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Haga K, Akagashi K, Tobe M, Uchida K, Honma I, Hirobe E, Ishizaki J, Shimizu T, Nakajima H, Urahama S, Sato Y. One hundred cases of Rezum water vapor thermal therapy for benign prostatic hyperplasia: Real-world data at a single institution in Japan. Int J Urol 2024. [PMID: 39187956 DOI: 10.1111/iju.15558] [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: 04/23/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVE The objective of our study was to assess the efficacy of Rezum, a minimally invasive surgical treatment, for patients with lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) in real-world clinical practice at a single institution in Japan. MATERIALS AND METHODS We conducted a prospective study involving 100 patients who underwent the Rezum procedure between October 2022 and February 2024. We analyzed patient backgrounds that are compliant with Japanese regulations and assessed descriptive outcomes such as symptom scores, peak flow in uroflowmetry, post-void residual (PVR) volume, and prostate volume (PVol). These data were collected at 1 and/or 3 months postoperatively. RESULTS On average, 4.7 water vapor injections were administered during the Rezum procedures, with a mean operative time of 6.3 min. Patients experienced significant relief in symptoms, with reductions of 55% in International Prostate Symptom Score, 53% in quality of life score, and 30% in Overactive Bladder Symptom Score. There was also a significant decrease in mean PVR volume (50% reduction) and PVol (27% reduction). Among the subgroup of 23 pre-interventional catheter-dependent patients, 91% achieved catheter independence. CONCLUSION Our single-center analysis demonstrates that Rezum is an effective and safe minimally invasive therapeutic option for patients with BPH. This promising novel technique can be particularly beneficial for patients at an augmented risk of bleeding or those considered high risk for anesthesia.
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Affiliation(s)
- Kazunori Haga
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
| | | | - Musashi Tobe
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
| | - Kosuke Uchida
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
| | - Ichiya Honma
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
| | - Emi Hirobe
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
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Furumido J, Ozaki N, Matsugase Y, Mori T. Evaluation of learning curves for contact laser vaporization of the prostate using the 980 nm diode laser for benign prostatic hyperplasia. Int J Urol 2024; 31:921-926. [PMID: 38708677 DOI: 10.1111/iju.15488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES We investigated the background of patients who underwent contact laser vaporization of the prostate (CVP) surgery and the learning curve of the operators. METHODS A total of 207 patients who underwent CVP surgery for benign prostatic hyperplasia between August 2018 and March 2023 were included in this study. Patient background, perioperative results, pre- and postoperative urinary flow tests, and complications were collected retrospectively. RESULTS We enrolled 12 doctors who were divided into expert (five doctors) and novice (seven doctors) groups based on the number of TURP experiences before CVP. The median patient age was 73 years (51-92 years) and prostate volume was 56 cc (15-190 cc) with no difference between the expert and novice groups. Complications included urinary retention (eight cases), hematuria (four), urinary tract infection (four), intraoperative perforation (two), and postoperative stricture (one). Both cases of intraoperative perforation occurred in the novice group. The expert group had a significantly shorter operative time (38 vs. 66 min) and a higher operative efficacy of prostate volume divided by operative time (1.43 vs. 0.88 cc/min). Postoperatively, IPSS, quality of life scores, and postvoid residual urine volume decreased, and maximal flow rate increased; however, there was no significant difference between the groups. The expert group showed stable operative time and operative efficacy after about five to eight cases, while the novice group showed stable after about 15 cases. CONCLUSIONS Our findings suggest that CVP was safely performed at our hospital, and operators with limited experience in TURP can achieve stable perioperative results.
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Affiliation(s)
- Jun Furumido
- Department of Urology, Asahikawa Kosei General Hospital, Asahikawa, Hokkaido, Japan
| | - Nariaki Ozaki
- Department of Urology, Asahikawa Kosei General Hospital, Asahikawa, Hokkaido, Japan
| | - Yasukuni Matsugase
- Department of Urology, Asahikawa Kosei General Hospital, Asahikawa, Hokkaido, Japan
| | - Tatsuya Mori
- Department of Urology, Asahikawa Kosei General Hospital, Asahikawa, Hokkaido, Japan
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Saeed A, Aziz W, Basit S, Bari I, Ather MH. Voiding efficiency: a predictor of failed trial off catheter after transurethral resection of prostate. Int Urol Nephrol 2024:10.1007/s11255-024-04128-z. [PMID: 38935322 DOI: 10.1007/s11255-024-04128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Following transurethral resection of the prostate (TURP), there is no clear recommendation for the catheter duration, and objective criteria are needed to determine appropriate time for trial off catheter. Current study is aimed to identify the high-risk patients for failed trial off catheter and the association with preoperative voiding efficiency with postoperative failed trial without catheter. METHODOLOGY This is cross-sectional single institutional study. All eligible patients who underwent TURP were followed preoperatively for symptoms and workup, including voiding efficiency based on ultrasound findings, intraoperatively for resection parameters, and postoperatively for a trial off a catheter. All the findings were documented, and the data were analyzed on SPSS(TM) 22. Demographic variables were calculated in the form of frequency and percentages. The association of voiding efficiency with failed trials off catheters was checked through Chi-square and binary logistic regression analysis. RESULTS 132 patients were included in the study. The mean voiding efficiency was 57.5%. Based on voiding efficiency cut off, of 50%, patients were divided into two groups. The association between voiding efficiency and failed trials off catheters was not found to be statistically significant, with a p value of 0.79. Only prevoid volume, postvoid volume, duration of symptoms, and upper tract damage were found to be statistically significant predictors of failed trial off catheter, with a p value of < 0.05.
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Affiliation(s)
- Aniqa Saeed
- Department of Surgery, Aga Khan University Hospital, Stadium Road, P O X 3500, Karachi, Pakistan.
| | - Wajahat Aziz
- Department of Surgery, Aga Khan University Hospital, Stadium Road, P O X 3500, Karachi, Pakistan
| | - Sana Basit
- Department of Surgery, Aga Khan University Hospital, Stadium Road, P O X 3500, Karachi, Pakistan
| | - Iman Bari
- University of South Wales, South Wales, Australia
| | - M Hammad Ather
- Department of Surgery, Aga Khan University Hospital, Stadium Road, P O X 3500, Karachi, Pakistan
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Maiti K, Dey PK, Pal DK. Short time (10 min) Catheter Traction Following TURP: IS it helpful with less morbidity? Urologia 2024; 91:306-310. [PMID: 38214446 DOI: 10.1177/03915603231222959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Transurethral Resection of Prostate (TURP) is the most common treatment for Benign Prostatic Hyperplasia (BPH). Blood loss during and after transurethral resection of the prostate (TURP) is a potential cause of morbidity and clot retention. Usual practise is to apply traction in every case of TURP to reduce early postoperative hematuria and clot retention. There are very few studies in the literature and they have mainly concentrated on the effect of traction on reducing blood loss but there is scanty data regarding the morbidity associated with the use of traction. Various authors have described their method of traction application. So, in this study, we will compare the result of short term (10 min) traction with standard (4-6 h) traction. MATERIALS AND METHODS It is a prospective comparative study with 50 participants, conducted at the department of Urology of a tertiary care hospital in eastern India after taking ethical clearance and consent from the patient. The patients attending urology O.P.D. with LUTS and diagnosed as BPH and planned for elective TURP and who had prolonged traction after TURP were excluded. Study period was one and the half year. RESULTS Post operatively 25 patients were managed with catheter traction while 25 patients were managed with short term traction of 10 min. Pain which is assessed by visual analog scale (VAS) at 2 and 4 h post operatively is statistically significant with p value of <0.05 and cut off of 65 g prostate volume is drawn below which the successful outcome of short term traction is feasible without any complications. CONCLUSION If hemostatsis is done properly then short term traction is preferable, safe and had fewer complications for prostate volume <65 g in comparison to standard traction TURP comparing the overall factors. Although, VAS score at 2 and 4 h post operatively shows patient experienced less pain even in prostate volume >65 g.
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Affiliation(s)
- Krishnendu Maiti
- Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Pankaj Kanti Dey
- Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Dilip Kumar Pal
- Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
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Carbin DD, Abou Chedid W, Hindley R, Eden C. Outcomes of robot-assisted radical prostatectomy in men after trans-urethral resection of the prostate: a matched-pair analysis. J Robot Surg 2024; 18:158. [PMID: 38568342 DOI: 10.1007/s11701-024-01935-5] [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: 03/15/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
Prior history of transurethral resection of the prostate (TURP) can complicate Robot-assisted radical prostatectomy (RARP). Very few studies analyse the outcomes of RARP in men with a prior history of TURP. We analysed the oncological and functional outcomes of RARP in post-TURP men from our prospectively maintained database. We included the RARP data from January 2016 to January 2022. Thirty men who had RARP with a prior history of TURP were identified (Group 2). They were matched using R software and propensity score matching to 90 men with no previous TURP (Group-1). The groups were matched for age, body mass index (BMI), Gleason score, stage, PSA and D'Amico risk category in a 1:3 ratio. The two-year oncological and functional outcomes were compared. Overall, the study found no significant difference between the groups in the preoperative parameters, such as BMI, age, Gleason grade, clinical stage, PSA, prostate volume, and D'amico risk grouping. There was no difference in the estimated blood loss. The TURP group had a lower chance of having a nerve spare (p = 0.03). The median console time was longer in the TURP group (140 min (120,180) versus 168 (129,190) p = 0.058). The postoperative complications (Clavien-Dindo 3a 2% versus 6.7%) and hospital stay (median of 2 days), positive surgical margins, continence, and biochemical recurrence rates at 3, 12, and 24 months were not statistically different between the groups. In high-volume centres, the oncological and continence outcomes of RARP post-TURP are not inferior to that of men without prior TURP.
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Affiliation(s)
| | - Wissam Abou Chedid
- Department of Urology, Royal Surrey County Hospital, Guildford, GU2 7XX, UK
| | | | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Guildford, GU2 7XX, UK
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Mete UK, Deshpande RS. Confronting urethrorrhagia after Otis urethrotomy: a case report. J Med Case Rep 2023; 17:522. [PMID: 38057872 DOI: 10.1186/s13256-023-04261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Otis urethrotomy can sometimes lead to troublesome bleeding after seemingly uneventful procedures. This case report highlights one such case which went unnoticed initially; the bleeding was erroneously ascribed to the prostate, thereby falsely indicting the "decoy" prostate. CASE PRESENTATION A 78-year-old Asian gentleman was referred to our hospital with complaint of intractable bleeding after undergoing laser enucleation of prostate at another institute, wherein he further underwent unsuccessful bilateral angioembolization of pudendal arteries. On endoscopy (for hemostasis), we found a spurting vessel in the navicular fossa, which was effectively controlled. CONCLUSIONS This case report highlights the importance of performing prompt endoscopy in case of uncontrolled bleeding after prostate endoscopic surgery.
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Hughes T, Harper P, Somani BK. Treatment Algorithm for Management of Benign Prostatic Obstruction: An Overview of Current Techniques. Life (Basel) 2023; 13:2077. [PMID: 37895457 PMCID: PMC10608556 DOI: 10.3390/life13102077] [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: 09/24/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The management of benign prostatic obstruction (BPO) should involve a treatment algorithm that takes into account prostate size, and patient's symptoms and preference with the aim of helping with urinary symptoms and enhance quality of life. The diagnostic assessment for men with lower urinary tract symptoms (LUTS) should be comprehensive to help choose the best management strategy. Strategies from lifestyle modifications to medical treatment with alpha blockers and/or 5-alpha-reductase inhibitors to surgical procedures can all be used in the management algorithm. Surgical management ranges from transurethral resection of prostate (TURP) to minimally invasive surgical therapies (MIST) including laser therapies such as Holmium laser enucleation (HoLEP) and photoselective vaporisation (PVP), aquablation, Rezūm system, prostate artery embolisation (PAE), prostatic urethral lift (PUL), temporary implantable nitinol device (iTind) and Optilume BPH catheter system. BPO is a common urological condition that has a significant impact on quality of life and economic burden globally and is likely to become increasingly prevalent with an ageing population. Selecting the most appropriate treatment modality will depend on the individual patient preferences, availability of resources, cost, anatomical factors and the goals of treatment.
