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Sadri I, Chakraborty A, Nguyen DD, Arezki A, Oumedjbeur K, Bhojani N, Elterman D, Chughtai B, Gilling P, Barber N, Badlani G, Desai M, Doumanian L, Te AE, Roehrborn C, Zorn KC. Aquablation in Patients on Antithrombotics: Assessment of Safety, Postoperative Bleeding Rates and Clinical Outcomes. Urology 2023; 181:112-118. [PMID: 37574143 DOI: 10.1016/j.urology.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/01/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To analyze the impact of perioperative antithrombotic use on the bleeding outcomes following Aquablation. METHODS One hundred sixteen men with who underwent Aquablation as part of the WATER prospective trial (NCT02505919) were assigned to 2 groups based on perioperative antithrombotic status. Antithrombotic cessation and restart timing were based on the surgeon's discretion. Methods of achieving intraoperative hemostasis consisted of no-cautery balloon tamponade or cautery. Primary endpoints included immediate postoperative hematuria rates and changes in hemoglobin. Secondary endpoints included 90-day bleeding complications and nonbleeding postoperative adverse events. RESULTS Forty-one men took antithrombotic medications in the perioperative period while 75 men had no antithrombotic medication. Preoperative hemoglobin levels were comparable between both groups. Postoperative hemoglobin change from baseline (drop of 1.8 ± 1.5 g/dL among the antithrombotic group vs 1.8 ± 1.7 g/dL among the antithrombotic-naïve group) did not differ between both groups (P = .896). In total, 4 (9.8%) men in the antithrombotic group and 4 (5.3%) patients in the antithrombotic-naïve group experienced a Clavien-Dindo grade 1 complication (P = .451) in the 3-month postoperative period. Eight (19.5%) patients in the antithrombotic group and 11 (14.7%) patients in the antithrombotic-naïve group experienced a Clavien-Dindo grade 2 complication (P = .601), none of which is associated with bleeding in both groups. No men in either group demonstrated de novo erectile dysfunction. One patient (2.4%) in the antithrombotic group and none in the antithrombotic-naïve group required blood products (P = .353). CONCLUSION Aquablation demonstrates comparable postoperative bleeding outcomes and other adverse effects for men with benign prostatic hypertrophy who are on antithrombotic therapy.
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Affiliation(s)
- Iman Sadri
- Department of Urology, McGill University, Montreal, Quebec, Canada
| | | | - David-Dan Nguyen
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Adel Arezki
- Department of Urology, McGill University, Montreal, Quebec, Canada
| | - Kussil Oumedjbeur
- Division of Urology, Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Peter Gilling
- Department of Urology, Tauranga Hospital, Tauranga, New Zealand
| | - Neil Barber
- Section of Urology, Department of Surgery, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - Gopal Badlani
- Department of Urology, Wake Forest University, Winston-Salem, NC
| | - Mihir Desai
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Leo Doumanian
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Alexis E Te
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Claus Roehrborn
- Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada.
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Kaplan S, Kaufman RP, Mueller T, Elterman D, Chughtai B, Rukstalis D, Woo H, Roehrborn C. Retreatment rates and postprocedural complications are higher than expected after BPH surgeries: a US healthcare claims and utilization study. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00741-8. [PMID: 37884615 DOI: 10.1038/s41391-023-00741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Up to 50% of men over 50 and 80% over 80 are affected by BPH. Shared decision-making regarding BPH treatment options can benefit from an improved understanding of relative risks and benefits for various treatments. METHODS Data for this longitudinal retrospective population-based cohort study were obtained from a random sample of US Medicare and commercial claims (IBM Watson MarketScan) and restricted to men undergoing BPH surgery (TURP, PVP, PUL, WVTT) from 2015 to 2021 across all sites of service. Retreatments included Holmium laser enucleation and index procedures. Main outcomes were rates of retreatment and procedural complications over 1 year, identified via CPT and ICD-9/10CM codes. Procedural complications that occurred at least 1 day post-index treatment were assessed, as were surgical retreatments with patients who had at least 1 and 5 year's-worth of data. Baseline phenotype characterization did not control for symptomatology and was limited to age, comorbidities, and BMI. Univariate cumulative incidence estimates, cumulative proportion and log-rank tests justified inclusion for covariate (e.g., age, comorbidities) adjustment in Cox proportional hazard models. RESULTS 43,147 men diagnosed with BPH underwent 22,629 TURP, 11,392 PVP, 7,529 PUL, and 1,597 WVTT. At 1-year post-index: PUL was associated with the lowest rate of complication (PUL 15%, TURP 17%; PVP 19%, ; WVTT 26%); retreatment rates were not different (TURP 5.3%, PVP 5.3%, PUL 5.9%, WVTT 6.2%). At 5 years post-index: retreatment was lowest for TURP (7.0%) and was not significantly different between PVP and PUL (8.9% and 11.6%, respectively). CONCLUSIONS Real-world patients diagnosed with BPH may be selected to undergo one of the various available therapies based on patient preference or baseline phenotype. These therapies, however, are associated with different risks for complications. The results of this study suggest that within one year of BPH surgery, one-in-twenty patients may require retreatment regardless of treatment choice, and for some technologies as many as one-in-four may require treatment for a complication.
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Affiliation(s)
| | | | | | | | | | | | - Henry Woo
- University of Sydney, Sydney, Australia
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Bhojani N, Bidair M, Kramolowsky E, Desai M, Doumanian L, Zorn KC, Elterman D, Kaufman RP, Eure G, Badlani G, Plante M, Uchio E, Gin G, Paterson R, So A, Roehrborn C, Motola J, Kaplan S, Humphreys M. Aquablation Therapy in Large Prostates (80-150 mL) for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: Final WATER II 5-Year Clinical Trial Results. J Urol 2023; 210:143-153. [PMID: 37115632 DOI: 10.1097/ju.0000000000003483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE We report 5-year safety and efficacy outcomes of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia and large-volume prostate glands. MATERIALS AND METHODS A total of 101 men with moderate to severe benign prostatic hyperplasia symptoms and prostate volumes between 80 and 150 mL underwent a robotic-assisted Aquablation procedure in a prospective multicenter international trial (NCT03123250). Herein we report the final 5-year results. RESULTS The study successfully met its safety and efficacy performance goal, which was based upon transurethral resection of the prostate outcomes typically done in smaller prostates, at 3 months. Mean prostate volume was 107 mL (range 80-150) at baseline. Patient symptoms showed a significant improvement where the mean (SD) International Prostate Symptom Score of 22.6 (6.4) at baseline to 6.8 (4.6) at 5 years, resulting in a change score of 15.9 (7.7, P < .001). Uroflowmetry measurements also demonstrated improvement where the mean maximum urinary flow rate increased from 8.6 (SD 3.4) to 17.1 (9.8) mL/s at 5 years, resulting in a change score of 9.2 (11.1) mL/s at 5 years (P < .001). A regression analysis evaluating change in PSA as a function of baseline PSA across all time points out to 5 years resulted in a 50% reduction. A prespecified subgroup analysis using a baseline prostate volume cutoff of 100 mL showed no difference in efficacy outcomes through 5 years. Freedom from a secondary benign prostatic hyperplasia procedure at 5 years was 96.3% based on Kaplan-Meier. CONCLUSIONS At 5-years of prospective follow-up, the Aquablation procedure was shown to be safe with durable efficacy and low rates of retreatment in men with large prostates (80-150 mL).
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Affiliation(s)
- Naeem Bhojani
- University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Mo Bidair
- San Diego Clinical Trials, San Diego, California
| | | | - Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Leo Doumanian
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Kevin C Zorn
- University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Dean Elterman
- University of Toronto University Health Network, Toronto, Ontario, Canada
| | | | - Gregg Eure
- Urology of Virginia, Virginia Beach, Virginia
| | - Gopal Badlani
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark Plante
- University of Vermont Medical Center, Burlington, Vermont
| | - Edward Uchio
- VA Long Beach Healthcare System, Long Beach, California
| | - Greg Gin
- VA Long Beach Healthcare System, Long Beach, California
| | | | - Alan So
- University of British Columbia, Vancouver, Canada
| | - Claus Roehrborn
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Jay Motola
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven Kaplan
- Icahn School of Medicine at Mount Sinai, New York, New York
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Roehrborn C, Gange S, Rochester M, Barber N, Chin P. Durability following treatment with the Prostatic Urethral Lift (PUL): Predictors from over 330 controlled subjects across 5 distinct studies. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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5
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Kaplan S, Kaufman R, Rukstalis D, Roehrborn C. The Impact of BPH Care: Procedural complications associated with MIST and traditional surgery compared to disease progression with medical therapy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00093-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Eure G, Rukstalis D, Roehrborn C. Prostatic Urethral Lift for Obstructive Median Lobes: Consistent Results Across Controlled Trial and Real-World Settings. J Endourol 2023; 37:50-59. [PMID: 35876440 PMCID: PMC9810349 DOI: 10.1089/end.2022.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: The evidence for prostatic urethral lift (PUL), in treating lower urinary tract symptoms/benign prostatic hyperplasia (BPH) in men with obstructive median lobes (OMLs), has grown. In this study, we present the first detailed comparison of outcomes between OML patients treated with PUL in controlled and real-world settings to relevant comparators (subjects treated with transurethral resection of the prostate [TURP] and sham in randomized controlled trials [RCTs]) to demonstrate similar symptom, safety, and patient experience outcomes. Materials and Methods: Symptom and safety outcomes and patient satisfaction were compared through 12 months among controlled PUL studies: BPH6 RCT (35 men randomized to TURP); L.I.F.T. pivotal RCT in subjects with lateral lobe obstruction (66 subjects randomized to sham) and MedLift, an U.S. Food and Drug Administration-approved Investigational Device Exemption (IDE) extension of the L.I.F.T. trial (45 men with OML). Symptom improvement, catheterization, and adverse event rates were compared between MedLift subjects and OML patients (n = 187) from the large real-world retrospective (RWR) study of PUL filtered on baseline characteristics to approximate the MedLift population. Results: Posttreatment, International Prostate Symptoms Score (IPSS) improvement for MedLift subjects was 170% greater compared with sham at 3 months with significantly better quality of life (QoL), Qmax, and benign prostatic hyperplasia impact index (BPHII). Compared with TURP, MedLift IPSS and QoL improved significantly better at 1 and 3 months and with superior ejaculatory function scores at all time points after PUL. IPSS, QoL, postvoid residual (PVR), and Qmax outcomes were equivalent between MedLift and RWR OML groups at 3, 6, and 12 months. RWR OML patients did not experience higher rates of overall adverse events compared with MedLift. Conclusion: Controlled and real-world outcomes confirm PUL is a safe and effective treatment for BPH patients with and without OML.
