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Coscarella M, Al Barajraji M, Moussa I, Hombert L, Naudin M, Roumeguère T. Predicting the risk of failed trial without catheter following Rezum™ therapy. World J Urol 2024; 42:129. [PMID: 38460028 DOI: 10.1007/s00345-024-04823-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024] Open
Abstract
PURPOSE Convective water vapor thermal therapy or "Rezum™" treatment for lower urinary tract symptoms in men with benign prostate hypertrophy require postoperative catheterization to avoid acute urinary retention. Unsuccessful catheter removal is still unpredictable. We, therefore, aimed to identify the risk factors of failed initial trial without catheter (TWOC) after Rezum™ therapy inside a large cohort of patients. METHODS A retrospective study was conducted on patients who underwent Rezum™ therapy by three referent urologists across two academic hospitals between January 2022 and January 2023. A Foley catheter was systematically placed after therapy for 7 days in all patients before TWOC. Patients characteristics [age, imagery, maximum urinary flow rate (Qmax), postvoid residual (PVR)], and treatment outcomes (International Prostate Symptom Score (IPSS), quality of life (QoL), adverse events) were analyzed at baseline and 3 months from procedure. Failed initial TWOC was defined as the incapacity to pass urine or measured PVR > 300 mL. After univariate selection, the risk factors for TWOC failure were identified using multivariate logistic regression analysis. RESULTS 216 patients qualified for analysis with 23 (10.6%) failing the first TWOC after 7 days of catheterization. After multivariate logistic regression, only preoperative PVR predicted TWOC failure (OR 1.01; p = 0.007). The cut-off of preoperative PVR increasing this risk was 120 mL (p = 0, 02). CONCLUSION Over 10% of men undergoing Rezum™ therapy for LUTS/BPH will experience TWOC failure and AUR after 7 days of catheterization. Preoperative PVR seems to be the only independent risk factor of unsuccessful catheter removal.
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Affiliation(s)
- Mathieu Coscarella
- Department of Urology, Ambroise Paré Hospital, Université Libre de Bruxelles, Mons, Belgium.
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium.
| | - Moncef Al Barajraji
- Department of Urology, Ambroise Paré Hospital, Université Libre de Bruxelles, Mons, Belgium
| | - Ilan Moussa
- Department of Urology, Ambroise Paré Hospital, Université Libre de Bruxelles, Mons, Belgium
| | - Leslie Hombert
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Michel Naudin
- Department of Urology, Ambroise Paré Hospital, Université Libre de Bruxelles, Mons, Belgium
| | - Thierry Roumeguère
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
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Spinos T, Tatanis V, Liatsikos E, Kallidonis P. Same-day catheter removal after holmium laser enucleation of the prostate (HoLEP): a systematic review. World J Urol 2023; 41:3503-3510. [PMID: 37878061 DOI: 10.1007/s00345-023-04655-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
PURPOSE To summarize all existing evidence regarding the feasibility, safety, and efficacy of same-day trial of void and catheter removal after Holmium Laser Enucleation of the Prostate (HoLEP). Although there have been many reports of the safety and efficacy of same-day discharge from the hospital for selected patients undergoing HoLEP, in most of these reports, patients return to the hospital, usually on postoperative day one, to undergo a trial of void and catheter removal. METHODS PubMed®, Scopus®, and Cochrane® primary databases were systematically screened, from inception to 17 January 2023. The search strategy used the PICO (Patient, Intervention, Comparison, Outcomes) Framework. We followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS Six studies met all the predefined criteria and were included in the final qualitative synthesis. Four studies were retrospective and two were prospective. Four studies were non-comparative, while two were comparative ones. The same-day catheter removal success rate ranged from 85.5 to 90% among studies, while only one grade-IIIb Clavien-Dindo complication was reported, which was unrelated to surgery. CONCLUSION Same-day catheter removal is a feasible, safe, and efficient approach for selected patients undergoing HoLEP. Certain factors, such as intraoperative furosemide administration, were found to improve same-day catheter-free rates, while preoperative PVR and urinary retention were independent predictive factors of same-day trial of void failure.
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Affiliation(s)
- Theodoros Spinos
- Department of Urology, University of Patras Hospital, 26504, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University of Patras Hospital, 26504, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Hospital, 26504, Patras, Greece
- Department of Urology, Medical University of Vienna, 1090, Vienna, Austria
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Shoma AM, Ghobrial FK, El-Tabey N, El-Hefnawy AS, El-Kappany HA. A randomized trial of holmium laser vs thulium laser vs bipolar enucleation of large prostate glands. BJU Int 2023; 132:686-695. [PMID: 37667842 DOI: 10.1111/bju.16174] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To compare the outcome and morbidity of bipolar transurethral enucleation of the prostate (B-TUEP) and thulium laser enucleation of the prostate (ThuLEP) with those of holmium laser enucleation of the prostate (HoLEP) in the treatment of large symptomatic benign prostatic obstruction (BPO) through a non-inferiority randomized controlled trial (NCT03916536). PATIENTS AND METHODS A total of 155 patients were recruited from a single centre between February 2019 and August 2020. All had BPO, with a prostate volume ≥80 ml. Patients were randomly assigned to HoLEP, ThuLEP or B-TUEP using computer-generated random tables in a 1:1:1 ratio. Participants, investigators and surgeons were blinded to group assignment until the date of the operation. Thereafter, the patients were followed up at 1, 3, 6 and 12 months. The primary outcome was maximum urinary flow rate (Qmax ) at 6 months. Secondary outcomes included assessment of other functional urinary variables, peri-operative records, and adverse events. RESULTS There were 138 and 120 patients available for analysis at 6 and 12 months. There was no significant difference in Qmax between the groups at 6 and 12 months (P = 0.4 and P = 0.7, respectively), and no significant difference regarding International Prostate Symptom Score (IPSS), quality of life (QoL) or postvoid residual urine volume (PVR). The median (interquartile range) prostate-specific antigen (PSA) reductions (ng/ml) were similar in the three groups at last follow-up point (4.7 [2.2-7.1]; 5.6 [2.3-9.5] and 5 [3.4-10] after HoLEP, ThuLEP and B-TUEP, respectively). Differences in enucleation time, enucleation efficiencies and auxiliary manoeuvres were statistically insignificant (P = 0.1, 0.8 and 0.07, respectively). At 1 year, patients with prostate volumes >120 ml showed significant IPSS improvement in favour of HoLEP and ThuLEP (P = 0.01). Low- and high-grade adverse effects were recorded in 31 and five cases, respectively, with no statistically significant difference between the groups. CONCLUSIONS We conclude that ThuLEP and B-TUEP are as safe and effective as HoLEP for the treatment of large-sized BPO. Significant PSA reductions indicate that there was effective adenoma enucleation with all three approaches. The study provides objective evidence that endoscopic enucleation of the prostate is a technique rather than energy dependent procedure.
