1
|
Creta M, Russo GI, Bhojani N, Drake MJ, Gratzke C, Peyronnet B, Roehrborn C, Tikkinen KAO, Cornu JN, Fusco F. Bladder Outlet Obstruction Relief and Symptom Improvement Following Medical and Surgical Therapies for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: A Systematic Review. Eur Urol 2024; 86:315-326. [PMID: 38749852 DOI: 10.1016/j.eururo.2024.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Symptomatic benefit and urodynamic obstruction relief represent relevant outcomes of therapies for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). We summarized evidence from studies concurrently assessing variations in terms of symptoms severity and invasive urodynamic measures of obstruction following medical and surgical therapies for LUTS/BPH. METHODS We performed a systematic review of PubMed, Scopus, and Web of Science in June 2023. KEY FINDINGS AND LIMITATIONS We identified 29 publications: 14 (872 patients) and 15 (851 patients) studies addressing medical and surgical therapies, respectively. The mean percentage total International Prostate Symptom Score (IPSS) improvements ranged from -2.5% to 56.3% and from 35.1% to 82.1% following medical and surgical therapies, respectively. The corresponding mean percentage Bladder Outlet Obstruction Index (BOOI) improvements ranged from 7.8% to 53.5% and from 22.4% to 138.6%, respectively. Holmium laser enucleation of the prostate (HoLEP) provided IPSS improvements in the higher range and the greatest BOOI reduction. CONCLUSIONS AND CLINICAL IMPLICATIONS Globally, based on available evidence, more pronounced symptomatic benefits are observed following treatments providing greater deobstructive effect. In detail, patients undergoing surgery exhibit greater IPSS and BOOI improvements than those receiving medical therapy.
Collapse
Affiliation(s)
- Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Giorgio I Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marcus J Drake
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Christian Gratzke
- Department of Urology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benoit Peyronnet
- Department of Urology, Rennes Academic Hospital, University of Rennes, Rennes, France
| | - Claus Roehrborn
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Ferdinando Fusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| |
Collapse
|
2
|
Lombardo R, Ghezzo N, Sarcinelli L, Turchi B, Zammitti F, Franco A, Nacchia A, Cicione A, Tema G, Pastore AL, Guarnotta G, Fuschi A, Al Salhi Y, Tubaro A, De Nunzio C. Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate. Life (Basel) 2024; 14:445. [PMID: 38672716 PMCID: PMC11051523 DOI: 10.3390/life14040445] [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: 01/31/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The purpose of this study was to assess the importance of the post-void residual (PVR) ratio (PVR ratio) in achieving a favorable trifecta outcome for patients suffering from lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) who undergo transurethral resection of the prostate (TURP). Starting from 2015, a series of patients with LUTS-BPE who underwent TURP were included in a forward-looking study. These patients were assessed using the international prostate symptom score (IPSS) screening tool, uroflowmetry, and a transrectal ultrasound to measure prostate volume (TRUS). Both the PVR urine volume and the PVR ratio (PVR-R), which is the PVR as a percentage of total bladder volume (voided volume + PVR), were measured. The assessment of outcomes was based on the trifecta favorable outcome, defined as meeting all of the following criteria: (1) absence of perioperative complications, (2) a postoperative IPSS of less than eight, and (3) a postoperative maximum urinary flow rate (Qmax) greater than 15 mL/s. A total of 143 patients were included, with a median age of 70 years (interquartile range 65-73). Of these, 58% (83/143) achieved a positive trifecta outcome. Upon conducting a multivariate analysis, both IPSS and Qmax were identified as predictors of a positive trifecta outcome, whereas the PVR-R did not prove to be an independent predictor. In summary, it was found that preoperative IPSS and Qmax are indicative of a trifecta outcome following TURP, whereas PVR-R is not.
Collapse
Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sapienza University of Rome, 00185 Rome, Italy; (N.G.); (L.S.); (B.T.); (F.Z.); (A.F.); (A.N.); (A.C.); (G.T.); (A.L.P.); (G.G.); (A.F.); (Y.A.S.); (A.T.); (C.D.N.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Wroclawski ML, Takemura LS, Santos HOD, Heldwein FL, Gauhar V, Lim EJ, Law YXT, Teoh JYC, Herrmann TRW, Castellani D. Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta-analysis. Neurourol Urodyn 2024; 43:126-143. [PMID: 38010924 DOI: 10.1002/nau.25336] [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: 06/19/2023] [Revised: 08/22/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Men with detrusor underactivity (DUA) and concomitant bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC). MATERIALS AND METHODS This review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short- and long-term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta-analysis was performed using Review Manager (RevMan) software. RESULTS There were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eight TURP (transurethral resection of the prostate) studies, four GreenLight PVP (photoselective vaporization of the prostate) studies, two HoLEP (Holmium laser enucleation of the prostate) studies, one GreenLight PVP/HoLEP study, one Holmium laser incision of the prostate study, and one study did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long-term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS), lower quality-of-life (QoL) score, better maximum flow rate (Qmax), and lower post-voiding residual (PVR) of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow-up. CONCLUSION In this meta-analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow-up period after surgery.
Collapse
Affiliation(s)
- Marcelo Langer Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Urology, Hospital Beneficencia Portuguesa de Sao Paulo, São Paulo, Brazil
- Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | - Flavio Lobo Heldwein
- Department of Urology, Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
- Department of Urology, National University Hospital, Singapore
| | - Ee Jean Lim
- Department of Urology, National University Hospital, Singapore
| | | | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliera-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
4
|
Gon LM, Riccetto C. When is the best surgical time for benign prostate hyperplasia treatment? Asian J Androl 2024; 26:119-121. [PMID: 37695245 PMCID: PMC10846827 DOI: 10.4103/aja202339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/26/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Lucas Mira Gon
- Division of Urology, Department of Surgery, University of Campinas, UNICAMP, Campinas, 13083888, Brazil
| | - Cássio Riccetto
- Division of Urology, Department of Surgery, University of Campinas, UNICAMP, Campinas, 13083888, Brazil
| |
Collapse
|
5
|
Bohlok J, Söderberg R, Patschan O. Transurethral versus open enucleation of the prostate in Sweden - a retrospective comparative cohort study. Scand J Urol 2023; 58:126-132. [PMID: 38078514 DOI: 10.2340/sju.v58.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To investigate if treatment with transurethral enucleation of the prostate (TUEP) during the learning curve is as efficient and safe in the short term as transvesical open prostate enucleation (OPE), in patients with benign prostatic obstruction (BPO) > 80 ml in a population in Sweden. Methods: 54 patients with ultrasound verified BPO > 80 ml and indication for surgery underwent TUEP or OPE between 2013 and 2019. Peri- and postoperative outcome variables regarding voiding efficiency and morbidity from 20 OPE at Skåne University Hospital (SUS) and from the first 34 TUEP performed at SUS and Ystad Hospital were retrospectively assembled. Follow-up data from the first 6 postoperative months were collected by chart review. RESULTS Intraoperative bleeding during TUEP was less than in OPE (225 ml vs. 1,000 ml). TUEP took longer surgery time than OPE (210 vs. 150 min.). Within 30 days postoperatively, bleeding occurred less often after TUEP (23% vs. 40%), requiring one fourth of the blood transfusions given after OPE. After TUEP, patients had shorter hospitalisation (3 days vs. 7 days) and catheterisation time (3 days vs. 12 days). During the 6-month follow-up period, incontinence and UTI defined as symtomatic significant bacteriuria (urinary culture) were observed as main complications after TUEP and OPE. Functional outcome data availability (International Prostate Symptom Score [IPSS] questionnaire, uroflowmetry, residual urine) were limited. CONCLUSIONS Treatment with TUEP during the learning curve led to less bleeding, shorter hospitalisation- and catheterisation time than treatment with OPE. However, surgery time was shorter with OPE. There were no major differences between the groups concerning mid-term functional outcomes, with the reservation of an inconsistent follow-up.