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Affiliation(s)
- Gregg Eure
- Department of Urology, Urology of Virginia, Virginia Beach, Virginia, USA.,Address correspondence to: Gregg Eure, MS, Department of Urology, Urology of Virginia, Virginia Beach, VA, USA
| | - Daniel Rukstalis
- Prisma Health USC Medical Group, Division of Urology, 300 Palmetto Health Pkwy, Columbia
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Garbens A, Kominsky H, Dai J, Steinberg RL, Trivedi H, Kusin S, Roehrborn C, Gahan J. Evaluating Surgical Outcomes of Robot Assisted Simple Prostatectomy in the Retreatment Setting. Urology 2022; 170:111-116. [PMID: 35988733 DOI: 10.1016/j.urology.2022.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To report perioperative and postoperative outcomes in men who undergo salvage RASP (sRASP) following some other endoscopic outlet procedure for benign prostate enlargement (BPE) compared to those undergoing RASP for primary treatment (pRASP). METHODS A prospectively maintained database consisting of all RASP surgeries (December 2014 - October 2019) performed at our institution by three different urologists was used. Patients who had received an endoscopic procedure for BPE prior to their RASP (sRASP) were compared to those who had not had a prior outlet procedure (pRASP). RESULTS In total, 310 men underwent RASP during the study period. Of those, 30 (9.7%) had undergone an endoscopic procedure prior to surgery. There were no significant differences in age, race, ASA, BMI, prostate volume, PSA or rates of preoperative retention (p>0.05 for all). Men who were treatment-naive had significantly higher preoperative International Prostate Symptom Scores (IPSS) than men who had a prior procedure (18.3 ±7.7 vs. 13.6 ±6.2, p=0.008). However, there were no significant differences in functional or quality of life outcomes between the two groups (p>0.05 for all). There were no significant differences in perioperative or post-operative outcomes between the two groups. Furthermore, rates of post-operative complications and incontinence were similar between groups (11% vs. 10%, p=0.9 and 2% vs. 0%, p=1 respectively). CONCLUSION Performing a RASP after prior endoscopic procedure for BPE was found to be safe and effective. Success and complication rates were similar to patients with no prior procedures.
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Affiliation(s)
- Alaina Garbens
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Hal Kominsky
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Jessica Dai
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Ryan L Steinberg
- University of Iowa, Department of Urology, Iowa City, Iowa, USA.
| | - Hersh Trivedi
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Sam Kusin
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Claus Roehrborn
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Jeffrey Gahan
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
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Bhanvadia RR, Carpinito G, Kavoussi M, Lotan Y, Margulis V, Bagrodia A, Roehrborn C, Gahan JC, Cadeddu JA, Woldu S. Safety and Feasibility of Telehealth Only Preoperative Evaluation Prior to Minimally Invasive Robotic Urologic Surgery. J Endourol 2022; 36:1070-1076. [PMID: 35596562 DOI: 10.1089/end.2021.0819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Telehealth utilization has increased dramatically over the past few years due to improvement in technology and the COVID-19 pandemic. To date, no study has examined whether a telehealth visit alone for preoperative evaluation is safe and sufficient prior to surgery. We examined the safety and feasibility of preoperative telehealth visits alone prior to minimally invasive urologic surgery Materials & Methods Single institution retrospective review of robotic prostate, kidney, and cystectomy procedures between April - Dec 2020. Cases were dichotomized into those who underwent preoperative evaluation by telehealth-only versus traditional in-person visits. Outcomes included complications, blood loss, conversion to open surgery rates, and operative times. We assessed efficiency of care by measuring time from preoperative visit to surgery. Results 314 patients were included in the study, with 14% of cases (n = 45) being performed after a preoperative telehealth visit. The majority of cases included in analysis were robotic surgeries of the prostate (56.1% of all cases, n = 176) and the kidney (35.0% of all cases, n = 110). Patients seen via telehealth alone preoperatively had no significant differences in any grade of complications, perioperative outcomes, blood loss, operative time, and length of stay. There was no difference in change in anticipated procedure between groups, and there was no cases of conversion to open surgery in the telehealth only group. Time from preoperative visit to surgery was significantly shorter for the telehealth group by 13 days. Conclusion Our study is the first to analyze the safety of telehealth-only preoperative visits prior to minimally invasive urologic surgery. We found no difference in perioperative outcomes including conversion to open surgery or change in planned procedure. Further, telehealth preoperative visits appeared to facilitate shorter time to surgery. This study has important implications for expediting patient care and medico-legal considerations.
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Affiliation(s)
- Raj Ramnik Bhanvadia
- University of Texas Southwestern Medical Center at Dallas, 12334, 2001 Inwood Road, 4th Floor, WBCE3, Dallas, Texas, United States, 75390;
| | | | | | - Yair Lotan
- University of Texas Southwestern Medical Center, Department of Urology, 5323 Harry Hines Blvd. J8.112, Dallas, Texas, United States, 75390;
| | - Vitaly Margulis
- UT Southwestern Medical, Urology, 5339 harry hines blvd, Dallas, Texas, United States, 75390;
| | - Aditya Bagrodia
- UT Southwestern, 12334, Urology, Dallas, Texas, United States;
| | - Claus Roehrborn
- UT Southwestern Medical Center, Urology, 5323 Harry Hines Blvd, J8 142, Dallas, Texas, United States, 75390-9110;
| | - Jeffrey C Gahan
- UT Southwestern medical center, Urology, 5323 Harry Hines Blvd., J8.106, Dallas, Texas, United States, 75390;
| | - Jeffrey A Cadeddu
- UT Southwestern Medical Center, Urology, 5323 Harry Hines Blvd, Dallas, Texas, United States, 75390-9110;
| | - Solomon Woldu
- University of Texas Southwestern Medical Center at Dallas, 12334, Urology, Dallas, Texas, United States, 75390;
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Bhanvadia R, Dropkin B, Wolfe A, Diao L, Sanders S, Joice G, Roehrborn C, Hudak S, Morey A. Artificial Urinary Sphincter Reverses Weight Gain Associated with Post-Prostatectomy Incontinence. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Chen L, Gannavarapu BS, Desai NB, Folkert MR, Dohopolski M, Gao A, Ahn C, Cadeddu J, Bagrodia A, Woldu S, Raj GV, Roehrborn C, Lotan Y, Timmerman RD, Garant A, Hannan R. Dose-Intensified Stereotactic Ablative Radiation for Localized Prostate Cancer. Front Oncol 2022; 12:779182. [PMID: 35265519 PMCID: PMC8899031 DOI: 10.3389/fonc.2022.779182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Stereotactic ablative radiation (SAbR) has been increasingly used in prostate cancer (PCa) given its convenience and cost efficacy. Optimal doses remain poorly defined with limited prospective comparative trials and long-term safety/efficacy data at higher dose levels. We analyzed toxicity and outcomes for SAbR in men with localized PCa at escalated 45 Gy in 5 fractions. Methods and Materials This study retrospectively analyzed men from 2015 to 2019 with PCa who received linear-accelerator-based SAbR to 45 Gy in 5 fractions, along with perirectal hydrogel spacer, fiducial placement, and MRI-based planning. Disease control outcomes were calculated from end of treatment. Minimally important difference (MID) assessing patient-reported quality of life was defined as greater than a one-half standard deviation increase in American Urological Association (AUA) symptom score after SAbR. Results Two-hundred and forty-nine (249) low-, intermediate-, and high-risk PCa patients with median follow-up of 14.9 months for clinical toxicity were included. Acute urinary grade II toxicity occurred in 20.4% of patients. Acute grade II GI toxicity occurred in 7.3% of patients. For follow-up > 2 years (n = 69), late GU and GI grade ≥III toxicity occurred in 5.8% and 1.5% of patients, respectively. MID was evident in 31.8%, 23.4%, 35.8%, 37.0%, 33.3%, and 26.7% of patients at 3, 6, 12, 24, 36, and 48 months, respectively. The median follow-up for biochemical recurrence was 22.6 months with biochemical failure-free survival of 100% at 1 year (n = 226) and 98.7% for years 2 (n = 113) and 3 (n = 54). Conclusions SAbR for PCa at 45 Gy in 5 fractions shows an encouraging safety profile. Prospective studies with longer follow-up are warranted to establish this dose regimen as standard of care for PCa.