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Affiliation(s)
- Ahmed M Shoma
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Fady K Ghobrial
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Department of Urology, Faculty of Medicine, Damietta University, Damietta, Egypt
| | - Nasr El-Tabey
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Del Rosso J, Sugarman J, Green L, Lain T, Levy-Hacham O, Mizrahi R, Gold LS. Efficacy and safety of microencapsulated benzoyl peroxide and microencapsulated tretinoin for the treatment of acne vulgaris: Results from two phase 3 double-blind, randomized, vehicle-controlled studies. J Am Acad Dermatol 2023; 89:719-727. [PMID: 37356627 DOI: 10.1016/j.jaad.2023.05.093] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Benzoyl peroxide and tretinoin are commonly prescribed acne treatments. Historically, they have been difficult to combine in a single formulation due to chemical instability, and both medications are potentially irritating. Microencapsulation helps overcome these challenges. OBJECTIVE Examine efficacy, safety, and tolerability of encapsulated BPO/encapsulated tretinoin (E-BPO/T) cream, 3%/0.1%. METHODS Subjects ≥9 years old with moderate to severe acne were enrolled in 2 multicenter, double-blind, vehicle-controlled, parallel trials and randomized (2:1) to 12 weeks of once-daily E-BPO/T (n = 571) or vehicle cream (n = 287). RESULTS E-BPO/T was significantly superior to vehicle in both studies, with more subjects achieving IGA success with E-BPO/T (38.5%/25.4%) versus vehicle (11.5%/14.7%; P < .001/P = .017). The change from baseline in inflammatory lesion count for E-BPO/T was -21.6 versus -14.8 for vehicle (P < .001) in study 1 and -16.2 versus -14.1 (P = .018) in study 2. The changes from baseline in noninflammatory lesions for E-BPO/T were -29.7 versus -19.8 for vehicle (P < .001) and -24.2 and -17.4 (P < .001) in studies 1 and 2, respectively. E-BPO/T was well tolerated in both studies. LIMITATIONS Long-term data are not available. CONCLUSION E-BPO/T provided statistically significant and clinically relevant improvements in IGA and inflammatory and noninflammatory lesion counts and was well tolerated in subjects with moderate to severe acne.
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Affiliation(s)
- James Del Rosso
- JDR Dermatology Research, Las Vegas, Nevada; Advanced Dermatology and Cosmetic Surgery, Maitland, Florida; Touro University Nevada, Henderson, Nevada.
| | - Jeffrey Sugarman
- University of California-San Francisco, San Francisco, California
| | - Lawrence Green
- Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia
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Bhatia ND, Werschler WP, Baldwin H, Sugarman J, Green LJ, Levy-Hacham O, Nov O, Ram V, Stein Gold L. Efficacy and Safety of Microencapsulated Benzoyl Peroxide Cream, 5%, in Rosacea: Results From Two Phase III, Randomized, Vehicle-Controlled Trials. J Clin Aesthet Dermatol 2023; 16:34-40. [PMID: 37636253 PMCID: PMC10452484] [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] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Objective A new formulation of benzoyl peroxide (E-BPO cream, 5%) entraps benzoyl peroxide (BPO) in silica microcapsules. This study assesses the efficacy, safety, and tolerability of E-BPO cream, 5%, in rosacea in two Phase III clinical trials. Methods In two 12-week, randomized, double-blind, vehicle cream-controlled Phase III trials, 733 subjects at least 18 years old with moderate to severe rosacea were randomized (2:1) to once-daily E-BPO cream, 5%, or vehicle. Results In Study 1, the proportion of subjects achieving IGA clear/almost clear at Week 12 was 43.5 percent for E-BPO cream, 5%, and 16.1 percent for vehicle. In Study 2, the respective values were 50.1 percent and 25.9 percent. In Study 1, the decrease in lesion count from baseline to Week 12 was -17.4 for E-BPO cream, 5%, versus -9.5 for vehicle. In Study 2, the respective values were -20.3 and -13.3 (all P<0.001). The difference was also significant at Week 2. There were no treatment-related serious adverse events; 1.4 percent of subjects (1.8% E-BPO cream, 5%, 0.4% vehicle) discontinued due to adverse events. Assessed local tolerability was found to be similar among subjects in both E-BPO and vehicle. E-BPO was not compared with unencapsulated BPO. Conclusion E-BPO is an effective and well tolerated treatment for rosacea. Clinicaltrials.gov Identifiers: NCT03564119, NCT03448939.
