Outcomes of Prostate Artery Embolisation in Patients with Severe Symptoms of Benign Prostate Hyperplasia

Background

Benign prostatic hyperplasia (BPH) is associated with severe lower urinary tract symptoms (LUTS). The severity of LUTS is assessed by the International Prostate Symptoms Score (IPSS). Prostate artery embolisation (PAE) is a newly available method for combating LUTS. This study aims to assess the outcomes of PAE in reducing LUTS and prostate volume in patients with BPH.

Methods

Patients diagnosed with BPH with severe LUTS who had undergone PAE were included. Their IPSS score was ≥ 20 despite medical therapy. PAE was performed via the unilateral femoral artery using various types of embolic material. Bilateral or unilateral embolisation of the prostate artery was considered a technical success. The severity of LUTS pre- and post-PAE were assessed using IPSS while prostate volume pre- and post-PAE were assessed by ultrasound and magnetic resonance imaging (MRI).

Results

Ninety percent of patients had technical success and one required transurethral resection of the prostate (TURP). The mean IPSS reduction at the final follow-up was 12.9 (P < 0.028). The mean reduction of prostate volume at the last follow-up by ultrasound was 114.99 mL (P < 0.028) and by MRI was 29.17 mL (P < 0.028).

Conclusion

PAE is safe and effective in reducing severe LUTS and prostate gland volume in BPH patients.

Uretroplasty with oral mucosal graft in patients with anterior urethral stenosis. Comparative study with conventional treatment

ANTECEDENTES

El manejo con uretroplastía de la estenosis uretral es una opción quirúrgica fundamental, y comparar la uretroplastía con injerto de mucosa oral con la uretroplastía término-terminal tiene trascendencia para conocer la diferencia entre ambas técnicas.

OBJETIVO

Comparar la uretroplastía con injerto de mucosa oral con la uretroplastía término-terminal en pacientes con estenosis uretral tipo Jordan C, D y E.

MÉTODO

Cuasiexperimento realizado en pacientes con estenosis uretral anterior operados de uretroplastía con anastomosis término-terminal o con injerto de mucosa bucal.

RESULTADOS

Veintinueve pacientes con una media de edad de 50.7 años, 6 diabéticos, 9 hipertensos, longitud media de la estenosis de 3.6 cm, 19 operados con uretroplastía termino-terminal (grupo 1) y uretroplastía con mucosa bucal (grupo 2). El Índice Internacional de Síntomas Prostáticos promedio preoperatorio fue grave en la mayoría de los pacientes (93%). Hubo mejoría significativa en el posoperatorio en ambos grupos (p = 0.0001 y p = 0.0011), así como en los resultados uroflujométricos (p = 0.0046 y p = 0.00062).

CONCLUSIONES

Ambos procedimientos lograron mejorías significativas en la sintomatología urinaria a los 6 meses en comparación con los valores preoperatorios.

BACKGROUND

Urethroplasty management of urethral stricture is a fundamental surgical option, and comparing urethroplasty with oral mucosal graft with end-to-end urethroplasty is important to know the difference between both techniques.

OBJECTIVE

To compare urethroplasty with oral mucosal graft with end-to-end urethroplasty in patients with urethral stricture type Jordan C, D and E.

METHOD

Quasi-experiment performed in patients with anterior urethral stricture operated with urethroplasty with end-to-end anastomosis or with oral mucosal graft.

RESULTS

Twenty-nine patients with a mean age of 50.7 years, 6 diabetic, 9 hypertensive, mean stenosis length of 3.6 cm, 10 with end-to-end urethroplasty (group 1) and 19 operated with urethroplasty with buccal mucosa (group 2). The average preoperative International Prostatic Symptom Index was severe in most patients (93%). There was significant improvement postoperatively in both groups (p = 0.0001 and p = 0.0011), as well as in uroflowmetric results (p = 0.0046 and p = 0.00062).

CONCLUSIONS

Both procedures achieved significant improvements in urinary symptomatology at 6 months compared to preoperative values.

Model-based meta-analysis of individual International Prostate Symptom Score trajectories in patients with benign prostatic hyperplasia with moderate or severe symptoms

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.