American Urological Association Symptom Score Research Articles

The SUB-urothelial DUrvalumab InjEction-1 (SUBDUE-1) trial: first-in-human trial in patients with bladder cancer.

To assess the safety of sub-urothelial injection of durvalumab and examine the impact on tissue and circulating immune cell populations. The patients were chemotherapy and immunotherapy naïve (bacille Calmette-Guérin allowed) with non-metastatic muscle-invasive bladder cancer or non-muscle-invasive bladder cancer planned for radical cystectomy (RC). The study was a Phase Ib 3 + 3 dose-escalation design with sub-urothelial injection of durvalumab at three pre-determined doses (25, 75, 150 mg) diluted in 25 mL normal saline, injected at 25 locations (25 × 1 mL injections), at least 2 weeks before RC. A total of 11 patients were recruited (10 male, one female). No significant changes were reported on American Urological Association Symptom Score or O'Leary Interstitial Cystitis Scale. In all, 14 adverse events (AEs) were reported (10 Grade 1, three Grade 2, one Grade 3), none considered immune-related. No Grade 4 or 5 AEs were recorded. All the patients underwent RC. Tissue immune populations changed following durvalumab injection (P = 0.012), with a statistically significant increase in M2-macrophage (CD163) when comparing the 25-150 mg dose (P = 0.021). Basal/mixed cancers showed a larger CD163 increase than luminal cancers (P = 0.033). Sub-urothelial injection of durvalumab is feasible and safe without immune-related AEs and shows local immunological effects.

Preoperative Bladder Scanning Can Predict Postoperative Urinary Retention Following Total Joint Arthroplasty.

As total joint arthroplasty (TJA) moves to the outpatient setting, it is becoming clear that postoperative urinary retention (POUR) is a potential impediment to same-day discharge. Although risk factors for POUR have been widely studied, the lack of their clinical utility warrants investigation of specific preoperative factors that can assist in surgical planning and patient optimization. The purpose of the current study was to determine whether preoperative symptom surveys and bladder scanning are useful tools in identifying POUR risk. We performed a prospective analysis of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a high-volume orthopaedic hospital between December 1, 2020, and September 30, 2021. A total of 507 patients (324 female and 183 male) undergoing TJA completed the American Urological Association (AUA) symptom index preoperatively and then again at 14 and 64 days postoperatively. Post-void bladder scans were obtained in the immediate preoperative setting. POUR was defined as a bladder volume of >500 mL that required catheterization. Chi-square and quintile analysis were used to compare bladder scanning volumes, and Student t tests were used to compare AUA scores. The rate of POUR was 37% (66 female and 34 male) and 23% (37 female and 19 male) in the TKA and THA groups, respectively. Increasing post-void residual volume (PVRV) measured on preoperative bladder scanning was found to be predictive of POUR. Among the TKA cohort, younger age and lower body mass index were also associated with increased catheterization, although age was not statistically significant. The AUA symptom survey was not found to correlate with POUR in either population. There was a predictable and exponential increase in the rate of catheterization as preoperative PVRV increased from 50 to 200 mL. The AUA symptom score showed no utility in predicting POUR in our study population. We propose that preoperative bladder ultrasonography become standard practice in TJA, especially among patients scheduled for same-day discharge. Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

(207) Ejaculatory Function After Benign Prostatic Hyperplasia (BPH) in Gay and Bisexual Men

Abstract Introduction Retrograde ejaculation (RE) is a common outcome of surgical treatments for benign prostatic hyperplasia (BPH). Previous qualitative work in the context of prostate cancer has shown that gay and bisexual men (GBM) experience greater bother from loss of ejaculatory function. Ideally, BPH treatment decision-making for GBM who prioritize ejaculatory function would take into consideration their specific needs and outcomes. However, there is no quantitative or prospective data on BPH outcomes in GBM men to inform their care. Objective Our objective was to analyze the characteristics of BPH patients in a urology clinic catered to the needs of GBM in order to fill the gaps in knowledge of BPH outcomes in GBM and improve care. Methods We performed a retrospective review of all GBM patients presenting to an LGBT specialized urology clinic between 9/1/2021 and 4/30/2023. Patients who underwent a procedure for BPH with at least one recorded AUA symptom score were included. Results 24 gay and bisexual BPH patients presenting to the clinic between 9/29/2021 and 4/25/2023 were included. Ages ranged from 32 to 82, with a mean age of 64.23 (SD = 11.43, n=24). The distribution of treatments offered was TURP (n=14), Rezum (n=4) and TUIP (n=1). Of the TURP procedures, 10 were ejaculatory sparing. Four patients received two forms of treatment. Of the 16 patients asked, 14 said ejaculatory sparing mattered to them (Mean age = 67.03, SD = 6.28) and 2 said it did not (Mean age = 77.63, SD = 10.57). The average pre-treatment AUA-Symptom Score for the patients was 20.85 (SD = 6.89, n=13) and average QoL was 4.00 (SD = 1.13, n=12). The average post-treatment AUA symptom score for patients was 8.50 (SD = 5.21, n=8), and average QoL was 1.38 (SD = 1.41, n=8). Conclusions A vast majority of the clinic’s GBM patients place importance on ejaculatory function. Younger GBM placed greater importance on ejaculatory function compared to older men. AUA symptom scores on average were on the low end of severe pre-treatment, with patients feeling mostly dissatisfied with urinary function. Post treatment AUA symptom scores varied but were centered around the low end of moderate, with patients feeling mostly pleased with urinary function. These initial findings from our clinic highlight the need for further prospective research on GBM patient values and outcomes surrounding ejaculatory function. Disclosure No.