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Affiliation(s)
- Neal D Bhatia
- Dr. Bhatia is with Therapeutics Clinical Research in San Diego, California
| | - Wm Philip Werschler
- Dr. Werschler is with the University of Washington and Premier Clinical Research in Spokane, Washington
| | - Hilary Baldwin
- Dr. Baldwin is with the Acne Treatment and Research Center in Brooklyn, New York, and the Rutgers Robert Wood Johnson Medical Center in New Brunswick, New Jersey
| | - Jeffrey Sugarman
- Dr. Sugarman is with the University of California San Francisco in San Francisco, California
| | - Lawrence J Green
- Dr. Green is with the George Washington University School of Medicine in Washington, DC
| | - Ofra Levy-Hacham
- Drs. Levy-Hacham and Nov are with Sol-Gel Technologies in Ness Ziona, Israel. Additionally, Ms. Ram is with Sol-Gel Technologies in Ness Ziona, Israel
| | - Ori Nov
- Drs. Levy-Hacham and Nov are with Sol-Gel Technologies in Ness Ziona, Israel. Additionally, Ms. Ram is with Sol-Gel Technologies in Ness Ziona, Israel
| | - Vered Ram
- Drs. Levy-Hacham and Nov are with Sol-Gel Technologies in Ness Ziona, Israel. Additionally, Ms. Ram is with Sol-Gel Technologies in Ness Ziona, Israel
| | - Linda Stein Gold
- Dr. Stein Gold is with Henry Ford Health Systems in Detroit, Michigan
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Werschler WP, Sugarman J, Bhatia N, Baldwin H, Green LJ, Nov O, Ram V, Levy-Hacham O, Stein Gold L. Long-term Efficacy and Safety of Microencapsulated Benzoyl Peroxide Cream, 5%, in Rosacea: Results From an Extension of Two Phase III, Vehicle-controlled Trials. J Clin Aesthet Dermatol 2023; 16:27-33. [PMID: 37636251 PMCID: PMC10452482] [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] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Objective We sought to assess the long-term safety and tolerability of microencapsulated benzoyl peroxide cream, 5% (E-BPO cream, 5%), in subjects with rosacea. Efficacy and tolerability have been previously demonstrated in two 12-week, randomized, double-blind, vehicle-controlled Phase III trials. Methods In this open-label extension study (NCT03564145; clinicaltrials.gov), all subjects from the initial placebo-controlled Phase III trials could receive E-BPO cream, 5%, for up to an additional 40 weeks, up to a total of 52 weeks of E-BPO cream, 5%, exposure. If a subject was assessed at study visits as "clear" or "almost clear" using the 5-point Investigator Global Assessment (IGA) scale (IGA 0 or 1), E-BPO cream, 5%, was not dispensed. If a subject was assessed as "mild to severe" (IGA 2+), E-BPO cream, 5%, was applied daily until they reached "clear" or "almost clear." Results The safety and tolerability profile for E-BPO cream, 5%, was similar to that reported in the Phase III studies. Five subjects (0.9%) discontinued study drug due to treatment-related adverse events, and 17 subjects (3.2%) experienced an adverse event considered related to study drug. IGA success after 40 weeks of active treatment was 66.5 percent for subjects continuing from the Phase III vehicle group (n=172) and 67.6 percent for subjects who continued Phase III E-BPO cream, 5% (n=363). The study ended early in accordance with the protocol. Limitations Safety and tolerability of E-BPO were not compared with those of unencapsulated BPO. Conclusion E-BPO cream, 5%, showed a favorable safety and tolerability profile during this 40-week, open-label extension study.
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Affiliation(s)
- William P. Werschler
- Dr. Werschler is with Spokane Dermatology Clinic and Werschler Aesthetics in Spokane, Washington
| | - Jeffrey Sugarman
- Dr. Sugarman is with the University of California San Francisco School of Medicine in San Francisco, California
| | - Neal Bhatia
- Dr. Bhatia is with Therapeutics Clinical Research in San Diego, California
| | - Hilary Baldwin
- Dr. Baldwin is with the Acne Treatment and Research Center in Brooklyn, New York, and Robert Wood Johnson Medical Center in New Brunswick, New Jersey
| | - Lawrence J. Green
- Dr. Green is with the George Washington University School of Medicine in Washington, DC
| | - Ori Nov
- Dr. Nov, Mr. Ram, and Dr. Levy-Hacham are with Sol-Gel Technologies Ltd in Ness Ziona, Israel
| | - Vered Ram
- Dr. Nov, Mr. Ram, and Dr. Levy-Hacham are with Sol-Gel Technologies Ltd in Ness Ziona, Israel
| | - Ofra Levy-Hacham
- Dr. Nov, Mr. Ram, and Dr. Levy-Hacham are with Sol-Gel Technologies Ltd in Ness Ziona, Israel
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Bertolo R, Iacovelli V, Cipriani C, Carilli M, Vittori M, Antonucci M, Maiorino F, Signoretti M, Petta F, Travaglia S, Panei M, Bove P. Ejaculatory Function following Transperineal Laser Ablation versus TURP for Benign Prostatic Obstruction: A Randomized Trial. BJU Int 2023. [PMID: 36917033 DOI: 10.1111/bju.16008] [Citation(s) in RCA: 8] [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: 03/16/2023]
Abstract
OBJECTIVES To evaluate the reliability of trans-perineal laser ablation of prostate (TPLA) in preserving antegrade ejaculation compared to trans-urethral resection of prostate (TURP). PATIENTS AND METHODS In this single-center, prospective, randomized, open-label study, consecutive patients with indication to surgical treatment for benign prostatic obstruction (BPO) were enrolled between January 2020 and September 2021 (NCT04781049). Randomization defined two treatment arms: Group A: patients assigned to TPLA (experimental); Group B: patients assigned to TURP (standard). Primary endpoint was change in ejaculatory function (assessed by EJ-MSHQ) at 1 month after surgery. Secondary endpoints included comparison of visual analogue scale (VAS), changes in sexual function (by IIEF-5), ΔIPSS and ΔQoL, and Qmax improvement at 1-6 months, as appropriate. RESULTS Fifty-one patients (26 TPLA versus 25 TURP) were analyzed. No differences were found in the perception of pain assessed by VAS. No differences in IIEF-5 score were found between groups. Distribution of ejaculatory function assessed by the EJ-MSHQ remained unmodified after TPLA (p=0.2) while a median 30% decrease in EJ-MSHQ score was observed after TURP (p=0.01). Absence of antegrade ejaculation was reported in one patient within the TPLA group (18 patients s/p TURP). A statistically significant difference between the treatment groups was found in terms of postoperative Qmax (15.2 (IQR 13.5-18.3) versus 26.0 (IQR 22.0-48.0) ml/s, TPLA versus TURP, p<0.001). Both treatments significantly improved Qmax : mean 23.9 ml/s improvement s/p TURP (95% C.I. 17.1-30.7) versus 6.0 ml/s s/p TPLA (95% C.I. (5.0-7.0); and IPSS: mean 11.6 decrease (95% C.I. 9.7-13.5) versus 5.8 s/p TPLA (95% C.I. (2-9.6) with respect to baseline. CONCLUSION In our study, TPLA preserved ejaculatory function in 96% of cases in addition to providing significant relief from BPO.
