up to 5 years after PV or HoLEP. Deterioration of voiding symptoms and urinary flow rate at long-term follow-up visits after PV or HoLEP was more pronounced in patients with LUTS/BPH with DU than in those without DU. Patients with BPH with DU may benefit from more complete removal of prostatic adenoma by HoLEP and greater baseline bladder contractility in terms of micturition symptoms and QoL.
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Affiliation(s)
- Min Chul Cho
- Department of Urology, Seoul National University Boramae Medical Centre, Seoul, Korea
| | - Sangjun Yoo
- Department of Urology, Seoul National University Boramae Medical Centre, Seoul, Korea
| | - Juhyun Park
- Department of Urology, Seoul National University Boramae Medical Centre, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Boramae Medical Centre, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University Boramae Medical Centre, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Mediplex Sejong Hospital, Seoul, Korea
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20
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Abstract
Underactive bladder (UAB) is an important and complex urological condition resulting from the urodynamic finding of detrusor underactivity. It can manifest in a wide range of lower urinary tract symptoms, from voiding to storage complaints, and can overlap with other conditions, including overactive bladder and bladder outlet obstruction. However, UAB continues to be poorly understood and inadequately researched. In this article, we review the contemporary literature pertaining to recent advances in defining, understanding, and managing UAB.
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Affiliation(s)
- Su-Min Lee
- Bristol Urological Institute, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
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21
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Ko KJ, Lee CU, Lee KS. Clinical implications of underactive bladder. Investig Clin Urol 2017; 58:S75-S81. [PMID: 29279879 PMCID: PMC5740033 DOI: 10.4111/icu.2017.58.s2.s75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022] Open
Abstract
Underactive bladder (UAB) is a common urologic condition but a complex disease that causes troublesome lower urinary tract symptoms. Currently, management of UAB remains unsatisfactory. Also, many urological diseases can be combined with UAB. In these combined cases, the treatment results may be affected by UAB component. This review focuses on the clinical implications of UAB in patients with common urologic conditions, including bladder outlet obstruction, overactive bladder syndrome and stress urinary incontinence.
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Affiliation(s)
- Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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22
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Kim DK. Current pharmacological and surgical treatment of underactive bladder. Investig Clin Urol 2017; 58:S90-S98. [PMID: 29279881 PMCID: PMC5740035 DOI: 10.4111/icu.2017.58.s2.s90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
Generally accepted guidelines are not yet available on the management of underactive bladder (UAB). Although the natural history of UAB is still not fully understood, observation may be an acceptable management option in patients with tolerable lower urinary tract symptoms and little risk of upper urinary tract damage. If needed, scheduled and double voiding may be recommended as an effective and safe add-on therapy. Parasympathomimetics have been widely used for the management of UAB, but the evidence does not support clinical benefit. The efficacy of alpha-blockers has also not yet been clearly demonstrated. However, selective alpha-blockers may help to enhance voiding efficiency and to decrease possible upper tract damage. Sacral neuromodulation is a surgical option for nonobstructive UAB approved by the Food and Drug Administration. However, the response rate of test stimulation is not high and the efficacy of permanent implants does not always coincide with that of test stimulation. Although surgery to reduce outlet resistance may be a viable option in UAB with presumed obstruction, surgery seems to have little role in those without obstruction. Latissimus dorsi detrusor myoplasty has shown promising results in restoring voluntary voiding in selected patients. The procedure requires a multidisciplinary team approach of urologists and plastic reconstructive experts. In summary, current treatments of UAB remain unsatisfactory. The multifactorial nature of UAB pathogenesis complicates the appropriate management for each patient. Future research to establish a more clinically relevant definition of UAB will be required to open new era of UAB management.