Magnetic resonance imaging-ultrasound fusion guided focal cryoablation for men with intermediate-risk prostate cancer

IntroductionFocal therapy (FT) is a form of ablative treatment offered to men with localized, organ-confined prostate cancer (CaP). Pelvic multiparametric magnetic resonance imaging (mpMRI) and mpMRI/transrectal ultrasound fusion (MRI-US) guidance enable the precise delivery of FT with limited ablation of adjacent benign tissue or vital genitourinary structures. This article presents our findings on using MRI-US to perform FT as a primary treatment for men with intermediate-risk CaP. MethodsThirty-six men underwent MRI-US fusion-guided FT cryoablation at a single center from 2018 to 2023 as a primary treatment for intermediate-risk CaP. Following FT, quarterly prostate-specific antigen (PSA) testing and a 6 to 9 month mpMRI and combined MRI-US targeted and systematic biopsy were performed. Oncological outcomes were determined using several endpoints containing biochemical recurrence, imaging failure, and pathological failure. Functional outcomes were measured using reported erectile dysfunction/potency rates, urinary incontinence rates, and the American Urologic Association Symptom Score (AUA-SS) and Sexual Health Inventory for Men (SHIM) indices. ResultsMedian follow-up was 29.1 months, most (75%) of whom had grade group 2 CaP. Out of the 36 men, 32 (88.9%) completed the combined MRI-targeted and systematic biopsy follow-up after treatment. The study had no major complications, but 12 (33.3%) patients experienced Clavien-Dindo grade II or lower complications. For oncological outcomes, 6 (16.7%) men had biochemical recurrence, 9 (25%) showed imaging failure, and 8 (22.2%) met the criteria for positive biopsy- out-of-field vs. in-field. 88.2% of previously potent patients remained potent postoperatively at 12 months. All patients were continent at 12 months. There were no statistically significant changes in the AUA-SS and SHIM scores postoperatively. ConclusionMRI-US-guided cryoablation to target lesions in intermediate-risk CaP appears to be a safe treatment option, with functional outcomes indicating minimal short and intermediate-term morbidity and acceptable oncological outcomes. However, despite close monitoring and follow-up, there is still a limitation in accurately predicting/detecting pathological failure after FT. The long-term durability of FT for intermediate-risk, organ-confined CaP remains uncertain.

Symptomatic Benign Prostatic Hyperplasia with Suppressed Epigenetic Regulator HOXB13 Shows a Lower Incidence of Prostate Cancer Development.

Our objective was to identify variations in gene expression that could help elucidate the pathways for the development of prostate cancer (PCa) in men with Benign Prostatic Hyperplasia (BPH). We included 98 men with BPH, a positive prostate MRI (Prostate Imaging Reporting and Data System; PIRADS ≥ 4), and a negative biopsy from November 2014 to January 2018. RNA sequencing (RNA-Seq) was performed on tissue cores from the MRI lesion and a geographically distant region (two regions per patient). All patients were followed for at least three years to identify who went on to develop PCa. We compared the gene expressions of those who did not develop PCa ("BPH-only") vs. those who did ("BPH/PCa"). Then, we identified the subset of men with BPH who had the highest American Urological Association (AUA) symptom scores ("symptomatic BPH") and compared their gene expression to the BPH/PCa group. At a median follow-up of 47.5 months, 15 men had developed PCa while 83 did not. We compared gene expressions of 14 men with symptomatic BPH (AUAss ≥ 18) vs. 15 with BPH/PCa. We found two clusters of genes, suggesting the two groups had distinctive molecular features. Differential analysis revealed genes that were upregulated in BPH-only and downregulated in BPH/PCa, and vice versa. Symptomatic BPH men had upregulation of T-cell activation markers (TCR, CD3, ZAP70, IL-2 and IFN-γ and chemokine receptors, CXCL9/10) expression. In contrast, men with BPH/PCa had upregulation of NKX3-1 and HOXB13 transcription factors associated with luminal epithelial progenitors but depleted of immune cells, suggesting a cell-autonomous role in immune evasion. Symptomatic BPH with immune-enriched landscapes may support anti-tumor immunity. RNA sequencing of benign prostate biopsy tissue showing upregulation of NKX3-1 and HOXB13 with the absence of T-cells might help in identifying men at higher risk of future PCa development, which may be useful in determining ongoing PCa screening.