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Affiliation(s)
| | | | - Chiara Cipriani
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Marco Carilli
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Matteo Vittori
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | | | | | - Marta Signoretti
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.,Department of Life, Health and Environmental Sciences, Urology Unit, University of L'Aquila, Coppito, AQ, Italy
| | - Filomena Petta
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Massimo Panei
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.,Urology Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy
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Szymanski L, Arekapudi KL. Adverse-Event Reports in Over-the-Counter Topical Acne Drug Products Containing Benzoyl Peroxide from a Specific Pharmaceutical Company in the USA. Dermatol Ther (Heidelb) 2022; 12:2397-2400. [PMID: 36152215 PMCID: PMC9588102 DOI: 10.1007/s13555-022-00808-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Benzoyl peroxide (BPO) has been used extensively in dermatology, often for the treatment of acne vulgaris. In a 20-year period, dermatologists in the United States used over-the-counter BPO more than 13 million times. However, skin irritation and other adverse events (AEs) are associated with the use of BPO. AEs associated with BPO were identified using the Galderma pharmacovigilance system, which collects AE reports from multiple sources. Over approximately 20 years, 558 AE reports were collected from the database, ranging from application site reactions to systemic hypersensitivity reactions, resulting in a reporting rate of under 1%. These data show that the risk of OTC topical acne drug products containing BPO is low.
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Becker B, Netsch C, Bozzini G, Herrmann TRW, Bach T, Enikeev D, Gross AJ. Reasons to go for thulium-based anatomical endoscopic enucleation of the prostate. World J Urol 2021; 39:2363-74. [PMID: 33948694 DOI: 10.1007/s00345-021-03704-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/17/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To summarize the current evidence and the reasons to go for thulium-based anatomical endoscopic enucleation of the prostate (AEEP). METHODS This review discusses the available literature on thulium-based AEEP. RESULTS Thulium lasers operate at a wavelength between 1940 and 2013 nm. This wavelength, which has a low penetration depth in water, allows to perform smooth cuts in the prostatic tissue and allows urologists to perform various procedures: resection, vaporization, enucleation, or vapoenucleation of the prostate. Depending on the type of thulium laser, it can be used either in a continuous, or pulsed mode. CONCLUSION In recent years, an increasing amount of evidence has described the thulium laser as a minimally invasive and size-independent treatment option for benign prostatic enlargement with excellent long-term results.
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Netsch C, Herrmann TRW, Bozzini G, Berti L, Gross AJ, Becker B. Recent evidence for anatomic endoscopic enucleation of the prostate (AEEP) in patients with benign prostatic obstruction on antiplatelet or anticoagulant therapy. World J Urol 2021. [PMID: 33721062 DOI: 10.1007/s00345-021-03647-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/19/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Due to demographic changes in today's society, the number of patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) is increasing. Similarly, the proportion of patients with cardiovascular risk factors undergoing antiplatelet (AP) or anticoagulation (AC) therapy is growing as well. METHODS This review discusses the current literature on various techniques used for anatomic endoscopic enucleation of the prostate (AEEP) in patients on AC/AP therapy. RESULTS The large number of energy sources used for AEEP makes it difficult to compare them. Overall, fewer bleeding-associated complications arise in patients under AP compared to AC or bridging therapy with low molecular weight heparin. However, perioperatively both AP and AC therapy lead to a higher risk of bleeding complications compared to patients not taking anticoagulants. CONCLUSIONS The literature shows that AEEP is possible and efficacious in patients under AC/AP therapy, with only slight differences compared to patients not taking AC/AP drugs, on a short and long-term basis. Nevertheless, the sparse data, the retrospective nature of many studies and the inclusion of prostate sizes between 50 and 110 ml only, make it difficult to come to strong conclusions.