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Affiliation(s)
- Thomas Hughes
- Department of Urology, South Warwickshire University Hospital NHS Foundation Trust, Warwick CV34 5BW, UK;
| | - Philip Harper
- Department of Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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Huang J, Fan Y, Wang K, Ding H, Mao D, Zhao L, Tai S. Transurethral 1470 nm diode laser vaporization versus plasma kinetic enucleation of the prostate for the treatment of benign prostatic hyperplasia: A retrospective study. Medicine (Baltimore) 2023; 102:e35031. [PMID: 37653733 PMCID: PMC10470672 DOI: 10.1097/md.0000000000035031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
To compare the efficacy, safety, and complications of transurethral 1470 nm diode laser vaporization and plasma kinetic enucleation of prostate (PKEP) in benign prostatic hyperplasia treatment. A retrospective matched-paired comparison of patients treated using transurethral 1470 nm diode laser vaporization (n = 40) or PKEP (n = 40) was conducted. Baseline characteristics, preoperative data, and postoperative outcomes at the 24-month follow-up of the patients were recorded. The present study found no significant preoperative differences between the 2 treatment groups. Compared with PKEP, 1470 nm diode laser vaporization had a significantly shorter operation time and less intraoperative blood loss, but there were no marked differences between the 2 groups in terms of postoperative bladder irrigation time, catheterization time, and hospital stay. Moreover, at the 24-month follow-up postoperatively, there were no marked differences in the International Prostatic Symptomatic Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and post-void residual urine volume (PVR) between the 2 groups. IPSS, QOL, Qmax, and PVR had improved significantly compared to preoperative assessment at 24-month follow-up in both groups and there was no significant difference in the variation of IPSS, QOL, Qmax and PVR before and after the operation. Furthermore, complications were comparable between the 2 treatment groups. Transurethral 1470 nm diode laser vaporization and PKEP are effective strategies in the treatment of benign prostatic hyperplasia. However, 1470 nm diode laser vaporization offers advantages over PKEP in terms of shortening operation time and reducing intraoperative bleeding. Nonetheless, further research with a larger number of patients and long-term follow-up is necessary to confirm and validate these findings.
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Affiliation(s)
- Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yi Fan
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Kai Wang
- Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongxiang Ding
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Dikai Mao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Liwei Zhao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Shengcheng Tai
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Al-Bakri A, Al-Jaser A, Al-Gamdi K, Al-Reshaid R, Al-Enizi A, Al-Kharji AA, Al-Zahrani I, Al-Modahi N, Al-Harbi M, Al-Mani A. Safety of transurethral resection of large prostate. Urol Ann 2023; 15:162-165. [PMID: 37304516 PMCID: PMC10252772 DOI: 10.4103/ua.ua_192_21] [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: 12/18/2021] [Revised: 06/18/2022] [Accepted: 06/02/2022] [Indexed: 06/13/2023] Open
Abstract
Background Benign prostatic hyperplasia is a common benign disease occurs in older men. Some patients can be treated medically but eventually, most of them will need a surgical intervention, and the most commonly applied procedure is transurethral resection of the prostate (TURP). Objectives The objective of this study is to assess the feasibility and safety of performing transurethral resection of large prostate (80 g and more). Methodology Out of 153 patients reviewed 48 cases included in this study. The main data collected from patients' files and patient interview. The criteria of exclusion were prostate size <80 g and previous history of TURP. The collected data were analyzed by the Statistical Package for the Social Sciences (SPSS). Results The main results showed that 93.7% of patients did not experience major bleeding postoperatively, neither major drop in hemoglobin level. Moreover, the patient's distribution according to the presence of TUR syndrome was only 2.1% with mild symptoms. No patient had an episode of retention during the hospital stay or in the follow-up. Conclusion Surgeon experience, systematic resection approach, and strict time of resection are important factors to assure the safety of TURP in large prostate. In cases of huge prostate size >100 g, staged TURP can be offered safely or if patients' obstructive symptoms do not resolve after the first procedure.
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Affiliation(s)
- Ayman Al-Bakri
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Abdullah Al-Jaser
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Khalid Al-Gamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Reshaid Al-Reshaid
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Abdullah Al-Enizi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Ali Ali Al-Kharji
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Ibrahim Al-Zahrani
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Nawaf Al-Modahi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Moath Al-Harbi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Abdullah Al-Mani
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
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Socarrás MR, Del Álamo JF, Espósito F, Elbers JR, Monsalve DC, Rivas JG, Greco I, González LLL, Rivera VC, Sancha FG. En Bloc enucleation with early apical release technique using MOSES (En Bloc MoLEP) vs. classic En Bloc HoLEP: a single arm study comparing intra- and postoperative outcomes. World J Urol 2023; 41:159-165. [PMID: 36335245 DOI: 10.1007/s00345-022-04205-x] [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: 04/06/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND PURPOSE We aimed to describe the technique and outcomes of En-Bloc MOSES laser enucleation of the prostate (En-Bloc MoLEP) with early apical release comparing it to En-Bloc HoLEP (non-MOSES). PATIENTS AND METHODS This is a single-arm prospective study, using a historical control. n = 80 patients were enrolled to the En Bloc MoLEP group and compared to a retrospective group of n = 137 patients treated by En Bloc HoLEP (non-MOSES), in total n = 217 patients. RESULTS En-Bloc MoLEP, showed to significantly improve the surgical time by 32% compared to non-MOSES HoLEP (32.16 ± 14.46 min, 47.58 ± 21.32, respectively; P = 0.003). Enucleation time, ablation rate and hemostasis time were also significantly improved (P < 0.001, for all three parameters). Enucleation time was 22.10 ± 9.27 min and 31.46 ± 14.85 min (P < 0.001), ablation rate 4.11 ± 2.41 and 2.54 ± 1.31 gr/min (P < 0.001), Hemostasis time 3.01 ± 2.50 and 8.35 ± 5.38 min (P < 0.001), for En Bloc MoLEP and En Bloc HoLEP, respectively. Q-max, PVR, PSA and IPSS showed significant improvement, however, at 12 months no significant differences were observed comparing both groups. CONCLUSIONS En-Bloc MoLEP was significantly better than En-Bloc HoLEP in terms of surgical time, enucleation time, ablation rate and hemostasis time. However, large comparative RCT with long-term follow-up are needed.
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Affiliation(s)
| | | | - Fabio Espósito
- Instituto de Cirugía Urológica Avanzada (ICUA), Clínica Cemtro, Madrid, Spain
| | | | | | - Juan Gómez Rivas
- Instituto de Cirugía Urológica Avanzada (ICUA), Clínica Cemtro, Madrid, Spain
| | - Isabella Greco
- Instituto de Cirugía Urológica Avanzada (ICUA), Clínica Cemtro, Madrid, Spain
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Raizenne BL, Zheng X, Oumedjbeur K, Mao J, Zorn KC, Elterman D, Bhojani N, McClure T, Te A, Kaplan S, Sedrakyan A, Chughtai B. Prostatic artery embolization compared to transurethral resection of the prostate and prostatic urethral lift: a real-world population-based study. World J Urol 2023; 41:179-188. [PMID: 36463348 DOI: 10.1007/s00345-022-04218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/04/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND There are growing interests for minimally invasive surgical techniques (MISTs) for the treatment of benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Prostatic artery embolization (PAE) uses selective angioembolization of prostatic arteries, thereby reducing size to improve LUTS/BPH. However, real-world data comparing surgical outcomes between MISTs and tissue resective techniques are lacking. We assessed the differences in surgical outcomes between PAE, transurethral resection of the prostate (TURP), and prostatic urethral lift (PUL) in a real-world population for LUTS/BPH. METHODS We present an observational population-based study of 12,902 men with BPH in New York State who received PAE, TURP, and PUL in outpatient and ambulatory surgery settings from 2014 to 2018. For short-term outcomes, we report 30-day and 90-day risks of readmission to inpatient and emergency room (ER) with/without complications and compared them across groups using χ2 tests and mixed-effect logistic regressions. For long-term outcomes, we report surgical retreatment and stricture rates using Kaplan-Meier failure curves and compared them using Log rank tests and Cox regression models. RESULTS Of 12 902 men, 335 had PAE, 11,205 had TURP, and 1362 had PUL. PAE patients had the highest 30-day (19.9%) and 90-day (35.6%) risks of readmission to inpatient or ER (p < 0.01). Non-specific abdominal pain was the main diagnosis associated with 30-day and 90-day readmissions to inpatient or ER after PAE (14.3% and 26.8%, respectively). After 2 years of follow-up, PAE patients had the highest retreatment rate of 28.5% (95%CI 23.7-34.2%) compared to TURP (3.4% (95%CI 3.1-3.8%)) and PUL (8.5% (95%CI 5.6-12.9%)) (p < 0.001). CONCLUSION In a real-world population, PAE was associated with the most frequent 30-day and 90-day readmission to inpatient or ER and the highest retreatment rate among all surgical techniques even when controlled for individual patient comorbidities and surgical volume.
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Affiliation(s)
- Brendan L Raizenne
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | | | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Timothy McClure
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA
| | - Steven Kaplan
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | - Bilal Chughtai
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA. .,Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA.
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12
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B-TURP versus HoLEP: Peri-Operative Outcomes and Complications in Frail Elderly (>75 y.o.) Patients: A Prospective Randomized Study. Biomedicines 2022; 10:biomedicines10123212. [PMID: 36551968 PMCID: PMC9776283 DOI: 10.3390/biomedicines10123212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background: The aim of this study was to compare the peri-operative and functional results between trans-urethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) in middle-old patients. Materials and Methods: This prospective single-center study included patients over 75 years old treated with B-TURP or HoLEP for BPH associated with LUTS with prostate volume (PV) <100 mL. Primary endpoints were the intra-operative blood loss, percentage of loss of hemoglobin, blood transfusion, complications, and the comparison of functional outcomes. All patients were evaluated at 1, 3, 6, and 12 months of follow-up. Results: Overall, 96 patients undergoing HoLEP and 104 B-TURP were eligible and enrolled for the study. Post-operative results showed statistically significant differences between the two groups, all in favor of HoLEP group, specifically in terms of removed prostate tissue, PV reduction rate, hemoglobin values at 24 h, hemoglobin loss, operative time, length of hospitalization, days of catheterization, and urinary flow rates. There was no significant difference in terms of postvoid residual urine volume, perioperative complication, blood transfusion, International Prostate Symptom Score (IPSS), and IPSS quality of life scores. Conclusions: In middle-old patients, the HoLEP technique represents a prostate size-independent treatment option with a more favorable safety profile defined by less bleeding, lower blood transfusions, and a significantly lower hemoglobin drop than B-TURP.
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Chin CP, Garden EB, Ravivarapu KT, Shukla D, Omidele O, Levy M, Qian D, Araya JS, Valenzuela R, Reddy A, Marshall S, Motola J, Nobert C, Gupta M, Small AC, Kaplan SA, Palese MA. Medium-Term Real-World Outcomes of Minimally Invasive Surgical Therapies for Benign Prostatic Hyperplasia: Water Vapor Thermal Therapy (Rezum) vs Prostatic Urethral Lift (UroLift) in a High-Volume Urban Academic Center. J Endourol 2022; 36:1559-1566. [PMID: 36039926 DOI: 10.1089/end.2022.0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: Water vapor thermal therapy (WVTT, i.e., Rezum®) and prostatic urethral lift (PUL, i.e., Urolift®) are minimally invasive surgical therapy (MIST) options for benign prostatic hyperplasia (BPH). Few studies have directly compared the two procedures. We examined the clinical characteristics and postoperative outcomes of patients undergoing WVTT and PUL at our high-volume urban academic center. Methods: We reviewed our institutional MIST database to identify patients with prostate sizes ≥30 and ≤80 cc who underwent WVTT or PUL for treatment of BPH between January 2017 and September 2021. Pre- and postoperative outcomes, including retreatment rates, American Urological Association symptom score (AUA-SS), maximum flow (Qmax), postvoid residual (PVR), medication usage, trial of void success rates, catheterization requirements, and postoperative complications within 90 days were extracted and compared between procedures. Results: Three hundred seven patients received WVTT and 110 patients received PUL with average follow-up times of 11.3 and 12.8 months, respectively. WVTT patients showed significant improvements in AUA-SS, Qmax, and PVR, whereas PUL patients showed improvements in only AUA-SS and Qmax. Both WVTT and PUL patients with longitudinal follow-up demonstrated improvements in AUA-SS, Qmax, and PVR. Postoperatively, alpha-blocker utilization was significantly decreased following both WVTT and PUL (WVTT: 73.9%-46.6%, PUL: 76.4%-38.2%, both p < 0.001). Compared to patients receiving PUL, WVTT patients more frequently reported postoperative dysuria (22.8% vs 8.3%, p = 0.001) and nonclot-related retention (18.9% vs 7.3%, p = 0.005); PUL patients more frequently experienced postoperative clot retention (7.3% vs 2.6%, p = 0.027). There were no differences in rates of postoperative bladder spasm, trial of void success, urinary tract infections, or emergency department visits. Postoperative erectile dysfunction and retrograde ejaculation were rare and occurred at similar rates. Conclusion: In the real-world setting, WVTT and PUL have similar medium-term efficacy in improving symptoms and decreasing medication utilization for patients with BPH. Differences in postoperative complication profiles should inform patient counseling.
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Affiliation(s)
- Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evan B Garden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Devki Shukla
- Department of Urology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Olamide Omidele
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Qian
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Sewell Araya
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Valenzuela
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Avinash Reddy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan Marshall
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jay Motola
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Craig Nobert
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander C Small
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Mathieu R, Doizi S, Bensalah K, Lebacle C, Legeais D, Madec FX, Phe V, Pignot G, Irani J. Les complications chirurgicales en urologie adulte : chirurgie de la prostate. Prog Urol 2022; 32:953-965. [DOI: 10.1016/j.purol.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
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15
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Robinson C, Hepburn A, Turner RM, Zarrabi AD. The role of intra‐operative void score during transurethral resection of prostate as a marker of efficacy: a feasibility study. ANZ J Surg 2022; 92:1492-1497. [PMID: 35486002 PMCID: PMC9314725 DOI: 10.1111/ans.17664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
Background To assess the feasibility of a novel intra‐operative void scoring technique. To determine if intra‐operative void score (VS) could act as a marker for post‐operative success following TURP. Methods Fifteen patients undergoing TURP were included in this single‐centre feasibility study. All patients had indwelling urinary catheters for recurrent retention due to benign prostatic hyperplasia (BPH). In theatre, immediately before‐ and after TURP, an intra‐operative VS was measured and graded 0–5. Primary outcomes were the feasibility of measuring intra‐operative VS and its accuracy in predicting surgical outcome. Results A combined pre‐ and post‐score with a threshold ≥6 correctly predicted 82% of those who were catheter free (sensitivity) and 100% of those who were not catheter free (specificity) at follow up and the positive predictive value was 100% and negative predictive value 60%. Conclusion Intra‐operative void score during TURP is simple, reproducible, fast and requires minimal resources. In TURP it may predict successful outcomes by identifying patients who will be catheter free post‐operatively as opposed to those who will be catheter dependent despite the procedure.
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Affiliation(s)
| | - Alastair Hepburn
- Dunedin Hospital Southern District Health Board Dunedin New Zealand
| | - Robin M. Turner
- Biostatistics Centre, Division of Health Sciences University of Otago Dunedin New Zealand
| | - Amir D. Zarrabi
- Department of Surgery University of Otago Dunedin New Zealand
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16
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Real-world data comparing minimally invasive surgeries for benign prostatic hyperplasia. World J Urol 2022; 40:1185-1193. [PMID: 35107632 DOI: 10.1007/s00345-021-03926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To assess the differences in surgical outcomes between the prostatic urethral lift (PUL) and previous thermal energy procedures for the treatment of benign prostatic hyperplasia (BPH). METHODS We present an observational population-based study of 2694 men with BPH in New York State and California who received PUL, transurethral needle ablation (TUNA), or transurethral microwave therapy (TUMT) in outpatient and ambulatory surgery settings from 2005 to 2018. For these surgical procedures, short-term outcomes were reported and compared using a Chi-square test and mixed-effect logistic regressions. Long-term outcomes were described using Kaplan-Meier failure curves and compared using a Log-rank test and Cox regressions. RESULTS A significant portion of PUL patients had a comorbidity count ≥ 2 (n = 838, 37.0%). PUL exhibited the lowest 30 day and 90-day inpatient or ER readmission rates among all surgical techniques except for 90-day ER readmission (p < 0.05). No differences were observed for 1- and 3-year risks of reoperation between PUL [5.5% (95% CI 4.4-6.8%) and 14.9% (95% CI 10.9-20.1%)], TUNA [7.4% (95% CI 5.0-10.9%) and 11.3% (95% CI 8.3-15.4%)] and TUMT [8.5% (95% CI 4.7-15.2%) and 15.3% (95% CI 9.5-24.0%)]. 1- and 3-year risks of stricture development for PUL were 0.2% (95% CI 0.0-0.7%) and 0.2% (95% CI 0.0-0.07%), respectively. CONCLUSION In a patient population with chronic conditions, patients treated with PUL exhibited similar 30- and 90-day inpatient or ER readmission rates when compared to previous reports. However, 1- and 3-year reoperation risks for PUL closely resembled previous thermal energy surgical procedures.
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17
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Patel N, Yung N, Vigneswaran G, de Preux L, Maclean D, Harris M, Somani B, Bryant T, Hacking N, Modi S. 1-year cost-utility analysis of prostate artery embolization (PAE) versus transurethral resection of the prostate (TURP) in benign prostatic hyperplasia (BPH). BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2021; 3:e000071. [PMID: 35047801 PMCID: PMC8749306 DOI: 10.1136/bmjsit-2020-000071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To determine whether prostate artery embolization (PAE) is a cost-effective alternative to transurethral resection of the prostate (TURP) in the management of benign prostate hyperplasia (BPH) after 1-year follow-up. Design, setting and main outcome measures A retrospective cost-utility analysis over a 12-month time period was conducted to compare the two interventions from a National Health Service perspective. Effectiveness was measured as quality-adjusted life years (QALYs) derived from data collected during the observational UK Register of Prostate Embolisation (UK-ROPE) Study. Costs for both PAE and TURP were derived from University Hospital Southampton, a tertiary referral centre for BPH and the largest contributor to the UK-ROPE. An incremental cost-effectiveness ratio (ICER) was derived from cost and QALY values associated with both interventions to assess the cost-effectiveness of PAE versus TURP. Further sensitivity analyses involved a decision tree model to account for the impact of patient-reported complications on the cost-effectiveness of the interventions. Results The mean patient age for TURP (n=31) and PAE (n=133) was 69 and 65.6 years, respectively. In comparison to TURP, PAE was cheaper due to shorter patient stays and the lack of necessity for an operating theatre. Analysis revealed an ICER of £64 798.10 saved per QALY lost when comparing PAE to TURP after 1-year follow-up. Conclusion Our findings suggest that PAE is initially a cost-effective alternative to TURP for the management of BPH after 1-year follow-up. Due to a higher reintervention rate in the PAE group, this benefit may be lost in subsequent years. Trial registration number NCT02434575.
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Affiliation(s)
- Nikisha Patel
- Faculty of Medicine, Imperial College London, London, UK
| | - Nathan Yung
- Faculty of Medicine, Imperial College London, London, UK
| | - Ganesh Vigneswaran
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Laure de Preux
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, UK
| | - Drew Maclean
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Mark Harris
- Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bhaskar Somani
- Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Timothy Bryant
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Nigel Hacking
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Sachin Modi
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
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18
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Beyene A, Lemma A, Tilahun S. A Retrospective Operative and Early Outcome Comparison of Suprapubic Transvesical Prostatectomy and Transurethral resection of the Prostate. Ethiop J Health Sci 2021; 31:785-792. [PMID: 34703178 PMCID: PMC8512948 DOI: 10.4314/ejhs.v31i4.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background BPH is the major cause of bladder outlet obstruction over the age of 40 years. Multiple surgical management options have been described of which STVP and TURP are the oldest and widely available procedures. The objective of this study is to describe and compare the intraoperative and early outcome situations of STVP and TURP. Methods This is a hospital-based retrospective descriptive study that compares intraoperative and early outcomes of STVP and TURP in Menilik II Hospital from January 2017 to December 2019. The study samples were 72 STVP and 72 TURP patients. Results The mean duration of surgery in the STVP group was 97.8 minutes which is significantly longer than TURP group (66.15 minutes). Duration of post-op catheterization and hospital stay are significantly longer in STVP than TURP. Conclusion The duration of surgery, length of hospital stays and post op catheterization are longer in STVP. There was no significant difference in intra-op and early complications from STVP and TURP.
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Affiliation(s)
- Andualem Beyene
- Department off Surgery, School of Medicine, College of Health Sciences, Addis Ababa University
| | - Abeselom Lemma
- Department off Surgery, School of Medicine, College of Health Sciences, Addis Ababa University
| | - Seyfe Tilahun
- Department off Surgery, School of Medicine, College of Health Sciences, Addis Ababa University
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19
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Teng TC, Shao IH, Hsu YC, Chen Y, Tsao SH, Kang YT, Hsieh ML. Risk Factors of Emergency Room Visits for Bleeding Complications Following Transurethral Procedures in the Treatment of Benign Prostatic Hyperplasia: A Retrospective Cohort Study. Clin Interv Aging 2021; 16:1747-1756. [PMID: 34616148 PMCID: PMC8487796 DOI: 10.2147/cia.s329468] [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: 07/19/2021] [Accepted: 09/15/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Transurethral procedures, including transurethral resection of the prostate (TURP) and laser prostatectomy, are often linked to emergency room (ER) visits for postoperative bleeding. Although some studies have been conducted, the risk factors associated with these ER visits are not completely understood. This retrospective cohort study identified potential risk factors associated with ER visits for postoperative bleeding. Patients and Methods Preoperative assessment data and operational and postoperational parameters recorded at Chang Gung Memorial Hospital, Taiwan between December 2015 and January 2017 for patients who underwent elective transurethral procedures were analyzed to identify potential risk factors. The primary endpoint was ER visits for gross hematuria within three months following operation, and the secondary endpoint was ER visits for blood clot-induced urinary retention (clot retention) within three months following operation. Results A total of 665 patients who underwent elective transurethral procedures were enrolled. The transurethral procedures included monopolar transurethral resection of the prostate (M-TURP), bipolar TURP (B-TURP), greenlight photoselective vaporization of the prostate (PVP), thulium laser enucleation of the prostate (ThuLEP) and thulium laser transurethral vaporesection of the prostate (ThuVARP). Regarding ER visits for clot retention within three months, multivariable logistic regression revealed significantly lower rates of clot retention in patients who received B-TURP than in those who underwent ThuVARP (AOR, 0.18; 95% confidence interval [CI], 0.04–0.82, p = 0.027). Moreover, significantly higher clot retention was observed in patients who underwent two or more rounds of manual irrigation (AOR, 9.51; 95% CI, 1.66–54.43, p = 0.011). Conclusion Multiple manual irrigations shortly after operation can be considered a novel predictor of postoperative clot retention-related ER visits. Among the transurethral procedures, ThuVARP was associated with a higher risk of clot retention-related ER visits than was B-TURP.
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Affiliation(s)
- Tzu-Chi Teng
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yu-Chao Hsu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yu Chen
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Shu-Han Tsao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yen-Te Kang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
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20
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Chen JW, Lin WJ, Lin CY, Hung CL, Hou CP, Tang CY. An Automatic Bleeding-Rank System for Transurethral Resection of the Prostate Surgery Videos Using Machine Learning. Diagnostics (Basel) 2021; 11:diagnostics11101767. [PMID: 34679465 PMCID: PMC8535166 DOI: 10.3390/diagnostics11101767] [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: 07/17/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in aging males. Transurethral resection of the prostate (TURP) surgery is performed by a cystoscope passing through the urethra and scraping off the prostrate piece by piece through a cutting loop. Although TURP is a minimally invasive procedure, bleeding is still the most common complication. Therefore, the evaluation, monitoring, and prevention of interop bleeding during TURP are very important issues. The main idea of this study is to rank bleeding levels during TURP surgery from videos. Generally, to judge bleeding level by human eyes from surgery videos is a difficult task, which requires sufficient experienced urologists. In this study, machine learning-based ranking algorithms are proposed to efficiently evaluate the ranking of blood levels. Based on the visual clarity of the surgical field, the four ranking of blood levels, including score 0: excellent; score 1: acceptable; score 2: slightly bad; and 3: bad, were identified by urologists who have sufficient experience in TURP surgery. The results of extensive experiments show that the revised accuracy can achieve 90, 89, 90, and 91%, respectively. Particularly, the results reveal that the proposed methods were capable of classifying the ranking of bleeding level accurately and efficiently reducing the burden of urologists.
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Affiliation(s)
- Jian-Wen Chen
- Department of Computer Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (J.-W.C.); (C.-Y.T.)
| | - Wan-Ju Lin
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan;
| | - Chun-Yuan Lin
- Department of Computer Science and Information Engineering, Asia University, Taichung 41354, Taiwan;
| | - Che-Lun Hung
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Computer Science and Communication Engineering, Providence University, Taichung 43301, Taiwan
- Correspondence: (C.-L.H.); (C.-P.H.)
| | - Chen-Pang Hou
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: (C.-L.H.); (C.-P.H.)
| | - Chuan-Yi Tang
- Department of Computer Science, National Tsing Hua University, Hsinchu 30013, Taiwan; (J.-W.C.); (C.-Y.T.)
- Department of Computer Science and Information Engineering, Providence University, Taichung 43301, Taiwan
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21
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Ofoha CG, Raphael JE, Dakum NK, Shu'aibu SI, Akhaine J, Yaki IM. Surgical management of benign prostate hyperplasia in Nigeria: open prostatectomy versus transurethral resection of the prostate. Pan Afr Med J 2021; 39:165. [PMID: 34539961 PMCID: PMC8434791 DOI: 10.11604/pamj.2021.39.165.24767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 06/26/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction transvesical (open) prostatectomy (OP), an invasive surgical procedure, is a common form of treatment offered to patients with benign prostatic enlargement in emerging economies. Recently, there has been an increase in the use of electrosurgical means in treating benign prostate hyperplasia in our environment, especially transurethral resection of the prostate (TURP). This study compares the perioperative, short-term outcomes and complications of open prostatectomy and TURP. Methods the records of men who had prostatectomies (OP and TURP) from Jan 2016 to Dec 2019 for prostate gland less than 80g were reviewed. The patients´ age, size of the prostate gland, duration of surgery (mins), blood transfusion, clot retention, length of catheterisation (days), hospital stay (days), postoperative infection, postoperative incontinence, reoperation, bladder neck stenosis and urethral stricture were analysed. Results fifty-nine patients were studied. Twenty-nine patients had OP, while 30 had TURP. Mean age for OP was 63.8 (SD 7.2) years, while for TURP is 68.5 (SD 8.0) years (p=0.019). The mean for length of catheterisation for OP vs TURP was 9.1 (SD 3.7) vs 3.3 (SD 1.03) days (p=0.001), mean hospital stay was 9.6 (SD 4.1) and 4.7 (SD 2.2) days (p=0.001) for OP and TURP while duration of surgery (mins) for OP and TURP was 106.7 (SD 15.2) vs 53.8 (SD 14.0) minutes (p=0.001). The blood transfusion rate was 13.8% and postoperative incontinence 13.8% in OP, while in the TURP group, the reoperation rate was 3.3% and urethral stricture at a rate of 3.3%. Overall complications showed no statistical difference (p=0.462) between the two groups. Conclusion the patients who underwent TURP had shorter hospital stay, shorter duration of surgery and catheterisation, and less frequently required blood transfusion compared to those who had open prostatectomy. However, reoperation rate was higher compared to open prostatectomy. The overall complication was fewer with TURP, but this is not statistically significant; hence both forms of surgical therapy remain relevant in a poor resource setting.
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Affiliation(s)
- Chimaobi Gideon Ofoha
- Department of Surgery, Jos University Teaching Hospital (JUTH), Jos, Nigeria.,College of Health Sciences, University of Jos, Jos, Nigeria
| | - John Edoka Raphael
- Department of Surgery, College of Health Sciences, University of PortHarcourt, PortHarcourt, Nigeria.,Department of Urology, University of PortHarcourt Teaching Hospital, PortHarcourt, Nigeria
| | - Nuhu Kutan Dakum
- Department of Surgery, Jos University Teaching Hospital (JUTH), Jos, Nigeria.,College of Health Sciences, University of Jos, Jos, Nigeria
| | - Samaila Ibrahim Shu'aibu
- Department of Surgery, Jos University Teaching Hospital (JUTH), Jos, Nigeria.,College of Health Sciences, University of Jos, Jos, Nigeria
| | - Julius Akhaine
- Department of Surgery, Jos University Teaching Hospital (JUTH), Jos, Nigeria
| | - Isaac Musa Yaki
- Department of Surgery, Jos University Teaching Hospital (JUTH), Jos, Nigeria
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22
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Franz J, Suarez-Ibarrola R, Pütz P, Sigle A, Lusuardi L, Netsch C, Lehrich K, Herrmann TRW, Gratzke C, Miernik A. Morcellation After Endoscopic Enucleation of the Prostate: Efficiency and Safety of Currently Available Devices. Eur Urol Focus 2021; 8:532-544. [PMID: 33858810 DOI: 10.1016/j.euf.2021.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Although several studies have compared different morcellators and enucleation techniques for the management of benign prostatic hyperplasia (BPH), there is sparse literature on morcellation, so further experimental and clinical research is required for its optimization. OBJECTIVE To critically appraise the contemporary literature on prostate morcellation and to evaluate the safety and efficiency of currently available morcellators for endoscopic enucleation of the prostate (EEP) in the context of BPH. EVIDENCE ACQUISITION A comprehensive review of the English and French literature relevant to prostate morcellation was performed using the PubMed-MEDLINE, Cochrane Library, Web of Science, and Wiley Online Library database from 1998 to 2020 using PICOS (patient population, intervention, comparison, outcome, and study design) criteria. EVIDENCE SYNTHESIS We retrieved 26 studies involving 5652 patients treated with a morcellator that were eligible for data extraction and analysis. The mean patient age was 67.4 (range 61.4-72.8) yr. The weighted mean efficiency of Piranha, VersaCut, and DrillCut morcellators was 5.29, 3.95, and 5.3 g/min, respectively. Several approaches, such as en bloc, two-lobe, inverse, and improved techniques, may increase morcellation efficiency and safety. The lowest weighted mean rate of bladder wall injury was 1.24% for Piranha, followed by 1.98% for DrillCut, and 5.23% for VersaCut, while the VersaCut morcellator had the lowest weighted mean rate of device malfunction at 0.74%, compared to 2.07% for Piranha and 7.86% for DrillCut. CONCLUSIONS All three morcellators are efficient and safe for prostatic morcellation after EEP. Further development of devices and techniques may improve the efficiency and safety profile of morcellation. To increase safety, surgeon expertise, technical equipment, and patient characteristics should be considered. Therefore, interdisciplinary exchange of knowledge and further technological innovations are strongly encouraged. PATIENT SUMMARY We reviewed the safety and efficacy of devices called morcellators. These devices cut tissue into small pieces that are easier to remove from the body, and are used during laser surgery for benign enlargement of the prostate. Three morcellators are currently available on the market and are comparable in safety and efficacy.
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Affiliation(s)
- Julia Franz
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Philipp Pütz
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - August Sigle
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Karin Lehrich
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany.
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Fogaing C, Alsulihem A, Campeau L, Corcos J. Is Early Surgical Treatment for Benign Prostatic Hyperplasia Preferable to Prolonged Medical Therapy: Pros and Cons. ACTA ACUST UNITED AC 2021; 57:medicina57040368. [PMID: 33918818 PMCID: PMC8069902 DOI: 10.3390/medicina57040368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) has shifted over the last decades, with medical therapy becoming the primary treatment modality while surgery is being reserved mostly to patients who are not responding to medical treatment or presenting with complications from BPH. Here, we aim to explore the evidence supporting or not early surgical treatment of BPH as opposed to prolonged medical therapy course. Materials and Methods: The debate was presented with a “pro and con” structure. The “pro” side supported the early surgical management of BPH. The “con” side successively refuted the “pro” side arguments. Results: The “pro” side highlighted the superior efficacy and cost-effectiveness of surgery over medical treatment for BPH, as well as the possibility of worse postoperative outcomes for delayed surgical treatment. The “con” side considered that medical therapy is efficient in well selected patients and can avoid the serious risks inherent to surgical treatment of BPH including important sexual side effects. Conclusions: Randomized clinical trials comparing the outcomes for prolonged medical therapy versus early surgical treatment could determine which approach is more beneficial in the long-term in context of the aging population. Until then, both approaches have their advantages and patients should be involve in the treatment decision.
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Affiliation(s)
- Cora Fogaing
- Department of Surgery/Urology, McGill University, 845 Rue Sherbrooke Ouest, Montréal, QC H3A 0G4, Canada; (C.F.); (L.C.)
| | - Ali Alsulihem
- Department of Urology, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh 11159, Saudi Arabia;
| | - Lysanne Campeau
- Department of Surgery/Urology, McGill University, 845 Rue Sherbrooke Ouest, Montréal, QC H3A 0G4, Canada; (C.F.); (L.C.)
| | - Jacques Corcos
- Department of Surgery/Urology, McGill University, 845 Rue Sherbrooke Ouest, Montréal, QC H3A 0G4, Canada; (C.F.); (L.C.)
- Correspondence:
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24
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The state of TURP through a historical lens. World J Urol 2021; 39:2255-2262. [PMID: 33772604 DOI: 10.1007/s00345-021-03607-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/15/2021] [Indexed: 10/21/2022] Open
Abstract
In 1926 Maximilian Stern introduced a new instrument to treat obstructions at the vesical orifice and baptized it resectoscope. With reference to astonishing historical statements about the new instrument and surgical technique made by the pioneers and their critics we will value why transurethral resection of the prostate (TURP) remains the gold standard for most men suffering from lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. TURP is currently challenged by recently introduced new instruments and techniques claiming advantages over TURP. However, TURP offers an excellent balance between high efficacy in symptom relieve and low morbidity along with low costs and favorable long term outcome compared to other treatment options. We will outline these arguments demonstrating that even after a century has elapsed, since its introduction into the urologists armamentarium, TURP continues to stand the passage of time.
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25
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Malde S, Lam W, Adwin Z, Hashim H. Pharmacological and interventional treatment of benign prostatic obstruction: An evidence‐based comparative review. BJUI COMPASS 2021; 2:238-259. [PMID: 35475299 PMCID: PMC8988658 DOI: 10.1002/bco2.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction The recommended treatment for bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) after the failure of behavioral therapy and fluid modification includes pharmacological, minimally invasive interventional, and surgical approaches. Each option has different risk and benefit profiles, and the urologist must be aware of the unique characteristics of each option in order to be able to accurately counsel the patients based on their individual values and preferences. We provide a comparative review of the commonest pharmacological and most widely performed interventional/surgical treatments for BPO, discussing the evidence for the treatment characteristics that are most useful for the practicing urologist. Methods A search of the PubMed database was performed for articles reporting on the following treatments for LUTS due to BPO: α‐blockers, 5α‐reductase inhibitors, phosphpdiesterase‐5 inhibitors, prostatic urethral lift (Urolift), convective radiofrequency water vapor thermal therapy (Rezum), Temporary implantable Nitinol Device (iTIND), prostate artery embolization (PAE), transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), Aquablation, and anatomical endoscopic enucleation of the prostate (AEEP). We performed a narrative review focussing on the following outcomes: efficacy, safety, durability, duration of catheterization, length of stay, re‐treatment rate, efficacy in special situations (enlarged median lobe, prostate size, urinary retention, and anticoagulant use), and sexual adverse events. Results AEEP offers the greatest long‐term improvement in maximum flow rate, IPSS, and prostate volume reduction, with lowest re‐treatment rate, followed by PVP, TURP, and Aquablation. Urolift, Rezum, and PAE have similar efficacy for prostate volume up to 80cc, and all are more effective than the pharmacological treatment. Urolift offers the lowest rate of sexual dysfunction, followed by Rezum, and both can be performed as a day case under local anesthesia. Conclusion Several treatment options exist to treat voiding LUTS due to BPO. Newer minimally invasive treatments reduce the hospital stay and postoperative complications, whereas AEEP provides the greatest long‐term symptom improvement at the expense of higher morbidity and sexual dysfunction. Men should be counseled regarding all suitable treatment options as some may favor reduced efficacy in association with reduced side effects.