What Clinical Parameter Strongly Associates White Matter Tract Alterations in a Multiple Sclerosis Population With Voiding Dysfunction? A Prospective Exploratory Study

Purpose: To correlate clinical and urodynamics parameters in patients with multiple sclerosis (MS) presenting lower urinary tract symptoms (LUTS) with both Expanded Disability Status Scale (EDSS) and changes in white matter integrity as seen on diffusion tensor images (DTIs). LUTS worsen throughout MS, as does lesion burden. We investigated which symptoms correlated best with structural changes in the white matter structure. Materials and Methods: Ten adult women >18 years were recruited with stable MS for ≥ 3 months and voiding dysfunction defined as % of post-void residual/bladder volume (%PVR/BV) > 20%. Patients participated in a clinical Urodynamic Study and completed several questionnaires (ie, Hamilton Rating Scale, American Urologic Association Symptom Score, NBS-QoL). DTI images were acquired using a 7-Tesla Siemens MAGNETOM Terra MRI scanner. DTI maps were constructed, and individual patients were coregistered with the International Consortium of Brain Mapping-DTI-81 white matter atlas to extract fractional anisotropy and mean diffusivity (MD). Pearson's correlation test was performed between each white matter tracts (WMT) and clinical parameters and between clinical parameters and the EDSS score as well. P < 0.05 was considered significant. Results: Of the clinical parameters, %PVR/BV obtained from the average of multiple un-instrumented uroflow assessments had significant correlations with the greatest number of WMTs. Furthermore, we observed that in all recorded clinical parameters, %PVR/BV was the only significant parameter correlated with the EDSS score. Conclusion: This study demonstrates that %PVR/BV can be used as an objective parameter to gauge WMT changes and disease progression in patients with MS. Future studies are needed to refine this model.

The natural history of benign prostatic hyperplasia-related voiding symptoms following penile prosthesis implantation.

There is a rising prevalence of benign prostatic hyperplasia (BPH)-related urinary symptoms along with erectile dysfunction in the aging male population. Therefore, assessment of lower urinary tract symptoms (LUTS) is advised before penile prosthesis surgery with some men requiring preoperative transurethral surgical management to reduce the risk of post-procedure complications. However, less is known about the natural history of men with uncomplicated LUTS who do not require surgical management for BPH before penile prosthesis. We sought to assess the natural history of BPH-related uncomplicated LUTS in men following penile prosthesis surgery. Single institution retrospective review. Following institutional review board approval, we performed a retrospective review of all adult males with a preoperative diagnosis of LUTS undergoing penile prosthesis surgery at our institution from January 2017 to November 2022. The primary outcome was progression to transurethral surgery. From 2017 to 2022, 211 patients with preexisting LUTS underwent penile prosthesis surgery and met all criteria for inclusion including no history of transurethral surgery. The median (interquartile range, IQR) AUA symptom score (AUA-SS) was 12 (12). Post-void residual was below 200 cc in 96.2% of patients preoperatively and 99.1% of patients after surgery. At a median (IQR) follow-up duration of 9 (23) months after surgery, 5.7% (12/211) of patients had progressed to bladder outlet surgery and 35.5% of patients endorsed LUTS bother with a median (IQR) AUA-SS of 14.5 (11.8). The majority of patients with uncomplicated LUTS did not require bladder outlet surgery following penile prosthesis implantation and could be managed with conservative or pharmacologic measures alone. Prostate gland size was significantly larger in patients who progressed to bladder outlet surgery. While the results are overall reassuring, further study is needed to identify specific factors associated with pursuing bladder outlet surgery in this small subset of patients.

The Reduction of Male Lower Urinary Tract Symptoms Is Associated With a Decreased Risk of Death.

Male lower urinary tract symptoms have been correlated with an increased risk of death; however, it is unclear if treatment will reduce this risk. Our objective was to determine whether a reduction in lower urinary tract symptoms is associated with a reduced risk of mortality. We conducted a secondary analysis of the MTOPS (Medical Treatment of Prostate Symptoms) randomized trial of placebo, doxazosin, finasteride, or doxazosin and finasteride. Men in the United States between 1993 and 1998 who were >50 years of age with moderate to severe lower urinary tract symptoms were included. We used various Cox regression models to assess the relationship between AUA Symptom Score (modeled as a time-varying exposure) and death. A total of 3,046 men (median age 62, quartiles 57-68) were randomized and had a baseline AUA Symptom Score. For each 1-point improvement in the AUA Symptom Score, the hazard ratio for death was 0.96 (0.94-0.99, P = .01). Our sensitivity analyses found a similar significant reduction in the hazard ratio for death within men who had active treatment, but not among men who were randomized to the placebo arm; our results did not change when men were censored at the time of transurethral prostate resection, with adjustment for potential confounders, or with a shorter observation period after the last study visit. A comparable significant reduction in death was seen with 1-point improvements in the storage (HR 0.94, 95% CI 0.88-0.99, P = .04) and voiding (HR 0.95, 95% CI 0.91-0.99, P = .03) subscales individually. Improvement in male lower urinary tract symptoms was associated with a reduced risk of death. Further study is warranted to determine if the male treatment paradigm should shift toward symptom treatment independent of bother.

Initial Postoperative Prostate Specific Antigen and Prostate Specific Antigen Velocity Are Important Indicators of Underlying Malignancy After Simple Prostatectomy.