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Affiliation(s)
- Lily Chen
- School of Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Bhavani S Gannavarapu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michael R Folkert
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michael Dohopolski
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ang Gao
- Department of Population and Data Sciences, University of Texas (UT) Southwestern Medical Center, Dallas, TX, United States
| | - Chul Ahn
- Department of Population and Data Sciences, University of Texas (UT) Southwestern Medical Center, Dallas, TX, United States
| | - Jeffrey Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ganesh V Raj
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Claus Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Aurelie Garant
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Roehrborn C, Gange S, Chin P, Eure G. Pooled outcomes from five Prostatic Urethral Lift (PUL) controlled studies reveal most patients can shift to lower IPSS symptom severity after treatment. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00799-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Elterman D, Gilling P, Roehrborn C, Barber N, Misrai V, Zorn KC, Bhojani N, Te A, Humphreys M, Kaplan S, Desai M, Bach T. Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due to BPH in various prostate anatomies. BMJ Surg Interv Health Technol 2022; 3:e000090. [PMID: 35047807 PMCID: PMC8749268 DOI: 10.1136/bmjsit-2021-000090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/03/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To evaluate functional outcomes following Aquablation in various prostate volume and anatomical subgroups. DESIGN A meta-analysis with individual patient data undergoing Aquablation therapy from four prospective, global, clinical studies that have been conducted with Aquablation; WATER, WATER II, FRANCAIS WATER and OPEN WATER. SETTING Australia, Canada, Lebanon, Germany, New Zealand, UK and the USA. PARTICIPANTS 425 men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 1-year follow-up. INTERVENTIONS Aquablation therapy is an ultrasound guided, robotically executed waterjet ablative procedure for the prostate. MAIN OUTCOME MEASURES The analyses focus International Prostate Symptom Score (IPSS), uroflowmetry, postoperative Incontinence Severity Index (ISI) and surgical retreatment. RESULTS 425 men with prostates ranging in size from 20 to 150 mL underwent Aquablation therapy. The outcomes from the seven questions in the IPSS questionnaire were grouped by the following; prostates <100 mL, prostates ≥100 mL, prostate anatomy with an obstructive median lobe identifed by imaging, and prostate anatomy without an obstructive median lobe. Regardless of subgroup, all outcomes are consistent and demonstrate a significant improvement from baseline. Specifically, improvements in frequency, urgency and nocturia demonstrated bladder function improvement. Patients entering treatment with severe incontinence, ISI score >4, and regardless of prostate size, showed a reduction in incontinence during patient follow-up. Surgical retreatment due to BPH symptoms occurred in 0.7% (95% CI 0.1%-2.0%). CONCLUSIONS Across a variety of prostate anatomies, Aquablation therapy showed remarkable functional improvements following the index procedure. Additionally, men with moderate to severe LUTS/BPH and overactive bladder resulting in urge incontinence showed a reduction in incontinence symptoms postprocedure.
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Affiliation(s)
- Dean Elterman
- Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Claus Roehrborn
- Urology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Neil Barber
- Urology, Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
| | | | - Kevin C Zorn
- University of Montreal Hospital Center, Universite de Montreal, Montreal, Québec, Canada
| | - Naeem Bhojani
- University of Montreal Hospital Center, Universite de Montreal, Montreal, Québec, Canada
| | - Alexis Te
- Urology, Weill Cornell Medical College, New York, New York, USA
| | | | - Steven Kaplan
- Urology, Mount Sinai Medical Center, New York, New York, USA
| | - Mihir Desai
- Urology, University of Southern California, Los Angeles, California, USA
| | - Thorsten Bach
- Urology, Asklepios Westklinikum Hamburg, Hamburg, Hamburg, Germany
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McVary KT, El-Arabi A, Roehrborn C. Preservation of Sexual Function 5 Years After Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia. Sex Med 2021; 9:100454. [PMID: 34731779 PMCID: PMC8766265 DOI: 10.1016/j.esxm.2021.100454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background Erectile dysfunction (ED) and ejaculatory dysfunction (EjD) are known outcomes of traditional surgery and some pharmacotherapies for treatment of benign prostatic hyperplasia (BPH). Minimally invasive treatment options, including water vapor thermal therapy (WVTT), are now available to treat lower urinary tract symptoms (LUTS) due to BPH. Aim The objective of this analysis was to evaluate long-term impact of a single water vapor thermal therapy procedure on erectile and ejaculatory function in subjects enrolled in the Rezum II prospective, multicenter, randomized, blinded controlled trial. Methods Fifteen centers enrolled 197 subjects with International Prostate Symptom Score (IPSS) ≥ 13, maximum flow rate (Qmax) ≤ 15 mL/s, and prostate volume 30–80 cc. Subjects were randomized (2:1) to (WVTT) or sham procedure (control) and followed for 5 years. Erectile and ejaculatory functions were quantitatively assessed at baseline and yearly thereafter. After 3 months, control subjects could opt to requalify for cross-over to WVTT and were followed for 5 years. Results of the per protocol analysis were reported previously. The current post hoc analysis was performed on all treated subjects who were sexually active at baseline with no other surgical or medical management for BPH during the 5-year study period. Outcomes LUTS was evaluated using IPSS, Benign Prostatic Hyperplasia Impact Index (BPHII), and Qmax. Sexual function was assessed using the International Index of Erectile Function (IIEF-EF) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD). Results A total of 197 subjects (136 treated, 61 control) were enrolled in the study, and 53 control subjects opted to cross-over and receive WVTT. All subgroups experienced significant, durable improvement in IPSS (P < .0001). Subjects with normal sexual function at baseline had little change in function over 5 years (IIEF-EF: −2.4 ± 8.9, P = .1414; MSHQ-EjD Function: −1.6 ± 3.2, P = .0083; MSHQ-EjD Bother: −0.5 ± 1.6, P = .1107). Subjects with baseline medical history of ED and EjD showed slight decline over time that was not clinically significant (ED, IIEF-EF: −3.0 ± 10.1, P = .1259; MSHQ EjD Function: −2.3 ± 4.7, P = .0158; MSHQ-EjD Bother: −0.1 ± 2.6, P = .7764; EjD, IIEF-EF: −4.1 ± 9.2, P = .0127; MSHQ EjD Function: −1.6 ± 4.8, P = .1970; MSHQ-EjD Bother: −0.4 ± 2.6, P = .440). Clinical Implications Treatment for BPH with Rezum durably improved IPSS without clinically significant impact on sexual function. Patients with baseline ED/EjD may expect continued decline from other causes but are unimpacted by the therapy. Strengths & Limitations, Conclusion The results are limited by the post-hoc nature of the analysis and attrition over the 5-year follow-up but provide long-term evidence of durable outcomes after treatment with Rezum without impact on sexual function scores. McVary KT, El-Arabi A, Roehrborn C. Preservation of Sexual Function 5 Years After Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia. Sex Med 2021;9:100454.
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Affiliation(s)
- Kevin T McVary
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.
| | - Ahmad El-Arabi
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
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Zorn KC, Bidair M, Trainer A, Arther A, Kramolowsky E, Desai M, Doumanian L, Elterman D, Kaufman RP, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Uchio E, Gin G, Goldenberg SL, Paterson R, So A, Humphreys M, Roehrborn C, Kaplan S, Motola J, Bhojani N. Aquablation therapy in large prostates (80–150 cc) for lower urinary tract symptoms due to benign prostatic hyperplasia: WATER II 3‐year trial results. BJUI Compass 2021; 3:130-138. [PMID: 35474721 PMCID: PMC8988689 DOI: 10.1002/bco2.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 01/09/2023] Open
Abstract
Objective The objective of this study is to determine if Aquablation therapy can maintain its effectiveness in treating men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with large‐volume (80–150 cc) prostates at 3 years. Subjects and Methods One hundred one men with moderate‐to‐severe BPH symptoms and prostate volumes between 80 and 150 cc were enrolled in a prospective, nonrandomized, multicenter, international clinical trial in late 2017. Baseline, procedural, and follow‐up parameters were recorded at baseline and scheduled postoperative visits. IPSS, Qmax, and treatment failure are reported at 3 years. Results The mean prostate volume was 107 cc (range 80–150). Mean IPSS improved from 23.2 at baseline to 6.5 at 3 years (16.3‐point improvement, p < 0.0001). Mean IPSS quality of life improved from 4.6 at baseline to 1.1 at 3 years (improvement of 3.4 points, p < 0.0001). Maximum urinary flow increased from 8.7 to 18.5 cc/s. At 3 year follow‐up, 6% of treated patients needed BPH medication and an additional 3% required surgical retreatment for LUTS. Conclusions Three‐year follow‐up demonstrates a sustained symptom reduction response along with low irreversible complications to Aquablation in men with LUTS due to BPH and prostates of 80–150 cc. Current treatment options available for men with prostates of this size have similar efficacy outcomes but are burdened with high rates of irreversible complications. There are now numerous clinical studies with Aquablation used in various prostates sizes, and it should be offered as an option to men with LUTS due to BPH.