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Affiliation(s)
- Sachin Malde
- Department of Urology Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Wayne Lam
- Division of Urology Department of Surgery LKS Faculty of Medicine Queen Mary Hospital The University of Hong Kong Hong Kong Hong Kong SAR
| | - Zainal Adwin
- Department of Surgery Faculty of Medicine Universiti Teknologi MARA Selangor Malaysia
| | - Hashim Hashim
- Bristol Urological Institute Southmead Hospital North Bristol NHS Trust Bristol UK
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26
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Changes in Prevalence and Treatment Pattern of Benign Prostatic Hyperplasia in Korea. Int Neurourol J 2021; 25:347-354. [PMID: 33504124 PMCID: PMC8748302 DOI: 10.5213/inj.2040412.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/21/2020] [Indexed: 11/08/2022] Open
Abstract
Purpose Benign prostatic hyperplasia (BPH) is associated with lower urinary tract symptoms and negatively affects the quality of life. We aimed to investigate the treatment pattern of BPH in South Korea. Methods Information on treatment modalities and diagnoses of BPH was obtained from the Health Insurance Review and Assessment Service-Aged Patient Sample. Data on BPH patients aged >60 years from 2012 to 2016 were obtained. We surveyed the treatment pattern of BPH, including the types of drugs used and surgeries performed, according to the type of institution. Results In this study, 18,260-24,657 BPH patients treated between 2012 and 2016 were included. The number of patients showed an increasing pattern, and drug therapy was the major treatment method used for BPH (98.77%). Moreover, the pattern of increased pharmacotherapy use for BPH was reinforced by the increasing number of patients. Prescription of α-blockers only was dominant in this cohort (45.7%). Transurethral resection of the prostate (TURP) was the most commonly used surgical treatment for BPH (53.6%), but it showed a decreasing pattern over time. In contrast, holmium laser enucleation of the prostate (HoLEP) showed an increase from 19.4% to 39.7%. Conclusions The most common treatment for BPH was drug therapy, predominantly only α-blocker therapy. The surgical treatment trend has changed from TURP to HoLEP.
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27
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Elterman D, Li W, Hatiboglu G, Relle J, Zorn KC, Bhojani N, Chin J. Relief of Lower Urinary Tract Symptoms After MRI-Guided Transurethral Ultrasound Ablation for Localized Prostate Cancer: Subgroup Analyses in Patients with Concurrent Cancer and Benign Prostatic Hyperplasia. J Endourol 2021; 35:497-505. [PMID: 32935575 DOI: 10.1089/end.2020.0511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: MRI-guided transurethral ultrasound ablation (TULSA) offers minimally invasive thermal ablation of benign and malignant prostate tissue, using directional high-intensity ultrasound and real-time, magnetic resonance thermometry feedback control. Feasibility of TULSA for alleviating lower urinary tract symptoms (LUTSs) associated with benign prostatic hyperplasia (BPH) is retrospectively assessed in a subgroup of men from a localized prostate cancer study who also had LUTSs. Patients and Methods: TULSA was used to ablate 90% of the prostate gland in 30 men with localized prostate cancer, without plans to spare ejaculatory ducts. Mean ± standard deviation treatment time was 37 ± 10 minutes. Retrospective analysis was conducted on a subpopulation of nine patients who also suffered from LUTSs (International Prostate Symptom Score [IPSS] ≥ 12 at baseline) as well as a smaller subgroup of five patients with IPSS >12 and peak urinary flow (Qmax) <15 mL/second. Urinary symptom relief, continence, and erectile function were assessed using IPSS, International Index of Erectile Function (IIEF), and uroflowmetry. Results: At 12 months post-TULSA, IPSS improved significantly by 58% to 6.3 ± 5.0 (p = 0.003), with at least a moderate (≥6 points) reduction in eight of nine patients. IPSS quality of life improved in eight of nine patients. Erectile function (IIEF-EF) remained stable from 14.6 ± 9.3 at baseline to 15.7 ± 9.0 at 12 months. The proportion of patients with erections sufficient for penetration (IIEF Q2 ≥2) was unchanged. Full urinary continence (pad free and leak free) was achieved at 12 months in all patients. In five men who suffered from more severe symptoms, Qmax increased from 11.6 ± 2.6 mL/second to 22.5 ± 14.2 mL/second at 12 months (p = 0.126). Perfused prostate volume, measured on MRI, decreased 70% to 13.6 ± 4.6 mL (p = 0.003) at 12 months. All adverse events were mild to moderate (Common Terminology Criteria for Adverse Events [CTCAE] Grade 1-2) with no serious events reported. Conclusions: This retrospective analysis demonstrates promising safety and feasibility of TULSA to relieve LUTSs, with improvement in IPSS comparable with modern, minimally invasive surgical therapies. Larger controlled studies with BPH-specific ablation plans in men seeking treatment for LUTSs are warranted.
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Affiliation(s)
- Dean Elterman
- University Health Network, University of Toronto, Toronto, Canada
| | | | - Gencay Hatiboglu
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - James Relle
- Beaumont Health System, Royal Oak, Michigan, USA
| | - Kevin C Zorn
- Department of Urology, University of Montreal, Montreal, Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal, Montreal, Canada
| | - Joseph Chin
- London Health Sciences Center, Western University, London, Canada
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28
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Chen LK, Lai YW, Chiu LP, Chen SSS. Significant relationship between parameters measured by transrectal color Doppler ultrasound and sexual dysfunction in patients with BPH 12 months after TURP. BMC Urol 2021; 21:9. [PMID: 33435935 PMCID: PMC7805164 DOI: 10.1186/s12894-020-00776-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 12/21/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A link between sexual dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) has been noticed. Transurethral resection of the prostate (TURP) remains the standard treatment for symptomatic BPH, whether TURP causes sexual dysfunction is still uncertain. In this retrospective study, we investigated the relationship between parameters measured by color Doppler ultrasound (CDU) and sexual dysfunction in patients with BPH 12 months after TURP. METHODS The parameters include presumed circle area ratio (PCAR), maximal horizontal area of seminal vesicles (MHA), resistive index of the prostate (RIP), and peak systolic velocity in the flaccid penis (PSV). The international prostate symptom score was used to evaluate the lower urinary tract symptoms and the five-item version of the International Index of Erectile Function was used to evaluate sexual function before and after TURP. RESULTS Of the 103 patients without sexual dysfunction before TURP, 11 (10.7%) had erectile dysfunction (ED) after TURP. These 11 patients had significantly lower PCAR, RIP, PSV and MHA than those without ED. The patients with retrograde ejaculation after TURP had significantly lower PCAR than those without retrograde ejaculation, and the patients with premature ejaculation after TURP had significantly lower MHA than those without premature ejaculation. Comparing the parameters between baseline and after TURP, PCAR, RIP, and MHA decreased significantly in the patients with sexual dysfunction, but no significant differences were noted in the patients without sexual dysfunction after TURP. CONCLUSIONS More extended TURP can lead to a higher incidence of ED and retrograde ejaculation in BPH patients without sexual dysfunction before TURP. Patients with a lower volume of seminal vesicles after TURP may have a higher incidence of premature ejaculation.
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Affiliation(s)
- Li K Chen
- Department of Anesthesiology, China Medical University, Taichung City, Taiwan.,Department of Anesthesiology, China Medical University Hospital, Taichung City, Taiwan
| | - Yu W Lai
- Division of Urology, Taipei City Hospital Ren Ai Branch, Taipei, Taiwan.,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li P Chiu
- Division of Urology, Taipei City Hospital Chushing Branch, Taipei, Taiwan.,General Education Center, University of Taipei, Taipei, Taiwan
| | - Saint Shiou-Sheng Chen
- Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,General Education Center, University of Taipei, Taipei, Taiwan. .,Division of Urology, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan. .,Commission for General Education, College of Applied Science, National Taiwan University of Science and Technology, Taipei, Taiwan.
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29
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Kumar N, Palve S, Marripeddi K, Thantla S. Effect of short-term preoperative dutasteride and finasteride on bleeding after transurethral resection of the prostate: A prospective randomized study. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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OPTIMIZATION OF TREATMENT TACTICS IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA ACCORDING TO MORPHOLOGICAL CHANGES OF THE URINARY BLADDER WALL. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-2-76-132-135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Chughtai B, Elterman D, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terrens W, Kohan A, Gonzalez RR, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu LM, Alshak MN, Kaminetzky J. The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial. Urology 2020; 153:270-276. [PMID: 33373708 DOI: 10.1016/j.urology.2020.12.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report the results of a multicenter, randomized, controlled trial with a temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Hadera, Israel) compared to sham for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS Men 50 years or older were randomized 2:1 between iTind and sham procedure arms. A self-expanding, temporary nitinol device was placed for 5-7 days and an 18F Foley catheter was inserted and removed for the iTind and sham group, respectively. Patients were assessed at baseline, 1.5, 3, and 12 months postoperatively using the IPSS, peak urinary flow rate, residual urine, quality of life, and the International Index of Erectile Function. Unblinding occurred at 3 months. RESULTS A total of 175 men (mean age 61.1 ± 6.5) participated (118 iTind vs 57 sham). A total of 78.6% of patients in the iTind arm showed a reduction of ≥3 points in IPSS, vs 60% of patients in the control arm at 3 months. At 12 months, the iTind group reported a 9.25 decrease in IPSS (P< .0001), a 3.52ml/s increase in peak urinary flow rate (P < .0001) and a 1.9-point reduction in quality of life (P < .0001). Adverse events were typically mild and transient, most Clavien-Dindo grade I or II, in 38.1% of patients in the iTind arm and 17.5% in the control arm. No de novo ejaculatory or erectile dysfunction occurred. CONCLUSION Treatment with the second-generation iTind provided rapid and sustained improvement in lower urinary tract symptoms for the study period while preserving sexual function.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, NY-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Neal Shore
- Carolina Urology Research Center, Myrtle Beach, SC
| | | | | | | | | | | | - Alfred Kohan
- Integrated Medical Professionals, Long Island, NY
| | | | | | | | | | | | - Le Mai Tu
- Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
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32
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Kiba K, Akashi Y, Yoshikawa M, Yamamoto Y, Hirayama A, Fujimoto K, Uemura H. Comparison of the Safety and Efficacy of Photoselective Vaporization of the Prostate (PVP) and Transurethral Enucleation with a Bipolar System (TUEB): A Single-Center Retrospective Study. Res Rep Urol 2020; 12:569-575. [PMID: 33235881 PMCID: PMC7680144 DOI: 10.2147/rru.s280113] [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: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to compare the safety and efficacy of photoselective vaporization of the prostate (PVP) and transurethral enucleation with a bipolar system (TUEB). Patients and Methods Patients who underwent PVP or TUEB surgery for lower urinary tract symptoms due to bladder outlet obstruction at our institution from September 2015 to May 2019 were retrospectively reviewed. A total of 83 patients (PVP: n=45, TUEB: n=38) who were available for follow-up at least 12 months after surgery were included. Preoperative characteristics, perioperative parameters, and postoperative outcomes-such as International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and complications-at 3, 6, and 12 months after surgery were compared between the two groups. Results Although differences in age, IPSS, and QoL were not significant, a significantly greater prostate volume, lower Qmax, and greater PVR were noted in the TUEB group. In perioperative parameters, a significantly shorter operation time, less change in serum hemoglobin, fewer days of catheterization, and shorter length of stay were observed in the PVP group. As for postoperative outcomes, the IPSS storage subscore and PVR were significantly improved in the TUEB group. As complications, stress urinary incontinence was more frequently observed in the TUEB group, and urethral stricture was more common in the PVP group. Conclusion The present data suggest that PVP and TUEB are efficient and safe surgical treatment options. Management of patients undergoing PVP in the perioperative period appears easy. Improvements of subjective and objective parameters were superior after TUEB than after PVP.