Background: There is a paucity of guidelines for prostate-specific antigen (PSA) monitoring after simple prostatectomy (SP) despite these patients remaining at risk for prostate cancer (PCa). Our objective was to determine if PSA kinetics can be a potential indicator of PCa after SP. Methods: A retrospective review was performed of all simple prostatectomies at our institution from 2014 to 2022. All patients who met criteria were included in the study. Relevant clinical variables were collected preoperatively, including PSA value, prostate size, and voiding symptoms. Surgical and urinary function outcomes were analyzed. Results: A total of 92 patients were divided into two groups based on malignancy status. Sixty-eight patients did not have PCa, while 24 patients had known PCa before surgery (14) or were diagnosed as having incidental PCa from the pathological specimen (10). Patients with benign prostates had an initial postoperative PSA value of 0.76 ng/mL compared with 1.68 ng/mL for those with cancer (p < 0.01). PSA velocity for the first 24 months after surgery was 0.042 ± 1.61 ng/(mL·year) for the benign cohort compared with 1.29 ± 1.02 ng/(mL·year) for the malignant cohort (p = 0.01). Voiding improvements were noted by objective (postvoid residual and flow rate) and subjective (American Urological Association symptom score and quality of life score) measures in both groups. Conclusions: PSA interpretation and monitoring after SP have not been well established. Our study indicates that initial postoperative PSA value and PSA velocity are important indicators of underlying malignancy in patients after SP. Further efforts are needed to establish threshold values and formal guidelines.

(395) Our Experience with Subcutaneous Injection of Non-Proprietary Testosterone Cypionate as a Novel Approach for Hypogonadism

Abstract Introduction Subcutaneous injection of testosterone has been investigated as a method of testosterone replacement therapy (TRT) in hypogonadal men. We have been investigating the use of a non-proprietary subcutaneous (SubQ) injection of testosterone cypionate using a ½ inch 27g needle for replacement to treat hypogonadism. This is an update on our work which includes a larger sample size and longer follow up. Objective To assess the use of non-proprietary SubQ TRT as treatment in hypogonadal men and its effect on HCT, PSA, and patient satisfaction. Methods This study is a retrospective chart review of patients receiving SubQ TRT with a mean follow up length of 9.8 months (range 0-24 months). Patient data was collected prior to initiation of therapy and at subsequent visits. Testosterone, HCT, and PSA were determined through regular blood draws and a patient satisfaction survey was performed over the phone. Univariate analysis and paired t-tests were used to analyze study variables. Results 41 total patients received SubQ TRT. Mean changes in total testosterone level (increased 281.3 + 81.1, p-value=0.0008), hematocrit (increased 1.5 + 1.0), PSA (increased 0.4 + 0.4), SHIM score (increased 3.8 + 1.4, p-value=0.0088) and AUA symptom score (decreased 0.9 + 1.6) were calculated at the patients’ initial visit and most recent follow up while still on SubQ TRT (Table 1). A total of 30 patients had been on various combinations of TRT before switching to SubQ including IM (13), CC (13) Testopel (8), HCG (2) SubQ (2), T gel (1) and Anastrozole (1). Data on the most frequent TRTs is demonstrated in Table 2. Patient satisfaction surveys were completed by 32 patients (78%), with 26 (81.2%) patients reporting overall satisfaction with SubQ TRT versus 45% (9/20) with past forms of TRT. 93.7% (15/16) reported SubQ TRT was both easier and less painful, and 73.6% (14/19) preferred SubQ injections over their previous form of TRT. Reasons for stopping SubQ TRT included unrelated stroke (1), prostate cancer (1), development of scar tissue (1) or bruising (1), ineffective therapy (1), difficulty drawing up the syringe (1), cost (1), and trouble obtaining medication from the pharmacy (1). Conclusions The use of non-proprietary testosterone cypionate SubQ as treatment for hypogonadism results in an elevation in serum total testosterone and improvement on both SHIM and AUA symptom scores at follow up. PSA and HCT rose over the span of treatment, but the rises were not statistically significant, and no patient developed erythrocytosis. Our data demonstrate SubQ TRT is easier and less painful to use and scores higher on overall patient satisfaction compared to other forms of TRT. Disclosure No

Intradetrusor OnabotulinumtoxinA Injections at the Time of Holmium Laser Enucleation of the Prostate for Men with Severe Storage Symptoms.

Introduction: Intradetrusor onabotulinumtoxinA (OTA) injection is a well-established treatment option for refractory overactive bladder; however, its use at the time of holmium laser enucleation of the prostate (HoLEP) for men with bladder outlet obstruction (BOO) and severe storage symptoms has not been previously reported. Materials and Methods: We retrospectively identified men with BOO and severe storage symptoms who underwent treatment with 200 U of intradetrusor OTA (Botox®) at the time of HoLEP. Patients were propensity score matched to a cohort of HoLEP-only patients based on age, Michigan Incontinence Symptom Index (M-ISI) score, preoperative urinary retention, urge incontinence, and prostate size. Perioperative, postoperative, and patient-reported outcomes were examined between groups. Results: We identified 82 men who underwent HoLEP, including 41 patients in the OTA group and 41 patients in the control group. There was no difference in operative times (59 minutes OTA vs 55 minutes control, p = 0.2), rates of same-day trial of void (TOV) (92% OTA vs 94% control, p = 0.7), or rates of same-day discharge (88% OTA vs 85% control, p = 0.6) between groups. There was no difference in temporary postoperative urinary retention (7% OTA vs 2% control, p = 0.3) between groups. Patients who received OTA injections had a significant reduction in their incontinence scores at 3-month follow-up (M-ISI -8, interquartile range [IQR]: -13 to 0, p < 0.001), whereas control patients did not (M-ISI -5, IQR: -8 to -1, p = 0.2). There was no difference in rates of 90-day complications between groups (OTA 10% vs control 5%, p = 0.7). Conclusions: Intradetrusor OTA at the time of HoLEP is safe and is associated with improved urinary incontinence scores and AUA Symptom Score. Rates of same-day discharge and same-day TOV after HoLEP were not affected by OTA. These findings support the role of OTA as an adjunct to surgical intervention in men with incontinence in the presence of BOO.

Outcomes of Robotic Simple Prostatectomy After Prior Failed Endoscopic Treatment of Benign Prostatic Hyperplasia.

Background: We compared outcomes of robot-assisted simple prostatectomy (RASP) in patients with and without a history of prior prostate surgery for management of symptomatic benign prostatic hyperplasia (BPH). Methods: We retrospectively reviewed our multi-institutional database for all consecutive patients who underwent RASP between May 2013 and January 2021. Postoperatively, urinary function was assessed using the American Urological Association symptom score (AUASS) and quality of life (QOL) score. Results: Overall, 520 patients met inclusion criteria. Among the 87 (16.7%) patients who underwent prior prostate surgery, 49 (56.3%), 26 (29.9%), 8 (9.2%), 3 (3.4%), and 1 (1.1%) patients underwent transurethral resection of the prostate, photoselective vaporization of the prostate, transurethral microwave therapy, prostatic urethral lift, or water vapor thermal therapy, respectively. There was no difference in mean prostate volume (p = 0.40), estimated blood loss (p = 0.32), robotic console time (p = 0.86), or major 30-day postoperative (Clavien >2) complications (p = 0.80) between both groups. With regard to urinary function, the mean improvement in preoperative and postoperative AUASS (p = 0.31), QOL scores (p = 0.11), and continence rates was similar between both groups. Conclusion: For management of patients with BPH and lower urinary tract symptoms, RASP is associated with an improvement in urinary function outcomes and a low risk of postoperative complications. Perioperative outcomes of RASP are similar in patients who underwent prior prostate surgery vs those that did not undergo prior prostate surgery.

The Role of Oxybutynin Chloride in the Management of Patientswith Benign Prostatic Hyperplasia

Objectives: To determine the efficacy and tolerability of Oxybutynin chloride in men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in which previous a-blocker therapy had failed. :&#x0D; Materials and Methods: A total of 38 consecutive men with BPH complaining of LUTS in whom a mean of 6.3 months of a-blocker therapy had failed received Oxybutynin (5 mg twice daily orally) for 3 months in addition to the usual a-blocker medication. Primary efficacy end points were American Urological Association symptom score, and mean daytime and nighttime micturition frequency. Secondary end points were the peak urinary flow rate, post-void residual volume, the incidence of urinary retention, and adverse events. Statistical analysis was used when needed.&#x0D; Results: A total of 33 men (87%) with a mean age of 59 years completed the 3-month trial. Mean 24- hour micturition frequency decreased from 11.2 to 6.5 voids and nocturia decreased from 5.1 to 2.4 episodes nightly. Significant changes in mean American Urological Association symptom scores (- 5.31), the peak urinary flow rate (1.8 ml per second) and post-void residual volume (=21 ml) were also observed. Five men (13%) discontinued therapy because of intolerable dry mouth. There were no reports of urinary retention.&#x0D; Conclusions: Treatment with Oxybutynin in carefully selected men with BPH and moderate LUTS may be a reasonable therapeutic option after failed treatment with a-blockers.

