Surgery For Benign Prostatic Hyperplasia Research Articles

PD45-07 PROSPECTIVE COMPARISON OF FUNCTIONAL OUTCOMES AFTER ENDOSCOPIC SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: THE ROLE OF EJACULATION-SPARING ANATOMIC PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (ESA-PVP)

You have accessJournal of UrologyCME1 May 2022PD45-07 PROSPECTIVE COMPARISON OF FUNCTIONAL OUTCOMES AFTER ENDOSCOPIC SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: THE ROLE OF EJACULATION-SPARING ANATOMIC PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (ESA-PVP) Mattia Sibona, Paolo Destefanis, Federico Vitiello, Eugenia Vercelli, Gabriele Montefusco, Alessandro Mara, Andrea Bosio, Alessandro Bisconti, and Paolo Gontero Mattia SibonaMattia Sibona More articles by this author , Paolo DestefanisPaolo Destefanis More articles by this author , Federico VitielloFederico Vitiello More articles by this author , Eugenia VercelliEugenia Vercelli More articles by this author , Gabriele MontefuscoGabriele Montefusco More articles by this author , Alessandro MaraAlessandro Mara More articles by this author , Andrea BosioAndrea Bosio More articles by this author , Alessandro BiscontiAlessandro Bisconti More articles by this author , and Paolo GonteroPaolo Gontero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ejaculatory Dysfunction (EjD) is still a common event after Benign Prostatic Hyperplasia (BPH) surgery, causing significant bother to younger and sexually active patients (pts). Recently, several ejaculation-sparing techniques were described. Ejaculation-sparing anatomic Photoselective Vaporization of the Prostate (ESa-PVP) with LBO laser has been proposed as a sexual function-sparing evolution of the anatomic PVP technique, showing promising preliminary results. The aim of our study was to present a prospective comparison of functional outcomes from a cohort of ESa-PVP pts versus standard PVP and Transurethral Resection of the Prostate (TUR-P). METHODS: Local Ethics Committee approval was obtained (n. 643/2018). Our study was conceived as a prospective, observational analysis. From 03/2018 to 06/2020, we enrolled pts undergoing endoscopic surgery for BPH at our institution (Molinette Hospital, Turin). Inclusion criteria: age > 50, sexually active, moderate to severe Lower Urinary Tract Symptoms (LUTS) [IPSS > 8]. Urinary and sexual function data were collected at baseline and at 6 and 12 month after surgery. Validated questionnaires were used to assess functional results (IPSS, IIEF5, MSHQ-Ej). Included pts were divided into groups, according to the type of intervention: bipolar TUR-P (group A); standard PVP (group B); ESa-PVP (group C). RESULTS: Globally, 95 pts were included (46 in group A, 26 in group B, 23 in group C). Median (IQR) age was 66 (60-71) years. Median prostate volume was 63 (50-90) cc. Median baseline IPSS score within groups was 25 vs 24.5 vs 28 (p=0.442); median IIEF-5 score was 21 vs 23.5 vs 20 (p=0.339); median MSHQ-Ej score was 30 vs 33.5 vs 34 (p=0.137). Baseline antegrade ejaculation rate was 84.78% vs 80.77% vs 91.30% (p=0.579). At 6-month follow-up, urinary and sexual function scores changed as follows: median IPSS: 6 vs 5 vs 1 (p=0.019); median IIEF5: 21 vs 21.5 vs 19 (p=0.750); median MSHQ-Ej: 4 vs 2 vs 15 (p=0.001). 6-month antegrade ejaculation rate was 28.89% vs 23.08% vs 60.87% (p=0.010). 12 months after surgery, no significant differences in IPSS and IIEF5 scores were detected within groups. Instead, median MSHQ-Ej score was 2 vs 2 vs 25 (p=0.006) and antegrade ejaculation rate was 26.09% vs 13.04% vs 58.82% (p=0.007). At a multivariable logistic regression analysis, pre-operative MSHQ-Ej score was identified as an independent predictor of antegrade ejaculation preservation both at 6 and 12 months, while surgical technique appeared as a significant predictor of the same outcome at 6 months. CONCLUSIONS: The Ejaculation-Sparing anatomic PVP technique (ESa-PVP) showed superiority over standard PVP and TUR-P in preserving antegrade ejaculation both at 6 and 12 month follow-up after BPH surgery. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e785 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mattia Sibona More articles by this author Paolo Destefanis More articles by this author Federico Vitiello More articles by this author Eugenia Vercelli More articles by this author Gabriele Montefusco More articles by this author Alessandro Mara More articles by this author Andrea Bosio More articles by this author Alessandro Bisconti More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY

You have accessJournal of UrologyCME1 May 2022MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY Kirby R. Qin, William Wang, Damien Bolton, and Gregory Jack Kirby R. QinKirby R. Qin More articles by this author , William WangWilliam Wang More articles by this author , Damien BoltonDamien Bolton More articles by this author , and Gregory JackGregory Jack More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) surgery is typically performed under general (GA) or spinal anaesthesia (SA). SA is considered the anaesthetic of choice for as it facilitates early identification of transurethral resection of prostate (TURP) syndrome. However, SA may be associated with longer time spent in the recovery room. Previous studies have compared GA and SA in regards to post-operative pain, but not post-operative recovery. We compare post-operative recovery metrics after GA and SA for BPH surgery. METHODS: This was a retrospective review of 500 consecutive patients from March 2019 to July 2021 who underwent surgical management of BPH at Austin Health in Melbourne, Australia. Our institution performs greenlight laser photoselective vaporisation of prostate (PVP), monopolar and bipolar TURP. All continuous variables were normally distributed, presented as mean±SD, and compared using the Student’s T-test and mean difference (MD) [95% CI]. Categorical variables were compared with the Chi-square test. Comparison of recovery time was achieved using multivariate linear regression. RESULTS: In total, 186 (37.2%) underwent SA for monopolar TURP (n=144, 77.4%), bipolar TURP (n=9, 4.8%) and PVP (n=33, 17.7%). In contrast, 314 (62.8%) underwent GA for monopolar TURP (n=213, 67.8%), bipolar TURP (n=6, 1.9%) and PVP (n=95, 30.3%). SA patients were older than GA patients (73.1±8.9 vs 71.2±8.9 years, MD 1.9 [0.3-3.5], p=0.02), but similar in terms of ASA (p=0.17) and prostate volume (67.3±35.0 cc vs 67.7±38.3 cc, p=0.91). As expected, anaesthetic time was longer for SAs (31.5±11.7 vs 26.6±25.3 minutes, MD 4.9 [2.8-7.0], p<0.001), but total operating room time was similar (76.7±26.6 vs 75.7±29.3 minutes, p=0.72). TURP syndrome amongst SAs and GAs were identical (1.6% vs 1.6%, p=0.99). Recovery room time (82.8±57.2 vs 74.7±42.7 minutes, p=0.07) and length-of-stay (2.5±2.0 vs 2.3±3.3 days, p=0.42) were similar after SA and GA. In multivariate analysis, higher ASA score (p<0.001), PVP surgery (p=0.03), longer resection time (p=0.04) and TURP syndrome (p=0.008) were associated with greater time spent in the recovery room, but choice of anaesthetic was non-significant (p=0.37). CONCLUSIONS: Although our study does not prove if SA can facilitate early identification of TURP syndrome, we have shown that the method of anaesthesia does not significantly impact time spent in the operating room and recovery room or inpatient length-of-stay. This may further support the ongoing use of SA for BPH surgery. Source of Funding: Nil © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e476 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kirby R. Qin More articles by this author William Wang More articles by this author Damien Bolton More articles by this author Gregory Jack More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP29-01 COMPARISON OF POSTOPERATIVE OUTCOMES OF TRANSURETHRAL RESECTION OF THE PROSTATE, LASER VAPORIZATION OR LASER ENUCLEATION FOR BENIGN PROSTATIC HYPERPLASIA TREATMENT USING THE AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (ACS-NSQIP) DATASET