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Affiliation(s)
- Keisuke Kiba
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Yasunori Akashi
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Motokiyo Yoshikawa
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Yutaka Yamamoto
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Akihide Hirayama
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara-City, Nara, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Sayama-City, Osaka, Japan
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33
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Stoddard MD, Cho A, Te AE, Chughtai B. A Systematic Review on the Timing of Surgical Intervention for Benign Prostatic Enlargement (BPE). Curr Urol Rep 2020; 21:64. [PMID: 33230722 DOI: 10.1007/s11934-020-01016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Surgical intervention for benign prostatic enlargement (BPE) is typically reserved for those who fail medical therapy (i.e., α-blocker or 5-α reductase inhibitor treatment). We conducted a systematic review to determine whether timing of surgical intervention for BPE affects patient outcomes. RECENT FINDINGS The studies we reviewed suggested that patients who undergo surgical intervention for BPE after failing medical therapy may have worse outcomes. Increased age, worsened bladder function, and worse overall health may contribute to worsened outcomes. To date, there are few high-quality studies on the timing of surgical intervention for BPE in the literature. Further prospective trials are needed to determine ideal timing for intervention.
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Affiliation(s)
| | - Ahra Cho
- Weill Cornell Medicine, New York, NY, 10065, USA
| | - Alexis E Te
- Weill Cornell Medicine, New York, NY, 10065, USA
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34
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Deng W, Chen L, Liu X, Jiang H, Zhou Z, Li Y, Wang G, Fu B. Bipolar plasmakinetic transurethral enucleation and resection versus bipolar plasmakinetic transurethral resection for surgically treating large (≥60 g) prostates: a propensity score-matched analysis with a 3-year follow-up. Minerva Urol Nephrol 2020; 73:376-383. [PMID: 32573172 DOI: 10.23736/s2724-6051.20.03804-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are extremely limited published studies comparing bipolar plasmakinetic transurethral resection of prostate (BP-TURP), bipolar plasmakinetic transurethral enucleation and resection of prostate (BP-TUERP) for enlarged prostates. Our purpose was to evaluate the safety and efficiency of BP-TUERP and BP-TURP for large (≥60 g) prostates with a 3-year follow-up. METHODS We retrospectively identified 229 patients according to inclusion criteria between 2014 and 2016. After applying propensity score matching method, preoperative results and three-year follow-up outcomes in International Prostate Symptom Score (IPSS), urinary peek flow rate (Q<inf>max</inf>), postvoid residual urine (PVRU) volume and quality of life (QoL) score were compared. RESULTS Finally, within the well-balanced matched cohort, the BP-TUERP was significantly associated with longer mean operating time (OT) (P=0.039), shorter mean catheter time (CT) (P=0.001) and lower mean hemoglobin decrease (P=0.002) with more prostatic tissue removed (P=0.001) than the BP-TURP, but the median hospital stay lengths and the short- and long-term complication rates were similar between the two series. The patients in the BP-TUERP group had better long-term outcomes in IPSS, Q<inf>max</inf> and PVRU volume than these in the BP-TURP group, but not in QoL score. CONCLUSIONS For patients with large (≥60 g) prostates, BP-TUERP and BP-TURP are safe options, but the former is a more effective choice in long-term follow-up outcomes. BP-TUERP is related to reduced CT and hemoglobin decrease with more removal of prostatic tissue at the expense of longer OT than BP-TURP.
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Affiliation(s)
- Wen Deng
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Luyao Chen
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Hao Jiang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Zhengtao Zhou
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Yulei Li
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Gongxian Wang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Bin Fu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China - .,Jiangxi Institute of Urology, Nanchang, China
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Multivariate Analysis of the Failure of Removal of the Urinary Catheter within 48 Hours after Transurethral Enucleation and Resection of the Prostate. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8241637. [PMID: 32104707 PMCID: PMC7040379 DOI: 10.1155/2020/8241637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/02/2022]
Abstract
Objective To assess the value of clinically relevant data for predicting the failure of removal of the urinary catheter within 48 hours after TUERP. Materials and Methods. We retrospectively analyzed the medical records of 357 patients who underwent TUERP between January 2015 and July 2018, all of whom stopped bladder irrigation and removed urinary catheter within 48 hours after the operation. According to whether the removal of the catheter was successful, the patients were classified into 2 groups: Group A was successful and group B was a failure. Univariate analysis was performed to determine the association between the failure of removal of the catheter and the patients' preoperative clinical characteristics. Logistic regression analysis and receiver operating characteristic analysis (ROC) were conducted to establish the prediction model. Then the area under the curve (AUC) and the cut-off value were calculated. Results 357 patients were divided into group A (n = 305, 85.4%) and group B (n = 305, 85.4%) and group B (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) (P=0.006), history of acute urinary retention (AUR) ( Conclusion This study demonstrated that IPSS, QoL, drug medication, history of AUR, TPV, and IPP are independent factors associated with the failure of removal of the urethral catheter within 48 hours after TUERP.
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Martins T, Mussi TC, Baroni RH. Prostate volume measurement by multiparametric magnetic resonance and transrectal ultrasound: comparison with surgical specimen weight. EINSTEIN-SAO PAULO 2020; 18:eAO4662. [PMID: 32022105 PMCID: PMC6986883 DOI: 10.31744/einstein_journal/2020ao4662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 08/28/2019] [Indexed: 11/08/2022] Open
Abstract
Objective To assess accuracy of multiparametric magnetic resonance of the prostate to estimate gland volume, comparing the results with transrectal ultrasound and surgical specimen. Methods A retrospective study of 85 patients who underwent multiparametric magnetic resonance and transrectal ultrasound (for fusion image-guided biopsy) before radical prostatectomy. Prostate measurements were obtained from magnetic resonance axial and sagittal T2-weighted images and ultrasound; the prostate volume was determined using the ellipsoid formula. The results were compared with the surgical specimen weight. Maximum interval between multiparametric magnetic resonance imaging, transrectal ultrasound, and prostatectomy was 6 months. Results The prostate volume measured by multiparametric magnetic resonance imaging was 18-157cm3 (mean of 49.9cm3) and by transrectal ultrasound, 22-165cm3 (mean of 54.9cm3); the surgical specimen weight was 20-154g (mean of 48.6g), with no statistical differences. Based on the values obtained from imaging examinations, the prostate volume obtained was very close to the real prostatic weight, and the measures by multiparametric magnetic resonance were slightly more precise. Conclusion Prostate volume measured by multiparametric magnetic resonance imaging and transrectal ultrasound showed similar values, and excellent agreement with real prostate weight of the surgical specimens. Prostate volume measured by magnetic resonance has been increasingly used in the clinical practice, and its value enables appropriate therapeutic planning and control of patients.
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Affiliation(s)
- Tatiana Martins
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Ecoar Medicina Diagnóstica, Belo Horizonte, MG, Brazil
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Clinical outcome of transurethral enucleation of the prostate using the 120-W thulium Laser (Vela™ XL) compared to bipolar transurethral resection of the prostate (TURP) in aging male. Aging (Albany NY) 2020; 12:1888-1898. [PMID: 31991402 PMCID: PMC7053585 DOI: 10.18632/aging.102720] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Abstract
This study compared the surgical outcomes of the 120-W Thulium laser (Vela™ XL) enucleation of the prostate and bipolar transurethral resection of the prostate (TURP) in terms of efficacy, safety, and improvements of quality of life (QoL) in patients with benign prostate hyperplasia (BPH). Records were obtained from January 2014 to September 2018 for selected patients with symptomatic BPH who underwent 120-W Thulium laser (Vela™XL) prostate enucleation and bipolar TURP in our institution. All the patients selected met the surgical criteria for TURP and had received medical treatment for at least 3 months. Patients were excluded if their ECOG performance status was >1, if they had active malignant disease, of if they had a history of prostate surgery or reconstruction surgery of the urinary system. Patients decided which treatment option would be performed. Both the procedures were conducted by a single surgeon. Clinical outcomes such as changes in the International Prostate Symptom Score (IPSS) score, urodynamic parameters, drug consumption, pain scores, and QoL were evaluated. The rate of urinary tract infection, recatheterization, additional analgesic requirement, return to the emergency department for treatment, and other surgical complications was analyzed and compared between the two cohorts. A total of 276 patients met the inclusion criteria. Among them, 141 patients received bipolar TURP, where as 135 decided to receive laser vaporesection. No significant difference was observed in age, PSA level, prostate volume, and comorbidities between the two cohorts. Pre-operative (pre-op) urodynamic parameters were also identical, except that the laser surgery group had a higher rate of admission with a urinary catheter (24.4% vs. 14.2%, p=0.044). The operating time was longer in the laser surgery group (79.3 minutes vs. 62.4 minutes, p<0.001). However, enucleation using the Thulium laser was superior to bipolar TURP in terms of post-operative (post-op) pain status, including the numeric rating scale of pain, rate of additional narcotic use, and oral analgesic requirement. Compared with bipolar TURP, laser enucleation achieved a higher improvement in the QoL score at post-op follow-up at 2 weeks and 3 months. Nevertheless, the complication rate, changes in IPSS score, Qmax, and post-op medication-free survival were statistically identical in the two cohorts. Our data revealed that compared with bipolar TURP, 120-W Thulium laser (Vela™ XL) enucleation of the prostate achieved lower post-op pain and higher improvement in the short-term QoL of patients after surgery.
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Matta R, Dvorani E, Wallis C, Hird A, LaBossiere J, Kulkarni G, Kodama R, Carr L, Radomski SB, Saskin R, Herschorn S, Nam RK. Complications after surgery for benign prostatic enlargement: a population-based cohort study in Ontario, Canada. BMJ Open 2019; 9:e032170. [PMID: 31892653 PMCID: PMC6955543 DOI: 10.1136/bmjopen-2019-032170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To examine the complication rates after benign prostatic enlargement (BPE) surgery and the effects of age, comorbidity and preoperative medical therapy. DESIGN A retrospective, population-based cohort study using linked administrative data. SETTING Ontario, Canada. PARTICIPANTS 52 162 men≥66 years undergoing first BPE surgery between 1 January 2003 to 31 December 2014. INTERVENTION Medical therapy preoperatively and surgery for BPE. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was overall 30-day postoperative complication rates. Secondary outcomes included BPE-specific event rates (bleeding, infection, obstruction, trauma) and non-BPE specific event rates (cardiovascular, pulmonary, thromboembolic and renal). Multivariable analysis examined the association between preoperative medical therapy and postoperative complication rates. RESULTS The 30-day overall complication rate after BPE surgery was 2828 events/10 000 procedures and increased annually over the study period. Receipt of preoperative α-blocker monotherapy (relative rate (RR) 1.05; 95% CI 1.00 to 1.09; p=0.033) and antithrombotic medications (RR 1.27; 95% CI 1.22 to 1.31; p<0.0001) was associated with increased complication rates. Among the ≥80-year-old group, the rate of complications increased by 39% from 2003 to 2014 (RR 1.39; 95% CI 1.21 to 1.61; p<0.0001). The mean duration of medical and conservative management increased by a mean of 2.1 years between 2007 and 2014 (p<0.0001 for trend). CONCLUSIONS Thirty-day complication rates after BPE surgery have increased annually between 2003 and 2014. Preoperative medical therapy with alpha blockers or antithrombotics was independently associated with higher rates of complications. Over this time, the duration of conservative therapy also increased.
