UroLift, Rezūm, and iTind for Benign Prostatic Hyperplasia.

Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization

A Prospective, Randomized Clinical Trial Comparing Plasmakinetic Resection of the Prostate with Holmium Laser Enucleation of the Prostate Based on a 2-Year Followup

Transurethral Holmium Laser Enucleation Versus Transurethral Resection of the Prostate and Simple Open Prostatectomy—Which Procedure is Faster?

Objective To evaluate the therapeutic efficacy of Aescuven forte on lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH) patients with histological prostatitis after transurethral resection of prostate (TURP). Methods From November 2015 to May 2018, 116 BPH patients with histological prostatitis were randomized divided into two groups with 58 cases in the treatment group and 58 cases in the control group. The treatment group received aescuven forte 2 pieces bid started at 3 days after surgery and continued till 4 weeks after catheter removal, while the control group received no such treatment. The IPSS and QOL scores were observed before surgery and at 7 days, 28 days after catheter removal. The numbers of AUR and UUI after surgery were counted. Results The IPSS and QOL scores after surgery were significantly lower than the those before surgery in both groups. But there were significant difference in the declining range between the two groups (P 0.05). Conclusion Aescuven forte can improve the LUTS after TURP in BPH patients with histological prostatitis. Key words: Prostatic hyperplasia; Resection of prostate; Prostatitis; Aescuven forte; Lower urinary tract symptoms

Treatment of lower urinary tract symptoms in benign prostatic hyperplasia and its impact on sexual function

Correlations of Urodynamic Changes With Changes in Symptoms and Well-being After Transurethral Resection of the Prostate

Benign prostatic hyperplasia (BPH) is a chronic and often progressive condition. It affects nearly three in four men by the seventh decade of life. Clinically, BPH is distinguished by progressive development of lower urinary tract symptoms (LUTS) even though not all patients with BPH develop LUTS. Retropubic simple prostatectomy was first described in 1945 and soon became the popular surgical management of BPH. Open prostatectomy was gradually replaced by transurethral resection of the prostate (TURP) as the standard surgical treatment of BPH. With the introduction of medical therapy in the 1980s, the standard treatment for patients with LUTS secondary to BPH shifted to pharmacotherapy with α-blockers and/or 5α-reductase inhibitors. This paradigm shift to pharmacological therapy led to a dramatic decrease in hospitalization for TURP throughout the 1990s. After more than 10 years of decrease in total BPH procedure rates, the trend was reversed after 2002 due to the marked increase in Minimally Invasive Surgical Techniques (MISTs) including transurethral microwave therapy, transurethral needle or ethanol ablation, high intensity frequency ultrasound, and laser resection/ablation as well as transurethral saline plasma vaporization. Unfortunately, all MISTs are associated with various degrees of sexual side effects, mainly ejaculatory dysfunction and erectile dysfunction. The UroLift System is newly approved technology by the FDA for BPH. This versatile implant self-sizes in the prostate and mechanically opens the prostatic urethra without causing any sexual side effects. This presentation will introduce this novel technology for the treatment of BPH.

Background: Lower Urinary Tract Symptoms (LUTS) after Transurethral Resection of the Prostate (TURP) occur in one-third of Benign Prostatic Hyperplasia (BPH) patients, may be caused by persistent prostatic inflammation and fibrosis. Objective: This study aims to evaluate the role of inflammation and fibrosis in pathological mechanism of LUTS among patients with BPH who underwent TURP by assessing their PSA, TNF-α, and TGF-β level. Design, Setting, and Participant: Data in this study were analyzed with the 2-way hypothesis. The study used odds ratio to define the risk factors of LUTS after TURP. The samples of the study are BPH patients after TURP aged 50-80 years old. Interventions: No intervention(s). Outcome Measurements and Statistical Analysis: The data analyzed using SPSS version 21.0 for Windows. Results and Limitations: There were 34 cases of LUTS and 42 controls without LUTS. We found that there were an increased levels of TNF-α (> 46.95 pg/ml) (OR 55.6, 95% Confidence Interval [CI] 11.1-278.4, p=0.00) and TGF-β (> 207.63 pg/ml) (OR 16.7, 95%CI 5.3-52.8, p=0.00). The result of multiple linear logistic regression analysis obtained equation Y= 0.033 x TNF-α + 0.031 x TGF-β. Population Attributable Risk (PAR) % TNF-α is 60%, PAR % TGF-β is 53%. Conclusion: Combination of elevated levels of TNF-α (>46.95 pg/ml) and TGF-β (>207.63) in prostate tissue is the risk factors for the occurrence of LUTS after TURP. Patient Summary: In this study, we enrolled 76 patients who were diagnosed with BPH and urinary retention. After TURP, there were 34 cases of LUTS and 42 controls without LUTS. We found that the levels of TNF-α and TGF-β between cases and controls were significantly different. We conclude that the combination of elevated levels of TNF-α and TGF-β in prostate tissue is the risk factors for the occurrence of LUTS after TURP.