PD02-05 SRD5A2 EXPRESSION IS A PREDICTOR OF RESPONSE TO FINASTERIDE IN THE MTOPS TRIAL

You have accessJournal of UrologyCME1 Apr 2023PD02-05 SRD5A2 EXPRESSION IS A PREDICTOR OF RESPONSE TO FINASTERIDE IN THE MTOPS TRIAL Ra'ad Al-Faouri, Christina Sharkey, Zongwei Wang, and Aria F. Olumi Ra'ad Al-FaouriRa'ad Al-Faouri More articles by this author , Christina SharkeyChristina Sharkey More articles by this author , Zongwei WangZongwei Wang More articles by this author , and Aria F. OlumiAria F. Olumi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003219.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Medical Therapy Of Prostatic Symptoms (MTOPS) study was a multi-center, randomized, controlled clinical trial conducted between 1995 and 2001 aiming to evaluate the effect of finasteride, doxazosin, or a combination of both drugs on the progression of urinary symptoms in men with benign prostatic hyperplasia (BPH). We have demonstrated that 30% of adult prostates do not express SRD5A2 through epigenetic regulation, enabling us to postulate that expression of SRD5A2 may be related to response to finasteride. Prostate biopsies and clinical data from 82 MTOPS trial participants were obtained to test the correlation between baseline expression of SRD5A2 and the response to medical treatment with finasteride. METHODS: We classified men based on changing their AUA symptom score (AUA SS) into good responders (change of AUASS ≤-12) and poor responders (change of AUASS ≥-2). Using immunoreactive score system (IRS score), we quantified the expression of SRD5A2 in the biopsies. We compared baseline age, demographics, AUA SS, BMI, serum dihydrotestosterone (DHT) between men in the two groups. RESULTS: There was no significant difference in TPV between the two groups. Men in the 5ARI good response group were found to have higher expression of SRD5A2 compared to men in the 5ARI poor response group (p-value <0.007). In addition, there was a statistically significant correlation between the expression of SRD5A2 and the 5-year change in AUASS (Pearson's correlation coefficient: -0.4279, p-value: 0.02). In a multiple linear regression model that adjusted for baseline AUA SS, baseline total prostate volume, baseline serum DHT level, age, and BMI, men with higher expression of SRD5A2 still had better response to finasteride with better improvement of urinary symptoms as reflected by AUA symptoms scores. CONCLUSIONS: The MTOPS study was a significant milestone in the curation BPH medical management. Since expression of SRD5A2 is epigenetically regulated during adulthood, our analysis of the biopsies and clinical data provided from the trial shines a light on the importance of SRD5A2 activity and response to 5-ARI therapy. The level of response to 5-ARI therapy correlated to higher SRD5A2 expression. This may contribute to precision medicine by predicting men that are most likely to benefit from tailored therapy by 5-ARI. Source of Funding: NIH: R01DK124502; X01DK131477 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e70 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ra'ad Al-Faouri More articles by this author Christina Sharkey More articles by this author Zongwei Wang More articles by this author Aria F. Olumi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP60-15 FAVORABLE PERIOPERATIVE AND FUNCTIONAL OUTCOMES AFTER ROBOTIC-ASSISTED BLADDER DIVERTICULECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP60-15 FAVORABLE PERIOPERATIVE AND FUNCTIONAL OUTCOMES AFTER ROBOTIC-ASSISTED BLADDER DIVERTICULECTOMY Rohit Reddy, Brandon Merkert, Naveen Krishnan, and Daniel Eun Rohit ReddyRohit Reddy More articles by this author , Brandon MerkertBrandon Merkert More articles by this author , Naveen KrishnanNaveen Krishnan More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted bladder diverticulectomy (RABD) has recently emerged as a management option for patients with problematic bladder diverticula due to recurrent urinary tract infections (rUTI) or incomplete emptying. Previous literature has shown favorable outcomes for RABD when combined with other procedures such as robotic-assisted simple or radical prostatectomy (RASP/RARP), but none have assessed RABD as a stand-alone procedure. The purpose of this study is to present the largest case series of stand-alone RABD and report perioperative and functional outcomes. METHODS: A retrospective analysis of all RABDs at a single institution from 2012-2021 was performed, and the subset of stand-alone RABDs was isolated. The primary outcome of interest was the change in AUA Symptom Score (AUA-SS) and post-void residual (PVR) after stand-alone RABD. RESULTS: A total of 70 patients underwent RABD, 16 of which were stand-alone RABD (23%) (Table 1). Indications for RABD included rUTI (5/16, 31%), incomplete emptying (13/16, 81%), and diverticular tumors (2/16, 13%). The median age was 70.5 and BMI was 29.7. Median operative time was 139 minutes, and none had Clavien 3 or greater complications within 90 days. Eleven patients (69%) had a staged outlet procedure, either before or after RABD. At median 1 year follow up, there were significant improvements in AUA-SS (21.5-6, p<0.001), PVR (452-20, p=0.01), number of patients that were catheter dependent (13-2, p<0.001), and number with UTIs (5-0, p=0.04) (Table 2). CONCLUSIONS: RABD is safe and effective as a stand-alone procedure, with long-term improvement in incomplete emptying and reduction of UTIs. Source of Funding: Temple University Hospital © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e849 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohit Reddy More articles by this author Brandon Merkert More articles by this author Naveen Krishnan More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

MP61-10 URINARY FUNCTIONAL OUTCOMES OF RADICAL PROSTATECTOMY VS. RADIATION THERAPY FOR PROSTATE CANCER FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)