You have accessJournal of UrologyCME1 May 2022MP29-01 COMPARISON OF POSTOPERATIVE OUTCOMES OF TRANSURETHRAL RESECTION OF THE PROSTATE, LASER VAPORIZATION OR LASER ENUCLEATION FOR BENIGN PROSTATIC HYPERPLASIA TREATMENT USING THE AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (ACS-NSQIP) DATASET Christian Ayoub, Rachelle Haber, Reem Amine, Diana Mikati, and Albert El Hajj Christian AyoubChristian Ayoub More articles by this author , Rachelle HaberRachelle Haber More articles by this author , Reem AmineReem Amine More articles by this author , Diana MikatiDiana Mikati More articles by this author , and Albert El HajjAlbert El Hajj More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Novel laser techniques for treating benign prostatic hyperplasia (BPH) are challenging gold standard techniques such as transurethral resection of the prostate (TURP). Comparing the outcomes of different techniques might serve in determining safety and efficacy compared to the current gold standard. The aim of this study is to compare the postoperative outcomes of three types of endourologic surgeries (TURP, laser vaporization (PVP) and laser enucleation (LEP)) for BPH treatment using the ACS-NSQIP database. METHODS: The ACS-NSQIP database was queried for men >50 years of age who underwent TURP, PVP and LEP for treatment of BPH from 2005 till 2017. Demographics, clinical, operative characteristics, and 30-day outcomes were compared. Univariate and multivariate regression models were performed for return to the operating room, morbidity, and length of hospital stay. RESULTS: 56,436 patients underwent endourologic surgeries for BPH, 64.0% had TURP, 31.1% PVP, and 4.9% LEP. Patients undergoing TURP were more likely to be smokers (11.2%, p-value<0.001), have diabetes (21.8%, p-value<0.001), with history of COPD (6.8%, p-value<0.001), disseminated cancer (1.5%, p-value<0.001), weight loss (0.6%, p-value 0.039), congestive heart failure (1%, p-value 0.02), and presenting as emergency cases (2.3%, p-value<0.001). Lower rates were seen in laser vaporization followed by laser enucleation with morcellation. After adjusting for covariates, PVP and LEP showed less return to the operating room with a 48.1% and 21.7% decrease in the odds as compared to TURP, respectively. PVP showed a significant 13.2% increase in the odds of experiencing morbidity as opposed to a decrease of 37.5% in LEP as compared to TURP. PVP and LEP showed a decrease in hospital stay by 0.988 and 0.305 days as compared to TURP, respectively. CONCLUSIONS: This study shows superiority of laser techniques in 30-day postoperative outcomes as compared to TURP. Further research is needed to account for longer duration of follow-up and patient-specific urologic outcomes, such as prostate size, urinary incontinence, erectile dysfunction, and retrograde ejaculation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e469 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Ayoub More articles by this author Rachelle Haber More articles by this author Reem Amine More articles by this author Diana Mikati More articles by this author Albert El Hajj More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP01-07 FACTORS ASSOCIATED WITH USE OF PROSTATIC URETHRAL LIFT (PUL)