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Affiliation(s)
- Kevin C. Zorn
- University of Montreal Hospital Center University of Montreal Montréal Québec Canada
| | - Mohamed Bidair
- Urology San Diego Clinical Trials San Diego California USA
| | - Andrew Trainer
- Urology Adult Pediatric Urology & Urogynecology, P.C. Omaha Nebraska USA
| | - Andrew Arther
- Urology Adult Pediatric Urology & Urogynecology, P.C. Omaha Nebraska USA
| | | | - Mihir Desai
- Institute of Urology University of Southern California Los Angeles California USA
| | - Leo Doumanian
- Institute of Urology University of Southern California Los Angeles California USA
| | - Dean Elterman
- University Health Network University of Toronto Toronto Ontario Canada
| | | | - James Lingeman
- Urology Indiana University Health Physicians Indianapolis Indiana USA
| | - Amy Krambeck
- Urology Indiana University Health Physicians Indianapolis Indiana USA
| | - Gregg Eure
- Urology Urology of Virginia Virginia Beach Virginia USA
| | - Gopal Badlani
- Urology Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Mark Plante
- Urology University of Vermont Medical Center Burlington Vermont USA
| | - Edward Uchio
- Urology VA Long Beach Healthcare System Long Beach California USA
| | - Greg Gin
- Urology VA Long Beach Healthcare System Long Beach California USA
| | | | - Ryan Paterson
- Urology University of British Columbia Vancouver British Columbia Canada
| | - Alan So
- Urology University of British Columbia Vancouver British Columbia Canada
| | | | - Claus Roehrborn
- UT Southwestern Medical Center, Department of Urology University of Texas Southwestern Dallas Texas USA
| | - Steven Kaplan
- Urology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Jay Motola
- Urology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Naeem Bhojani
- University of Montreal Hospital Center University of Montreal Montréal Québec Canada
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Folkert MR, Zelefsky MJ, Hannan R, Desai NB, Lotan Y, Laine AM, Kim DWN, Neufeld SH, Hornberger B, Kollmeier MA, McBride S, Ahn C, Roehrborn C, Timmerman RD. A Multi-Institutional Phase 2 Trial of High-Dose SAbR for Prostate Cancer Using Rectal Spacer. Int J Radiat Oncol Biol Phys 2021; 111:101-109. [PMID: 33753140 DOI: 10.1016/j.ijrobp.2021.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE High-dose SABR for prostate cancer offers the radiobiologic potency of the most intensified radiation therapy regimens but was associated with >90% rates of ulceration of the anterior rectal wall on endoscopic assessment; this infrequently progressed to severe rectal toxicity in prior prospective series. A multi-institutional phase 2 prospective trial was conducted to assess whether placement of a perirectal hydrogel spacer would reduce acute periprostatic rectal ulcer events after high-dose (>40 Gy) SABR. METHODS AND MATERIALS Eligible patients included men with stage ≤T2c localized grade group 1 to 3 prostate cancer, a prostate-specific antigen (PSA) level ≤15 ng/mL, American Urological Association Symptom Index = AUA-SI scores ≤18, and a gland volume ≤80 cm3. Patients underwent perirectal hydrogel spacer placement, followed by SABR of 45 Gy in 5 fractions every other day to the prostate only. Androgen deprivation was not allowed except for cytoreduction. The rectal wall was directly assessed by serial anoscopy during follow-up to determine whether the spacer would reduce acute periprostatic rectal ulcer events from >90% to <70% within 9 months of treatment. RESULTS Forty-four men were enrolled and 43 were eligible for protocol analysis. The median follow-up for surviving patients was 48 months. Acute periprostatic ulcers were observed in 6 of 42 patients (14.3%; 95% confidence interval, 6.0%-27%; P < .001) at a median of 2.9 months posttreatment (range, 1.7-5.6 months). All ulcers (grade 1, 5 ulcers; grade 2, 1 ulcer) resolved on repeat anoscopy within 8 months of incidence. There were no grade ≥3 late gastrointestinal toxicities; the incidence of late grade-2 gastrointestinal toxicities was 14.3%, with a prevalence at 3 years of 0%. No toxicities greater than grade 3 occurred in any domain. Four-year freedom from biochemical failure was 93.8% (95% CI, 85.2%-100.0%). CONCLUSIONS Temporary hydrogel spacer placement before high-dose SABR treatment for localized prostate cancer and use of strict dose constraints are associated with a significant reduction in the incidence of rectal ulcer events compared with prior phase 1/2 trial results.
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Affiliation(s)
- Michael R Folkert
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aaron M Laine
- Center for Cancer and Blood Disorders, Weatherford, Texas
| | - D W Nathan Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah Hardee Neufeld
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brad Hornberger
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chul Ahn
- Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Claus Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Zorn K, Bidair M, Bhojani N, Trainer A, Arther A, Kramolowsky E, Doumanian L, Elterman D, Kaufman R, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Gin G, Goldenberg L, Patterson R, So A, Humphreys M, Kaplan S, Motola J, Desai M, Roehrborn C. Aquablation for benign prostatic hyperplasia in large prostates (80-150cc): 3-year results. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nguyen DD, Barber N, Bidair M, Gilling P, Anderson P, Zorn KC, Badlani G, Humphreys M, Kaplan S, Kaufman R, So A, Paterson R, Goldenberg L, Elterman D, Desai M, Lingeman J, Roehrborn C, Bhojani N. WATER versus WATER II 2-Year Update: Comparing Aquablation Therapy for Benign Prostatic Hyperplasia in 30-80-cm 3 and 80-150-cm 3 Prostates. EUR UROL SUPPL 2021; 25:21-28. [PMID: 34337500 PMCID: PMC8317818 DOI: 10.1016/j.euros.2021.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 10/26/2022] Open
Abstract
Background Surgical options are limited when treating large (>80 cm3) prostates for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Open simple prostatectomy remains the most common procedure performed for large prostates. There is a need for novel surgical approaches with shorter learning curves and effective treatment. Aquablation could be this novel tool. Objective To compare the outcome of Aquablation for 30-80-cm3 prostates with the outcome for 80-150-cm3 prostates at 2-yr follow-up. Design setting and participants We used data from two trials. WATER is a prospective, double-blind, multicenter, international clinical trial comparing the safety and efficacy of Aquablation and transurethral resection of the prostate in the treatment of LUTS/BPH in men aged 45-80 yr with a prostate of 30-80 cm3. WATER II is a prospective, multicenter, single-arm international clinical trial of Aquablation in men with a prostate of 80-150 cm3. Intervention Aquablation, an ultrasound-guided, robotically executed waterjet ablative procedure. Outcome measurements and statistical analysis We compared 24-mo outcomes between 116 WATER and 101 WATER II study subjects. Student's t test or a Wilcoxon test was used to compare continuous variables and Fisher's test for categorical variables. Results and limitations The International Prostate Symptom Score (IPSS) reductions at 24 mo was 14.5 points for WATER and 17.4 points for WATER II (p = 0.31). At baseline, the maximum urinary flow rate (Qmax) was 9.4 and 8.7 cm3/s in WATER and WATER II, improving to 20.5 and 18.2 cm3/s, respectively (p = 0.60) at 24 mo. Improvements in both IPSS and Qmax were immediate and sustained throughout follow-up. At 2 yr, the surgical retreatment rate was 4% in WATER and 2% in WATER II. Conclusions Aquablation is effective in patients with a prostate of 30-80 cm3 and patients with a prostate of 80-150 cm3 treated for LUTS/BPH, with comparable outcomes in both groups. It has low complication and retreatment rates at 2 yr of follow-up, with durable improvements in functional outcome. Patient summary Outcomes of Aquablation for both small-to-moderately-sized and large prostates are similar and sustainable at 2 yr of follow-up.
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Affiliation(s)
| | - Neil Barber
- Department of Urology, Frimley Park Hospital, Frimley, UK
| | - Mo Bidair
- San Diego Clinical Trials, San Diego, CA, USA
| | - Peter Gilling
- Department of Urology, Bay of Plenty District Health Board Clinical School, Tauranga, New Zealand
| | - Paul Anderson
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Gopal Badlani
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Steven Kaplan
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Ronald Kaufman
- Division of Urology, Albany Medical College, Albany, NY, USA
| | - Alan So
- Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Ryan Paterson
- Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Larry Goldenberg
- Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, Canada
| | - Mihir Desai
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Jim Lingeman
- Institute for Kidney Stone Disease, Methodist Hospital, Indianapolis, IN, USA
| | - Claus Roehrborn
- Department of Urology, UT Southwestern Medical Centre, Dallas, TX, USA
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
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Bhanvadia R, Ashbrook C, Gahan J, Mauck R, Bagrodia A, Margulis V, Lotan Y, Roehrborn C, Woldu S. Perioperative outcomes and cost of robotic vs open simple prostatectomy in the modern robotic era: results from the National Inpatient Sample. BJU Int 2020; 128:168-177. [PMID: 32981194 DOI: 10.1111/bju.15258] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To perform a comparative analysis of perioperative outcomes and hospitalisation cost between open (OSP) and robot-assisted simple prostatectomy (RASP) for treatment of benign prostatic hyperplasia (BPH) using the National Inpatient Sample (NIS) in the contemporary robotic era. MATERIALS AND METHODS The NIS was queried for cases of OSP and RASP for the treatment of BPH between 2013 and 2016. Perioperative complications, unadjusted hospital cost and length of stay (LOS) were compared between RASP and OSP. Smoothed linear regression curves comparing hospitalisation cost by increasing LOS was stratified by surgical approach to identify point of cost equivalency between RASP and OSP. Multivariable linear regression analysis was used to construct a hospitalisation cost model to examine the contribution of the robotic approach and LOS to hospitalisation cost. RESULTS The total analytical cohort included 2551 OSP and 704 RASP procedures. Patients undergoing RASP were younger, at a median (interquartile range [IQR]) age of 68 (63-73) vs 71 (65-77) years, and with less comorbidity (76.8% vs 86.5%, P < 0.01). RASP was associated with fewer total complications (11.1% vs 29.2%, P < 0.01) and a greater likelihood of routine discharge to home rather than another facility (88.9% vs 76.7%, P < 0.01). While LOS was shorter with RASP (median [IQR], 2 [1-3] vs 4 [3-6] days, P < 0.01), total unadjusted hospitalisation cost (in United States dollars) was greater (median [IQR], $10 855 [$7965-$15 675] vs $13 467 [$10 572-$17 722], P < 0.01). Presence of any complication increased both LOS and hospitalisation cost (P < 0.01). Linear regression modelling determined the point of cost equivalence between RASP staying a median of 2 days was an OSP case staying between 5 and 6 days. On multivariable regression analysis, the robotic approach contributed an additional $6175 (P < 0.01) to the cost model, whereas each additional day of hospitalisation contributed $1687 (P < 0.01), suggesting LOS would need to be 3-4 days shorter with RASP to offset surgical costs of the robot. CONCLUSIONS While RASP appears to have significantly better perioperative complication rates with shorter LOS and likely discharge to home, total hospitalisation cost remained greater, likely related to upfront operative costs. While this retrospective study is limited by selection bias for patients undergoing RASP, the benefits of improved convalescence, discharge to home, and lower rate of perioperative complications appear to justify performance of RASP in an experienced pelvic robotic centre despite relatively greater hospitalisation cost if referral to an experienced holmium laser enucleation of the prostate centre is not feasible.