Collapse
Affiliation(s)
| | | | - Oliver Patschan
- Department of Translational Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
6
|
Yoo S, Jeong H, Son H, Oh SJ, Paick JS, Cho MC. Does Preoperative Bladder Compliance Affect Long-Term Functional Outcomes after Laser Prostatectomy? World J Mens Health 2023:41.e35. [PMID: 37118952 DOI: 10.5534/wjmh.220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/26/2022] [Accepted: 01/23/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE We assessed the effects of preoperative bladder compliance on the long-term functional outcomes, especially focused on postoperative storage symptom changes, after laser prostatectomy. MATERIALS AND METHODS From January 2008 to March 2014, 1,608 men who underwent laser prostatectomy, including holmium laser enucleation or photo-vaporization of the prostate, were included in the analysis. We divided patients into 3 groups according to bladder compliance on a baseline urodynamic study: <12.5, 12.5-25, ≥25 mL/cmH2O. A multivariable analysis was performed to determine the impact of bladder compliance on changes in long-term functional outcomes after laser prostatectomy. RESULTS Bladder compliance was less than 12.5 mL/cmH2O in 50 (3.1%), 12.5-25 mL/cmH2O in 232 (14.4%) patients. As bladder compliance decreased, the baseline International Prostate Symptom (IPSS) total score and storage sub-score were increased; the voiding sub-score remain unchanged. At postoperative 12 and 36 months, absolute improvements in the IPSS total score and storage sub-score were higher in <12.5 mL/cmH2O group compared to other groups, although those were equivalent at postoperative 1 months. On the multivariable analysis, decreased bladder compliance <12.5 mL/cmH2O was significantly associated with superior improvement in storage sub-score at postoperative 36 months, although it was not associated with voiding sub-score. CONCLUSIONS In patients with preoperative bladder compliance <12.5 mL/cmH2O, storage symptoms could be further improved at 36 months after laser prostatectomy compared to others. Thus, laser prostatectomy could be a considerable treatment option for patients with severely decreased bladder compliance.
Collapse
Affiliation(s)
- Sangjun Yoo
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Mediplex Sejong Hospital, Incheon, Korea
| | - Min Chul Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| |
Collapse
|
7
|
Gharib T, Eldakhakhny A, Alazaby H, Khalil M, Elgamal K, Alhefnawy M. Evaluation of Storage Symptoms Improvement and Factors Affecting, After Relief of Obstruction in Patients With Benign Prostatic Enlargement. Urology 2022; 169:180-184. [PMID: 35853509 DOI: 10.1016/j.urology.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the improvement of storage symptoms in accordance with voiding symptoms and assess the prognostic factors that influence the relief of storage symptoms after transurethral resection of the prostate (TURP). METHODS Between August 2017 and November 2019, 75 patients indicated for TURP were included in the study, we assessed the improvement of storage symptoms and factors that may influence storage symptoms persistence after TURP such as Age, Overactive bladder symptoms (OABS) score (Blaivas 2007) and Urodynamic parameters such as maximum flow rate (Q MAX), maximum cystometric capacity (MCC), bladder contractility index (BCI), phasic and terminal detrusor overactivity (DO). Assessment of patients was done before and 6 months after TURP by international prostate symptom score (IPSS), quality of life score (QLSS), OABSS (Blaivas score 2007), and urodynamic studies. RESULTS Mean age of the patients was 67.88±7.82 years. The patients with persistence of storage symptoms were significantly older 70.43±8.32 vs 67.04±7.49 respectively P-value = 0.022, also IPSS score was significantly higher in patients with resolution of symptoms (26.83±3.91 vs 24.35±3.68 P = .017). Terminal D.O and Q max were significantly higher in patients with persistence of storage symptoms (26.3% and 8.1 vs 8.9% and 6 respectively). MCC was significantly higher in a patient with resolution vs persistence of storage symptoms (345.18±90.89 mL vs 242.16±72.73) respectively P = 0.001 There was no significant difference between both groups regarding duration of symptoms, prostate size, prostatic specific antigen (PSA), QOL score, OABS score, and maximum detrusor pressure CONCLUSION: more elderly patients with MCC less than 250 ccs and terminal DO were associated with worse outcomes and persistence of storage symptoms post TURP.
Collapse
Affiliation(s)
- Tarek Gharib
- Urology department, Faculty of Medicine, Benha University, Benha, Egypt.
| | - Amr Eldakhakhny
- Urology department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hisham Alazaby
- Urology department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mostafa Khalil
- Urology department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Khaled Elgamal
- Urology department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Alhefnawy
- Urology department, Faculty of Medicine, Benha University, Benha, Egypt
| |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Kim JH, Yu SH, Kim SO. Decreased urothelial expression of caveolin 1 and 2 in aging rats showing detrusor overactivity: Potential association with aging bladder. Investig Clin Urol 2021; 62:690-696. [PMID: 34729968 PMCID: PMC8566782 DOI: 10.4111/icu.20210284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/29/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the effect of aging on bladder function and caveolin protein expression in rat urothelium. MATERIALS AND METHODS Female Sprague-Dawley rats were divided into the following two groups: young age control group (12 weeks) and old-aged group of rats (80 weeks). Urodynamic measurements were taken to compare the contraction interval and the contraction pressure between the two groups. The expression and cellular localization of caveolin 1 and 2 in the urothelium of the rat urinary bladder were determined by Western blot and immunofluorescence microscopy. RESULTS In cystometrograms, the contraction interval (min) was significantly shorter in the old-aged group (3.7±0.5 min) than in the young age control group (6.2±0.8 min). Also, the average contraction pressure (mmHg) was lower in the old-aged group (8.4±0.6 mmHg) than in the young age control group (13.2±1.3 mmHg). Caveolin 1 and 2 were expressed in the subepithelial area in the urothelium. The protein expression of both caveolin 1 and 2 was significantly lower in the old-aged group than in the young age control group. CONCLUSIONS Aging caused a significant change in the expression of caveolin 1 and 2 in the urothelium of the rat urinary bladder. These findings suggest that these molecules might have specific roles in the functional change of the urinary bladder that occurs in association with aging.
Collapse
Affiliation(s)
- Jae Hyeon Kim
- Department of Urology, Chonnam National University Medical School, Research Institute of Medical Sciences, Gwangju, Korea
| | - Seong Hyeon Yu
- Department of Urology, Chonnam National University Medical School, Research Institute of Medical Sciences, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Medical School, Research Institute of Medical Sciences, Gwangju, Korea.
| |
Collapse
|
10
|
Cluster analysis of men undergoing surgery for BPH/LUTS reveals prominent roles of both bladder outlet obstruction and diminished bladder contractility. PLoS One 2021; 16:e0251721. [PMID: 34029333 PMCID: PMC8143400 DOI: 10.1371/journal.pone.0251721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/30/2021] [Indexed: 01/10/2023] Open
Abstract
Lower urinary tract symptoms (LUTS) in aging men are commonly attributed to bladder outlet obstruction from benign prostatic hyperplasia (BPH) but BPH/LUTS often reflects a confluence of many factors. We performed a hierarchical cluster analysis using four objective patient characteristics (age, HTN, DM, and BMI), and five pre-operative urodynamic variables (volume at first uninhibited detrusor contraction, number of uninhibited contractions, Bladder Outlet Obstruction Index (BOOI), Bladder Contractility Index (BCI) and Bladder Power at Qmax) to identify meaningful subgroups within a cohort of 94 men undergoing surgery for BPH/LUTS. Two meaningful subgroups (clusters) were identified. Significant differences between the two clusters included Prostate Volume (95 vs 53 cc; p-value = 0.001), BOOI (mean 70 vs 49; p-value = 0.001), BCI (mean 129 vs 83; p-value <0.001), Power (689 vs 236; p-value <0.001), Qmax (8.3 vs 4.9 cc/sec; p-value <0.001) and post-void residual (106 vs 250 cc; p-value = 0.001). One cluster is distinguished by larger prostate volume, greater outlet resistance and better bladder contractility. The other is distinguished by smaller prostate volume, lower outlet resistance and worse bladder contractility. Remarkably, the second cluster exhibited greater impairment of urine flow and bladder emptying. Surgery improved flow and emptying for patients in both clusters. These findings reveal important roles for both outlet obstruction and diminished detrusor function in development of diminished urine flow and impaired bladder emptying in patients with BPH/LUTS.