Long-term outcome of men with lower urinary tract symptoms recruited to the CLasP randomised trial comparing transurethral resection of the prostate, conservative management and laser therapy

Tel: 212-241-9955 Benign prostatic hyperplasia (BPH) is a common condition related to aging that can lead to a cluster of chronic symptoms collectively known as lower urinary tract symptoms (LUTS), including urinary frequency, urinary urgency, nocturia, hematuria, and decreased urinary stream. It is estimated that BPH affects 75% of men in the United States by age 70, with more than $1 billion US dollars a year spent in direct health care expenditures related to BPH, exclusive of outpatient medications [1]. Treatment options for BPH are outlined out by the American Urologic Association Clinical Guidelines and include watchful waiting, medical therapy, minimally invasive therapies (including transurethral ablations), or surgical therapies including open prostatectomy or transurethral resection of the prostate (TURP) [2]. Medical therapy is often considered the first-line option for symptomatic patients; however, a large subset of patients does not respond to or cannot tolerate pharmacotherapy, in part owing to a number of side effects including sexual dysfunction [3]. TURP has remained the ‘gold standard’ surgical treatment for BPH for over half a century, owing to its high success rate in reducing LUTS. Over the past two decades, the TURP procedure has undergone significant technical improvements, with morbidity rates reported to be <1% [4]. However, with a general shift towards minimally invasive treatment options, the number of TURPs performed has fallen in more recent years [5]. Manuscript Click here to download Manuscript SAPE final (1).docx Embolization of the prostatic arteries has been used for many years as a technique to control severe bladder and prostate hemorrhage as well as hematuria following TURP [6-9]. A case report by DeMeritt et al in 2000 described a patient with BPH and refractory hematuria treated by prostatic artery embolization, who subsequently had alleviation in his LUTS and reduction in the volume of his prostate [10]. This case report introduced the idea that BPH could intentionally be treated by selective arterial prostatic embolization (SAPE). In 2008, Carnevale et al used SAPE as the primary treatment in two patients with BPH [11]. After 6-month follow-up, MRI demonstrated a relative prostate reduction of 47.8% in the patient who had undergone bilateral SAPE and 27.8% in the patient who had undergone unilateral SAPE. Since this initial study, there has been an enthusiastic response in the literature regarding the future role of this technique, and the Society of Interventional Radiology has encouraged further research into this intervention [12]. A growing body of literature suggests that SAPE enables reduction in prostate volume with improvements in uroflometry parameters, quality of life, and sexual function [13]. The largest prospective non-randomized series published to date looked at 255 patients who underwent SAPE [14]. The authors describe technical success in 250 of the patients (98%), with a clinical success rate of 82% at one month decreasing to 72% at 3 years. In the only RCT to date assessing SAPE, 57 patients were assigned to prostatic artery embolization and 57 were assigned to TURP for the treatment of BPH [15]. The authors demonstrated that all parameters: including improvement of the International Prostate Symptom Score (IPSS), quality of life (QOL), peak urinary flow, and post void residual(PVR) urine volume were improved by both treatment modalities and there was no difference at two years between the treatment arms. The paper does state there was a higher complication rate for PAE, if one controls for acute urinary retention post operatively, there would be similar complication rates for both groups. The technique for SAPE involves unilateral access of the femoral artery and subsequent catheterization of the anterior division of the internal iliac artery. Digital subtraction angiography is used to confirm arterial anatomy and allow for superselective catheterization of the prostatic artery. A number of different embolic materials have been used, including polyvinyl alcohol particles, trisacryl gelatin microspheres, and Embozene Selective Arterial Prostatic Embolization (SAPE) for the Treatment of Lower Urinary Tract Symptoms in the Setting of Benign Prostatic Hyperplasia: A Brief Review