You have accessJournal of UrologyCME1 May 2022MP01-07 FACTORS ASSOCIATED WITH USE OF PROSTATIC URETHRAL LIFT (PUL) Samantha L. Thorogood, Tenny R. Zhang, Christina Sze, Gina DeMeo, Mary O. Strasser, Richard K. Lee, Bilal Chughtai, Alexis Te, and Jim C. Hu Samantha L. ThorogoodSamantha L. Thorogood More articles by this author , Tenny R. ZhangTenny R. Zhang More articles by this author , Christina SzeChristina Sze More articles by this author , Gina DeMeoGina DeMeo More articles by this author , Mary O. StrasserMary O. Strasser More articles by this author , Richard K. LeeRichard K. Lee More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Alexis TeAlexis Te More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PUL vs. other benign prostatic hyperplasia (BPH) surgical approaches improves preservation of antegrade ejaculation and shortens both operative time and postoperative catheterization. We investigated trends associated with its use. METHODS: We obtained de-identified, self-reported American Board of Urology (ABU) case logs from 2015-2021. We identified 4,131 urologists who performed 48,610 surgeries with an indication for BPH per ICD coding. CPT codes distinguished BPH surgical approaches. We identified 786 urologists who performed 7,895 PUL: 24 urologists only performed PUL, and 3,345 urologists did not perform any PUL. A logistic regression model assessed factors independently associated with PUL use. RESULTS: Annual PUL surgeon volume ranged from 101 to 2,852 cases; PUL comprised 1.6% of BPH surgeries in 2015 and increased to 32.5% in 2020. In adjusted analyses (Table 1), factors associated with higher odds of performing PUL included subspecialization in andrology (odds ratio [OR] 4.01, 95% CI 1.94-8.29); practice area population >1,000,000 (OR 1.55, 95% CI 1.01-2.38); and government (OR 4.22, 95% CI 1.83-9.74), private practice group (OR 2.68, 95% CI 1.53-4.68), and salaried hospital employment (OR 1.94, 95% CI 1.00-3.96). The operative year (OR 1.66 per year, 95% CI 1.54-1.80) and surgeon BPH surgical volume (OR 1.02 per case increase, 95% CI 1.01-1.02) were associated with increased odds of performing PUL. Endourology subspecialization was associated with lower odds of PUL (OR 0.40, 95% CI 0.2-0.8). Geographic region, surgeon age, surgeon gender, certification vs recertification status, and patient age were not associated with PUL use. CONCLUSIONS: PUL utilization varies based on subspecialization, practice area, practice type, and BPH surgeon volume. Use of PUL has increased significantly and currently comprises one third of all BPH surgeries. More study is needed to determine durability of PUL outcomes particularly given its current widespread use and increasing adoption. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e3 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha L. Thorogood More articles by this author Tenny R. Zhang More articles by this author Christina Sze More articles by this author Gina DeMeo More articles by this author Mary O. Strasser More articles by this author Richard K. Lee More articles by this author Bilal Chughtai More articles by this author Alexis Te More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP29-02 SALVAGE VERSUS PRIMARY HOLMIUM LASER ENUCLEATION FOR BPH: AN OUTCOMES AND SAFETY ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP29-02 SALVAGE VERSUS PRIMARY HOLMIUM LASER ENUCLEATION FOR BPH: AN OUTCOMES AND SAFETY ANALYSIS Adri Durant, Sandeep Voleti, Sarah Wu, Jonathan Moore, Gopal Narang, Scott Cheney, and Mitchell Humphreys Adri DurantAdri Durant More articles by this author , Sandeep VoletiSandeep Voleti More articles by this author , Sarah WuSarah Wu More articles by this author , Jonathan MooreJonathan Moore More articles by this author , Gopal NarangGopal Narang More articles by this author , Scott CheneyScott Cheney More articles by this author , and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Repeat surgical treatment for benign prostatic hyperplasia (BPH) is not uncommon. Minimally invasive surgical therapies (MIST) and transurethral resection of the prostate (TURP) have known retreatment rates ranging from 5% to 13% at 5 years. Holmium laser enucleation of the prostate (HoLEP) is an effective primary treatment for BPH but also as can be utilized as a salvage modality. This study assesses the safety and efficacy of salvage HoLEP (s-HoLEP) after prior BPH surgery. METHODS: A retrospective review of HoLEP at a single institution between 2006 and 2020 was performed. Patients who had a s-HoLEP were evaluated and compared to those undergoing a primary HoLEP (p-HoLEP). Out of a total of 1960 HoLEPs, 217 were s-HoLEP and these were matched 2:1 to 416 p-HoLEPs to compare preoperative, operative and post-operative characteristics. The primary endpoint was Clavien complications within 90 days of surgery. Secondary endpoints included quantitative measurements of lower urinary tract symptoms (LUTS), International Prostate Symptoms Score (IPSS), maximum urinary flow (Qmax) and postvoid residual volumes (PVR). Kruskal-Wallis rank sum test was used for analysis of continuous variables and Fischer’s exact test was used for categorical variables. RESULTS: The s-HoLEP cohort was older, median age of 71.2 years, compared to p-HoLEP at 68.8 years (p = 0.03). All other factors were well matched. Pre-operative prostate volume, IPSS and Qmax were not different (p = 0.783, 0.278, and 0.759, respectively). However, rates of pre-op urinary retention and PVRs were higher in the p-HOLEP group (p = <0.001 and 0.045, respectively). Intra-operatively, the s-HOLEP cohort had longer procedure and morcellation times (p = 0.011 and 0.007). Post-operatively, the s-HOLEP required longer catheter duration and hospitalization (both p < 0.001). There was no difference in Qmax, IPSS or 90-day complication rates (p = 0.108, 0.247, and 0.506, respectively). CONCLUSIONS: S-HoLEP is a safe treatment option for patients requiring repeat BPH surgical therapy. S-HoLEP patients had longer operative times and hospital stay but equivalent long-term efficacy compared to p-HoLEP. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e469 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adri Durant More articles by this author Sandeep Voleti More articles by this author Sarah Wu More articles by this author Jonathan Moore More articles by this author Gopal Narang More articles by this author Scott Cheney More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP04-09 TRENDS IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 May 2022MP04-09 TRENDS IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA Tenny R. Zhang, Mary O. Strasser, Samantha L. Thorogood, Christina Sze, Bilal Chughtai, Alexis Te, Richard K. Lee, and Jim C. Hu Tenny R. ZhangTenny R. Zhang More articles by this author , Mary O. StrasserMary O. Strasser More articles by this author , Samantha L. ThorogoodSamantha L. Thorogood More articles by this author , Christina SzeChristina Sze More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Alexis TeAlexis Te More articles by this author , Richard K. LeeRichard K. Lee More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Compared to traditional treatment options for benign prostatic hyperplasia (BPH), holmium laser enucleation of the prostate (HoLEP) has demonstrated improved outcomes in hemostasis, urinary symptoms, and immediate complication rates. We investigated practice patterns associated with the use of HoLEP. METHODS: We obtained de-identified, self-reported American Board of Urology (ABU) certification/recertification case log data from 2008-2021. We identified 6,632 urologists who performed 73,884 surgeries with an indication for BPH. Current Procedural Terminology (CPT) codes distinguished HoLEP, transurethral resection of prostate (TURP), laser TURP, simple prostatectomy, prostatic urethral lift, transurethral incision of the prostate, and microwave and radiofrequency ablation. We identified 548 urologists (8.3%) who performed 7,386 HoLEP surgeries. Forty-three urologists (0.7%) performed HOLEP exclusively (no other BPH surgical approaches). A logistic regression model was used to determine factors independently associated with using HoLEP. RESULTS: The annual number of HoLEP procedures performed ranged from 3 to 1276, comprising 0.06% to 17.3% of total BPH surgeries annually. Highest HoLEP volumes were logged in 2019, representing 17.3% of total BPH cases. In adjusted analyses (table) factors associated with lower odds of performing HoLEP include surgeon age (odds ratio [OR] 0.93); government (OR 0.06), private practice group (OR 0.44), managed care (OR 0.14), salaried hospital (OR 0.38) vs. academic employment; and Mid-Atlantic (OR 0.28) and New England (0.45) regions vs. South Central (referent). Factors associated with higher odds of performing HoLEP include higher BPH surgical volume (OR 1.02) and endourology (OR 2.41) vs. general urology subspecialty. CONCLUSIONS: HoLEP is more likely to be performed by younger urologists, urologists in academic practice, endourology subspecialists, and those with higher BPH volume. HoLEP was less likely to be performed in Mid-Atlantic and New England regions. Additional studies are needed to elucidate practice pattern variations. Despite evidence demonstrating improved perioperative outcomes compared to competing BPH surgical approaches, HoLEP dissemination over time has been limited, possibly due to prolonged learning curve. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e60 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tenny R. Zhang More articles by this author Mary O. Strasser More articles by this author Samantha L. Thorogood More articles by this author Christina Sze More articles by this author Bilal Chughtai More articles by this author Alexis Te More articles by this author Richard K. Lee More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP04-03 CAN HANDHELD POINT OF CARE ULTRASOUND PROBES RELIABLY MEASURE TRANSABDOMINAL PROSTATE VOLUME? A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 May 2022MP04-03 CAN HANDHELD POINT OF CARE ULTRASOUND PROBES RELIABLY MEASURE TRANSABDOMINAL PROSTATE VOLUME? A PROSPECTIVE RANDOMIZED STUDY Henry Wright, Hermen Brar, Fabrice Henry, Dillon Corrigan, and Smita De Henry WrightHenry Wright More articles by this author , Hermen BrarHermen Brar More articles by this author , Fabrice HenryFabrice Henry More articles by this author , Dillon CorriganDillon Corrigan More articles by this author , and Smita DeSmita De More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate gland volume (PGV) helps guide management for prostatic disease. The American Urological Association (AUA) benign prostatic hyperplasia (BPH) guidelines recommend PGV assessment prior to BPH surgery via one of the following: magnetic resonance imaging (MRI), trans rectal or trans abdominal ultrasound (TRUS/TAUS), or computed tomography (CT). Handheld ultrasound (HUS) probes show promise as point of care ultrasound (POCUS) for PGV, yet evidence is limited. Our objective was to independently evaluate the accuracy of two HUS probes (Butterfly IQ, Clarius C3) in measuring trans abdominal PGV compared to guideline imaging (MRI, TRUS, TAUS, or CT). METHODS: In this prospective clinical study, enrolled subjects were randomized in a 1:1 ratio to undergo HUS PGV measurement with either the Clarius or Butterfly probe. Demographics, urologic history, and PGV data were collected. Reliability was quantified by estimating the intraclass correlation coefficient (ICC) between the HUS and guideline imaging and its 95% confidence interval (R version 4.1.0). We used the following standard criteria: ICC <0.5: poor reliability; 0.5 ≤ ICC <0.75: moderate reliability; ICC ≥0.75: good reliability. RESULTS: 78 men were randomized (38 Butterfly, 40 Clarius). Baseline characteristics similar between groups (p >0.05). The mean PGV based on HUS and gold standard imaging was higher in the Clarius group compared to Butterfly (p=0.011 and 0.044, respectively). The ICCs were 0.78 (95% CI: 0.62, 0.88) and 0.71 (95% CI: 0.51, 0.83) for the Butterfly and Clarius probes, respectively (Table 1), indicating that the Butterfly IQ produced good reliability between HUS and reference measurements, and the Clarius C3 produced moderate reliability between HUS and reference measurements. CONCLUSIONS: When compared to guideline imaging, the Butterfly IQ demonstrated good reliability for PGV, in comparison to moderate reliability for the Clarius C3. Further studies evaluating these probes as POCUS for urologic diseases are warranted. Source of Funding: Cleveland Clinic Research Programs Committee Grant © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e57 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henry Wright More articles by this author Hermen Brar More articles by this author Fabrice Henry More articles by this author Dillon Corrigan More articles by this author Smita De More articles by this author Expand All Advertisement PDF DownloadLoading ...

INCIDENTALLY DIAGNOSED ADENOCARCINOMA PROSTATE AFTER SURGERY FOR CLINICALLY BENIGN PROSTATOMEGALY A 2 YEARS RETROSPECTIVE STUDY

Introduction:Prostate cancer (PCa) is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide. The worldwide PCa burden is expected to grow to 1.7 million new cases and 499 000 new deaths by 2030 simply due to the growth and aging of the global population. Aims: To incidentally diagnose prostate cancer during TURP or open prostatectomy in patients clinically diagnosed with prostatomegaly with severe Lower urinary tract symptoms (LUTS). Methods:This study “Incidental Prostate Cancer” was conducted on 100 patients selectedin Surgery Department at M.L.B. Medical College, Jhansi between January 2020 to June 2021according to the inclusion criteria; patients were first examined clinically followed specific investigation like PSA, Prostate volume measurement before undertaking surgery for Benign prostatic hyperplasia and the resected specimen/chips of prostate were sent for histopathological examination for confirmation of malignancy. Result: The result of this study demonstrated 1 12% incidence of IPC on clinically diagnosed BPH patients. Patient’s age and PSA level were determined to be factors affecting IPC incidence. Compared to other age groups and PSA level groups, IPC incidence was higher in patients aged &gt;60 years and/or with PSA level &gt;4m=ng/mL. A relation between IPC and Gleason GG2 of 50% was determined statistically on histopathological examination. Conclusion: Incidental prostate cancer diagnosis among patients operated for BPH accounts for a significant proportion. PSA levels and patient’s age are valid diagnostic indicators of IPC. Higher Gleason score ………… significantly correlated with IPC.