Collapse
|
11
|
Chen L, Lv L, Zhang L, Gao Z, Liu Y, Wang S, Zhou N, Xia Y, Cui J, Jiang X, Zhang X, Li Y, Shi B. Metformin ameliorates bladder dysfunction in a rat model of partial bladder outlet obstruction. Am J Physiol Renal Physiol 2021; 320:F838-F858. [PMID: 33645317 DOI: 10.1152/ajprenal.00625.2020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Alteration of bladder morphology and function was the most important consequence of bladder outlet obstruction (BOO). Using a rat model of partial BOO (pBOO), we found that rats treated with metformin showed lower baseline pressures with a reduced inflammatory reaction in the early phase (2 wk) after pBOO. The NLR family pyrin domain containing 3 inflammasome pathway was inhibited in pBOO rat bladders with treatment of metformin in the early phase. Metformin reduced the activity of NLR family pyrin domain containing 3 in primary urothelial cells. In the chronic phase (9 wk after pBOO), metformin treatment ameliorated bladder fibrosis and improved the reduced compliance. Treatment with metformin suppressed the activation of Smad3 and compensated the diminished autophagy in 9-wk pBOO rat bladders. Autophagy was inhibited with upregulation of profibrotic proteins in primary fibroblasts from chronic pBOO bladders, which could be restored by administration of metformin. The antifibrotic effects of metformin on fibroblasts were diminished after silencing of AMP-activated protein kinase or light chain 3B. In summary, this study elucidates that oral administration of metformin relieves inflammation in the bladder during the early phase of pBOO. Long-term oral administration of metformin can prevent functional and histological changes in the pBOO rat bladder. The current study suggests that metformin might be used to prevent the development of bladder dysfunction secondary to BOO.NEW & NOTEWORTHY The present study in a rat model showed that oral administration of metformin alleviated inflammation following partial bladder outlet obstruction in the early phase and ameliorated bladder fibrosis as well as bladder dysfunction by long-term treatment. Our study indicated that metformin is a potential drug to inhibit bladder remodeling and alleviate bladder dysfunction. Clinical trials are needed to validate the effect of metformin on the bladder dysfunction and bladder fibrosis in the future.
Collapse
Affiliation(s)
- Lipeng Chen
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Linchen Lv
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Lekai Zhang
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Zhengdong Gao
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Yaxiao Liu
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
- Laboratory of Basic Medical Sciences, Qilu Hospital, Cheeloo College of Medicine, Jinan, China
| | - Shuai Wang
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Nan Zhou
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Yangyang Xia
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Jianfeng Cui
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Xuewen Jiang
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Xiulin Zhang
- Department of Urology, Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan Li
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Sipal T, Akdere H. The relation between the storage symptoms before and after transurethral resection of the prostate, analysis of the risk factors and the prevention of the symptoms with solifenacin. Int Braz J Urol 2020; 46:575-584. [PMID: 32374123 PMCID: PMC7239300 DOI: 10.1590/s1677-5538.ibju.2019.0227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/13/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE AND HYPOTHESIS We aimed to investigate the reasons of storage symptoms ( SS) after transurethral resection of the prostate (TURP). The hypothesis was that a positive correlation would be identified between preoperative and postoperative SS in patients with undergoing TURP and starting early solifenacin treatment in patients with high preoperative SS would be reasonable. In addition, we aimed to analyze multiple other risk factors for post-TURP SS. MATERIALS AND METHODS A total of 160 patients undergoing TURP were prospectively evaluated and divided into two groups according to their OABS. Those with a score of ≥10 points were Group 1 (G1), and those with < 10 points Group 2 (G2). In addition, patients in each group were randomly further divided into two subgroups: those who were started on 5 mg solifenacin succinate in the early postoperative period (G1/G2 A) and those who were not (G1/G2 B). In additions to SS Preop, perop and at the 3rd-month of postoperatively 14 variable were evaluated. The effects of these factors, surgery and the efficacy of an early medical treatment on the postoperative SS were investigated. LUTS were assessed by International Prostate Symptom Score (IPSS) and SS were assessed by sum of IPSS 2, 4 and 7 questionnaires (Storage, S- IPSS). RESULTS Preoperative IPSS and S-IPSS were significantly higher in G1 (p< 0.001); there was a significant improvement at IPSS, S-IPSS, QoL score, Qmax, and PVR for all groups after surgery. Only preoperative S-IPSS was found to have significant effect on postoperative SS (p< 0.001). There was a significant difference between G1A and G1B but no significant difference between G2A and G2B in terms of SS at postoperatively. In addition to this, prostatic volume was found smaller than non-symptomatic patients in de novo SS patients. CONCLUSION TURP provides significant improvement in both storage and voiding symptoms. The predictive value of the preoperative S-IPSS on postop SS is significant. These results suggest that 5 mg solifenacin succinate treatment in the early postoperative period may be beneficial for patients with high preoperative SS and may not be beneficial in others. Small prostatic volume may bode ill for postoperative SS in the patients with de novo SS.
Collapse
Affiliation(s)
- Timucin Sipal
- Depertment of Urology, Cerkezkoy State Hospital, Tekirdag, Turkey
| | - Hakan Akdere
- Depertmen of Urology, Trakya University Medical Faculty, Edirne, Turkey
| |
Collapse
|
14
|
Reply to Sachin Malde, Arun Sahai, and Eskinder Solomon's Letter to the Editor re: Marcus J. Drake, Amanda L. Lewis, Grace J. Young, et al. Diagnostic Assessment of Lower Urinary Tract Symptoms in Men Considering Prostate Surgery: A Noninferiority Randomised Controlled Trial of Urodynamics in 26 Hospitals. Eur Urol 2020;78:701-10. Eur Urol 2020; 78:e234-e235. [PMID: 32900552 DOI: 10.1016/j.eururo.2020.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022]
|
15
|
Sagen E, Nelzén O, Peeker R. Transurethral resection of the prostate: fate of the non-responders. Scand J Urol 2020; 54:443-448. [PMID: 32885703 DOI: 10.1080/21681805.2020.1812712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) has been the standard method of surgical management of benign prostatic enlargement for decades. Some patients experience significant voiding dysfunction and discomfort postoperatively, without any apparent clinical complications from the procedure. Furthermore, a significant proportion of men still require postoperative catheterisation. This study analysed patients defined as non-responders after TURP with the principal aim to reveal their fate. METHODS A prospectively recruited cohort of 355 men, who underwent TURP during 2010-2012, was investigated. Non-responders were identified as still requiring catheterisation postoperatively and/or exhibiting all of the following voiding outcomes based on the de Wildt criteria: IPSS > 7, bother score > 2, Qmax < 15 mL/s and PVR > 100 mL. The non-responders were followed for a maximum period of three years using retrospective chart reviews. RESULTS Thirty-five men were defined as non-responders. Of these, 26 men were operated on due to urinary retention and nine men due to bothersome symptoms. The non-responders were followed for a mean time of 72 months. Seven men underwent a redo-TURP and two men a bladder neck incision. Eleven of the 35 men were finally judged as having satisfactory voiding parameters. Sixteen men used CISC. Eleven men reduced the frequency of CISC to a minimum. Seven men had to use an indwelling catheter indefinitely. CONCLUSION Men with preoperative urinary retention constituted the vast majority of non-responders. The use of postoperative urodynamic studies was remarkably low. Almost one in three non-responders finally had a satisfactory outcome with or without re-intervention.
Collapse
Affiliation(s)
- Erik Sagen
- Research and Development Centre, NU Hospital Group, Uddevalla, Sweden.,Research and Development Centre, Hospital of Skaraborg, Skövde, Sweden.,Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Olle Nelzén
- Research and Development Centre, Hospital of Skaraborg, Skövde, Sweden
| | - Ralph Peeker
- Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy, Gothenburg, Sweden
| |
Collapse
|
16
|
Al Rawashdah SF, Pastore AL, Velotti G, Fuschi A, Capone L, Suraci PP, Martoccia A, Saltarelli A, Minucci S, Falsaperla M, Al Salhi Y, Illiano E, Costantini E, Carbone A. Sexual and functional outcomes of prostate artery embolisation: A prospective long-term follow-up, large cohort study. Int J Clin Pract 2020; 74:e13454. [PMID: 31769906 DOI: 10.1111/ijcp.13454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 01/28/2023] Open
Abstract
AIM OF THE STUDY Among minimally invasive procedures for treating benign prostate hyperplasia (BPH) prostate artery embolisation (PAE) is described as safe and effective. Aim of this study is to report our results, focusing on sexual outcomes (erectile and ejaculatory functions sparing) of PAE in patients suffering from bladder outlet obstruction (BOO) secondary to BPH. METHODS We prospectively enrolled and submitted to PAE subjects suffering from BOO secondary to BPH. All patients were not suitable for surgery or declined invasive approaches. All subjects were preoperatively and postoperatively (3, 6, 12 and 18 months after) evaluated by urinary flowmetry, post voiding residual volume, prostate volume, serum PSA levels, International Index of Erectile Function, International Prostate Symptom Score and QoL scores. RESULTS PAE was performed in 147 patients (mean age 72.5 y.o.). PAE was technically successful in all patients. The procedure lasted a mean time of 94.3 minutes, with a mean fluoroscopic time of 42.5 minutes. Twelve months follow-up data were available for all patients, while 126 patients (85%) completed the 18 months follow up. At 12 months follow up, the mean IPSS and QoL scores significantly decreased, and all the objective parameters (mean Qmax, PVR and prostate volume) reported a significant improvement. A total of 130 patients (88.5%) at 12 months reported the antegrade ejaculation preserved, and a slight not significant improvement of IIEF scores. The 18 months after PAE outcomes confirmed the significant improvement of all the variables evaluated (even for PSA values and IIEF scores). No major complications occurred. CONCLUSIONS Our results evidence prostate artery embolisation as highly feasible and safe procedure with interesting outcomes. In particular, in our study PAE reported promising results in preserving antegrade ejaculation and erectile function. Our data are in line with the literature, confirming how PAE reduces obstructive symptoms in BPH patients not suitable or refusing standard surgical approaches.