ImportanceUp to 40% of men older than 50 years have lower urinary tract symptoms, including urinary urgency, nocturia, and weak urinary stream, due to disorders of the bladder and prostate. These symptoms negatively affect quality of life and may be associated with urinary retention, which can cause kidney insufficiency, bladder calculi, hematuria, and urinary tract infections.ObservationsIn men, lower urinary tract symptoms can be caused by bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), an overactive bladder detrusor (a syndrome of urinary urgency and frequency), or both. Behavioral therapy, including pelvic floor physical therapy, timed voiding (voiding at specific intervals), and fluid restriction, can improve symptoms. Medications including α-blockers (such as tamsulosin), 5α-reductase inhibitors (such as finasteride), and phosphodiesterase 5 inhibitors (such as tadalafil) improve lower urinary tract symptoms (mean improvement, 3-10 points on the International Prostate Symptom Score [IPSS], which ranges from 0-35, with higher scores indicating greater severity) and can prevent symptom worsening measured by increased IPSS greater than or equal to 4 points or development of secondary sequelae, such as urinary retention. Combination therapies are more effective than monotherapy. For example, α-blockade (eg, tamsulosin) combined with 5α-reductase inhibition (eg, finasteride) lowers progression risk to less than 10% compared with 10% to 15% with monotherapy. Treatment for overactive bladder detrusor muscle, including anticholinergics (eg, trospium) and β3 agonists (eg, mirabegron), reduces voiding frequency by 2 to 4 times per day and reduces episodes of urinary incontinence by 10 to 20 times per week. Surgery (eg, transurethral resection of the prostate, holmium laser enucleation of the prostate) and minimally invasive surgery are highly effective for refractory or complicated cases of BPH, defined as persistent symptoms despite behavioral and pharmacologic therapy, and these therapies can improve IPSS by 10 to 15 points. Minimally invasive procedures, such as water vapor therapy (endoscopic injection of steam into BPH tissue) and prostatic urethral lift (endoscopic insertion of nonabsorbable suture implants that mechanically open the urethra), have lower complication rates of incontinence (0%-8%), erectile dysfunction (0%-3%), and retrograde ejaculation (0%-3%) but are associated with increased need for surgical retreatment (3.4%-21%) compared with transurethral resection of the prostate (5%) and holmium laser enucleation of the prostate (3.3%).Conclusions and RelevanceLower urinary tract symptoms, defined as urinary urgency, nocturia, or weak stream, are common among men and are usually caused by BPH, overactive bladder detrusor, or both. First-line therapy consists of behavioral interventions, such as pelvic floor physical therapy and timed voiding, as well as pharmacologic therapy, including α-adrenergic blockers (tamsulosin), 5α-reductase inhibitors (finasteride), phosphodiesterase inhibitors (tadalafil), anticholinergics (trospium), and β3 agonists (mirabegron).

Objective To compare the efficacy and complications between transurethral resec-tion of the prostate(TURP) and transurethral vaporization-resection of the prostate (TUVRP). Methods 637 cases of benign prostatic hyperplasia(BPH)were divided into 2 groups, 298 cases un-derwent TURP and 339 underwent TUVRP. The maximal flow rates (Qmax) were (9.8±2.3)ml/s, (10.1±2.1) ml/s, the international prostatic symptom scores (IPSS) were 15.3±3.1,15.1±3.7 re-spectively. The surgical outcomes and the complications of the 2 groups were analyzed. Results For the TURP group and TUVRP group, the postoperative Qmax were (19.0±2.9)ml/s and (18.0±2.3) ml/s, both significantly higher than those of preoperation(P<0.01). There was no significant differ-ence between the 2 groups(P0.05). For the TURP group, the mean operation time was (52±16) rain, visual hematuria lasting for (9.0±2.3) d, secondary bleeding in 6 cases (2.0%), lower urinary tract infection in 14 cases(4.7%), 1 month after operation lower urinary tract symptom(LUTS) in 26 case(8.7%), IPSS was 5.0±1.4, contemporary incontinence in 6 cases(2.0%), memberanous sticture 4 cases(1.3%). For the TUVRP group, the mean operation time was (68%19)min, visual hematuria lasting for (12.0±3.6) d, secondary bleeding in 19 cases (5.6%), lower urinary tract infection in 38 cases(11.2%) ,1 month after operation LUTS in 59 cases(17.4%) ,IPSS was 8.0±1.6,contemporary incontinence in 13 cases(3.8%), memberanous stieture in 16 cases (4.7%). There were significant differences between the 2 groups. For the TURP group, blood loss during operation was (126±29) ml, resected tissue weighed (31±8)g, pre- and post-operative serum natium consentration balance was (8±6)mmol/L,TURS developed in 3 cases(1%). For the TUVRP group, blood loss during opera-tion was (122±38)ml, resected tissue weighed (33±9)g,pre- and post-operative serum natium con-sentration balance was (7±7) mmol/L, TURS developed in 2 cases(0.6%). There was no significant differences(P0.05). Conclusions TURP and TUVRP have similar efficacy treating symptomatic BPH. The incidences of complications of TUVRP are slightly higher than those of TURP. Key words: Benign prostatic hyperplasia; Surgical procedures,elective