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Wenzel M, Welte MN, Grossmann L, Preisser F, Theissen LH, Humke C, Deuker M, Bernatz S, Gild P, Ahyai S, Karakiewicz PI, Bodelle B, Kluth LA, Chun FKH, Mandel P, Becker A. Multiparametric MRI may Help to Identify Patients With Prostate Cancer in a Contemporary Cohort of Patients With Clinical Bladder Outlet Obstruction Scheduled for Holmium Laser Enucleation of the Prostate (HoLEP). Front Surg 2021; 8:633196. [PMID: 33718429 PMCID: PMC7947872 DOI: 10.3389/fsurg.2021.633196] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/25/2021] [Indexed: 01/15/2023] Open
Abstract
Objective: To investigate the value of standard [digital rectal examination (DRE), PSA] and advanced (mpMRI, prostate biopsy) clinical evaluation for prostate cancer (PCa) detection in contemporary patients with clinical bladder outlet obstruction (BOO) scheduled for Holmium laser enucleation of the prostate (HoLEP). Material and Methods: We retrospectively analyzed 397 patients, who were referred to our tertiary care laser center for HoLEP due to BOO between 11/2017 and 07/2020. Of those, 83 (20.7%) underwent further advanced clinical PCa evaluation with mpMRI and/or prostate biopsy due to elevated PSA and/or lowered PSA ratio and/or suspicious DRE. Logistic regression and binary regression tree models were applied to identify PCa in BOO patients. Results: An mpMRI was conducted in 56 (66%) of 83 patients and revealed PIRADS 4/5 lesions in 14 (25%) patients. Subsequently, a combined systematic randomized and MRI-fusion biopsy was performed in 19 (23%) patients and revealed in PCa detection in four patients (5%). A randomized prostate biopsy was performed in 31 (37%) patients and revealed in PCa detection in three patients (4%). All seven patients (9%) with PCa detection underwent radical prostatectomy with 29% exhibiting non-organ confined disease. Incidental PCa after HoLEP (n = 76) was found in nine patients (12%) with advanced clinical PCa evaluation preoperatively. In univariable logistic regression analyses, PSA, fPSA ratio, and PSA density failed to identify patients with PCa detection. Conversely, patients with a lower International Prostate Symptom Score (IPSS) and PIRADs 4/5 lesion in mpMRI were at higher risk for PCa detection. In multivariable adjusted analyses, PIRADS 4/5 lesions were confirmed as an independent risk factor (OR 9.91, p = 0.04), while IPSS did not reach significance (p = 0.052). Conclusion: In advanced clinical PCa evaluation mpMRI should be considered in patients with elevated total PSA or low fPSA ratio scheduled for BOO treatment with HoLEP. Patients with low IPSS or PIRADS 4/5 lesions in mpMRI are at highest risk for PCa detection. In patients with a history of two or more sets of negative prostate biopsies, advanced clinical PCa evaluation might be omitted.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Maria N. Welte
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Lina Grossmann
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Lena H. Theissen
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Marina Deuker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Philipp Gild
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Ahyai
- Department of Urology, University Hospital Goettingen, Goettingen, Germany
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis A. Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
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Rücker F, Lehrich K, Böhme A, Zacharias M, Ahyai SA, Hansen J. A call for HoLEP: en-bloc vs. two-lobe vs. three-lobe. World J Urol 2021; 39:2337-2345. [PMID: 33486536 DOI: 10.1007/s00345-021-03598-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/01/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Holmium Laser Enucleation of the Prostate (HoLEP) is widely accepted as standard laser enucleation technique for patients with benign prostate obstruction (BPO). Initially developed as a three-lobe enucleation technique, several modifications have been published. Comparison of the enucleation techniques is lacking. Therefor we aimed to compare outcomes of three enucleation techniques (en-bloc vs. two-lobe vs. three-lobe). MATERIAL AND METHODS We prospectively collected data of 600 patients treated between 01/2017 and 12/2017 with HoLEP for BPO. Patients were randomised to either enbloc, two-lobe, or three-lobe enucleation, respectively. Data collection consisted of parameters on operation time, perioperative parameters, and functional outcomes. Univariate and multivariate analyses (ANOVA-test for continuous variables; Chi2-test for categorical variables) were performed regarding differences between the three enucleation techniques. RESULTS Patient characteristics were not significantly different (all p > 0.05). Significant differences were observed with respect to overall operation time (en-bloc vs. two-lobe vs. three-lobe: 40.5 vs. 40.7 vs. 47.9, respectively; p < 0.001), speed (g/min.) (en-bloc vs. two-lobe vs. three-lobe, 1.82 vs. 1.76 vs. 1.67, respectively; p 0.006), and enucleation time (en-bloc vs. two-lobe vs. three-lobe: 31.7 vs. 32 vs. 37.7, respectively; p < 0.001). When solely comparing en-bloc vs. two-lobe enucleation, differences in terms of enucleation time, operation time, and speed were not significantly different (p 0.8, 0.9, and 0.2, respectively). Postoperative outcomes were not significantly different. CONCLUSION All three HoLEP enucleation techniques show similar postoperative outcomes. However, enbloc and two-lobe enucleation are significantly faster with respect to enucleation, overall operation time, and speed compared to the three-lobe technique.
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Affiliation(s)
- Frank Rücker
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Rubensstraße 125, 12157, Berlin, Germany
| | - Karin Lehrich
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Rubensstraße 125, 12157, Berlin, Germany.
| | - Axel Böhme
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Rubensstraße 125, 12157, Berlin, Germany
| | - Mario Zacharias
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Rubensstraße 125, 12157, Berlin, Germany
| | - Sascha A Ahyai
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Jens Hansen
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Rubensstraße 125, 12157, Berlin, Germany
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Pascoe J, Fontaine C, Hashim H. Modern advancements in minimally invasive surgical treatments for benign prostatic obstruction. Ther Adv Urol 2021; 13:17562872211030832. [PMID: 34349840 PMCID: PMC8287272 DOI: 10.1177/17562872211030832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/20/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022] Open
Abstract
A wide variety of minimally invasive surgical techniques are now being offered for treating voiding lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). These options offer an alternative to both medical therapy and traditional surgical options. Minimally invasive surgical treatments in LUTS/BPO boast both day case and local anaesthetic options, with a potentially reduced side effect profile compared to traditional surgical interventions matching the needs for a range of patients. We provide a narrative review of minimally invasive surgical treatments available for BPO in terms of the technology, efficacy, safety, institutional recommendations, cost and potential future developments.