Collapse
Affiliation(s)
| | - Antonio Luigi Pastore
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Gennaro Velotti
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Lorenzo Capone
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Pietro Paolo Suraci
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Alessia Martoccia
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | | | - Sergio Minucci
- Radiology Unit, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Yazan Al Salhi
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| | - Ester Illiano
- Department of Urology, AOU Santa Maria Terni, University of Perugia, Terni, Italy
| | | | - Antonio Carbone
- Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy
| |
Collapse
|
17
|
Braga A, Serati M, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Finazzi Agrò E. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 2 - Male and neurogical population. MINERVA UROL NEFROL 2019; 72:187-199. [PMID: 31166102 DOI: 10.23736/s0393-2249.19.03447-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent studies in literature, have raised some doubts on the routine use of urodynamic testing. Many physicians and articles recommend a selective use of this tool, considering carefully risks and benefits. These recommendations are intended to guide clinicians in the right selection of the male and neurological patients to submit to a urodynamic evaluation. This is the second part of a previous article regarding the urodynamic recommendations in the female population. We reviewed the literature, regarding the use of UDS in male and neurological population with lower urinary tract symptoms (LUTS). Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and urogynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in male and neurological population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with LUTS, and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
Collapse
Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Ester Illiano
- Division of Urology and Andrology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | | |
Collapse
|
18
|
Prostate artery embolisation: an initial experience from an Indian perspective. Pol J Radiol 2019; 83:e554-e559. [PMID: 30800193 PMCID: PMC6384402 DOI: 10.5114/pjr.2018.81318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/09/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose The study aims to report our very early experience with prostate artery embolisation in patients with benign prostatic hypertrophy (BPH) in an Indian setting. Material and methods This prospective study was approved by the Institutional Ethical Review Board, and informed consent was obtained from all the patients. Four patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent prostate embolisation. Embolisation was performed using polyvinyl alcohol (PVA) particles. International Prostate Symptom Score (IPSS), quality of life (QOL) score, postvoid residual volume, and prostate volume was recorded in each patient for 12 months. No major complications were seen in any patient. Results Four patients with a mean age of 74.2 years underwent prostate artery embolisation. It was successful in all the cases. Bilateral embolisation was performed in three patients and unilateral approach in one patient. Clinical improvement was characterised by a mean prostate volume reduction of 22% and mean IPSS reduction of 30% at 12-month follow-up. Conclusions The initial experience with prostate embolisation has been very rewarding and is a great alternative treatment for BPH. It is a very safe and effective procedure and can be an ideal procedure from an Indian perspective.
Collapse
|
19
|
Averbeck MA, de Lima NG, Motta GA, Beltrão L, Abboud NJ, Rigotti CP, Dos Santos WN, Dos Santos SKJ, da Silva LFB, Rhoden EL. Oxidative stress in the bladder of men with LUTS undergoing open prostatectomy: a pilot study. Int Braz J Urol 2019; 44:1182-1193. [PMID: 30325606 PMCID: PMC6442189 DOI: 10.1590/s1677-5538.ibju.2018.0127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 08/12/2018] [Indexed: 02/08/2023] Open
Abstract
Purpose: This study aims to evaluate the link between preoperative parameters and oxidative stress (OS) markers in the bladder wall of men undergoing open prostatectomy. Materials and Methods: From July 2014 to August 2016, men aged ≥ 50 years and presenting with LUTS were prospectively enrolled. Preoperative assessment included validated questionnaires (IPSS and OAB - V8), lower urinary tract ultrasound and urodynamics. Bladder biopsies were taken during open prostatectomy for determination of OS markers. Increased OS was defined by increased concentration of malondialdehyde (MDA) and / or decreased concentration of antioxidant enzymes (superoxide dismutase and / or catalase). P<0.05 was regarded as statistically significant. Results: Thirty - eight consecutive patients were included. Mean age was 66.36 ± 6.44 years, mean prostate volume was 77.7 ± 20.63 cm3, and mean IPSS was 11.05 ± 8.72 points. MDA concentration was increased in men with severe bladder outlet obstruction (BOO grade V - VI according to the Schaefer's nomogram) in comparison with BOO grade III - IV (p = 0.022). Patients with severe LUTS also had higher MDA concentration when compared to those with mild LUTS (p = 0.031). There was a statistically significant association between increased post - void residual urine (cut off ≥ 50 mL) and not only higher levels of MDA, but also reduced activity of SOD and catalase (p < 0.05). Conclusions: This pilot study showed that severity of LUTS and BOO were associated with increased MDA concentration in the bladder wall of men undergoing open prostatectomy. Further studies are still needed to assess the role of non - invasive biomarkers of OS in predicting bladder dysfunction in men with LUTS.
Collapse
Affiliation(s)
- Marcio Augusto Averbeck
- Departamento Pós-graduação em Ciências da Saúde da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil.,Serviço de Urologia, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brasil.,Serviço de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | | | - Gabriela Almeida Motta
- Departamento Pós-graduação em Ciências da Saúde da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Lauro Beltrão
- Serviço de Urologia, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brasil
| | - Nury Jafar Abboud
- Serviço de Urologia, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brasil
| | | | | | | | | | - Ernani Luis Rhoden
- Serviço de Urologia, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brasil.,Serviço de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.,Disciplina de Urologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| |
Collapse
|
20
|
Sagen E, Hedelin H, Nelzén O, Peeker R. Defining and discriminating responders from non-responders following transurethral resection of the prostate. Scand J Urol 2019; 52:437-444. [DOI: 10.1080/21681805.2018.1536677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Erik Sagen
- Department of Urology, Hospital of Skaraborg, Skövde, Sweden
- Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Hans Hedelin
- Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Olle Nelzén
- Research and Development Centre, Hospital of Skaraborg, Skövde, Sweden
| | - Ralph Peeker
- Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Sweden
| |
Collapse
|
21
|
Transurethral resection of the prostate with preservation of the bladder neck decreases postoperative retrograde ejaculation. Wideochir Inne Tech Maloinwazyjne 2018; 14:96-101. [PMID: 30766635 PMCID: PMC6372866 DOI: 10.5114/wiitm.2018.79536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/07/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Even though transurethral resection of the prostate (TURP) is the standard surgical treatment for benign prostatic hyperplasia (BPH), there is a high rate of postoperative retrograde ejaculation. Aim To evaluate the effectiveness of TURP with preservation of the bladder neck in comparison with that of standard TURP. Material and methods This is a retrospective study. 137 men with BPH were divided into two groups: TURP with preservation of the bladder neck and standard TURP were performed respectively in group A and group B. The patients were evaluated preoperatively and at 3, 6 and 12 months after surgery by International Prostate Symptom Score (IPSS), health-related quality of life (HRQL) score, maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR) and the rate of complications including retrograde ejaculation. Results There was no statistically significant difference between groups in terms of the operative duration, catheterization period, hemoglobin decrease, and hospital stay. At the 3-month follow-up, the rates of incontinence and retrograde ejaculation in group A were lower than those in group B. At the 6- and 12-month follow-ups, the difference in the frequency of retrograde ejaculation remained constantly stable whereas the incontinence rates were similar in both groups. The IPSS, HRQL score, Qmax, PVR and the rate of complications including hematuria, clot retention, urinary tract infection, urethral stricture, and bladder neck contracture evaluated at 3, 6 and 12 months also displayed a very similar response in the two groups. Conclusions Comparable with standard TURP, TURP with preservation of the bladder neck appears to provide a satisfactory clinical outcome in decreasing early postoperative incontinence and lowering the rate of retrograde ejaculation.
Collapse
|
22
|
Rantell A, Lu Y, Averbeck MA, Badawi JK, Rademakers K, Tarcan T, Cardozo L, Djurhuus JC, Castro-Diaz D. What is the utility of urodynamics, including ambulatory, and 24 h monitoring, in predicting upper urinary tract damage in neuro-urological patients and other lower urinary tract dysfunction? ICI-RS 2017. Neurourol Urodyn 2018; 37:S25-S31. [PMID: 30024052 DOI: 10.1002/nau.23599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/28/2018] [Indexed: 01/30/2023]
Abstract
AIMS This article focuses on how, and if, urodynamics can help to identify which kidneys are in danger of deteriorating in function and also gives recommendations for future research. METHODS At the International Consultation on Incontinence-Research Society (ICI-RS) in 2017, a multi-disciplinary group presented a literature search of what is known about the utility of Urodynamics, including ambulatory, and 24 h monitoring, in predicting upper urinary tract damage in neuro-urological patients and other lower urinary tract dysfunctions. Wider discussions regarding knowledge gaps, and ideas for future research ensued and are presented in this paper along with a review of the evidence. RESULTS The current treatment strategy both in congenital and acquired neurogenic bladder is rather aggressive and successful when addressing hazards to kidney function. This article has highlighted uncertainties concerning the use of 40 cmH2O DLPP and even the lower value of 20. The current literature suggests that patients with spina bifida and those with spinal cord injury have a higher risk of developing upper urinary tract damage and kidney function impairment than those with multiple sclerosis. CONCLUSIONS Future research should focus on less invasive methods to assess the risk to the upper and lower urinary tract such as urine and serum measurements of cytokines that are involved in the pathophysiology of urinary tract impairment.
Collapse
Affiliation(s)
| | - Yutao Lu
- Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Jasmin K Badawi
- Depertment of Urology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - Kevin Rademakers
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tufan Tarcan
- School of Medicine, Marmara University, İstanbul, Turkey
| | | | - Jens C Djurhuus
- Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - David Castro-Diaz
- Hospital Universitario de Canarias, Universidad de La Laguna, Canary Islands, Spain
| |
Collapse
|
23
|
Effect of urodynamic preoperative detrusor overactivity on the outcomes of transurethral surgery in patients with male bladder outlet obstruction: a systematic review and meta-analysis. World J Urol 2018; 37:529-538. [PMID: 30006907 DOI: 10.1007/s00345-018-2402-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/05/2018] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the effect of urodynamic detrusor overactivity (DO) on the outcomes of transurethral surgery in patients with male bladder outlet obstruction (BOO). MATERIALS AND METHODS We systematically searched the PubMed, Embase, and Cochrane Library databases for articles published between January 1989 and June 2017. All results of eligible studies were synthesized. RESULTS Nine articles met the eligibility criteria. These studies included a total of 932 patients with a median number of 92 patients per study (range 40-190). Of the nine studies, the conventional transurethral prostatectomy was adopted in four studies, photoselective vaporization of prostate in three studies, and other surgical modalities in two studies. In patients with DO positive, the pooled mean difference (MD) was not significant for a better or poorer improvement in the International Prostate Symptom Score [pooled MD, - 0.27; 95% confidence interval (CI), - 1.75 to 1.22; studies, 9; participants, 827], quality-of-life score (pooled MD, - 0.14; 95% CI, - 0.46 to 0.18; studies, 7; participants, 734), maximal flow rate (pooled MD, 0.79; 95% CI, - 1.57 to 3.14; studies, 8; participants, 781), and post-void residual volume (pooled MD, 2.81; 95% CI, - 4.70 to 10.32; studies, 6; participants, 509) compared to patients with DO negative. Some comparisons showed between-study heterogeneity despite the strict criteria of the eligible studies. However, there was no clear evidence of publication bias in the funnel plots. CONCLUSIONS Our meta-analysis results demonstrated that preoperative urodynamic DO has no diagnostic role in the prediction of surgical outcomes in patients with male BOO.
Collapse
|
24
|
|
25
|
Urethral stricture disease after bipolar prostatectomy: Is it a concern? AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
26
|
Park S, Kwon T, Park S, Moon KH. Efficacy of Holmium Laser Enucleation of the Prostate in Patients with a Small Prostate (≤30 mL). World J Mens Health 2017; 35:163-169. [PMID: 29164833 PMCID: PMC5746487 DOI: 10.5534/wjmh.17011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/14/2017] [Accepted: 08/23/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose We investigated the effects of holmium laser enucleation of the prostate (HoLEP) in patients with a small prostate (≤30 mL) in whom medical treatment was ineffective. Materials and Methods Data from 132 patients who underwent HoLEP by a single surgeon between 2012 and 2015 were retrospectively analyzed. All patients received benign prostatic hyperplasia medication for at least 6 months before surgery. The patients were divided into 2 groups according to prostate size: group 1, ≤30 mL (n=30); and group 2, >30 mL (n=102). Clinical characteristics and the International Prostate Symptom Score (IPSS), including quality of life (QoL), peak urinary flow rate (Qmax), and postvoid residual urine (PVR), before surgery and 3 months postoperatively, were compared between the 2 groups. Results In group 1, the IPSS, QoL, and PVR significantly decreased and the Qmax significantly increased 3 months after surgery. The voiding subscore also significantly decreased 3 months after surgery (p<0.001), but the storage subscore was not significantly different (p=0.055). In group 2, hemoglobin, the IPSS, QoL, and PVR significantly decreased and the Qmax significantly increased 3 months after surgery. In these patients, both the storage subscore and voiding subscore significantly decreased after surgery (both p<0.001). There were no significant differences between the groups in hemoglobin, IPSS, QoL, Qmax, and PVR either before or 3 months after surgery. Conclusions When other medical treatments are ineffective, HoLEP is an effective intervention for patients with a small prostate.
Collapse
Affiliation(s)
- Sejun Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Taekmin Kwon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyung Hyun Moon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. urofirst@hanm ail.net
| |
Collapse
|
27
|
Kaplan SA. Re: Analysis of Risk Factors Leading to Postoperative Urethral Stricture and Bladder Neck Contracture following Transurethral Resection of Prostate. J Urol 2017; 198:720-721. [PMID: 28905747 DOI: 10.1016/j.juro.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
28
|
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
| |
Collapse
|
29
|
Gerullis H, Eitzen A, Uphoff J, Daaboul F, Chavan A, Ermert L, Wawroschek F, Winter A. Recurrent symphysitis culminating in pelvic ring fracture after hyperextended transurethral prostate resection and vaporization with symphysis erosion: a case report. J Med Case Rep 2017; 11:141. [PMID: 28521832 PMCID: PMC5437573 DOI: 10.1186/s13256-017-1292-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/11/2017] [Indexed: 11/13/2022] Open
Abstract
Background Short-term and long-term complications of transurethral prostate resection can be different in nature. Capsule perforation and subsequent fistulation after resection and electrovaporization is seldom reported in the literature. Case presentation Here we report the case of a 79-year-old caucasian man with capsule perforation after transurethral prostate resection and electrovaporization resulting in a severe and recurrent symphysitis and subsequent pelvic ring fracture. The bladder-symphysis fistulation was surgically removed and additional orthopedic surgery could be avoided after definitely solving the urological problem. Conclusions Urologists should be aware of rare complications after transurethral resection and electrovaporization of the prostate.
Collapse
Affiliation(s)
- Holger Gerullis
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany.
| | - Arne Eitzen
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
| | - Jens Uphoff
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
| | - Fadi Daaboul
- Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Oldenburg, Germany
| | - Ajay Chavan
- Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Oldenburg, Germany
| | | | - Friedhelm Wawroschek
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
| | - Alexander Winter
- School of Medicine and Health Sciences, University Hospital for Urology, Klinikum Oldenburg, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany
| |
Collapse
|
30
|
Benign Prostatic Obstruction Relief in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Enlargement Undergoing Endoscopic Surgical Procedures or Therapy with Alpha-Blockers: A Review of Urodynamic Studies. Adv Ther 2017; 34:773-783. [PMID: 28255867 DOI: 10.1007/s12325-017-0504-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 01/22/2023]
Abstract
Benign prostatic obstruction (BPO) contributes to the genesis of lower urinary tract symptoms as well as to pathologic remodeling of the lower and upper urinary tract in patients with benign prostate enlargement. Urodynamic studies demonstrate that both medical therapy with alpha-blockers (ABs) and endoscopic surgical procedures provide BPO relief. However, the magnitude of improvement is higher after surgery. Among ABs, silodosin is associated with the highest improvement of bladder outlet obstruction index (BOOI). A complex relationship exists between BOOI improvement and variations of both maximum urinary flow (Q max) and detrusor pressure. When the reduction of BOOI is small, the improvement of Q max is clinically irrelevant and the BOOI is mainly influenced by a decrease of detrusor pressure. In contrast, when the magnitude of BOOI reduction is robust, a meaningful improvement of both detrusor pressure and urinary flow is evident. When clustering ABs according to their receptor pharmacologic selectivity and urodynamic efficacy, three subgroups can be identified,with silodosin being the only member of a subgroup characterized by the highest levels of BOOI improvement and α-1A/α-1B receptor affinity ratio.
