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Gravas S, De Nunzio C, Campos Pinheiro L, Ponce de León J, Skriapas K, Milad Z, Lombardo R, Medeiros M, Makrides P, Samarinas M, Gacci M. Development and validation of a clinical nomogram to predict prostatic inflammation in men with lower urinary tract symptoms. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00857-5. [PMID: 38971935 DOI: 10.1038/s41391-024-00857-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Prostatic inflammation is an important etiological component of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). The Prostatic Inflammation Nomogram Study (PINS) aimed to develop and validate a nomogram for predicting the presence of prostatic inflammation in men with LUTS. METHODS This non-interventional, cross-sectional, prospective study was conducted in six secondary/tertiary centers across Cyprus, Greece, Italy, Portugal, and Spain. Men (≥40 years) with BPH/LUTS scheduled to undergo prostatic surgery or transrectal ultrasound-guided (TRUS) prostate biopsy were included. Fifteen demographic and clinical participant characteristics were selected as possible predictors of prostatic inflammation. The presence of inflammation (according to Irani score) in the prostatic tissue samples obtained from surgery/TRUS biopsy was determined. The effect of each characteristic on the likelihood a prostate specimen demonstrated inflammation (classified by Irani score into two categories, 0-2 [no/minimal inflammation] or 3-6 [moderate/severe inflammation]) was assessed using multiple logistic regression. A nomogram was developed and its discriminatory ability and validity were assessed. RESULTS In total, 423 patients (mean age 68.9 years) were recruited. Prostate volume ultrasound (PVUS) > 50 mL, history of urinary tract infection (UTI) treatment, presence of diabetes, and International Prostate Symptom Score (IPPS) Storage score were statistically significant predictors of Irani classification. Logistic regression demonstrated a statistically significant effect for leucocytes detected via urine dipstick, presence of diabetes, PVUS > 50 mL, history of UTIs, and higher IPSS Storage score for the odds of an inflammatory score category of 3-6 versus 0-2. The nomogram had a concordance index of 0.71, and good internal validity. CONCLUSIONS The nomogram developed from PINS had good predictive ability and identified various characteristics to be predictors of prostatic inflammation. Use of the nomogram may aid in individualizing treatment for LUTS, by identifying individuals who are candidates for therapies targeting prostatic inflammation.
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Affiliation(s)
| | | | | | | | | | - Ziad Milad
- Medical School, University of Cyprus, Nicosia, Cyprus
| | | | | | | | | | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Busetto GM, Lombardo R, De Nunzio C, Santoro G, Tocci E, Schiavone N, Tubaro A, Carrieri G, Kaplan SA, Herrmann TRW. Ejaculation sparing of classic and minimally invasive surgical treatments of LUTS/BPH. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00834-y. [PMID: 38615071 DOI: 10.1038/s41391-024-00834-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The surgical landscape for Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) has evolved with the introduction of Minimally Invasive Surgical Therapies (MISTs), recognizing the impact of sexual function on patients' well-being, and prioritizing ejaculation-sparing approaches. METHODS This systematic review explored ejaculation sparing after classic endoscopic procedures and MISTs (iTind, Rezūm, Urolift, Aquablation, and TPLA) and a literature search yielded 41 studies. RESULTS While all procedures demonstrated efficacy in improving LUTS/BPH symptoms (IPSS, QoL, Qmax), a subset of studies evaluated ejaculatory function. Positive outcomes were noted, challenging the historical association of BPH surgeries with ejaculatory dysfunction. Variations in study design, patient cohorts, and limited long-term data present challenges. Notably, the lack of baseline specificity, use of alpha-blockers, and non-specific sexual function assessments underscore potential biases. CONCLUSIONS Despite limitations, the review tentatively concluded that MISTs, including iTind, Rezūm, Urolift, Aquablation, and TPLA, appear comparable in sparing ejaculation. Long-term studies are essential to validate sustainability, and comparative research should assess trade-offs between MISTs and traditional surgeries. Incorporating patient-reported outcomes and quality of life assessments will enhance future investigations, refining MISTs as standard therapeutic options for LUTS/BPH.