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Affiliation(s)
- Dae Kyung Kim
- Department of Urology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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23
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Kuebker JM, Miller NL. Holmium Laser Enucleation of the Prostate: Patient Selection and Outcomes. Curr Urol Rep 2017; 18:96. [PMID: 29046983 DOI: 10.1007/s11934-017-0746-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Holmium laser enucleation of the prostate (HoLEP) is a proven technique to alleviate bladder outlet obstruction (BOO) from benign prostatic hyperplasia (BPH). Herein, we review factors relevant to selecting patients who will benefit from this procedure and expected outcomes. RECENT FINDINGS New randomized trials have validated the excellent outcomes achieved by HoLEP in the management of BOO from BPH. Its success has been reproduced in a diverse array of patients including those on anticoagulation, with detrusor underactivity/acontractility, prostate cancer, and in the retreatment setting. HoLEP can be applied to the majority of patients with BOO from BPH regardless of prostate size, previous operations, or the condition of the detrusor. HoLEP can also be carefully considered in patients requiring anticoagulation or who are undergoing active surveillance for low-risk prostate cancer. Immediate complication rate is low and incontinence is rare. Retrograde ejaculation occurs in approximately 75% patients. Furthermore, the retreatment rate for HoLEP is lower than reported for other endoscopic BPH procedures demonstrating its durability.
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Affiliation(s)
- Joseph M Kuebker
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 MCN, Nashville, TN, 37232, USA.
| | - Nicole L Miller
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 MCN, Nashville, TN, 37232, USA
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24
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Cho MC, Park J, Kim JK, Cho SY, Jeong H, Oh S, Paick J, Son H. Can preoperative detrusor underactivity influence surgical outcomes of 120 W HPS vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP)? A serial 3‐year follow‐up study. Neurourol Urodyn 2017; 37:407-416. [DOI: 10.1002/nau.23317] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/10/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Min Chul Cho
- Department of UrologySeoul National University Boramae Medical CenterSeoulKorea
- Department of UrologySeoul National University College of MedicineSeoulKorea
| | - Juhyun Park
- Department of UrologySeoul National University College of MedicineSeoulKorea
| | - Jung Kwon Kim
- Department of UrologySeoul National University Boramae Medical CenterSeoulKorea
| | - Sung Yong Cho
- Department of UrologySeoul National University Boramae Medical CenterSeoulKorea
| | - Hyeon Jeong
- Department of UrologySeoul National University College of MedicineSeoulKorea
| | - Seung‐June Oh
- Department of UrologySeoul National University College of MedicineSeoulKorea
| | - Jae‐Seung Paick
- Department of UrologySeoul National University Boramae Medical CenterSeoulKorea
| | - Hwancheol Son
- Department of UrologySeoul National University Boramae Medical CenterSeoulKorea
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25
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Oh JK, Ko KP, Oh SJ. Measuring change in prostate size after holmium laser enucleation: A prospective study. Investig Clin Urol 2017; 58:200-204. [PMID: 28480346 PMCID: PMC5419102 DOI: 10.4111/icu.2017.58.3.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/20/2017] [Indexed: 02/04/2023] Open
Abstract
Purpose To analyze postoperative outcomes of prostate surgery, resected specimen weight is commonly used. The difference between the preoperative calculated transitional zone volume and actual enucleated specimen weight following holmium laser enucleation of the prostate (HoLEP) is reported at over 20%. The reason for this difference is unclear. We assessed the association of volume of the prostatic adenoma with enucleated weight, the volume and calculated volume of the adenoma by pre- and postoperative ultrasonographic measurement. Materials and Methods All patients were prospectively enrolled who underwent HoLEP by two surgeons (SJO and JKO) between 2010 and 2015. Preoperative and postoperative prostate ultrasonography examinations were performed by a single examiner (JKO) during surgery, and weight and volume of the enucleated adenoma were measured. We compared preoperative adenoma size with postoperative weight and volume of the enucleated adenoma, calculated enucleated volume using ultrasonography, and calculated the correlation coefficients between preoperative adenoma volume and postoperative parameters. Results One hundred forty-two patients with a mean age (±standard deviation) of 69.8 (±8.8) years were analyzed. The mean preoperative ultrasound-measured adenoma volume was 31.7 (±21.4) mL, while postoperatively the mean retrieved weight of the adenoma was 22.3 (±17.0) g and the mean volume was 22.3 (±16.8) mL. Postoperatively calculated enucleated volume using ultrasonography was most strongly correlated with preoperative adenoma size (Pearson correlation coefficient 0.965, p<0.01). Conclusions Our study showed a significant difference between preoperative adenoma size and postoperative enucleated weight of adenoma during HoLEP. Postoperatively calculated enucleated volume using ultrasonography may be the most reliable parameter to assess surgical outcomes following HoLEP.