Collapse
|
31
|
Tao H, Jiang YY, Jun Q, Ding X, Jian DL, Jie D, Ping ZY. Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate. Int Braz J Urol 2017; 42:302-11. [PMID: 27256185 PMCID: PMC4871391 DOI: 10.1590/s1677-5538.ibju.2014.0500] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 05/04/2015] [Indexed: 02/20/2024] Open
Abstract
Purpose: To determine risk factors of postoperative urethral stricture (US) and vesical neck contracture (BNC) after transurethral resection of prostate (TURP) from perioperative parameters. Materials and Methods: 373 patients underwent TURP in a Chinese center for lower urinary tract symptoms suggestive of benign prostatic obstruction (LUTS/BPO), with their perioperative and follow-up clinical data being collected. Univariate analyses were used to determine variables which had correlation with the incidence of US and BNC before logistic regression being applied to find out independent risk factors. Results: The median follow-up was 29.3 months with the incidence of US and BNC being 7.8% and 5.4% respectively. Resection speed, reduction in hemoglobin (ΔHb) and hematocrit (ΔHCT) levels, incidence of urethral mucosa rupture, re-catheterization and continuous infection had significant correlation with US, while PSA level, storage score, total prostate volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), resection time and resected gland weight had significant correlation with BNC. Lower resection speed (OR=0.48), urethral mucosa rupture (OR=2.44) and continuous infection (OR=1.49) as well as higher storage score (OR=2.51) and lower TPV (OR=0.15) were found to be the independent risk factors of US and BNC respectively. Conclusions: Lower resection speed, intraoperative urethral mucosa rupture and postoperative continuous infection were associated with a higher risk of US while severer storage phase symptom and smaller prostate size were associated with a higher risk of BNC after TURP.
Collapse
Affiliation(s)
- Huang Tao
- Department of Urology, Anhui Provincial Hospital,Hefei, Anhui, China
| | - Yu Yong Jiang
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Jun
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu Ding
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Duan Liu Jian
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding Jie
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhu Yu Ping
- Department of Urology, Anhui Provincial Hospital,Hefei, Anhui, China
| |
Collapse
|
32
|
Abstract
Lower urinary tract symptoms (LUTS) are a common problem in men especially with aging. The International Continence Society (ICS) revealed an overall prevalence of LUTS of about two-thirds of men age 40 years and above. The treatment approach depends on accurate determination of the underlying etiology. LUTS is not unique to benign prostate enlargement (BPE) and can be secondary to other causes. In the era where quality of care is important, accurate diagnosis and counseling to meet patients' expectations is of extreme paramount. Thus, proper assessment of patients who present with BPE and LUTS should be an important part of the work up process. Accurate diagnosis and identification of the cause will help to improve quality of treatment, optimize counseling, and improve treatment outcomes. Pressure flow urodynamic studies (PFUDs) are not only important tools that help to identify the underlying causes of LUTS; it is considered the "gold standard" for diagnosis of bladder outlet obstruction (BOO) in patients with enlarged prostate [1, 2]. However, there is a continuous debate on the value of using PFUDs and its association with improved outcomes.
Collapse
|
33
|
[S2e guideline of the German urologists: Instrumental treatment of benign prostatic hyperplasia]. Urologe A 2016; 55:195-207. [PMID: 26518304 DOI: 10.1007/s00120-015-3983-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.
Collapse
|
34
|
Mirakhur A, McWilliams JP. Prostate Artery Embolization for Benign Prostatic Hyperplasia: Current Status. Can Assoc Radiol J 2016; 68:84-89. [PMID: 27887933 DOI: 10.1016/j.carj.2016.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/04/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022] Open
Abstract
Prostate artery embolization has garnered much attention as a promising treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. We aim to provide an up-to-date review of this minimally invasive technique, including discussion of potential benefits and technical challenges. Current evidence suggests it is a safe and effective option for patients with medication-refractory urinary obstructive symptoms who are poor surgical candidates or refuse surgical therapy. Larger, randomized studies with long-term follow-up data are needed for this technique to be formally established in the treatment paradigm for benign prostatic hyperplasia.
Collapse
Affiliation(s)
- Anirudh Mirakhur
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Justin P McWilliams
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA.
| |
Collapse
|
35
|
Heydari F, Rezadoust B, Abbaszade S, Jahan Afrouz E, Ghadian A. The Value of Urodynamic Study for Diagnosing the Causes of Lower Urinary Tract Symptoms in Male Patients: A Study From Iran. Nephrourol Mon 2016; 8:e34342. [PMID: 27703952 PMCID: PMC5039782 DOI: 10.5812/numonthly.34342] [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: 11/03/2015] [Revised: 02/23/2016] [Accepted: 04/06/2016] [Indexed: 11/16/2022] Open
Abstract
Background Most disorders of the lower urinary tract are functional, so diagnoses are typically based on urodynamic findings. Treatment is likely to fail if the pathology is not correctly diagnosed. Objectives There are various diagnostic tests for lower urinary tract symptoms (LUTS). In this study, we evaluated the value of urodynamic testing to diagnose the causes of lower urinary symptoms in male patients. Patients and Methods Urodynamic tests were performed in 407 patients referred to the urology clinic in Baqiyatallah in 2014 with complaints of LUTS, and the diagnosis was based on the findings of the tests. Results The mean age of patients in this study was 50.88 years, and most patients were in their third decade (20 - 30 years of age). Urinary frequency (28.8%), enuresis (22.22%), and incontinence (16.12%) were the most common complaints. The most prevalent disorder was bladder sensation disorder. Conclusions Patients made various complaints, and several pathologies were diagnosed, which emphasizes the importance of using urodynamic tests for subsequent medical approaches as a non-invasive, accessible, and inexpensive tool.
Collapse
Affiliation(s)
- Fatemeh Heydari
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Bentolhoda Rezadoust
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Shahin Abbaszade
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Eidi Jahan Afrouz
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Alireza Ghadian
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Alireza Ghadian, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2181262073, Fax: +98-2181262073, E-mail:
| |
Collapse
|
36
|
Shaker M, Abd El Tawab KA, Abd El Tawab KH, El-Gharib M. Role of prostatic artery embolization in management of symptomatic benign prostatic hyperplasia. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
37
|
Jiang YH, Liao CH, Kuo HC. Role of Bladder Dysfunction in Men with Lower Urinary Tract Symptoms Refractory to Alpha-blocker Therapy: A Video-urodynamic Analysis. Low Urin Tract Symptoms 2016; 10:32-37. [PMID: 27366877 DOI: 10.1111/luts.12139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/23/2016] [Accepted: 04/10/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Lower urinary tract symptoms (LUTS) in men result from a complex interplay of pathophysiology, including bladder and bladder outlet dysfunction. This study retrospectively analyzed bladder dysfunction in men with LUTS based on the results of video-urodynamic studies (VUDS). METHODS Male patients (aged ≥40 years), with LUTS and an International Prostate Symptom Score of 8 or more, who were refractory to alpha-blocker treatment were retrospectively recruited and evaluated with VUDS and total prostate volume (TPV). Patients were further divided into subgroups of bladder dysfunction and bladder outlet dysfunction according to characteristic VUDS findings. Age, TPV and VUDS findings were compared among different subgroups. RESULTS After VUDS, bladder outlet obstruction (BOO) was only noted in 48.6% of men. Of patients, 919 of 2991 (30.7%) had bladder dysfunction including detrusor underactivity (DU, 5.1%), detrusor overactivity and inadequate contractility (DHIC, 5.3%), detrusor overactivity (DO, 17%) and hypersensitive bladder (HSB, 3.3%). In addition, 1941 (64.9%) had bladder outlet dysfunction including BOO + DO (33.8%), BOO alone (14.8%), and poor urethral sphincter relaxation (PRES, 16.3%). Among the 1519 patients with DO, 66.6% (1012) had BOO while, among 1454 patients with BOO, 69.5% (1010) had DO. Patients with DHIC, DU and DO were 5 years older than patients with HSB and normal men. TPV was significantly smaller in patients with DHIC, DU and DO as compared with BOO + DO. CONCLUSION Approximately one-third of male LUTS was due to bladder dysfunction. A man older than 70 years with LUTS and TPV less than 30 mL usually indicates the presence of bladder dysfunction rather than BOO.