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Affiliation(s)
- John Pascoe
- Specialist Registrar in Urology, University Hospitals Plymouth, Derriford Rd, Devon PL6 8DH, UK
| | - Christina Fontaine
- Specialist Registrar in Urology, University Hospitals Plymouth, Devon, UK
| | - Hashim Hashim
- Consultant Urological Surgeon and Honorary Professor in Urology, Bristol Urological Institute, Southmead Hospital, Bristol, Somerset, UK
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14
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Misrai V, Pradere B. Transurethral laser ablation of the prostate: from "which technique does better" to "what patient benefits the most" the real challenge in contemporary surgery. World J Urol 2021; 39:4507-8. [PMID: 32959069 DOI: 10.1007/s00345-020-03455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
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Stenmark F, Brudin L, Kjölhede H, Peeker R, Stranne J. Prostate volume and age are predictors of energy delivery using the CoreTherm Concept in patients with LUTS/ BPO: a study on thermal dose. Scand J Urol 2020; 54:248-252. [PMID: 32401123 DOI: 10.1080/21681805.2020.1763454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/24/2022]
Abstract
Objective: The primary aim of this study was to evaluate the scientific evidence supporting the use of thermal dose as a secondary (or an alternative) endpoint when using the CoreTherm Concept.Material and methods: Baseline and treatment data from 283 consecutive treatments were evaluated. All patients had lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). After evaluation, benign prostatic enlargement (BPE) with benign prostatic obstruction (BPO) was evident. As treatment, the CoreTherm Concept was used in all patients with LUTS/BPO. Data parameters were retrospectively extracted and included patient age, prostate volume, energy delivery, treatment time and calculated cell kill. In addition, assessment of temperature curves and calculated intraprostatic blood flow was made to define an optimal treatment. In total, 199 treatments assessed as optimal were included in the study.Results: There was a significant correlation between pretreatment prostate volume and energy delivery (p < .001). Age also influenced energy consumption significantly (p = .01).Conclusion: The solid correlation between pretreatment prostate volume and age versus total energy deposition implies the recommendation that a pretreatment calculation of an appropriate energy deposition should be used in all treatments as an alternative treatment endpoint.
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Affiliation(s)
- Fredrik Stenmark
- Department of Urology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Urology, Kalmar County Hospital, Kalmar, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden
| | - Henrik Kjölhede
- Department of Urology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Ralph Peeker
- Department of Urology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Arcaniolo D, Manfredi C, Veccia A, Herrmann TRW, Lima E, Mirone V, Fusco F, Fiori C, Antonelli A, Rassweiler J, Liatsikos E, Porpiglia F, De Sio M, Autorino R. Bipolar endoscopic enucleation versus bipolar transurethral resection of the prostate: an ESUT systematic review and cumulative analysis. World J Urol 2019; 38:1177-1186. [PMID: 31346761 DOI: 10.1007/s00345-019-02890-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To perform a cumulative analysis of the current evidence on the surgical and functional outcomes of bipolar endoscopic enucleation of the prostate (b-EEP) versus bipolar transurethral resection of the prostate (b-TURP). METHODS A systematic review of the literature was performed on PubMed, Ovid®, and Scopus® according to Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA Statement). The meta-analysis was conducted using the Review Manager 5.3 software. Parameters of interest were surgical and functional outcomes. Weighted mean difference, and odds ratio with 95% confidence interval were calculated for continuous and binary variables, respectively. Pooled estimates were calculated using the random-effect model. RESULTS Fourteen comparative studies were included. No statistically significant difference in terms of overall baseline characteristics was found. b-EEP had higher amount of resected tissue (p < 0.0001), shorter catheter time (p = 0.006), lower Hb drop (p = 0.03), and shorter length of stay (p < 0.0001). Equally, overall post-operative complications were lower (p = 0.01) as well as short (p = 0.04), and long-term complication rate (p = 0.04). There was higher re-intervention rate in the b-TURP group (p = 0.02) whereas b-EEP group had smaller residual prostate volume (p = 0.03), and lower post-operative PSA values (p < 0.00001). At long term, b-EEP presented lower IPSS (p = 0.04), higher Qmax (p = 0.002), and lower PVR (p < 0.00001). CONCLUSIONS b-EEP is an effective and safe surgical treatment for BPO. This procedure might offer several advantages over standard b-TURP, including the resection of a larger amount of tissue within the same operative time, shorter hospitalization, lower risk of complications, and lower re-intervention rate. This was submitted to PROSPERO registry: CRD42019126748.
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Affiliation(s)
| | | | - Alessandro Veccia
- Division of Urology, Department of Surgery, VCU Health, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
- Urology Unit and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Thomas R W Herrmann
- Department of Urology, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Estevão Lima
- Department of Urology, Braga Hospital, Braga, Portugal
| | - Vincenzo Mirone
- Department of Urology, Federico II University, Naples, Italy
| | | | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alessandro Antonelli
- Urology Unit and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Jens Rassweiler
- Department of Urology, University of Heidelberg, SLK Kliniken, Heilbronn, Germany
| | | | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Marco De Sio
- Urology Unit, Luigi Vanvitelli University, Naples, Italy
| | - Riccardo Autorino
- Urology Unit, Luigi Vanvitelli University, Naples, Italy.
- Division of Urology, Department of Surgery, VCU Health, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.