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Affiliation(s)
- Raj Bhanvadia
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Caleb Ashbrook
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Jeffery Gahan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Ryan Mauck
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Claus Roehrborn
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
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Meng X, Roehrborn C, Margulis V. The Changing Landscape of Upper Tract Urothelial Carcinoma Management. Urology 2020; 145:316-318. [DOI: 10.1016/j.urology.2020.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roehrborn C, McVary K. Five-year preliminary functional urinary outcomes of the prospective, randomized controlled trial of convective water vapor thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32820-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Roehrborn C, Rukstalis D. Meta-analysis comparison of sexual function outcomes after treatment with prostatic urethral lift or medical therapy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32999-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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D'Agate S, Wilson T, Adalig B, Manyak M, Palacios-Moreno JM, Chavan C, Oelke M, Roehrborn C, Della Pasqua O. Model-based meta-analysis of individual International Prostate Symptom Score trajectories in patients with benign prostatic hyperplasia with moderate or severe symptoms. Br J Clin Pharmacol 2020; 86:1585-1599. [PMID: 32144791 PMCID: PMC7373698 DOI: 10.1111/bcp.14268] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/01/2020] [Accepted: 02/11/2020] [Indexed: 12/01/2022] Open
Abstract
Aims International Prostate Symptom Score (IPSS) is a marker of lower urinary tract symptoms (LUTS) deterioration or improvement in benign prostate hyperplasia (BPH). Whereas changes in IPSS relative to baseline have been used as endpoints in clinical trials, little attention has been given to the time course of symptoms. The current investigation aimed to develop a drug‐disease model to describe individual IPSS trajectories in moderate and severe BPH patients. Methods A model‐based meta‐analytical approach was used including data from 10 238 patients enrolled into Phase III and IV studies receiving placebo, tamsulosin, dutasteride or combination therapy over a period of up to 4 years. Model predictive performance was assessed using statistical and graphical criteria. Subsequently, simulations were performed to illustrate the implications of treatment with drugs showing symptomatic and disease‐modifying properties in patients with varying disease progression rates. Results Improvement and worsening of IPSS could be characterized by a model including a sigmoid function which disentangles drug effects from placebo and varying disease progression rates on IPSS. Mean estimate (95% confidence intervals) for the disease progression rate was 0.319 (0.271–0.411) month−1. Treatment effect on IPSS (DELTA) was found to be 0.0605, 0.0139 and 0.0310 month−1 for placebo, tamsulosin and combination therapy, respectively. In addition, it appears that individual trajectories can be clustered together into different phenotypes describing the underlying disease progression rate (i.e. slow, moderate and fast progressors). Conclusions The availability of a drug‐disease model enables the evaluation of interindividual differences in disease progression rate, deterioration of symptoms and treatment effects on LUTS/BPH.
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Affiliation(s)
- Salvatore D'Agate
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK
| | | | - Burkay Adalig
- Classic & Established Products, GSK, Istanbul, Turkey
| | - Michael Manyak
- Classic & Established Products, GSK, Washington, DC, USA
| | | | | | - Matthias Oelke
- Department of Urology, St Antonius Hospital, Gronau, Germany
| | - Claus Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK.,Clinical Pharmacology Modelling and Simulation, GSK, Uxbridge, Middlesex, UK
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Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Kaufman RP, Trainer A, Arther A, Badlani G, Plante M, Desai M, Doumanian L, Te AE, DeGuenther M, Roehrborn C. Three-year outcomes after Aquablation therapy compared to TURP: results from a blinded randomized trial. Can J Urol 2020; 27:10072-10079. [PMID: 32065861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION To compare 3-year efficacy and safety after prostate resection with Aquablation therapy or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms related to benign prostate hyperplasia (BPH). MATERIALS AND METHODS One hundred and eighty-one patients assigned to either Aquablation therapy or TURP were followed for 3 years postoperatively. Patients and follow up assessors were blinded to treatment. Assessments included International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire (MSHQ-EjD), International Index of Erectile Function (IIEF) and uroflow. RESULTS Over 3 years of treatment, improvements in IPSS scores were statistically similar across groups. Mean 3-year improvements were 14.4 and 13.9 points in the Aquablation and TURP groups, respectively (difference of 0.6 points, 95% CI -3.3-2.2, p = .6848). Similarly, 3-year improvements in Qmax were 11.6 and 8.2 cc/sec (difference of 3.3 [95% CI -0.5-7.1] cc/sec, p = .0848). At 3 years, PSA was reduced significantly in both groups by 0.9 and 1.1 ng/mL, respectively; the reduction was similar across groups (p = .5983). There were no surgical retreatments for BPH beyond 20 months for either Aquablation or TURP. CONCLUSIONS Three-year BPH symptom reduction and urinary flow rate improvement were similar after TURP and Aquablation therapy. No subjects required surgical retreatment beyond 20 months postoperatively. (ClinicalTrials.gov number, NCT02505919).
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Bach T, Gilling P, Roehrborn C. Two-year outcomes after aquablation compared to TURP: Results from a blinded randomized trial. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Nguyen DD, Barber N, Bidair M, Gilling P, Anderson P, Zorn KC, Badlani G, Humphreys M, Kaplan S, Kaufman R, So A, Paterson R, Goldenberg L, Elterman D, Desai M, Lingeman J, Roehrborn C, Bhojani N. Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue trial (WATER) vs WATER II: comparing Aquablation therapy for benign prostatic hyperplasia in 30-80 and 80-150 mL prostates. BJU Int 2019; 125:112-122. [PMID: 31599044 PMCID: PMC6972548 DOI: 10.1111/bju.14917] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective To compare the outcomes of Aquablation in 30–80 mL prostates with those in 80–150 mL prostates. Surgical options, especially with short learning curves, are limited when treating large prostates for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Aquablation (AquaBeam System, PROCEPT BioRobotics Inc., Redwood City, CA, USA) could solve this issue with global reproducibility, independent of prostate volume. Patients and Methods Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue (WATER [W‐I]; NCT02505919) is a prospective, double‐blind, multicentre, international clinical trial comparing Aquablation and transurethral resection of the prostate (TURP) for the treatment of LUTS/BPH in prostates between 30 and 80 mL. WATER II (W‐II; NCT03123250) is a prospective, multicentre, single‐arm international clinical trial of Aquablation in prostates between 80 and 150 mL. We compare baseline parameters and 12‐month outcomes in 116 W‐I and 101 W‐II study patients. Students’ t‐test or Wilcoxon tests were used for continuous variables and Fisher’s test for binary variables. Results The mean (SD) operative time was 33 (17) and 37 (13) min in W‐I and W‐II, respectively. Actual treatment time was 4 and 8 min in W‐I and W‐II, respectively. The mean change in the International Prostate Symptom Score was substantial averaging (at 12 months) 15.1 in W‐I and 17.1 in W‐II (P = 0.605). By 3 months, Clavien–Dindo grade ≥II events occurred in 19.8% of W‐I patients and 34.7% of W‐II patients (P = 0.468). Conclusion Aquablation clinically normalises outcomes between patients with 30–80 mL prostates and patients with 80–150 mL prostates treated for LUTS/BPH, with an expected increase in the risk of complications in larger prostates. Long‐term outcomes of procedure durability are needed.