Collapse
Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Chun-Hou Liao
- Department of Urology, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
38
|
Cho MC, Ha SB, Park J, Son H, Oh SJ, Kim SW, Paick JS. Impact of Detrusor Underactivity on Surgical Outcomes of Laser Prostatectomy: Comparison in Serial 12-Month Follow-Up Outcomes Between Potassium-Titanyl-Phosphate Photoselective Vaporization of the Prostate (PVP) and Holmium Laser Enucleation of the Prostate (HoLEP). Urology 2016; 91:158-66. [PMID: 26879733 DOI: 10.1016/j.urology.2015.11.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate impacts of preoperative detrusor underactivity (DU) on outcomes of photoselective vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia, and to compare them between the two surgeries. MATERIALS AND METHODS A total of 1423 men, who underwent PVP (group A) or HoLEP (group B), were categorized into four groups: A1 (239 without DU), A2 (432 with DU), B1 (329 without DU), and B2 (423 with DU). DU was defined as bladder contractility index of <100. Outcomes were assessed at 1, 3, 6, and 12 months postoperatively using International Prostate Symptom Score (IPSS), uroflowmetry, and prostate-specific antigen. Successful outcome was defined as reductions by ≥50% of total IPSS at 12 months postoperatively. RESULTS In all four groups, almost all parameters of IPSS and uroflowmetry improved starting from 1 month. A1 or B1 had greater increases in maximum flow rate than A2 or B2. Decreases of total IPSS in A2 were less than in A1 starting from 1 month after PVP, whereas those in B2 were less than those in B1 as late as 12 months after HoLEP. B2 showed greater improvements in maximum flow rate, subtotal voiding symptom score, bladder voiding efficiency, and total IPSS than A2. In all patients, multivariate regression analysis revealed that the absence of DU, presence of bladder outlet obstruction, and higher baseline total IPSS were independent predictors of successful outcome after surgery, but the type of laser surgery (PVP vs HoLEP) was not. CONCLUSION Our data suggest that micturition symptoms, maximum flow rate, bladder voiding efficiency, and quality of life improve starting from the early period after PVP or HoLEP, irrespective of DU. However, patients with DU may have less degree of improvement in micturition after PVP or HoLEP than those without DU.
Collapse
Affiliation(s)
- Min Chul Cho
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seung Beom Ha
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo Woong Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Huang T, Yu YJ, Qi J, Xu D, Duan LJ, Ding J, Zhu YP. Establishment and value assessment of efficacy prediction model about transurethral prostatectomy. Int J Urol 2015; 22:854-60. [PMID: 26059608 DOI: 10.1111/iju.12836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 05/04/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish and to evaluate discriminant models to predict the outcomes of transurethral prostatectomy. METHODS Clinical data of patients treated with transurethral prostatectomy between January and December 2013 were collected, including medical history, symptoms, biochemical tests, ultrasonography and urodynamics. Surgical efficacy was evaluated at 6-month follow up. Predictive models were constructed by logistic regression. Receiver operating characteristic curve and diagnostic tests were used to test the accuracy of models before the predictive value between models was compared. RESULTS A total of 182 patients were included, with 73.6% having an effective outcome. History of recurrent urinary tract infection (OR 1.33), score of storage phase (OR 2.58), maximum flow rate (OR 2.11) and detrusor overactivity (OR 3.13) were found to be risk factors. International Prostate Symptom Score (OR 0.13), transitional zone index (OR 0.58), resistive index of prostatic artery (OR 0.46), bladder wall thickness (OR 0.78), ultrasonic estimation of bladder weight (OR 0.28), bladder outlet obstruction index (OR 0.20) and bladder contractility index (OR 0.83) were found to be protective factors. The areas under the curve of models using factors from ultrasonography and urodynamics were 0.792 and 0.829 respectively, with no significant difference being found between them (P = 0.348). CONCLUSIONS Surgical efficacy of transurethral prostatectomy is positively correlated to severe voiding phase symptoms, outlet obstruction and better detrusor contractility, and negative correlated with urinary infection, severe storage phase symptoms and excessive detrusor contractibility. Ultrasonography might replace urodynamics in selecting patients for whom transurethral prostatectomy is more likely to be beneficial.
Collapse
Affiliation(s)
- Tao Huang
- Department of Urology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Yong Jiang Yu
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Jun Qi
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Ding Xu
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Liu Jian Duan
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Jie Ding
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Yu Ping Zhu
- Department of Urology, Anhui Provincial Hospital, Hefei, Anhui, China
| |
Collapse
|
41
|
Urodynamics in Male Lower Urinary Tract Symptoms. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0299-2] [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]
|
42
|
Fathy HM, Hussein HA, Salem HK, Azab SS, ElFayoumy HM. Transurethral bipolar prostatectomy: Where do we stand now? World J Clin Urol 2015; 4:64-67. [DOI: 10.5410/wjcu.v4.i1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/11/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023] Open
Abstract
Transurethral resection of the prostate (TURP) is considered the gold standard surgical treatment of symptomatic benign prostatic hyperplasia. TURP has gained ground in urologic centers of excellence for its effective long term results with low incidence of complications. Far away from excellence, it associated with blood loss, and TUR syndrome particularly in patients with larger prostates. For this reasons, many minimally invasive new techniques have been implemented in recent years. Bipolar technique has recently been introduced, to minimize the complications of the standard TURP technique.
Collapse
|
43
|
Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, Oelke M, Tikkinen KAO, Gravas S. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol 2015; 67:1099-1109. [PMID: 25613154 DOI: 10.1016/j.eururo.2014.12.038] [Citation(s) in RCA: 611] [Impact Index Per Article: 67.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/26/2014] [Indexed: 11/25/2022]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) represent one of the most common clinical complaints in adult men and have multifactorial aetiology. OBJECTIVE To develop European Association of Urology (EAU) guidelines on the assessment of men with non-neurogenic LUTS. EVIDENCE ACQUISITION A structured literature search on the assessment of non-neurogenic male LUTS was conducted. Articles with the highest available level of evidence were selected. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS As a routine part of the initial assessment of male LUTS, a medical history must be taken, a validated symptom score questionnaire with quality-of-life question(s) should be completed, a physical examination including digital rectal examination should be performed, urinalysis must be ordered, post-void residual urine (PVR) should be measured, and uroflowmetry may be performed. Micturition frequency-volume charts or bladder diaries should be used to assess male LUTS with a prominent storage component or nocturia. Prostate-specific antigen (PSA) should be measured only if a diagnosis of prostate cancer will change the management or if PSA can assist in decision-making for patients at risk of symptom progression and complications. Renal function must be assessed if renal impairment is suspected from the history and clinical examination, if the patient has hydronephrosis, or when considering surgical treatment for male LUTS. Uroflowmetry should be performed before any treatment. Imaging of the upper urinary tract in men with LUTS should be performed in patients with large PVR, haematuria, or a history of urolithiasis. Imaging of the prostate should be performed if this assists in choosing the appropriate drug and when considering surgical treatment. Urethrocystoscopy should only be performed in men with LUTS to exclude suspected bladder or urethral pathology and/or before minimally invasive/surgical therapies if the findings may change treatment. Pressure-flow studies should be performed only in individual patients for specific indications before surgery or when evaluation of the pathophysiology underlying LUTS is warranted. CONCLUSIONS These guidelines provide evidence-based practical guidance for assessment of non-neurogenic male LUTS. An extended version is available online (www.uroweb.org/guidelines). PATIENT SUMMARY This article presents a short version of European Association of Urology guidelines for non-neurogenic male lower urinary tract symptoms (LUTS). The recommended tests should be able to distinguish between uncomplicated male LUTS and possible differential diagnoses and to evaluate baseline parameters for treatment. The guidelines also define the clinical profile of patients to provide the best evidence-based care. An algorithm was developed to guide physicians in using appropriate diagnostic tests.