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Affiliation(s)
- Rano Matta
- Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Erind Dvorani
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Christopher Wallis
- Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Hird
- Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Joseph LaBossiere
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Girish Kulkarni
- Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, University Health Network, Toronto, Ontario, Canada
| | - Ronald Kodama
- Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Carr
- Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sidney B Radomski
- Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, University Health Network, Toronto, Ontario, Canada
| | - Refik Saskin
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sender Herschorn
- Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert K Nam
- Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Sayedahmed K, El Shazly M, Olianas R, Kaftan B, Omar M. The outcome of Y-V plasty as a final option in patients with recurrent bladder neck sclerosis following failed endoscopic treatment. Cent European J Urol 2019; 72:408-412. [PMID: 32015912 PMCID: PMC6979556 DOI: 10.5173/ceju.2019.1977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/30/2019] [Accepted: 11/24/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Bladder neck sclerosis is a rare late complication of transurethral resection of the prostate (TURP). Endoscopic resection or incision of the bladder neck is usually successful in the management of such cases. In some cases, even repeated endoscopic management always followed with recurrent sclerosis. In these cases, the Y-V plasty of the bladder neck provides a final option of treatment. MATERIAL AND METHODS Retrospective evaluation of 24 patients who underwent Y-V plasty of the bladder neck from 2007 to 2014 was performed. All patients had TURP once and presented after at least 2 failed attempts of endoscopic management. The principle of this technique is to insert a V-shaped part of the bladder wall into the fibrosed bladder neck. The patient evaluation included measuring Q max, residual urine volume and asking about their satisfaction. All patients were operated in the same center by the same surgeon. RESULTS The mean age of patients at surgery was 66.8 years (range 56-74 years). All patients presented preoperatively with obstructive micturition with mean Qmax 2.2 ml/s (SD ±1.9) and mean residual urine volume of 381 ±169 ml. After a mean follow-up of 46 months (SD ±22), the mean Qmax reached 16.4 ml/s (SD 3.3) while the mean residual urine volume was 18 ml (SD ±6). Recurrent sclerosis occurred in three patients (12.5%). A total of 94.1% of patients reported satisfactory micturition with significant improvement in the quality of life. CONCLUSIONS The Y-V plasty can provide a final option with a high success rate for patients with bladder neck sclerosis after failed endoscopic treatment.
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Affiliation(s)
| | | | | | - Bjoern Kaftan
- Department of Urology, Lüneburg Hospital, Lüneburg, Germany
| | - Mohamed Omar
- Department of Urology, Menoufia University, Menoufia, Egypt
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Shim M, Bang WJ, Oh CY, Lee YS, Cho JS. Correlation between prostatic urethral angulation and symptomatic improvement after surgery in patients with lower urinary tract symptoms according to prostate size. World J Urol 2019; 38:1997-2003. [PMID: 31646381 DOI: 10.1007/s00345-019-02990-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/13/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To investigate the effect of prostate anatomical factors on the changes in lower urinary tract symptoms (LUTS) and uroflowmetric values after surgery. METHODS The medical records of 448 patients who underwent transurethral resection of the prostate (TURP) from January 2006 to December 2018 were analyzed retrospectively. Changes in the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual urine volume (PVR) at 3 months after TURP were evaluated. Prostate volume, intravesical prostatic protrusion (IPP), and prostatic urethral angulation (PUA) were measured using transrectal ultrasonography, and their effect on the changes in LUTS after TURP was analyzed using multivariable linear regression. RESULTS Among patients with prostate volume < 50 mL, preoperative IPSS total score (IPSS-t), voiding symptom score (IPSS-vs), and storage symptom score (IPSS-ss) were significantly better in patients with a smaller PUA (< 51°) than in those with a larger PUA (≥ 51°) (p = 0.001, < 0.001, and 0.020, respectively). Changes in IPSS-t, IPSS-vs, IPSS-ss, and PVR at 3 months after TURP were significantly correlated with PUA (p ≤ 0.001, < 0.001, 0.048, and 0.012, respectively). Multivariable linear regression revealed PUA to be independently associated with changes in IPPS-t and IPSS-vs (p = 0.025 and < 0.001, respectively) only in patients with prostate volume < 50 mL. CONCLUSION Prostatic urethral angulation was significantly associated with postoperative changes in LUTS only in patients with small prostate, and had no clinical significance in patients with large prostate. In patients with small prostate and large PUA, surgery should actively be considered.
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Affiliation(s)
- Myungsun Shim
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea.
| | - Yong Seong Lee
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
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The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature. Asian J Urol 2019; 6:353-358. [PMID: 31768321 PMCID: PMC6872824 DOI: 10.1016/j.ajur.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/23/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022] Open
Abstract
Objective Our objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia (BPH). Methods A retrospective analysis was performed for all patients who underwent 180 W XPS-laser photoselective vaporization of the prostate (PVP) vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers. Data collection included baseline comorbidities, disease-specific quality of life scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), complications, prostate volume and prostate-specific antigen (PSA). The secondary endpoints were the incidence of intraoperative and postoperative adverse events. Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery. Results Mean age of men was 67.8 years old, with a mean body mass index of 29.7 kg/m2. Mean prostate volume as measured by transrectal ultrasound was 29 mL. Anticoagulation use was 47% and urinary retention with catheter at time of surgery was 17%. Mean hospital stay and catheter time were 0.5 days. Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months (interquartile range, 3–22.5 months). The International Prostate Symptom Score improved from 22.8 ± 7.0 at baseline to 10.7 ± 7.4 (p < 0.01) and 6.3 ± 4.4 (p < 0.01) at 1 and 6 months, respectively. The Qmax improved from 7.70 ± 4.46 mL/s at baseline to 17.25 ± 9.30 mL/s (p < 0.01) and 19.14 ± 7.19 mL/s (p < 0.001) at 1 and 6 months, respectively, while the PVR improved from 216.0 ± 271.0 mL preoperatively to 32.8 ± 45.3 mL (p < 0.01) and 26.2 ± 46.0 mL (p < 0.01) at 1 and 6 months, respectively. The PSA dropped from 1.97 ± 1.76 ng/mL preoperatively to 0.71 ± 0.61 ng/mL (p < 0.01) and 0.74 ± 0.63 ng/mL at 1 and 6 months, respectively. No patient had a bladder neck contracture postoperatively and no capsular perforations were noted intraoperatively. Conclusion The 180 W GreenLight XPS system is safe and effective for men with small volume BPH. PVP produced improvements in symptomatic and clinical parameters without any safety concern. It represents a safe surgical option in this under studied population.
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Association between Bladder Outlet Obstruction and Bladder Cancer in Patients with Aging Male. J Clin Med 2019; 8:jcm8101550. [PMID: 31569597 PMCID: PMC6832159 DOI: 10.3390/jcm8101550] [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: 08/14/2019] [Revised: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 12/28/2022] Open
Abstract
The associations between the treatment outcomes of benign prostatic hyperplasia/benign prostatic obstruction and lifelong health status, including urologic cancer incidence as well as geriatric adverse events (AEs), are unknown. This retrospective cohort study analyzed claims data collected during the period of 1997–2012 from Taiwan’s Longitudinal Health Insurance Database 2000. Patients who received transurethral resection of the prostate (TURP) were prioritized, and the remaining patients who were prescribed alpha-blockers were, subsequently, identified. Patients in the TURP and medication-only groups were further divided into two groups, according to the presence or absence of AEs during the first six-month follow-up. Outcomes of primary interest were all-cause mortality, occurrence of prostate cancer, transurethral resection of the bladder tumor, and radical cystectomy for bladder cancer. Compared with patients in the AE-free TURP group, those in the TURP with AEs had a higher risk of lifelong bladder cancer (subdistribution hazard ratio: 2.3, 95% confidence interval (CI): 1.56–3.39), whereas the risk of prostate cancer was comparable between the two groups (SHR: 1.2, 95% CI: 0.83–1.74). In the medication cohorts, patients undergoing alpha-blocker treatment who had AEs had a higher risk of all-cause mortality (hazard ratio: 1.63, 95% CI: 1.49–1.78) and a higher risk of lifelong bladder cancer (SHR: 2.72, 95% CI: 1.99–3.71) when compared with those without AE. Our study reveals that unfavorable treatment outcomes of benign prostate hyperplasia, whether caused by medication or surgical treatment, are associated with a higher incidence of bladder cancer. Unfavorable outcomes of surgical treatment are associated with higher risk of geriatric AEs, and unfavorable outcomes of medication treatment are associated with a higher risk of all-cause mortality.
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Two-year Follow-up in Bipolar Transurethral Enucleation and Resection of the Prostate in Comparison with Bipolar Transurethral Resection of the Prostate in Treatment of Large Prostates. Randomized Controlled Trial. Urology 2019; 133:192-198. [PMID: 31404581 DOI: 10.1016/j.urology.2019.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/08/2019] [Accepted: 07/24/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the safety and long-term efficacy of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in the treatment of enlarged prostate in comparison with bipolar transurethral resection of the prostate (B-TURP). MATERIALS AND METHODS From June 2015 to March 2019, a total of 240 patients with enlarged prostates of more than 80 gm were randomized into 2 groups, each containing 120 patients. Patients in group A were subjected to B-TUERP while those in group B underwent B-TURP. The perioperative data and postoperative outcomes followed at 1, 6, and 24 months after surgery at which points they were analyzed, and a comparison made between the 2 groups. RESULTS There were no significant differences in the preoperative parameters of the 2 groups. Comparing with B-TURP, B-TUERP had longer operative time (105.09 ± 31.08 vs 61.09 ± 29.28 min), more resected prostatic tissue (50.41 ± 13.07 vs41.12 ± 8.91 g) and had less hemoglobin drop (1.5 vs 2g/dL). In addition, indwelling catheter time, postoperative bladder irrigation duration, and hospital stay were significantly shorter in the B-TUERP group than in the B-TURP group. At 24 month after the procedure, patients with B-TUERP achieved better results of International Prostate Symptom Score (6 vs 7 P = .008), quality of life (1 vs 2, P = .243), maximal flow rate (24.9 ± 5.74 vs 20.09 ± 3.27mL/sec, P = .034), post-voiding residual urine volume (18.64 ± 3.28 vs 24.74 ± 4.02 mL, P = .001), and residual prostate volume (18.64 ± 3.28 vs 20.74 ± 4.02 mL, P < .001). On the other hand, there were no significant differences in postoperative complications between both groups. CONCLUSION B-TUERP is a more effective modality in the treatment of enlarged prostate compared to B-TURP with almost no variation in safety.
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Ruetten H, Wegner KA, Zhang HL, Wang P, Sandhu J, Sandhu S, Mueller B, Wang Z, Macoska J, Peterson RE, Bjorling DE, Ricke WA, Marker PC, Vezina CM. Impact of sex, androgens, and prostate size on C57BL/6J mouse urinary physiology: functional assessment. Am J Physiol Renal Physiol 2019; 317:F996-F1009. [PMID: 31390231 DOI: 10.1152/ajprenal.00270.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Laboratory mice are used to identify causes of urinary dysfunction including prostate-related mechanisms of lower urinary tract symptoms. Effective use of mice for this purpose requires a clear understanding of molecular, cellular, anatomic, and endocrine contributions to voiding function. Whether the prostate influences baseline voiding function has not been specifically evaluated, in part because most methods that alter prostate mass also change circulating testosterone concentrations. We performed void spot assay and cystometry to establish a multiparameter "baseline" of voiding function in intact male and female 9-wk-old (adult) C57BL/6J mice. We then compared voiding function in intact male mice to that of castrated male mice, male (and female) mice treated with the steroid 5α-reductase inhibitor finasteride, or male mice harboring alleles (Pbsn4cre/+; R26RDta/+) that significantly reduce prostate lobe mass by depleting prostatic luminal epithelial cells. We evaluated aging-related changes in male urinary voiding. We also treated intact male, castrate male, and female mice with exogenous testosterone to determine the influence of androgen on voiding function. The three methods used to reduce prostate mass (castration, finasteride, and Pbsn4cre/+; R26RDta/+) changed voiding function from baseline but in a nonuniform manner. Castration feminized some aspects of male urinary physiology (making them more like intact female mice) while exogenous testosterone masculinized some aspects of female urinary physiology (making them more like intact male mice). Our results provide evidence that circulating testosterone is responsible in part for baseline sex differences in C57BL/6J mouse voiding function while prostate lobe mass in young, healthy adult mice has a lesser influence.