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Affiliation(s)
| | - Neil Barber
- Frimley Park Hospital, Urology, Frimley, Surrey, UK
| | - Mo Bidair
- San Diego Clinical Trials, San Diego, CA, USA
| | - Peter Gilling
- Bay of Plenty District Health Board Clinical School, Urology, Tauranga, New Zealand
| | - Paul Anderson
- Royal Melbourne Hospital, Urology, Melbourne, Victoria, Australia
| | - Kevin C Zorn
- Centre Hospitalier de l'Université de Montréal, Division of Urology, Montreal, QC, Canada
| | - Gopal Badlani
- Wake Forest School of Medicine, Urology, Winston-Salem, NC, USA
| | | | - Steven Kaplan
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Ronald Kaufman
- Division of Urology, Albany Medical College, Albany, NY, USA
| | - Alan So
- University of British Columbia, Urologic Sciences, Vancouver, BC, Canada
| | - Ryan Paterson
- University of British Columbia, Urologic Sciences, Vancouver, BC, Canada
| | - Larry Goldenberg
- University of British Columbia, Urologic Sciences, Vancouver, BC, Canada
| | - Dean Elterman
- Division of Urology, University of Toronto, Montréal, QC, Canada
| | - Mihir Desai
- USC Institute of Urology, University of Southern California, Urology, Los Angeles, CA, USA
| | - Jim Lingeman
- Institute for Kidney Stone Disease, Methodist Hospital, Indianapolis, IN, USA
| | | | - Naeem Bhojani
- Centre Hospitalier de l'Université de Montréal, Division of Urology, Montreal, QC, Canada
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Bhojani N, Bidair M, Zorn KC, Trainer A, Arther A, Kramolowsky E, Doumanian L, Elterman D, Kaufman RP, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Uchio E, Gin G, Goldenberg L, Paterson R, So A, Humphreys M, Kaplan S, Motola J, Desai M, Roehrborn C. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology 2019; 129:1-7. [DOI: 10.1016/j.urology.2019.04.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/18/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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D'Agate S, Wilson T, Adalig B, Manyak M, Palacios-Moreno JM, Chavan C, Oelke M, Roehrborn C, Della Pasqua O. Impact of disease progression on individual IPSS trajectories and consequences of immediate versus delayed start of treatment in patients with moderate or severe LUTS associated with BPH. World J Urol 2019; 38:463-472. [PMID: 31079189 PMCID: PMC6994451 DOI: 10.1007/s00345-019-02783-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/23/2019] [Indexed: 01/07/2023] Open
Abstract
Purpose Despite superiority of tamsulosin–dutasteride combination therapy versus monotherapy for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH), patients at risk of disease progression are often initiated on α-blockers. This study evaluated the impact of initiating tamsulosin monotherapy prior to switching to tamsulosin–dutasteride combination therapy versus immediate combination therapy using a longitudinal model describing International Prostate Symptom Score (IPSS) trajectories in moderate/severe LUTS/BPH patients at risk of disease progression. Methods Clinical trial simulations (CTS) were performed using data from 10,238 patients from Phase III/IV dutasteride trials. The effect of varying disease progression rates was explored by comparing profiles on- and off-treatment. CTS scenarios were investigated, including a reference (immediate combination therapy) and six alternative virtual treatment arms (delayed combination therapy of 1–24 months). Clinical response (≥ 25% IPSS reduction relative to baseline) was analysed using log-rank test. Differences in IPSS relative to baseline at various on-treatment time points were assessed by t tests. Results Delayed combination therapy initiation led to significant (p < 0.01) decreases in clinical response. At month 48, clinical response rate was 79.7% versus 74.1%, 70.3% and 71.0% and IPSS was 6.3 versus 7.6, 8.1 and 8.0 (switchers from tamsulosin monotherapy after 6, 12 and 24 months, respectively) with immediate combination therapy. More patients transitioned from severe/moderate to mild severity scores by month 48. Conclusions CTS allows systematic evaluation of immediate versus delayed combination therapy. Immediate response to α-blockers is not predictive of long-term symptom improvement. Observed IPSS differences between immediate and delayed combination therapy (6–24 months) are statistically significant. Electronic supplementary material The online version of this article (10.1007/s00345-019-02783-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salvatore D'Agate
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK
| | | | - Burkay Adalig
- Classic and Established Products, GSK, Istanbul, Turkey
| | - Michael Manyak
- Classic and Established Products, GSK, Washington, DC, USA
| | | | | | - Matthias Oelke
- Department of Urology, St. Antonius Hospital, Gronau, Germany
| | - Claus Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK.
- Clinical Pharmacology Modelling and Simulation, GSK, Stockley Park, 1-3 Ironbridge Road, Uxbridge, Middlesex, UB11 1BT, UK.
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Desai M, Bidair M, Zorn KC, Trainer A, Arther A, Kramolowsky E, Doumanian L, Elterman D, Kaufman RP, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Uchio E, Gin G, Goldenberg L, Paterson R, So A, Humphreys M, Roehrborn C, Kaplan S, Motola J, Bhojani N. Aquablation for benign prostatic hyperplasia in large prostates (80-150 mL): 6-month results from the WATER II trial. BJU Int 2019; 124:321-328. [PMID: 30734990 DOI: 10.1111/bju.14703] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present 6-month safety and effectiveness data from a multicentre prospective study of aquablation in men with lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) with prostate volumes between 80 and 150 mL. METHODS Between September and December 2017, 101 men with LUTSattributable to BPHwere prospectively enrolled at 16 centres in Canada and the USA. RESULTS The mean prostate volume was 107 mL. The mean length of hospital stay after the aquablation procedure was 1.6 days (range: same day to 6 days). The primary safety endpoint (Clavien-Dindo grade 2 or higher or any grade 1 event resulting in persistent disability) at 3 months occurred in 45.5% of men, which met the study design goal of < 65% (P < 0.001). At 6 months, 22% of the patients had experienced a Clavien-Dindo grade 2, 14% a grade 3 and 5% a grade 4 adverse event. Bleeding complications requiring intervention and/or transfusion were recorded in eight patients prior to discharge and in six patients after discharge. The mean International Prostate Symptom Score improved from 23.2 ± 6.3 at baseline to 6.7 ± 5.1 at 3 months, meeting the study's primary efficacy endpoint goal (P < 0.001). The maximum urinary flow rate increased from 8.7 to 18.8 mL/s (P < 0.001) and post-void residual urine volume decreased from 131 at baseline to 47 at 6 months (P < 0.0001). At 6 months, prostate-specific antigen concentration reduced from 7.1 ± 5.9 ng/mL at baseline to 4.0 ± 3.9 ng/mL, a 44% reduction. CONCLUSIONS Aquablation is safe and effective in treating men with larger prostates (80-150 mL), without significant increase in procedure or resection time.
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Affiliation(s)
- Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Mo Bidair
- San Diego Clinical Trials, San Diego, CA, USA
| | - Kevin C Zorn
- University of Montreal Hospital Center, Université de Montréal, Montreal, QC, Canada
| | - Andrew Trainer
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, NE, USA
| | - Andrew Arther
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, NE, USA
| | | | - Leo Doumanian
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Dean Elterman
- University of Toronto - University Health Network, Toronto, ON, Canada
| | | | - James Lingeman
- Indiana University Health Physicians, Indianapolis, IN, USA
| | - Amy Krambeck
- Indiana University Health Physicians, Indianapolis, IN, USA
| | - Gregg Eure
- Urology of Virginia, Virginia Beach, VA, USA
| | - Gopal Badlani
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark Plante
- University of Vermont Medical Center, Burlington, VT, USA
| | - Edward Uchio
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Greg Gin
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | | | - Ryan Paterson
- University of British Columbia, Vancouver, BC, Canada
| | - Alan So
- University of British Columbia, Vancouver, BC, Canada
| | | | - Claus Roehrborn
- UT Southwestern Medical Center, Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Steven Kaplan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jay Motola
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naeem Bhojani
- University of Montreal Hospital Center, Université de Montréal, Montreal, QC, Canada
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Gilling PJ, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Roehrborn C. Randomized Controlled Trial of Aquablation versus Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia: One-year Outcomes. Urology 2018; 125:169-173. [PMID: 30552937 DOI: 10.1016/j.urology.2018.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report 1-year safety and efficacy outcomes after either Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) METHODS: This double-blinded, multicenter prospective randomized controlled trial assigned 181 patients with BPH-related moderate-to-severe lower urinary tract symptoms to either electrocautery-based prostate resection (TURP) or Aquablation. Efficacy endpoints included reduction in International Prostate Symptom Score and improvement in uroflow parameters. The primary safety endpoint was the occurrence of Clavien-Dindo persistent grade 1 or grade 2 or higher complications. RESULTS BPH symptom score improvements were similar across groups with 12-month reduction of 15.1 points after TURP or Aquablation. In both groups, mean maximum urinary flow rates increased markedly postoperatively, with mean improvements of 10.3 cc/s for Aquablation versus 10.6 cc/s for TURP (P = .8632). At 1 year, Prostate-specific antigen (PSA) was reduced significantly (P < .01) in both groups by 1 point; the reduction was similar across groups (P = .9125). Surgical retreatment for BPH rates for TURP were 1.5% and Aquablation 2.6% within 1 year from the study procedure (P = not significant (NS)). The rate of late complications was low, with no procedure-related adverse events after month 6. CONCLUSION The 1-year outcomes after TURP and Aquablation were similar and the rate of late procedure-related complications was low. (ClinicalTrials.gov number, NCT02505919).