You have accessJournal of UrologyCME1 Apr 2023MP61-10 URINARY FUNCTIONAL OUTCOMES OF RADICAL PROSTATECTOMY VS. RADIATION THERAPY FOR PROSTATE CANCER FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Alex Piroozi, Austen Slade, RJ Caras, T. Max Shelton, Udit Vyas, Katrina Collins, Omar Ishaq, Mohamed Elsaqa, Corey Able, Ronald Boris, Marawan M. El tayeb, Marcelino Rivera, and James Lingeman Alex PirooziAlex Piroozi More articles by this author , Austen SladeAusten Slade More articles by this author , RJ CarasRJ Caras More articles by this author , T. Max SheltonT. Max Shelton More articles by this author , Udit VyasUdit Vyas More articles by this author , Katrina CollinsKatrina Collins More articles by this author , Omar IshaqOmar Ishaq More articles by this author , Mohamed ElsaqaMohamed Elsaqa More articles by this author , Corey AbleCorey Able More articles by this author , Ronald BorisRonald Boris More articles by this author , Marawan M. El tayebMarawan M. El tayeb More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , and James LingemanJames Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is a well-documented finding in Holmium Laser Enucleation of the Prostate (HoLEP); however, there is little data on the outcomes of patients who underwent HoLEP followed by definitive therapy for subsequent prostate cancer diagnosis. We sought to compare the urinary functional outcomes after undergoing radical prostatectomy or external beam radiation for prostate cancer following HoLEP. METHODS: All patients from 2010 to 2021 at Indiana University and Baylor Scott and White Hospitals who underwent radiation or prostatectomy for treatment of prostate cancer after HoLEP were included. We performed a retrospective analysis of their urinary function with greater than 1-year post-treatment American Urological Association Symptom Index (AUA), Quality of Life (QOL), and incontinence follow up. Incontinence was defined as patient reported leakage of any urine. RESULTS: There were 33 radical prostatectomy and 36 radiation patients who met the inclusion criteria. There was no statistical significance between the mean AUA scores of greater than 1-year post-prostatectomy patients (7.69) and post-radiation patients (8.08) (p=0.8175). Similarly, there was no statistical significance between the QOL scores of greater than 1-year post-prostatectomy patients (1.96) and post-radiation patients (2.00) (p=0.9175). There is a statistically significant decrease in complaints of incontinence in greater than 1-year post-radiation patients (28%) compared to post-prostatectomy patients (73.3%) (p=0.0017). There was also a significant difference between mean age of the prostatectomy group (66.4 years) and the radiation group (75.3 years) (p<0.001). There was no significant difference in BMI, pre-HoLEP prostate size, pre-HoLEP AUA score, or pre-HoLEP QOL score between the groups. CONCLUSIONS: Radical prostatectomy and radiation provide similar AUA and QOL symptom scores for prostate cancer patients who previously underwent HoLEP, with radiation associated with decreased incidence of incontinence. Patients specifically concerned with the risk of incontinence following prostate cancer treatment may consider the increased risk from a prostatectomy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e856 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Piroozi More articles by this author Austen Slade More articles by this author RJ Caras More articles by this author T. Max Shelton More articles by this author Udit Vyas More articles by this author Katrina Collins More articles by this author Omar Ishaq More articles by this author Mohamed Elsaqa More articles by this author Corey Able More articles by this author Ronald Boris More articles by this author Marawan M. El tayeb More articles by this author Marcelino Rivera More articles by this author James Lingeman More articles by this author Expand All Advertisement PDF downloadLoading ...

V08-07 FREE GRAFT + PEDICLED TUBE IN BULBAR NECROSIS: HOW TO MAKE IT WORK

You have accessJournal of UrologyCME1 Apr 2023V08-07 FREE GRAFT + PEDICLED TUBE IN BULBAR NECROSIS: HOW TO MAKE IT WORK Pankaj Joshi, Cora Fogging, Daniel Gomez, Apurva Anand, Rateesh Rajendran, Shreyas Bhadranavar, and Sanjay Kulkarni Pankaj JoshiPankaj Joshi More articles by this author , Cora FoggingCora Fogging More articles by this author , Daniel GomezDaniel Gomez More articles by this author , Apurva AnandApurva Anand More articles by this author , Rateesh RajendranRateesh Rajendran More articles by this author , Shreyas BhadranavarShreyas Bhadranavar More articles by this author , and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Redo Urethroplasty after pelvic fracture urethra injury are challenging cases. Bulbar necrosis happens due to poor flow in the circumflex and dorsal penile arteries. These leads to long gaps. We have extensive experience of bulbar urethral necrosis .Our algorithm uses pedicled preputial tube as the best option for such condition. We present rare situations where there are desperate attempts to solve the remaining gaps .and it works, How? METHODS: Our tertiary referral centre caters to over 500 Urethroplasties a year. These include more than 120 PFUI. We collected prospective data from 2010.These is a worksheet with over 50 parameters .Patients with bulbar necrosis with pedicled tube and yet remaining gap were included. We excise the outer skin as onlay one side(inner or outer) can be used as a flap. If there is still a gap remaining between the 2 urethral ends, we have used the excised preputial skin as free tube. We wrapped the dartos of the pedicled tube around the free tube. And it works. Catheter was kept for 6 weeks.Pericatheter urethrogram was performed before catheter removal. Patients were followed long term with uroflow, PVR,USG for upper tracts and AUA symptom score RESULTS: We had 9 patients out of 1564 who had such situations as shown in the video. In all 9 patients the urethra remained patent .Patients had good voiding per urethra. All patients had ED and 3. underwent penile prosthesis. All patients had post micturition dribble and diverticulum formation in long term. CONCLUSIONS: It is not recommended to perform free graft tube. However there are desperate situations. In these cases the blood supply came from the wrapped dartos tissue around the free graft tube. Other options would have been to leave a penoscrotal urethrostomy at the distal end of tube and perform a second staged penile urethroplasty later.Desperation urethroplasty works. Complex situations need simple answers. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e750 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj Joshi More articles by this author Cora Fogging More articles by this author Daniel Gomez More articles by this author Apurva Anand More articles by this author Rateesh Rajendran More articles by this author Shreyas Bhadranavar More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...