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Affiliation(s)
- Jin Kyu Oh
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
| | - Kwang-Pil Ko
- Department of Preventive Medicine, Graduate School of Medicine, Gachon University, Incheon, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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26
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Ahmed A, Farhan B, Vernez S, Ghoniem GM. The challenges in the diagnosis of detrusor underactivity in clinical practice: A mini-review. Arab J Urol 2016; 14:223-7. [PMID: 27547465 PMCID: PMC4983158 DOI: 10.1016/j.aju.2016.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/08/2016] [Accepted: 06/23/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To review the current definitions, terminology, epidemiology and aetiology of detrusor underactivity (DU), with specific attention to the diagnostic criteria in use. In addition, we address the relation and the overlap between DU and bladder outlet obstruction (BOO). In this mini-review, we hope to help identify DU patients and facilitate structured clinical evaluation and research. Methods We searched the English literature using ScienceDirect and PubMed for relevant articles. We used the following terms: ‘detrusor underactivity’, ‘underactive bladder’, ‘post voiding residual’, ‘post micturition residual’, ‘acontractile bladder’, ‘detrusor failure’, and ‘detrusor areflexia’. Result DU is one of the most common conditions causing lower urinary tract symptoms (LUTS). Unfortunately, it is also the most poorly understood bladder dysfunction with scant research. To our knowledge there is no clear definition and no non-invasive method to characterise this important clinical condition. DU may result from the normal ageing process; however, it has multiple aetiologies including neurogenic and myogenic dysfunction. In many cases the symptoms of DU are similar to those of BOO and it usually requires invasive urodynamic study (UDS) for diagnosis to differentiate the two diagnoses. A number of diagnostic tests may be used including: UDS testing, the Schafer pressure/flow nomogram, linear passive urethral resistance relation, Watts factor, and the bladder contractility index. Of these, UDS testing is the most practical as it determines both the maximum urinary flow rate and the pressure exerted by the detrusor muscle relative to the maximal flow of urine, allowing for precise characterisation of detrusor function. Conclusion Currently, the diagnosis of DU is based on invasive urodynamic parameters as defined by the International Continence Society in 2002. There is no consensus for the definition of DU prior to 2002. As there is significant overlap between the symptoms of DU and BOO, it is difficult to diagnose DU clinically.
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Key Words
- BCI, bladder contractility index
- Bladder outlet obstruction
- CUR, chronic urinary retention
- Chronic urinary retention
- DHIC, detrusor hyperactivity with impaired contractility
- DO, detrusor overactivity
- DU, detrusor underactivity
- Detrusor underactivity
- ICS, International Continence Society
- LinPURR, linear passive urethral resistance relation
- OAB, overactive bladder
- PVR, post-void residual urine
- Pdet@Qmax, detrusor pressure at maximal flow
- Qmax, maximum urinary flow rate
- UDS, urodynamic study
- Underactive bladder
- Urodynamic
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Affiliation(s)
- Ahmed Ahmed
- Department of Urology, University of California Irvine, CA, USA; Department of Urology, Faculty of Medicine, Aswan University, Egypt
| | - Bilal Farhan
- Department of Urology, University of California Irvine, CA, USA
| | - Simone Vernez
- Department of Urology, University of California Irvine, CA, USA
| | - Gamal M Ghoniem
- Department of Urology, University of California Irvine, CA, USA
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