Collapse
Affiliation(s)
- Christian Gratzke
- Department of Urology, Urologische Klinik und Poliklinik, Klinikum der Universität München-Grosshadern, Munich, Germany
| | | | - Aurelien Descazeaud
- Department of Urology, Dupuytren Hospital, University of Limoges, Limoges, France
| | - Marcus J Drake
- Bristol Urological Institute and School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Kari A O Tikkinen
- Departments of Urology and Public Health, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Stavros Gravas
- Department of Urology, University of Thessaly, Larissa, Greece.
| |
Collapse
|
44
|
Determination of prostate adenoma weight reduction due to vaporisation process occurring during transurethral resection of the prostate. Wideochir Inne Tech Maloinwazyjne 2014; 9:404-8. [PMID: 25337165 PMCID: PMC4198647 DOI: 10.5114/wiitm.2014.44141] [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: 12/04/2013] [Revised: 01/21/2014] [Accepted: 02/28/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Transurethral resection of the prostate (TURP) is regarded as the gold standard surgical treatment for benign prostatic hyperplasia (BPH). The completeness of TURP may be assessed indirectly by estimation of the weight of glandular tissue removed. This parameter is often lower than expected. Tissue vaporisation in the course of TURP could be a contributory cause. Aim To quantitatively evaluate tissue vaporisation occurring in the course of transurethral resection of the prostate and electrovaporisation of the prostate (EVAP) performed under experimental conditions. Material and methods The study was performed on 26 prostate glands removed during retropubic prostatectomy. Immediately following surgery all adenomas were halved and TURP or EVAP were carried out on both halves of each gland for period of 5 min. The amount of prostate tissue which vaporised during EVAP and TURP were calculated. Results The mean weight (± standard deviation) of the adenoma lost due to resection and vaporisation in the TURP group was 10.00 ±2.92 g and 4.26 ±1.59 g, respectively. The latter accounted for 30.10 ±7.71% of total prostate weight reduction. The mean prostate weight lost in the course of EVAP was 5.03 ±1.58 g. Conclusions The vaporisation significantly contributes to the prostate tissue loss occurring during transurethral resection of the prostate.
Collapse
|
45
|
Sinanoglu O, Ekici S, Balci MC, Hazar AI, Nuhoglu B. Comparison of plasmakinetic transurethral resection of the prostate with monopolar transurethral resection of the prostate in terms of urethral stricture rates in patients with comorbidities. Prostate Int 2014; 2:121-6. [PMID: 25325023 PMCID: PMC4186955 DOI: 10.12954/pi.14043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/02/2014] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare urethral stricture rates in comorbid patients undergoing plasmakinetic transurethral resection of the prostate (PK-TURP) and monopolar transurethral resection of the prostate (M-TURP) for benign prostatic hyperplasia. Methods The data of 317 patients with comorbidities undergoing either PK-TURP or M-TURP from September 2008 to December 2012 were retrospectively evaluated. Preoperative and postoperative 12-month International Prostate Symptom Score, maximal flow rate, postoperative International Index of Erectile Function scores, and urethral stricture rates were evaluated. Results A total of 154 patients underwent M-TURP and 163 patients underwent PK-TURP. Urethral stricture rates were 6/154 in the M-TURP treatment arm and 17/163 in the PK-TURP treatment arm (P=0.000). In the presence of hypertension and/or coronary artery disease and/or diabetes mellitus, the risk of urethral stricture complication was significantly higher in the PK-TURP group than in the M-TURP group (P=0.000). Conclusions The risk of urethral stricture increases with PK-TURP in elderly patients with a large prostate and concomitant hypertension and/or coronary artery disease and/or diabetes mellitus. Therefore, PK-TURP should be performed cautiously in this group of benign prostatic hyperplasia patients.
Collapse
Affiliation(s)
- Orhun Sinanoglu
- Department of Urology, Maltepe University School of Medicine, Istanbul, Turkey
| | - Sinan Ekici
- Department of Urology, Maltepe University School of Medicine, Istanbul, Turkey
| | - Mb Can Balci
- Department of Urology, Maltepe University School of Medicine, Istanbul, Turkey
| | - A Ismet Hazar
- Department of Urology, Maltepe University School of Medicine, Istanbul, Turkey
| | - Baris Nuhoglu
- Department of Urology, Maltepe University School of Medicine, Istanbul, Turkey
| |
Collapse
|
46
|
Choi H, Kim JH, Shim JS, Park JY, Kang SH, Moon DG, Cheon J, Lee JG, Kim JJ, Bae JH. Prediction of Persistent Storage Symptoms after Transurethral Resection of the Prostate in Patients with Benign Prostatic Enlargement. Urol Int 2014; 93:425-30. [DOI: 10.1159/000357626] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/25/2013] [Indexed: 11/19/2022]
|
47
|
Management of Lower Urinary Tract Dysfunction in Parkinson’s Disease: a Review of Recent Treatment Options. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
48
|
McWilliams JP, Kuo MD, Rose SC, Bagla S, Caplin DM, Cohen EI, Faintuch S, Spies JB, Saad WE, Nikolic B. Society of Interventional Radiology Position Statement: Prostate Artery Embolization for Treatment of Benign Disease of the Prostate. J Vasc Interv Radiol 2014; 25:1349-51. [DOI: 10.1016/j.jvir.2014.05.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/09/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022] Open
|
49
|
Abstract
Monopolar transurethral resection of the prostate (TURP) with endoscopic electrocautery remains the gold standard surgical technique for benign prostatic hypertrophy (BPH) by which all new procedures are compared. We reviewed the current literature, and international urological guidelines and consensus opinion on various surgical options for BPH and present a brief overview of alternative techniques including bipolar TURP, transurethral incision of the prostate, transurethral vaporization of the prostate, laser prostatectomy (with holmium, thulium and potassium titanyl phosphate greenlight lasers) and open prostatectomy (with mention of new techniques including laparoscopic and robotic prostatectomy). Emerging, experimental and less established techniques are also described including endoscopic heat generation (transurethral microwave thermotherapy, radiofrequency transurethral needle ablation of the prostate, high intensity focused ultrasound, hot water induced thermotherapy, pulsed electromagnetic radiofrequency), injection therapy (transurethral ethanol ablation and botulinum toxin) and mechanical devices (intraprostatic stents and urethral lift devices). Despite a plethora of surgical options, none have realistically improved outcomes in the long-term compared with TURP. Improvements have been made on improving surgical morbidity and time in hospital. Questions remain in this area, including what specific elements of bladder outflow obstruction (BOO) result in damage to the urinary tract, how does BPH contribute to BOO and how much prostate volume reduction is necessary to relieve BOO or lower urinary tract symptoms. Given these unanswered questions and the multitude of procedures available, it is clear that appropriate counselling is necessary in all men who undergo BPH surgery.
Collapse
Affiliation(s)
- Nikesh Thiruchelvam
- Department of Urology, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| |
Collapse
|
50
|
Pöyhönen A, Auvinen A, Häkkinen JT, Koskimäki J, Hakama M, Tammela TLJ. Outcomes of medical and surgical treatment for lower urinary tract symptoms (benign prostatic obstruction)--a population-based cohort study. Int J Clin Pract 2014; 68:349-55. [PMID: 24372641 DOI: 10.1111/ijcp.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare outcome of lower urinary tract symptoms (LUTS) between men with medical and surgical treatment. MATERIALS AND METHODS A questionnaire was mailed to men aged 55, 65 and 75 years living in Tampere region, Finland in 1999 and the survey was repeated in 2004. LUTS were evaluated using DAN-PSS-1 questionnaire. A total of 1679 men (68% of the eligible) responded to both questionnaires. Of them, 114 men reported LUTS at baseline and medical treatment in the repeat survey and 47 men with LUTS had received surgical treatment. Seventy-two men with prostate cancer were excluded. Men with no medical treatment or surgery for LUTS in either questionnaire were included to no-treatment group. RESULTS The men after surgical treatment showed a reduction in all LUTS symptom groups. However, among the medically treated and untreated men, all the symptoms worsened during the follow up. The proportion of symptomatic men after surgery was lower than among the medically treated men. In men with medical treatment, the prevalence of all 12 LUTS increased. Dysuria and postmicturition dribble were the only symptoms that had slightly better results in medical than in surgical treatment group. CONCLUSIONS In this population-based study, operative treatment seemed to relieve LUTS, whereas medical treatment only slowed down their progression. These findings suggest that men with surgical treatment experience a more favourable outcome in LUTS than those receiving medical treatment.
Collapse
Affiliation(s)
- A Pöyhönen
- Department of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland; Keski-Suomi Central Hospital, Jyväskylä, Finland
| | | | | | | | | | | |
Collapse
|