Mortality after surgery for benign prostate hyperplasia: a nationwide cohort study

PurposeTo investigate postoperative mortality rates and risk factors for mortality after surgical treatment of benign prostate hyperplasia (BPH).MethodsAll patients who underwent partial prostate excision/resection from 2004 to 2014 in Finland were retrospectively assessed for eligibility using a nationwide registry. Procedures were classified as transurethral resection of the prostate (TURP), laser vaporization of the prostate (laser), and open prostatectomy. Univariable and multivariable regression were used to analyze the association of age, Charlson comorbidity index (CCI), operation type, annual center operation volume, study era, atrial fibrillation, and prostate cancer diagnosis with 90 days postoperative mortality.ResultsAmong the 39,320 patients, TURP was the most common operation type for lower urinary tract symptoms in all age groups. The overall 90 days postoperative mortality was 1.10%. Excess mortality in the 90 days postoperative period was less than 0.5% in all age groups. Postoperative mortality after laser operations was 0.59% and 1.16% after TURP (p = 0.035). Older age, CCI score, and atrial fibrillation were identified as risk factors for postoperative mortality. Prostate cancer diagnosis and the center’s annual operation volume were not significantly associated with mortality. The most common underlying causes of death were malignancy (35.5%) and cardiac disease (30.9%).ConclusionElective urologic procedures for BPH are generally considered safe, but mortality increases with age. Laser operations may be associated with lower mortality rates than the gold standard TURP. Thus, operative risks and benefits must be carefully considered on a case-by-case basis. Further studies comparing operation types are needed.

Surgical Complications in the Management of Benign Prostatic Hyperplasia Treatment.

There are a variety of treatment options for men with symptomatic benign prostatic hyperplasia (BPH); transurethral resection of the prostate (TURP) remains the gold standard surgical treatment. The field continues to evolve with the introduction of new energy and laser technologies, increasing adoption of enucleation techniques, in addition to the advent of minimally invasive surgical technologies (MIST) that enable office-based treatments. The choice in surgical management has become very nuanced depending on a variety of patient and anatomic factors. There continues to be high success rates for surgical treatment of BPH; however, the risk profiles vary across the various surgical treatments. We sought to evaluate contemporary series and summarize the experience of complications associated with BPH treatment and management of these complications. A comprehensive literature review was performed, and identified 79 manuscripts, published between 2005 and 2021 characterizing the diagnosis and management of complications following BPH surgery. Commonly cited issues included bleeding, ureteral orifice injury, bladder neck injury, rectal injury, TURP syndrome, bladder neck contractures, urethral stricture disease, refractory OAB symptoms, and complications unique to new modalities of treatment. The practicing urologist has multiple surgical options to choose from in treating patients with symptomatic BPH. The surgical management of BPH is generally well tolerated with high objective success rates that allow for significant improvement in urinary quality of life. It is critical to understand the potential complications associated with these various treatment options, which will enable trainees and practicing urologists to better counsel patients and manage these potential complications.

Real-world data comparing minimally invasive surgeries for benign prostatic hyperplasia.

To assess the differences in surgical outcomes between the prostatic urethral lift (PUL) and previous thermal energy procedures for the treatment of benign prostatic hyperplasia (BPH). We present an observational population-based study of 2694 men with BPH in New York State and California who received PUL, transurethral needle ablation (TUNA), or transurethral microwave therapy (TUMT) in outpatient and ambulatory surgery settings from 2005 to 2018. For these surgical procedures, short-term outcomes were reported and compared using a Chi-square test and mixed-effect logistic regressions. Long-term outcomes were described using Kaplan-Meier failure curves and compared using a Log-rank test and Cox regressions. A significant portion of PUL patients had a comorbidity count ≥ 2 (n = 838, 37.0%). PUL exhibited the lowest 30day and 90-day inpatient or ER readmission rates among all surgical techniques except for 90-day ER readmission (p < 0.05). No differences were observed for 1- and 3-year risks of reoperation between PUL [5.5% (95% CI 4.4-6.8%) and 14.9% (95% CI 10.9-20.1%)], TUNA [7.4% (95% CI 5.0-10.9%) and 11.3% (95% CI 8.3-15.4%)] and TUMT [8.5% (95% CI 4.7-15.2%) and 15.3% (95% CI 9.5-24.0%)]. 1- and 3-year risks of stricture development for PUL were 0.2% (95% CI 0.0-0.7%) and 0.2% (95% CI 0.0-0.07%), respectively. In a patient population with chronic conditions, patients treated with PUL exhibited similar 30- and 90-day inpatient or ER readmission rates when compared to previous reports. However, 1- and 3-year reoperation risks for PUL closely resembled previous thermal energy surgical procedures.