Effectiveness of osteopathic treatment in patients with Lower Urinary Tract Symptoms (LUTS)

Introduction and Aim: International continence society mentions that more than 50 % of females suffer from lower urinary tract symptoms (LUTS) and more than 90% of them were not on any medication. LUTS is a term that covers symptoms resulting from conditions affecting the urinary bladder and urethra, prostate, other pelvic organs or any other part of the body which is related to the bladder and urethra anatomically. LUTS can be classified into 3 subcategories, i.e., storage symptoms (symptoms during storage of urine), voiding symptoms (symptoms during micturition), and post micturition symptoms (symptoms after completing micturition). Patients with LUTS may present with a combination of storage, voiding, and post micturition symptoms. The aim of this study is to assess the effectiveness of osteopathy treatment in patients with lower urinary tract symptoms.&#x0D; &#x0D; Materials and Methods: This is a pre-test post-test single group experimental study conducted at Sri Sri University. In this study, 20 females having the mean age of 21.9± 2.61 years with moderate and severe symptoms voluntarily participated. The pre-test scores were measured in 3 different questionnaires (AUA symptom score index, ICIQ – FLUTS and HPMDQ). The subjects were diagnosed and given 4 osteopathy sessions. The post-test scoring was noted and data was analysed using MS Excel. &#x0D; &#x0D; Results: Compared to the baseline scoring, the post intervention scores on all the questionnaires reduced significantly. Subjects having moderate and severe symptoms were selected for the study. After intervention either the symptoms were absent or mild residual symptoms were seen.&#x0D; &#x0D; Conclusion: The results shows that osteopathy treatment is effective in patients having lower urinary tract symptoms.

Ejaculatory Preserving Holmium Laser Enucleation of the Median Lobe: Preserving Sexual Function While Improving Urinary Outcomes

To evaluate perioperative outcomes related to sexual and urinary function in patients who underwent a holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe. We retrospectively reviewed the first 450 HoLEP cases by a single surgeon from April 2019 to March 2022. Fifty-five patients with intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes underwent selective enucleation of the median lobe of the prostate. Patients were asked to comment on whether they had retrograde ejaculation during their follow-up appointment. Urinary function was assessed using the American Urological Association Symptom Score and subjective evaluation of urinary incontinence. Median age of the cohort was 65 years (range: 44-91). Compared to preoperative, there was significant improvement in mean postoperative American Urological Association Symptom Score (22.5 vs 6.9, P < .001), mean postoperative quality of life scores (4 vs 1.2, P < .001), and mean postoperative post void residual volumes (244.1 vs 69.3 cc, P < .001). No patients reported stress urinary incontinence. Of the 55 patients who underwent selective enucleation of the median lobe, 40 were sexually active. Of those men, 35 reported normal ejaculation, 3 had retrograde ejaculation that was unchanged from pre-op, and 2 had new ejaculatory dysfunction. In this case series of selective laser enucleation of the median lobe, urinary function significantly improved in short-term follow-up with preservation of ejaculation in approximately 90% of men.

Post-operative Urinary Dysfunction Following Shoulder Surgery: Rates and Risk Factors.

Post-operative urinary retention (POUR) and dysfunction are recognized complications following orthopaedic surgery. Recent literature has focused on urinary retention and its associated complications following hip and knee reconstruction and lower extremity surgery. There is a paucity of literature focusing on POUR and shoulder surgery. The purpose of this study is to describe the rates of urinary dysfunction in patients undergoing shoulder surgery as well as the associated risk factors. This was a single institution, prospective cohort study. Eligibility criteria included patients older than 50 years of age undergoing open or arthroscopic shoulder surgery. The primary outcome was the American Urological Association (AUA) symptom score (7 questions total scored 0-5, total 35 points max) administered before and after surgery. Higher scores reflect worse urinary dysfunction. Intra-operative data such as type of surgery, type of anesthesia, use of anticholinergics, peripheral nerve block, length of case, and amount of intravenous fluids were collected. Of 194 patients, the mean age was 61.4 years (Standard Deviation (S.D.) = 13.0)) and the average BMI was 29.2 (S.D. = 5.6). The sample was 35.6% female. Overall, 46.4% reported worse AUA scores post-operatively within the first 3 to 5 days, including 4.1% of which were clinically defined as "moderately worse" (>5 point worse) or "much worse" (>11 points worse). Worse preoperative AUA scores correlated with worse postop AUA score on linear regression analysis (r=0.883, P<0.0001). Males with a history of BPH showed a statistically significant positive association with worsening urinary dysfunction postoperatively (P=0.039). Four patients (2.1%) required postoperative catheterization. A significantly higher percentage of patients with preoperative AUA scores of ≥11 experienced worsening of urinary function post-operatively (P=0.04). Worsening of urinary function following shoulder surgery is common. The AUA score may be used to identify at-risk patients and to track changes in urinary function post-operatively. Men with a diagnosis of BPH are at particularly high risk. Further investigation is needed to elucidate the impact of urinary dysfunction on patient outcomes, satisfaction, and cost as well as the role of prophylactic medications.