To compare the costs and outcome of high-energy transurethral microwave thermotherapy of the prostate (HE-TUMT) with transurethral resection of the prostate (TURP), as the former is considered to be the best minimally invasive method for managing lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Between January 1996 and March 1997, 144 patients were randomized to treatment with HE-TUMT (78) using the Prostatron device and Prostasoft 2.5 software (EDAP Technomed, Lyon, France), or TURP (66). At baseline and during the annual follow-up, patients were evaluated by the International Prostate Symptom Score and uroflowmetry (maximum flow rate and postvoid residual volume). Kaplan-Meier survival analyses were used to calculate the cumulative risk of re-treatment. A cost-consequences analysis was performed based on the prospective measurement of healthcare use, with costs expressed as Netherland guilders (NLG). During a 3-year follow-up period, the mean (95% confidence interval) risk of re-treatment was 22.9 (12.5-33.2)% and 13.2 (4.5-21.9)% for HE-TUMT and TURP, respectively (P = 0.215). The mean direct cost of treatment was 3450 (3444-3456) and 6560 (5992-7128) NLG for HE-TUMT and TURP, respectively. The mean total (including re-treatments), discounted (4%) 3-year cost for the HE-TUMT and TURP group was 5300 (4692-5908) and 7800 (7118-8482) NLG, respectively. In this prospective randomized trial, HE-TUMT and TURP had a comparable 3-year risk of re-treatment. Healthcare expenditure on HE-TUMT, mainly because it is an outpatient treatment, was significantly lower than for TURP.

BackgroundA link between sexual dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) has been noticed. Transurethral resection of the prostate (TURP) remains the standard treatment for symptomatic BPH, whether TURP causes sexual dysfunction is still uncertain. In this retrospective study, we investigated the relationship between parameters measured by color Doppler ultrasound (CDU) and sexual dysfunction in patients with BPH 12 months after TURP.MethodsThe parameters include presumed circle area ratio (PCAR), maximal horizontal area of seminal vesicles (MHA), resistive index of the prostate (RIP), and peak systolic velocity in the flaccid penis (PSV). The international prostate symptom score was used to evaluate the lower urinary tract symptoms and the five-item version of the International Index of Erectile Function was used to evaluate sexual function before and after TURP.ResultsOf the 103 patients without sexual dysfunction before TURP, 11 (10.7%) had erectile dysfunction (ED) after TURP. These 11 patients had significantly lower PCAR, RIP, PSV and MHA than those without ED. The patients with retrograde ejaculation after TURP had significantly lower PCAR than those without retrograde ejaculation, and the patients with premature ejaculation after TURP had significantly lower MHA than those without premature ejaculation. Comparing the parameters between baseline and after TURP, PCAR, RIP, and MHA decreased significantly in the patients with sexual dysfunction, but no significant differences were noted in the patients without sexual dysfunction after TURP.ConclusionsMore extended TURP can lead to a higher incidence of ED and retrograde ejaculation in BPH patients without sexual dysfunction before TURP. Patients with a lower volume of seminal vesicles after TURP may have a higher incidence of premature ejaculation.

Development of a patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia.