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Elsaqa M, Papaconstantinou H, El Tayeb MM. Preoperative Frailty Scores Predict the Early Postoperative Complications of Holmium Laser Enucleation of Prostate. J Endourol 2023; 37:1270-1275. [PMID: 37776182 DOI: 10.1089/end.2023.0196] [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: 10/01/2023] Open
Abstract
Background: Frailty is a recent multidimensional concept of a contemporary growing interest for understanding the complex health status of elderly population. We aimed to assess the impact of frailty scores on the outcome and complication rate of holmium laser enucleation of prostate (HoLEP). Methods: A 7-year data of HoLEP patients in a single tertiary referral center were reviewed. The preoperative, operative, early, and late postoperative outcome data were collected and compared according to the preoperative frailty scores. Frailty was assessed preoperatively using the Modified Hopkins frailty score. Results: The study included 837 patients categorized into two groups: group I included 533 nonfrail patients (frailty score = 0), whereas group II included 304 frail patients (frailty score ≥1). The median (interquartile range) age was 70 (11) and 75 (11) years for groups I and II, respectively (<0.001). The 30-day perioperative complication rate (p = 0.005), blood transfusion (p = 0.013), failed voiding trial (p = 0.0015), and 30-day postoperative readmission (p = 0.0363) rates were significantly higher in frail patients of group II. The two groups were statistically comparable regarding postoperative international prostate symptom score (p = 0.6886, 0.6308, 0.9781), incontinence rate (p = 0.475, 0.592, 0.1546), postvoid residual (p = 0.5801, 0.1819, 0.593) at 6 weeks and 3 months, and 1-year follow-up intervals, respectively. Conclusion: In elderly patients undergoing HoLEP, the preoperative frailty scores strongly correlate with the risk of perioperative complications. Frail patients should be counseled regarding their relative higher risk of early perioperative complications although they gain the same functional profit of HoLEP as nonfrail patients.
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Affiliation(s)
- Mohamed Elsaqa
- Division of Urology, Department of Surgery, Baylor Scott and White Health, CTX, Temple, Texas, USA
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Harry Papaconstantinou
- Division of Urology, Department of Surgery, Baylor Scott and White Health, CTX, Temple, Texas, USA
| | - Marawan M El Tayeb
- Division of Urology, Department of Surgery, Baylor Scott and White Health, CTX, Temple, Texas, USA
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Niu X, Liu B. Six novel minimally invasive therapies for benign prostatic hyperplasia. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:162-168. [PMID: 37283100 DOI: 10.3724/zdxbyxb-2022-0593] [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: 06/08/2023]
Abstract
Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms in men. When drug treatment is ineffective or conventional surgery is not suitable, novel minimally invasive therapies can be considered. These include prostatic urethral lift, prostatic artery embolisation, water vapor thermal therapy, Aquablation-image guided robotic waterjet ablation, temporary implantable nitinol device and prostatic stents. These novel therapies can be performed in outpatient setting under local anesthesia, with shorter operative and recovery times, and better protection of ejaculatory function and erectile function. General conditions of the patient and advantages and disadvantages of the each of these therapies should be fully considered to make individualized plans.
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Affiliation(s)
- Xinyang Niu
- Department of Urology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| | - Ben Liu
- Department of Urology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Soyster ME, Agarwal D, Slade A, Sahm E, Large T, Rivera M. Impact of American Society of Anesthesiologists score on postoperative holmium enucleation of the prostate outcomes and complications. Prostate 2023; 83:316-322. [PMID: 36415930 DOI: 10.1002/pros.24463] [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: 09/06/2022] [Revised: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTIONS The American Society of Anesthesiologists Physical Status Classification System (ASA) is a validated risk stratification method for patients undergoing surgery. There is an increased prevalence of benign prostatic hyperplasia and comorbidities in our aging population. The role of ASA related to postoperative complications in patients undergoing holmium laser enucleation of the prostate (HoLEP) has not been described. METHODS A review of our database was performed for patients who underwent HoLEP from July 2018 to December 2020. Patients were stratified based on ASA score. Preoperative, perioperative, and complication data were analyzed using SAS analytics software. RESULTS Of 472 patients undergoing HoLEP, 320 (67.8%) were ASA 3-4 patients. There was a statistically significant difference found in age (72.3 ± 9.8 vs. 69.1 ± 9.0 years, p < 0.001), body mass index (BMI) (29.0 ± 5.9 vs. 27.3 ± 4.2, p = 0.004), and use of antiplatelet/anticoagulant medications (14.6% vs. 2.6%, p < 0.001) in the ASA 3-4 group. There was no significant difference between prostate volume (p = 0.158) or catheter-dependent urinary retention (p = 0.376). No difference was found in enucleation time (52.76 ± 24.8 vs. 54.16 ± 23.7 min, p = 0.587), OR specimen weight (70.24 ± 58.5 vs. 81.53 ± 65.9, p = 0.094). or intraoperative complications (2.8% vs. 1.3%, p = 0.330). There were higher postoperative complications in the ASA 3-4 group (12.8% vs. 7.9%, p = 0.03), but no difference in Clavien ≥3 complications (p = 0.068). ASA 3-4 patients had similar postoperative international prostate symptom score (p = 0.159). CONCLUSION HoLEP is feasible and effective in patients who are ASA 3-4. The high-risk cohort had an increased rate of low-grade complications. Patients with an ASA score of 3-4 should be counseled regarding a higher rate of low-grade complications.
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Affiliation(s)
- Mary E Soyster
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Deepak Agarwal
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Austen Slade
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Erica Sahm
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
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Spinos T, Katafigiotis I, Leotsakos I, Grivas N, Zabaftis C, Ermidis D, Sfoungaristos S, Karavitakis M. Rezūm water vapor therapy for the treatment of patients with urinary retention and permanent catheter dependence secondary to benign prostate hyperplasia: a systematic review of the literature. World J Urol 2023; 41:413-420. [PMID: 36534152 DOI: 10.1007/s00345-022-04258-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Recurrent urinary retention due to benign prostate hyperplasia (BPH), requiring permanent catheterization, represents one of the most challenging issues geriatric patients can face. Rezūm, as a minimal invasive treatment for BPH, takes the advantage of sterile water vapor injections directly into the prostate. The purpose of this Systematic Review is to report the safety and the efficacy of Rezūm regarding urinary retention relief and permanent catheter withdrawal. METHODS PubMed, Scopus and Cochrane databases were meticulously screened using the keywords "Rezum", "retention" and "permanent catheter". Only human studies and articles in English were included. Rezūm should be the only intervention employed in patients. Patients of included studies should not have been submitted to any prior interventions, such as transurethral prostatectomy (TURP) for the relief of their symptoms. Patients' baseline characteristics along with intraoperative and postoperative parameters were collected and analysed. Catheter relief was the primary outcome. RESULTS Five studies fulfilled all the criteria and were included in the final qualitative synthesis. Four studies were retrospective and one was prospective. All studies were non-comparative. The success rate ranged from 70.3 to 100%, while no grade ≥ III Clavien-Dindo complications were reported in any of the studies. CONCLUSION Rezūm Water Vapor Therapy Treatment seems to be a feasible, safe and efficient minimally-invasive procedure for catheterized patients with urinary retention secondary to BPH, especially for frail ones with comorbidities who cannot undergo general anesthesia.
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Affiliation(s)
| | - Ioannis Katafigiotis
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros the Athens Clinic, Athens, Greece
| | - Ioannis Leotsakos
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros the Athens Clinic, Athens, Greece
| | - Nikolaos Grivas
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros the Athens Clinic, Athens, Greece
| | - Christos Zabaftis
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros the Athens Clinic, Athens, Greece
| | - Dimitrios Ermidis
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros the Athens Clinic, Athens, Greece
| | - Stavros Sfoungaristos
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros the Athens Clinic, Athens, Greece
| | - Markos Karavitakis
- Department of Laparoscopy and Endourology, Central Urology, Lefkos Stavros the Athens Clinic, Athens, Greece
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Bellos TC, Tzelves LI, Manolitsis IS, Katsimperis SN, Berdempes MV, Skolarikos A, Karakousis ND. Frailty and benign prostatic hyperplasia: The thrilling underlying impact. Arch Ital Urol Androl 2022; 94:345-349. [DOI: 10.4081/aiua.2022.3.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background: World population is aging. The number of individuals aged over 65 are expected to be 71 million only in the US. 43% of this population will be men. Benign prostatic hyperplasia (BPH), defined as the benign neoplasm of the prostate gland affects 8% of men by their forties, but 90% of men over 90 years old. Lower urinary tract symptoms (LUTS) can be caused by an enlarged prostate, and it seems to be associated more with older and frailer individuals. Methods: The purpose of this study is to review the potential interplay between frailty syndrome and benign prostatic hyperplasia. A thorough MEDLINE/PubMed non-systematic literature review was conducted from 1990 to March of 2022. The terms used for the search were “frailty and benign prostatic hyperplasia” and “low muscle mass and benign prostatic hyperplasia”. Results: It seems that, frailty poses a negative impact on the prognosis of patients with BPH, as it is associated with increased incidence of LUTS. In addition, frailty seems to be a strong predictor concerning surgical procedure failure and mortality following invasive procedures for BPH. Prostatic stent placement on the other hand appears to be the ideal solution for frail patients. Conclusions: BPH has a strong association with frailty and increasing age.
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Eredics K, Wehrberger C, Henning A, Sevcenco S, Marszalek M, Rauchenwald M, Falkensammer C, Stoces U, Madersbacher S, Horetzky M, Kunit T, Lusuardi L. Rezūm water vapor therapy in multimorbid patients with urinary retention and catheter dependency. Prostate Cancer Prostatic Dis 2021; 25:302-305. [PMID: 34588631 DOI: 10.1038/s41391-021-00462-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Water vapor thermal therapy (Rezūm) is a minimally invasive treatment for benign prostatic enlargement (BPE). We report on safety and efficacy of this method for treatment of recurrent urinary retention and relief of catheter dependency owing to BPE in multimorbid patients, considered unfit for surgery. METHODS We retrospectively evaluated 136 patients with recurrent urinary retention who underwent water vapor therapy in an ambulatory setting with periprostatic block and optional sedation between 11/2017 and 02/2021 in three urological departments. The objective was successful catheter withdrawal and continuing catheter independency after 3- and 12-months following treatment. RESULTS Mean patient age was 80.3 years (±7.8), mean prostate volume 54 ml (±27.3), and mean catheter dependency before treatment was 4.8 months (±6.0). ASA classification was a followed: II: 10%, III: 71%, and IV: 19%. All procedures were performed successfully in an ambulatory setting. Perioperative complications were infrequent and minor (Clavien-Dindo Grade 1-2) and included haematuria in 4.4% and urinary tract infection in 3.9% of all cases. A total of 103 patients (78.6%) were able to void spontaneously after a median of 31 days. No significant differences in age, prostate volume, duration of catheter dependency, vapor injections, and ASA score were found between patients with successful or unsuccessful outcome. The mean follow-up period was 6.1 months (±5.9, range 1-22 months). A 3-month follow-up was available for 77 patients (75%) and 34 patients (33%) were followed for 12 months. After 3 and 12 months, 93.5 and 91% of patients remained catheter independent. Fifteen patients (11%) died during follow-up, with a mean overall survival of 7.7 months (±4.7). CONCLUSIONS Water vapor therapy may prove to be a useful, minimally invasive treatment in a multimorbid population with catheter dependency after urinary retention, secondary to BPE, considered at highest risk or unfit for surgery. Future studies are warranted.
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Affiliation(s)
- K Eredics
- Department of Urology, Klinik Donaustadt, Vienna, Austria.
| | - C Wehrberger
- Department of Urology, Klinik Donaustadt, Vienna, Austria
| | - A Henning
- Department of Urology, Klinik Donaustadt, Vienna, Austria
| | - S Sevcenco
- Department of Urology, Klinik Donaustadt, Vienna, Austria.,Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - M Marszalek
- Department of Urology, Klinik Donaustadt, Vienna, Austria
| | - M Rauchenwald
- Department of Urology, Klinik Donaustadt, Vienna, Austria
| | - C Falkensammer
- Department of Urology, Klinik Favoriten, Vienna, Austria
| | - U Stoces
- Department of Urology, Klinik Favoriten, Vienna, Austria
| | - S Madersbacher
- Department of Urology, Klinik Favoriten, Vienna, Austria.,Department of Urology, Sigmund Freud Private University, Vienna, Austria
| | - M Horetzky
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - T Kunit
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - L Lusuardi
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
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Madersbacher S. Re: Water Vapor Thermal Therapy to Alleviate Catheter-dependent Urinary Retention Secondary to Benign Prostatic Hyperplasia. Eur Urol 2021; 80:759. [PMID: 34535346 DOI: 10.1016/j.eururo.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Stephan Madersbacher
- Department of Urology, Clinic Favoriten, Sigmund Freud Private Medical University, Vienna, Austria.
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Kahlmeyer A, Fiebig C, Mueller M, Kraulich M, Brendel-Suchanek J, Kunath F, Wach S, Goebell PJ, Ritt M, Gassmann KG, Wullich B. Geriatric Assessments Can Predict Functional Outcome and Mortality after Urological Tumor Surgery. Urol Int 2021; 106:848-857. [PMID: 34537771 DOI: 10.1159/000518978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Older patients undergoing major urological tumor surgery are at severe risk of functional deterioration, complications, and mortality. We prospectively evaluated geriatric assessment tools and developed a novel easy-to-use assessment tool for clinical use. METHODS In 159 patients, geriatric assessment tools were used prior to cystectomy, prostatectomy, and renal tumor surgery, and their peri- and postoperative courses were recorded. Using all the tests, a short and easy-to-use assessment tool was developed, and nomograms were generated to predict functional outcomes and mortality. RESULTS Of all the patients, 13.8% underwent radical cystectomy, 37.7% underwent radical prostatectomy, and 48.4% underwent tumor surgery of the kidney at the age of 70 years or older. The average age was 75.6 years. Incomplete functional recovery at day 30 and day 180 was observed in 37.7% and 36.1% of the patients, respectively, and incomplete functional recovery was associated with impaired mobility, previous care dependency, frailty, comorbidities, and a high ASA score. The only predictor for high-grade complications was comorbidities, whereas mortality was associated with the geriatric screening tool scores, impaired mobility, preoperative care dependency, and comorbidities. The Erlangen Index (EI), a combination of the selected assessment tools, showed a good prediction of early (p = 0.002) and medium-term (p = 0.002) functional outcomes and mortality (p = 0.001). CONCLUSION Our prospective evaluation confirms the high risk of incomplete functional recovery, high-grade complications, and mortality in older patients undergoing major urological tumor surgery. The EI is an easy-to-use preoperative assessment tool and therefore should be used in preoperative patient counseling.
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Affiliation(s)
- Andreas Kahlmeyer
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Christian Fiebig
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Marco Mueller
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Matthias Kraulich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Jonas Brendel-Suchanek
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Frank Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Peter J Goebell
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Martin Ritt
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien gGmbH, Erlangen, Germany
| | - Karl-Guenter Gassmann
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien gGmbH, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
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