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De Nunzio C, Presicce F, Lombardo R, Trucchi A, Bellangino M, Tubaro A, Moja E. Patient centred care for the medical treatment of lower urinary tract symptoms in patients with benign prostatic obstruction: a key point to improve patients' care - a systematic review. BMC Urol 2018; 18:62. [PMID: 29940928 PMCID: PMC6019782 DOI: 10.1186/s12894-018-0376-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 02/22/2017] [Accepted: 06/17/2018] [Indexed: 11/24/2022] Open
Abstract
Background Even though evidence based medicine, guidelines and algorithms still represent the pillars of the management of chronic diseases (i.e: hypertension, diabetes mellitus), a patient centred approach has been recently proposed as a successful strategy, in particular to improve drug adherence. Aim of the present review is to evaluate the unmet needs in LUTS/BPH management and the possible impact of a patient centered approach in this setting. Methods A National Center for Biotechnology Information (NCBI) PubMed search for relevant articles published from January 2000 until December 2016 was performed by combining the following MESH terms: patients centred medicine, patient centered care, person centered care, patient centered outcomes, value based care, shared decision making, male, Lower Urinary Tract Symptoms, Benign Prostatic Hyperplasia, treatment. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). All studies reporting on patient centred approach, shared decision making and evidence-based medicine were included in the review. All original article, reviews, letters, congress abstracts, and editorials comments were included in the review. Studies reporting single case reports, experimental studies on animal models and studies not in English were not included in the review. Results Overall 751 abstracts were reviewed, out of them 87 full texts were analysed resulting in 36 papers included. The evidence summarised in this systematic review confirmed how a patient centred visit may improve patient’s adherence to medication. Although a patient centred model has been rarely used in urology, management of Low Urinary Tract Symptoms (LUTS) and Benign Prostatic Obstruction (BPO) may represent the perfect ground to experiment and improve this approach. Notwithstanding all the innovations in LUTS/BPO medical treatment, the real life picture is far from ideal. Conclusions Recent evidence shows a dramatical low drug adherence and satisfaction to medical treatment in LUTS/BPH patients. A patient centred approach may improve drug adherence and some unmet needs in this area, potentially reducing complications and costs. However further well designed studies are needed to confirm this data.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy.
| | - Fabrizio Presicce
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Alberto Trucchi
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Mariangela Bellangino
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Egidio Moja
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy.,CURA Centre, University of Milan, Milan, Italy
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Finkel L, Hogrefe K, Frey SH, Goldenberg G, Randerath J. It takes two to pantomime: Communication meets motor cognition. Neuroimage Clin 2018; 19:1008-1017. [PMID: 30003038 PMCID: PMC6039835 DOI: 10.1016/j.nicl.2018.06.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 01/12/2023]
Abstract
For over a century, pantomime of tool use has been employed to diagnose limb apraxia, a disorder of motor cognition primarily induced by left brain damage. While research consistently implicates damage to a left fronto-temporo-parietal network in limb apraxia, findings are inconsistent regarding the impact of damage to anterior versus posterior nodes within this network on pantomime. Complicating matters is the fact that tool use pantomime can be affected and evaluated at multiple levels. For instance, the production of tool use gestures requires the consideration of semantic characteristics (e.g. how to communicate the action intention) as well as motor features (e.g. forming grip and movement). Together, these factors may contribute substantially to apparent discrepancies in previously reported findings regarding neural correlates of tool use pantomime. In the current study, 67 stroke patients with unilateral left-brain damage performed a classic pantomime task. In order to analyze different error characteristics, we evaluated the proper use of grip and movement for each pantomime. For certain objects, healthy subjects may use body parts as representative for the object, e.g. use of the fingers to indicate scissors blades. To specify the pathological use of body parts as the object (BPO) we only assessed pantomime items that were not prone to this response in healthy participants. We performed modern voxel-based lesion analyses on MRI or CT data to determine associations between brain injury and the frequency of the specific types of pantomime errors. Our results support a model in which anterior and posterior nodes of the left fronto-temporo-parietal network contribute differentially to pantomime of tool use. More precisely, damage in the inferior frontal cortex reaching to the temporal pole is associated with an increased frequency of BPO errors, whereas damage to the inferior parietal lobe is predominantly linked to an increased frequency of movement and/or grip errors. Our work suggests that the validity of attempts to specify the neural correlates of limb apraxia based on tool use pantomime depends on differentiating the specific types of errors committed. We conclude that successful tool use pantomime involves dissociable functions with communicative aspects represented in more anterior (rather ventral) regions and motor-cognitive aspects in more posterior (rather dorsal) nodes of a left fronto-temporo-parietal network.
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Affiliation(s)
- Lisa Finkel
- Department of Psychology, University of Konstanz, Germany; Lurija Institute for Rehabilitation Science and Health Research, Kliniken Schmieder, Allensbach, Germany
| | | | - Scott H Frey
- Department of Psychological Sciences, University of Missouri, USA
| | - Georg Goldenberg
- Technical University Munich, Germany; Medical Practice for Cognitive Neurology, Vienna, Austria
| | - Jennifer Randerath
- Department of Psychology, University of Konstanz, Germany; Lurija Institute for Rehabilitation Science and Health Research, Kliniken Schmieder, Allensbach, Germany.