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Affiliation(s)
- Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy.
| | | | | | | | - Edoardo Tocci
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Nicola Schiavone
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Andrea Tubaro
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, Stellenbosch, South Africa
- Hannover Medical School, Hannover, Germany
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Cindolo L, Al Jaafari F, De Nunzio C. The times have changed. Let the urologists change! Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00828-w. [PMID: 38575746 DOI: 10.1038/s41391-024-00828-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Luca Cindolo
- Dept of Urology, "Villa Stuart" Private Hospital, Rome, and Centro Urologico Europeo, Modena, Italy.
| | - Feras Al Jaafari
- Department of Urology, Victoria Hospital, NHS Fife, Kirkcaldy, Scotland
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El Khoury J, Hermieu N, Chesnel C, Xylinas E, Teng M, Ouzaid I, Hermieu JF, Amarenco G, Hentzen C. Primary bladder neck obstruction in men: The importance of urodynamic assessment and cystourethrography in measuring its severity. Neurourol Urodyn 2024; 43:874-882. [PMID: 38390751 DOI: 10.1002/nau.25429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Primary bladder neck obstruction (PBNO) is a condition primarily affecting young men, characterized by obstruction at the bladder neck, leading to lower urinary tract symptoms. The aim of this study was to identify a correlation between the severity of bladder neck opening impairment and urinary symptoms by means of urodynamic studies. MATERIALS AND METHODS A retrospective analysis was conducted in adult males diagnosed with PBNO at a university neurourology department between 2015 and 2022 who underwent voiding cystourethrography (VCUG) and pressure-flow studies. The cohort was divided into two groups: absence of bladder neck opening on VCUG (Group A) and incomplete bladder neck opening (Group B). RESULTS Out of the 82 patients with PBNO screened, 53 were included in the analysis. Nocturia was the only symptom more prevalent in Group A (65% in Group A vs. 30% in Group B, p = 0.02) but scores and subscores of the Urinary Symptom Profile questionnaire were not different between groups. In addition, the detrusor pressure at a maximum flow rate (PdetQmax), bladder outlet obstruction index (BOOI), and bladder contractility index (BCI) were higher in Group A than in Group B [PdetQmax (A = 93.7 ± 53.7 cmH2O vs. B = 65.7 ± 26.4 cmH2O; p = 0.01)-BOOI (A = 77 ± 58.3 vs. B = 48 ± 25.7; p = 0.03)-BCI (A = 136 ± 51.3 vs. B = 110 ± 41.7; p = 0.04)]. CONCLUSION This study demonstrates a significant association between the extent of bladder neck opening impairment observed on VCUG and obstruction and contraction urodynamic parameters, but no association with the severity of urinary symptoms. Future studies should evaluate the predictive value of treatment response and the occurrence of complications based on clinical and urodynamic parameters.
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Affiliation(s)
- Joey El Khoury
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France
| | - Nicolas Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France
| | - Camille Chesnel
- Green Group of Clinical Research in Neuro-Urology, AP-HP, Tenon Hospital, Sorbonne University GRC 01, Paris, France
| | | | - Maëlys Teng
- Green Group of Clinical Research in Neuro-Urology, AP-HP, Tenon Hospital, Sorbonne University GRC 01, Paris, France
| | - Idir Ouzaid
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France
| | | | - Gérard Amarenco
- Green Group of Clinical Research in Neuro-Urology, AP-HP, Tenon Hospital, Sorbonne University GRC 01, Paris, France
| | - Claire Hentzen
- Green Group of Clinical Research in Neuro-Urology, AP-HP, Tenon Hospital, Sorbonne University GRC 01, Paris, France
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De Nunzio C, Lombardo R. Best of 2023 in Prostate Cancer and Prostatic Diseases. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00790-7. [PMID: 38263282 DOI: 10.1038/s41391-024-00790-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sapienza University of Rome, Rome, Italy.
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