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Affiliation(s)
| | - Neil Barber
- Frimley Park Hospital, Frimley Health Foundation Trust, Surrey, UK
| | | | | | | | - Tev Aho
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | | | | | | | - Claus Roehrborn
- UT Southwestern Medical Center, Department of Urology, University of Texas Southwestern, Dallas, TX
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30
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Johnson B, Sorokin I, Singla N, Roehrborn C, Gahan JC. Determining the Learning Curve for Robot-Assisted Simple Prostatectomy in Surgeons Familiar with Robotic Surgery. J Endourol 2018; 32:865-870. [DOI: 10.1089/end.2018.0377] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Brett Johnson
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Igor Sorokin
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Claus Roehrborn
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey C. Gahan
- Department of Urology, University of Texas Southwestern, Dallas, Texas
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Plante M, Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Kaufman RP, Trainer A, Arther A, Badlani G, Desai M, Doumanian L, Te AE, DeGuenther M, Roehrborn C. Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial. BJU Int 2018; 123:651-660. [DOI: 10.1111/bju.14426] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mark Plante
- University of Vermont Medical Center; Burlington VT USA
| | | | - Neil Barber
- Frimley Park Hospital; Frimley Health Foundation Trust; Surrey UK
| | | | | | | | - Tev Aho
- Addenbrooke's Hospital; Cambridge University Hospitals; Cambridge UK
| | | | | | | | | | - Andrew Trainer
- Adult Pediatric Urology and Urogynecology, P.C.; Omaha NE USA
| | - Andrew Arther
- Adult Pediatric Urology and Urogynecology, P.C.; Omaha NE USA
| | - Gopal Badlani
- Wake Forest School of Medicine; Winston-Salem NC USA
| | - Mihir Desai
- Institute of Urology; University of Southern California; Los Angeles CA USA
| | - Leo Doumanian
- Institute of Urology; University of Southern California; Los Angeles CA USA
| | | | | | - Claus Roehrborn
- Department of Urology; UT Southwestern Medical Center; University of Texas Southwestern; Dallas TX USA
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Desai M, Bidair M, Bhojani N, Trainer A, Arther A, Kramolowsky E, Doumanian L, Elterman D, Kaufman RP, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Uchio E, Gin G, Goldenberg L, Paterson R, So A, Humphreys M, Roehrborn C, Kaplan S, Motola J, Zorn KC. WATER II (80-150 mL) procedural outcomes. BJU Int 2018; 123:106-112. [DOI: 10.1111/bju.14360] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mihir Desai
- Institute of Urology; University of Southern California; Los Angeles CA USA
| | - Mo Bidair
- San Diego Clinical Trials; San Diego CA USA
| | - Naeem Bhojani
- University of Montreal Hospital Centre; University of Montréal; Montreal QC Canada
| | - Andrew Trainer
- Adult Paediatric Urology and Urogynecology, P.C.; Omaha NE USA
| | - Andrew Arther
- Adult Paediatric Urology and Urogynecology, P.C.; Omaha NE USA
| | | | - Leo Doumanian
- Institute of Urology; University of Southern California; Los Angeles CA USA
| | - Dean Elterman
- University Health Network University of Toronto; Toronto ON Canada
| | | | - James Lingeman
- Indiana University Health Physicians; Indianapolis IN USA
| | - Amy Krambeck
- Indiana University Health Physicians; Indianapolis IN USA
| | - Gregg Eure
- Urology of Virginia; Virginia Beach VA USA
| | - Gopal Badlani
- Wake Forest School of Medicine; Winston-Salem NC USA
| | - Mark Plante
- University of Vermont Medical Centre; Burlington VT USA
| | - Edward Uchio
- VA Long Beach Healthcare System; Long Beach CA USA
| | - Greg Gin
- VA Long Beach Healthcare System; Long Beach CA USA
| | | | | | - Alan So
- University of British Columbia; Vancouver BC Canada
| | | | - Claus Roehrborn
- Department of Urology; UT Southwestern Medical Centre; University of Texas Southwestern; Dallas TX USA
| | - Steven Kaplan
- Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Jay Motola
- Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Kevin C. Zorn
- University of Montreal Hospital Centre; University of Montréal; Montreal QC Canada
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Patel DN, Feng T, Simon RM, Howard LE, Vidal AC, Moreira DM, Castro-Santamaria R, Roehrborn C, Andriole GL, Freedland SJ. PSA predicts development of incident lower urinary tract symptoms: results from the REDUCE study. Prostate Cancer Prostatic Dis 2018; 21:238-244. [PMID: 29795141 DOI: 10.1038/s41391-018-0044-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/06/2018] [Accepted: 02/17/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The relationship between baseline prostate-specific antigen (PSA) and development of lower urinary tract symptoms (LUTS) in asymptomatic and mildly symptomatic men is unclear. We sought to determine if PSA predicts incident LUTS in these men. METHODS A post-hoc analysis of the 4-year REDUCE study was performed to assess for incident LUTS in 1534 men with mild to no LUTS at baseline. The primary aim was to determine whether PSA independently predicted incident LUTS after adjusting for the key clinical variables of age, prostate size, and baseline International prostate symptom score (IPSS). Incident LUTS was defined as the first report of medical treatment, surgery, or sustained clinically significant symptoms (two IPSS >14). Cox proportional hazards, cumulative incidence curves, and the log-rank test were used to test our hypothesis. RESULTS A total of 1534 men with baseline IPSS <8 were included in the study cohort. At baseline, there were 335 men with PSA 2.5-4 ng/mL, 589 with PSA 4.1-6 ng/mL, and 610 with PSA 6-10 ng/mL. During the 4-year study, 196 men progressed to incident LUTS (50.5% medical treatment, 9% surgery, and 40.5% new symptoms). As a continuous variable, higher PSA was associated with increased incident LUTS on univariable (HR 1.09, p = 0.019) and multivariable (HR 1.08, p = 0.040) analysis. Likewise, baseline PSA 6-10 ng/mL was associated with increased incident LUTS vs. PSA 2.5-4 ng/mL in adjusted models (HR 1.68, p = 0.016). This association was also observed in men with PSA 4.1-6 ng/mL vs. PSA 2.5-4 ng/mL (HR 1.60, p = 0.032). CONCLUSIONS Men with mild to no LUTS but increased baseline PSA are at increased risk of developing incident LUTS presumed due to benign prostatic hyperplasia.
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Affiliation(s)
- Devin N Patel
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Tom Feng
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ross M Simon
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Adriana C Vidal
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel M Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Claus Roehrborn
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gerald L Andriole
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Stephen J Freedland
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Urology Section, Veterans Affairs Medical Center, Durham, NC, USA
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Shakir N, Passoni N, Wong D, Gold S, Hale G, Rayn K, Baiocco J, Bloom J, Valero V, Merino M, Turkbey B, Choyke P, Wood B, Pinto P, Costa D, Roehrborn C. PD23-07 INCREASED DETECTION OF HIGHER GRADE PROSTATE CANCER WITH MRI-FUSION PROSTATE BIOPSY AT HIGHER PSA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Freifeld Y, Xi Y, Roehrborn C, Francis F, Passoni N, Lotan Y, Goldberg K, Hornberger B, Margulis V, Pedrosa I, Raj G, Cadeddu J, Costa D. PD23-04 ADDED VALUE OF SYSTEMATIC BIOPSIES IN MEN WITH ABNORMAL MULTIPARAMETRIC MRI UNDERGOING MRI-TRUS FUSION PROSTATE BIOPSY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Costa D, Xi Y, Aziz M, Francis F, Roehrborn C, Goldberg K, Passoni N, Shakir N, Diaz de Leon A, Pedrosa I. PD06-07 AGGRESSIVENESS OF PROSTATE CANCER: CORRELATION BETWEEN PROSPECTIVELY ASSIGNED APPARENT DIFFUSION COEFFICIENT VALUES AND ISUP GRADE GROUP. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roehrborn C, Gilling P. MP62-05 OUTCOMES ASSESSMENT OF AQUABLATION IN PROSTATES 50 TO 80ML IN VOLUME - A SUBGROUP ANALYSIS FROM THE PHASE III BLINDED RANDOMIZED WATER STUDY COMPARING AQUABLATION VS. TRANSURETHRAL RESECTION OF THE PROSTATE FOR MODERATE-TO-SEVERE LUTS IN MEN WITH BPH. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Gilling P, Roehrborn C. PD64-01 THE WATER STUDY CLINICAL RESULTS – A PHASE III BLINDED RANDOMIZED TRIAL OF AQUABLATION VS. TURP WITH BLINDED OUTCOME ASSESSMENT FOR MODERATE-TO-SEVERE LUTS IN MEN WITH BPH. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Shakir N, Passoni N, Wong D, Gold S, Hale G, Rayn K, Baiocco J, Bloom J, Valero V, Merino M, Turkbey B, Choyke P, Wood B, Pinto P, Costa D, Roehrborn C. MP04-11 CORRELATION OF MRI PROSTATE VOLUME WITH SERUM PROSTATE-SPECIFIC ANTIGEN IN MEN WITH NEGATIVE STANDARD AND MRI-FUSION BIOPSIES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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40
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Kaplan S, Roehrborn C. MP62-07 PREDICTORS OF RESPONSE TO THE PROSTATIC URETHRAL LIFT TREATMENT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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McVary K, Roehrborn C. LBA14 WATER VAPOR THERMAL THERAPY WITH REZUM SYSTEM: 3-YEAR RESULTS OF PROSPECTIVE CROSSOVER TRIAL REPLICATE DURABLE OUTCOMES OF PHASE III RANDOMIZED CONTROLLED STUDY FOR TREATMENT OF LOWER URINARY TRACT SYMPTOMS / BENIGN PROSTATIC HYPERPLASIA. J Urol 2018. [DOI: 10.1016/j.juro.2018.03.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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42
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Roehrborn C, Lowe F, Gittelman M, Wruck J, Verbeek A. MP04-08 CHARACTERISTICS OF MEN WITH UNTREATED LOWER URINARY TRACT SYMPTOMS PARTICIPATING IN A STUDY ASSESSING SELF-DIRECTED USE OF OVER-THE-COUNTER TAMSULOSIN. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Costa D, Freifeld Y, Xi Y, Francis F, Roehrborn C, Pedrosa I. PD47-12 DIAGNOSTIC PERFORMANCE OF PROSPECTIVELY ASSIGNED LIKERT SCALE SCORES FOR DETERMINATION OF EXTRAPROSTATIC TUMOR EXTENSION WITH MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING OF THE PROSTATE. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bloom JB, Shakir N, Passoni N, Gold S, Wong D, Hale G, Rayn K, Baiocco J, Mehralivand S, Valera V, Merino M, Wood BJ, Choyke PL, Turkbey B, Roehrborn C, Pinto PA. MP46-19 MULTI-INSTITUTIONAL COMPARISON AND EXPERIENCE OF UPGRADING RATES OF STANDARD VS. TARGETED PROSTATE BIOPSIES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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45
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Valenzuela R, Roehrborn C, Gange S, Bolton D, Chin P, Rashid P, Rukstalis D, McVary K. 192 Five Year Sexual Function Results of the Multi-Center, Prospective, Randomized Study of the Prostatic Urethral Lift (PUL). J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Kaufman RP, Trainer A, Arther A, Badlani G, Plante M, Desai M, Doumanian L, Te AE, DeGuenther M, Roehrborn C. WATER: A Double-Blind, Randomized, Controlled Trial of Aquablation ® vs Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia. J Urol 2018; 199:1252-1261. [PMID: 29360529 DOI: 10.1016/j.juro.2017.12.065] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE We compared the safety and efficacy of Aquablation and transurethral prostate resection for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. MATERIALS AND METHODS In a double-blind, multicenter, prospective, randomized, controlled trial 181 patients with moderate to severe lower urinary tract symptoms related to benign prostatic hyperplasia underwent transurethral prostate resection or Aquablation. The primary efficacy end point was the reduction in International Prostate Symptom Score at 6 months. The primary safety end point was the development of Clavien-Dindo persistent grade 1, or 2 or higher operative complications. RESULTS Mean total operative time was similar for Aquablation and transurethral prostate resection (33 vs 36 minutes, p = 0.2752) but resection time was lower for Aquablation (4 vs 27 minutes, p <0.0001). At month 6 patients treated with Aquablation and transurethral prostate resection experienced large I-PSS improvements. The prespecified study noninferiority hypothesis was satisfied (p <0.0001). Of the patients who underwent Aquablation and transurethral prostate resection 26% and 42%, respectively, experienced a primary safety end point, which met the study primary noninferiority safety hypothesis and subsequently demonstrated superiority (p = 0.0149). Among sexually active men the rate of anejaculation was lower in those treated with Aquablation (10% vs 36%, p = 0.0003). CONCLUSIONS Surgical prostate resection using Aquablation showed noninferior symptom relief compared to transurethral prostate resection but with a lower risk of sexual dysfunction. Larger prostates (50 to 80 ml) demonstrated a more pronounced superior safety and efficacy benefit. Longer term followup would help assess the clinical value of Aquablation.