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Affiliation(s)
- Hannah Ruetten
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin.,University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts
| | - Kyle A Wegner
- University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts.,Molecular and Environmental Toxicology Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Helen L Zhang
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin.,University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts
| | - Peiqing Wang
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin.,University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts.,Center for Personalized Cancer Therapy, The University of Massachusetts Boston, Boston, Massachusetts
| | - Jaskiran Sandhu
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin.,University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts
| | - Simran Sandhu
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin.,University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts
| | - Brett Mueller
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin.,University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts
| | - Zunyi Wang
- University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts.,Center for Personalized Cancer Therapy, The University of Massachusetts Boston, Boston, Massachusetts
| | - Jill Macoska
- University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts.,Center for Personalized Cancer Therapy, The University of Massachusetts Boston, Boston, Massachusetts
| | - Richard E Peterson
- Division of Pharmaceutical Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Dale E Bjorling
- University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts.,Department of Surgical Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - William A Ricke
- University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts.,Molecular and Environmental Toxicology Center, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Paul C Marker
- University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts.,Center for Personalized Cancer Therapy, The University of Massachusetts Boston, Boston, Massachusetts
| | - Chad M Vezina
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin.,University of Wisconsin-Madison/UMASS Boston George M. O'Brien Center for Benign Urologic Research, Madison, Wisconsin, and Boston, Massachusetts.,Molecular and Environmental Toxicology Center, University of Wisconsin-Madison, Madison, Wisconsin
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Sagen E, Namnuan RO, Hedelin H, Nelzén O, Peeker R. The morbidity associated with a TURP procedure in routine clinical practice, as graded by the modified Clavien-Dindo system. Scand J Urol 2019; 53:240-245. [PMID: 31156002 DOI: 10.1080/21681805.2019.1623312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Transurethral resection of the prostate (TURP) is considered the reference surgical method of treating benign prostatic enlargement (BPE) causing obstruction. The procedure still carries a significant risk of perioperative morbidity according to previous reports. The aim of the present study was to disclose complications after TURP undertaken in routine clinical practice at a non-academic center.Methods: All patients with BPE submitted to TURP from January 2010 to December 2012 were evaluated for complications occurring during hospital stay, after discharge up to the end of the third post-operative month and finally for any late endourological re-interventions undertaken up to five years after TURP. All complications were graded according to the Clavien-Dindo system.Results: In total, 354 men underwent a TURP during the study period. In total, 47% had pre-operative urinary retention. Significant co-morbidity was seen in 17% of men (ASA III-IV). Spinal anaesthesia was applied to 312 men (88%). During hospital stay, major complications, graded as Clavien-Dindo ≥ III, was seen in only eight men (2.3%). Minor complications occurred in 91 men (26%). Between hospital discharge and follow-up visit major complications were noted in 12 men (3.4%). Minor complications occurred in 79 men (22%). The only factor that was associated with an increased risk of a major complication was general anaesthesia. Late complications, requiring an endourological re-intervention, occurred in 30 men (9.7%).Conclusion: TUR-P in routine clinical practice was associated with a low incidence of severe complications. TUR syndrome was very rare. Within five years a small proportion of men require the transurethral intervention to be redone.
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Affiliation(s)
- Erik Sagen
- Department of Urology, Hospital of Skaraborg, Skövde, Sweden.,Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ruji-On Namnuan
- Department of Urology, Hospital of Skaraborg, Skövde, Sweden
| | - Hans Hedelin
- Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, 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, Gothenburg, Sweden
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Nettleton J, Jones P, Pietropaolo A, Geraghty R, Rai B, Drake M, Dragos L, Veneziano D, Somani BK. The industrial revolution for the management of benign prostate obstruction: worldwide publication trends for surgical and medical therapies over the past two decades. Cent European J Urol 2019; 72:149-155. [PMID: 31482021 PMCID: PMC6715083 DOI: 10.5173/ceju.2019.1876] [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: 01/30/2019] [Revised: 03/20/2019] [Accepted: 04/24/2019] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Research for management of benign prostate obstruction (BPO) for adult males remains a cornerstone of urology research. This landscape has witnessed the rise and fall of multiple therapies, both surgical and medical. Our aim was to formally evaluate the publication trends for these interventions over the past 20 years. MATERIAL AND METHODS A systematic search was performed in a Cochrane style. Data was analysed using the independent t-test and Pearson's correlation coefficient (SPSS version 24). To observe changes in trends more effectively, data was sub-divided into two time periods: 1997 to 2006 and 2007 to 2016. RESULTS Over the past 20 years, 4236 papers have been published concerning for BPO (surgical, n = 2177 and medical, n = 2059). For surgical treatments, these included articles on monopolar transurethral resection of prostate (TURP) (n = 340), bipolar TURP (n = 260), HoLEP (n = 293) and Greenlight laser (n = 395). For medical therapies, these included alpha blockers (848), 5-alpha reductase inhibitors (n = 618) and PDE5I (n = 91). Between the two time periods the change was +18.8% (p = 0.108) for monopolar TURP, +497.1% (<0.001) for bipolar TURP, -54.5% (p <0.001 for prostatic stents and -81.9% (p <0.001) for transurethral microwave therapy (TUMT). There was over 290% rise in number of publications related to BPO laser surgery (p <0.001). For medical interventions, the change was +11.5% (p = 0.397) for alpha blockers, -1.9% (p = 0.867), +49.0%( 0.122) for phytotherapy, +2075% (p <0.001) for PDEI and +2375.0% (p <0.001) for combined alpha blocker and anti-muscarinics. CONCLUSIONS Interventions for BPO have undergone a high volume of research. In particular, minimally invasive laser surgeries and combined medical therapies have seen significant expansion.
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Affiliation(s)
| | - Patrick Jones
- Bristol Urological Institute, Bristol, United Kingdom
| | | | - Robert Geraghty
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Bhavan Rai
- Department of Urology, Freeman Hospital, Newcastle, United Kingdom
| | - Marcus Drake
- Bristol Urological Institute, Bristol, United Kingdom
| | - Laurian Dragos
- Urology Department, Emergency County Hospital, Pius Branzeu, Timisoara, Romania
| | - Domenico Veneziano
- Department of Urology and Kidney Transplant G.O.M. Reggio Calabria, Italy
| | - Bhaskar K. Somani
- Consultant Urological Surgeon (Endourology Lead), University Hospital Southampton, NHS Trust Southampton, United Kingdom
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47
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Lavan L, Kyriazis G, Mbiabjeu D, Gormley R, Hall S, Robinson R, Hodgson D. Day-case surgery is possible in the majority of men undergoing transurethral resection of the prostate – a report on over 1000 cases. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818786667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We describe our experience of performing bipolar transurethral resection in saline (Olympus Medical) as a day-case procedure over an initial five-year period. Patients and methods: All procedures coded as transurethral resection of the prostate over a 60-month period were analysed to determine whether the procedure was planned as a day-case or as an inpatient admission, and whether post-operative discharge proceeded as intended. Re-admission rates, reasons for re-admission and transfusion rates were also recorded. Results: Of the 1035 operations, 689 (66.57%) were planned as a day-case procedure (mean age 70.5 years) with 176 (25.5%) requiring inpatient admission, and 346 (33.43%) were planned for inpatient admission (mean age 73.6) but 58 (16.8%) were discharged the same day. Overall 571 (55.17%) procedures were performed as day cases. Readmission rates for day-case and inpatient procedures were 7.4%, and 6.3% respectively ( p=0.48). Transfusion rates were lower in the day-case group (0.7% vs 3.7%, p<0.05). Day-case rates improved from 48.70% in 2011 to 75.22% in 2016. Conversion from day case to inpatient fell from 34.6% in 2011 to 14.8% in 2016. Conclusions: Our experience indicates that day-case transurethral resection of the prostate can be performed safely in appropriately selected patients, without increased rates of re-admission or complications. Level of evidence: 4 (Oxford Centre for Evidence-Based Medicine (CEBM)).
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Affiliation(s)
- L Lavan
- Department of Urology, Queen Alexandra Hospital, UK
| | - G Kyriazis
- Department of Urology, Queen Alexandra Hospital, UK
| | - D Mbiabjeu
- Department of Urology, Queen Alexandra Hospital, UK
| | - R Gormley
- Department of Urology, Queen Alexandra Hospital, UK
| | - S Hall
- Department of Urology, Queen Alexandra Hospital, UK
| | - R Robinson
- Department of Urology, Queen Alexandra Hospital, UK
| | - D Hodgson
- Department of Urology, Queen Alexandra Hospital, UK
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48
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The impact of surgical duration on complications after transurethral resection of the prostate: an analysis of NSQIP data. Prostate Cancer Prostatic Dis 2018; 22:303-308. [DOI: 10.1038/s41391-018-0104-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/07/2018] [Accepted: 09/18/2018] [Indexed: 11/08/2022]
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49
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Davis NF, Jack GS, Witjes WP, Bjartell A, Caris C, Patel A, de la Taille A, Lawrentschuk N, Bolton DM, Tubaro A. Medical therapy versus transurethral resection of the prostate (TURP) for the treatment of symptomatic benign prostatic enlargement (BPE): a cost minimisation analysis. World J Urol 2018; 37:873-878. [PMID: 30145778 DOI: 10.1007/s00345-018-2454-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE A cost minimisation analysis compares the costs of different interventions' to ascertain the least expensive over time. We compared different prostate targeted drug treatments with TURP to identify the optimal cost saving duration of a medical therapy for symptomatic benign prostatic enlargement (BPE). METHODS The Evolution registry is a prospective, multicentre registry, conducted by the European Association of Urology Research Foundation (EAUrf) for 24 months in 5 European countries. Evolution was designed to register the management of symptomatic BPE in clinical practice settings in 5 European countries. Direct cost evaluation associated with prostate targeted medical therapies and TURP was also recorded and analysed. RESULTS In total, 1838 men were enrolled with 1246 evaluable at 24 months. Medical therapies were more cost saving than TURP for treatment durations ranging from 2.9 to 70.4 years. Cost saving depended on both medication class and individual country assessed. Daily tamsulosin monotherapy was more cost saving than TURP for ≤ 13.9 years in Germany compared to ≤ 32.7 years in Italy. Daily finasteride monotherapy was more cost saving for ≤ 5.9 years in France compared to ≤ 36.9 years in Spain. Combination therapy was more cost saving for ≤ 5.9 years for Italian patients versus ≤ 13.8 years in Germany. CONCLUSIONS BPE medical management was more cost saving than TURP for different specific treatment durations. Information from this study will allow clinicians to convey medical and surgical costs over time, to both patients and payors alike, when considering BPE treatment.
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Affiliation(s)
- Niall F Davis
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia.
| | - G S Jack
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - W P Witjes
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands
| | - A Bjartell
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands.,Department of Urology, Lund University, Skane Hospital, Malmö, Sweden
| | - C Caris
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands
| | - A Patel
- Department of Urology, Spire London East Hospital, Roding Lane South, Redbridge, Essex, Ilford, IG4 5PZ, UK
| | - A de la Taille
- Department of Urology, Assistance Publique des Hopitaux de Paris, 54 av du Mal de Lattre de Tassigny, 94000, Créteil, France
| | - N Lawrentschuk
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - D M Bolton
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - A Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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50
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Clinical Implications for the Early Treatment of Benign Prostatic Enlargement (BPE): a Systematic Review. Curr Urol Rep 2018; 19:70. [PMID: 29987480 DOI: 10.1007/s11934-018-0823-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Therapeutic options for the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) have considerably increased in recent years. However, the ideal timing to initiate medical treatment of LUTS/BPE has not been fully established. The aim of this review was to systematically collect available evidence on the influence of early treatment on the natural history of LUTS/BPE patients. RECENT FINDINGS A systematic literature search from January 1996 until April 2018 was performed by combining the following MESH terms: Lower Urinary Tract Symptoms, Benign Prostatic Enlargement, male, medical treatment, surgical treatment, early treatment/intervention, and early intervention/treatment. The Medline, PubMed, and Scopus databases were searched. Each article title and abstract was reviewed for relevance and appropriateness with regard to the topic of this review. In recent years, the medical armamentarium for the management of LUTS secondary to BPE has been extensively implemented, significantly improving treatment outcomes and markedly reducing the need for BPE surgery. Early intervention in patients at risk for disease progression may offer better clinical outcomes compared to a deferred approach. However, evidences supporting early treatment are scarce, and criteria to discriminate patients that could mostly benefit from immediate treatment remain poorly defined. Moreover, as a result of delayed surgery after prolonged medical treatment, patients undergoing surgical relief show larger prostates, older age, and comorbidities. Nevertheless, technological advancements in surgical techniques have largely counterweighed this critical scenario, and commonly, a non-pejorative trend has been reported in perioperative complications. The timeliest moment to start a medical treatment in LUTS/BPE patients is still undefined, and unexpectedly, peer-reviewed evidence remains scarce. Further studies are awaited to better discriminate patients who mostly benefit from early treatment of LUTS/BPE.
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