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Bach T, Wölbling F, Gross AJ, Netsch C, Tauber S, Pottek T, Wülfing C, Brunken C. Prospective assessment of perioperative course in 2648 patients after surgical treatment of benign prostatic obstruction. World J Urol 2016; 35:285-292. [PMID: 27263019 DOI: 10.1007/s00345-016-1866-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 04/22/2016] [Accepted: 05/23/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE TUR-prostate (TUR-P) is considered the reference method for surgical treatment of benign prostatic obstruction (BPO); Greenlight laser photoselective vaporization (PVP) and thulium laser vapoenucleation (ThuVEP) have also been established as treatments of BPO. Objective of this prospective observation was to compare a large numbers of patients treated in everyday routine. METHODS This prospective multicentre data collection assesses morbidity and perioperative course of consecutive men treated with BPO-related transurethral surgery between 2011 and 2014 in a German metropolis area with TUR-P, PVP or ThuVEP. RESULTS Two thousand six hundred and forty-eight patients have been treated in the time period. All treatment options achieved immediate improvement of voiding parameters. Multivariate analyses proved shorter hospital stay after laser treatments as compared to resection (p < 0.001). In terms of hospital stay, the advantage of ThuVEP compared to TUR-P increased with prostate volume (p < 0.001). Patients with ongoing anticoagulation or bridging had prolonged hospital stay (p < 0.001). Overall adverse events were least frequent in PVP (p 0.016), as were Clavien 3b events (p < 0.001). CONCLUSIONS Surgical treatment of BPO is effective and safe independent of the surgical procedure. Volume reduction is most effective in ThuVEP; PVP has the lowest rate of severe complications. Laser treatment is associated with shorter hospital stay. Surgery under ongoing anticoagulation prolonged the post-operative hospital stay.
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Affiliation(s)
- Thorsten Bach
- Department of Urology, Asklepios Hospital Harburg, Eissendorfer Pferdeweg 52, 21075, Hamburg, Germany.
| | - Felix Wölbling
- Department of Urology, Asklepios Hospital Harburg, Eissendorfer Pferdeweg 52, 21075, Hamburg, Germany
| | - Andreas J Gross
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - S Tauber
- Department of Urology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Tobias Pottek
- Department of Urology, Asklepios Westklinkum Rissen, Hamburg, Germany
| | | | - Claus Brunken
- Department of Urology, Asklepios Hospital St. Georg, Hamburg, Germany
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Yu H, Zhang Z, Zhu Y, Chen J, Jiang X, Meng H, Shi B. Long-term outcome following thulium vaporesection of the prostate. Lasers Surg Med 2016; 48:505-10. [PMID: 26940981 DOI: 10.1002/lsm.22495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The continuous wave 2-μm Thulium Laser has been introduced as potential technology with both high efficiency and safe practice; although little data have been shown regarding the long-term outcomes. OBJECTIVE To analyze the long-term outcomes after thulium vaporesection of the prostate (ThuVaRP). METHODS ThuVaRP was performed using the continuous wave, 2-μm Thulium: YAG laser at 70 W. The perioperative and post-operative follow-up data were analyzed. RESULTS The average age at surgery was 71.5 (range 55-94 years). The median prostate size was 60.1 g (range 36.3-109.8 g). A median operation time was noted at 44.8 ± 6.5 minutes, while the median catheterization time was 3.5 ± 0.5 days. In regards to hospital stay, most patients had an average duration of 5.5 ± 1.5 days. Minor complications requiring non-interventional treatment happened in 237 (36.24%) of 654 patients, while major complications requiring re-interventions occurred in one patient (0.15%). During a 60-month follow-up, bladder neck fibrosis occurred in 1.22% of the patients. A BPH recurrence happened in 17 (2.60%) patients, of which 14 patients (2.14%) received a second surgery. In comparison to the pre-operative baseline, the patients Qmax, PVR volume, IPSS, and Qol scores all improved significantly (P < 0.01) at time of discharge. This continued into the post-operative follow-up visits (3-6-12-18-14-26-48-60 months). CONCLUSIONS ThuVaRP is both an effective and safe treatment procedure for symptomatic BPO (with a low occurrence of complications). Lasers Surg. Med. 48:505-510, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Haiyi Yu
- Department of Urology, 89th Hospital of PLA, Weifang, Shandong, 261000, People's Republic of China
| | - Zhaocun Zhang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Yaofeng Zhu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Jun Chen
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Xuewen Jiang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Hui Meng
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Benkang Shi
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
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Zhong DC, Wen YQ, Deng JH, Jian TH, Wang KJ. Two cobalt(II) supramolecular isomers based on N,N'-bis(pyridin-3-yl)oxalamide induced by the molecular orientation of lattice DMF molecules. Acta Crystallogr C Struct Chem 2016; 72:170-3. [PMID: 26846505 DOI: 10.1107/s205322961600156x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 11/10/2022]
Abstract
Supramolecular isomerism for coordination networks refers to the existence of different architectures having the same building blocks and identical stoichiometries. For a given building block, different arrangements can lead to the formation of a series of supramolecular isomers. Two one-dimensional Co(II) coordination polymers based on N,N'-bis(pyridin-3-yl)oxalamide (BPO), both catena-poly[[[dichloridocobalt(II)]-bis[μ-N,N'-bis(pyridin-3-yl)oxalamide-κ(2)N:N']] dimethylformamide disolvate], {[CoCl2(C12H10N4O2)2]·2C3H7NO}n, have been assembled by the solvothermal method. Single-crystal X-ray diffraction analyses reveal that the two compounds are supramolecular isomers, the isomerism being induced by the orientation of the dimethylformamide (DMF) molecules in the crystal lattice.
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Affiliation(s)
- Di-Chang Zhong
- School of Chemistry and Chemical Engineering, Gannan Normal Unversity, Ganzhou 341000, People's Republic of China
| | - Ya-Qiong Wen
- School of Chemistry and Chemical Engineering, Gannan Normal Unversity, Ganzhou 341000, People's Republic of China
| | - Ji-Hua Deng
- School of Chemistry and Chemical Engineering, Gannan Normal Unversity, Ganzhou 341000, People's Republic of China
| | - Tao-Hua Jian
- School of Chemistry and Chemical Engineering, Gannan Normal Unversity, Ganzhou 341000, People's Republic of China
| | - Ke-Jun Wang
- School of Chemistry and Chemical Engineering, Gannan Normal Unversity, Ganzhou 341000, People's Republic of China
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