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Affiliation(s)
| | - Neil Barber
- Frimley Park Hospital, Frimley Health Foundation Trust, Surrey, United Kingdom
| | | | | | | | - Tev Aho
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - Andrew Thomas
- Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | | | | | - Andrew Trainer
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, Nebraska
| | - Andrew Arther
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, Nebraska
| | - Gopal Badlani
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark Plante
- University of Vermont Medical Center, Burlington, Vermont
| | - Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Leo Doumanian
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Alexis E Te
- Weill Cornell Medical College, New York, New York
| | | | - Claus Roehrborn
- Department of Urology, Southwestern Medical Center, University of Texas Southwestern, Dallas, Texas.
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Folkert M, Zelefsky M, Hannan R, Desai N, Lotan Y, Laine A, Kim D, Hardee S, Hornberger B, Kollmeier M, McBride S, Xie X, Roehrborn C, Timmerman R. Multi-Institutional Phase 2 Trial of High-Dose Stereotactic Body Radiation Therapy with Temporary Hydrogel Spacer for Low- and Intermediate-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Sorokin I, Sundaram V, Singla N, Walker J, Margulis V, Roehrborn C, Gahan JC. Robot-Assisted Versus Open Simple Prostatectomy for Benign Prostatic Hyperplasia in Large Glands: A Propensity Score-Matched Comparison of Perioperative and Short-Term Outcomes. J Endourol 2017; 31:1164-1169. [PMID: 28854815 DOI: 10.1089/end.2017.0489] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To report the largest comparative analysis of robotic vs open simple prostatectomy (OSP) for large-volume prostate glands. MATERIALS AND METHODS We retrospectively reviewed 103 patients that underwent open and 64 patients that underwent robotic simple prostatectomy from 2012 to 2016 at a single institution. A propensity score-matched analysis was performed with five covariates, including age, body mass index, race, Charlson comorbidity index, and prostate volume. Perioperative, postoperative, and functional outcomes were compared between groups. RESULTS After propensity score matching there were 59 patients in each group available for comparison. There was no statistically significant difference between groups for all preoperative demographic variables. Robotic compared with OSP demonstrated a significant shorter average length of stay (LOS) (1.5 vs 2.6 days, p < 0.001), but longer mean operative time (161 vs 93 minutes, p < 0.001). The robotic approach was also associated with a lower estimated blood loss (339 vs 587 mL, p < 0.001) and lower percentage hematocrit drop (12.3% vs 19.5%, p = 0.001). Two patients required blood transfusions in the robot group compared with four in the open group, but this was not significant (p = 0.271). Improvements in maximal flow rate, International Prostate Symptom Score, quality of life, postvoid residual, and postoperative prostate-specific antigen levels were similar before and after surgery for both groups, but there was no difference between groups. There was no difference in complications between groups. CONCLUSION Robotic simple prostatectomy is a safe and effective treatment for the surgical management of benign prostatic hyperplasia. It provides similar function outcomes to the open approach; however, offers the advantage of reduced LOS and reduced blood loss.
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Affiliation(s)
- Igor Sorokin
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Varun Sundaram
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Nirmish Singla
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Jordon Walker
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Claus Roehrborn
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
| | - Jeffrey C Gahan
- Department of Urology, UT Southwestern Medical Center , Dallas, Texas
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49
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Branche BL, Howard LE, Moreira DM, Roehrborn C, Castro-Santamaria R, Andriole GL, Hopp ML, Freedland SJ. Sleep Problems are Associated with Development and Progression of Lower Urinary Tract Symptoms: Results from REDUCE. J Urol 2017; 199:536-542. [PMID: 28870861 DOI: 10.1016/j.juro.2017.08.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Although lower urinary tract symptoms and sleep problems often develop together, to our knowledge it is unknown whether sleep disturbances are linked to lower urinary tract symptoms development and progression. As measured by the 6-item MOS-Sleep (Medical Outcomes Study Sleep Scale) survey we examined the relationship between sleep problems, and the development and progression of lower urinary tract symptoms in the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) study. MATERIALS AND METHODS REDUCE was a randomized trial testing prostate cancer chemoprevention with dutasteride in men with prostate specific antigen 2.5 to 10 ng/ml and a negative biopsy. At baseline men completed MOS-Sleep and a scaled average was used to calculate the sleep score. Men were followed for 4 years and I-PSS (International Prostate Symptom Score) was completed at baseline and every 6 months. Asymptomatic men had I-PSS less than 8 while symptomatic men had I-PSS 8 or greater. In the placebo arm of 2,588 men not receiving α-blockers or 5α-reductase inhibitors at baseline we tested the association between sleep problems and lower urinary tract symptom development and progression using Cox models. RESULTS During followup lower urinary tract symptoms developed in 209 of 1,452 asymptomatic men (14%) and 580 of 1,136 (51%) with lower urinary tract symptoms demonstrated progression. On multivariable analysis higher sleep scores were suggestively associated with increased lower urinary tract symptoms in asymptomatic men (quartile 4 vs 1 HR 1.41, 95% CI 0.92-2.17, p = 0.12) and with lower urinary tract symptom progression in symptomatic men (per 10 points of sleep score HR 1.06, 95% CI 1.01-1.12, p = 0.029). CONCLUSIONS Among men with lower urinary tract symptoms worse sleep scores were associated with the progression of lower urinary tract symptoms and among asymptomatic men worse sleep scores were suggestively associated with the development of lower urinary tract symptoms. If confirmed, these data suggest that sleep problems may precede such symptoms. Whether treating sleep problems would improve lower urinary tract symptoms requires further testing.
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Affiliation(s)
- Brandee L Branche
- Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Lauren E Howard
- Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | | | - Claus Roehrborn
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ramiro Castro-Santamaria
- Metabolic Pathways and Cardiovascular R&D Unit, GlaxoSmithKline, Inc., King of Prussia, Pennsylvania
| | - Gerald L Andriole
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Martin L Hopp
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephen J Freedland
- Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina; Cedars-Sinai Medical Center, Los Angeles, California.
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50
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Aljuri N, Gilling P, Roehrborn C. How I do it: Balloon tamponade of prostatic fossa following Aquablation. Can J Urol 2017; 24:8937-8940. [PMID: 28832316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Since its first report in the 1870s, control of bleeding after transurethral resection of the prostate (TURP) has remained a concern. Foley's initial report of a urinary catheter involved placement of the balloon into the prostatic fossa following TURP. Removal of prostate tissue with a high-velocity saline stream (Aquablation) is a recently reported alternative to TURP. As Aquablation is heat-free, alternatives to non-thermal hemostasis were sought to optimize the procedure. We report use of a balloon catheter in the prostatic fossa after Aquablation as a post-resection hemostatic method.
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Affiliation(s)
- Nikolai Aljuri
- PROCEPT BioRobotics Corporation, Redwood Shores, California, USA
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