A0112 - Risk factors of infectious complications after benign prostatic hyperplasia surgery: Preliminary results from the retrospective and multicenter TOCUS cohort

A0112 - Risk factors of infectious complications after benign prostatic hyperplasia surgery: Preliminary results from the retrospective and multicenter TOCUS cohort

Tissue Kallikrein Protects Rat Prostate against the Inflammatory Damage in a Chronic Autoimmune Prostatitis Model via Restoring Endothelial Function in a Bradykinin Receptor B2-Dependent Way.

Objective The aim of this study was to investigate whether tissue kallikrein (KLK1) can protect the prostate from inflammatory damage and the mechanism involved in it. Methods A total of 50 male Wistar rats were used in this study. Initially, 20 rats were sacrificed to obtain the prostate antigen to induce experimental autoimmune prostatitis (EAP), and the remaining 30 rats were randomly divided into 5 experimental groups (normal control group (NC group), NC+KLK1 group (NCK group), EAP group, EAP+KLK1 group (EAPK group), and EAP+KLK1+HOE140 group (EAPKH group); n = 6). It should be explained that KLK1 mainly exerts its biological effects through bradykinin, and HOE140 is a potent and selective bradykinin receptor B2 (BDKRB2) antagonist. EAP was induced by intradermal injection of 15 mg/ml prostate antigen and complete Freund's adjuvant on days 0, 14, and 28. KLK1 was injected via tail vein at a dose of 1.5 × 10−3 PAN U/kg once a day, and HOE140 was administered by intraperitoneal injection at 20 μg/kg once every two days. Rats were sacrificed on day 42. The RNA and protein of the rat prostate were extracted to analyze the expression differences of KLK1, as well as the inflammation-, fibrosis-, and oxidative stress-related genes. The inflammatory cell infiltration and microvessel density of the prostate were also analyzed by pathological examination. In addition, pathological analysis was performed on prostate samples from patients undergoing benign prostate hyperplasia (BPH) surgery. Results The expression of KLK1 in the prostate decreased in the EAP group as well as BPH patients with obvious inflammation. KLK1 administration significantly inhibited inflammatory cell infiltration and reduced the production of inflammatory cytokines in the EAPK group. Prostate samples from the EAP group showed increased infiltration of T cells and macrophages, as well as gland atrophy, hypoxia, fibrosis, and angiogenesis. KLK1 administration upregulated endothelial nitric oxide synthase (eNOS) expression and suppressed oxidative stress, as well as transforming growth factor β1 (TGF-β) signaling pathways and the proangiogenic vascular endothelial growth factor (VEGF) in the EAPK group. However, in the EAPKH group in which HOE140 blocked BDKRB2, the beneficial effects of KLK1 were all cancelled. In addition, KLK1 intervention in normal rats had no obvious side effects. Conclusion The KLK1 expression is inhibited in the inflamed prostates of humans and rats. Exogenous KLK1 restored endothelial function via a BDKRB2-dependent way and then played a role in improving microcirculation and exerted anti-inflammatory, antifibrotic, and antioxidative stress effects in the rat chronic-inflamed prostate.

Long-Term Risk of Surgery Following First Diagnosis of Benign Prostatic Hyperplasia in Middle-Aged Men.

ObjectivePharmacotherapy is often used to relieve lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), yet surgery may be indicated for persistent bothersome symptoms. BPH is common among older men, yet the burden of BPH among middle-aged men may be under-recognized. This study examined the 5-year risk of BPH surgery among middle-aged men following the first BPH diagnosis.MethodsUsing the IBM MarketScan Commercial Claims and Encounters Database, males aged 35 to 64 years with a first-time primary diagnosis of BPH who were prescribed oral medication for LUTS were identified. The primary outcome was the risk of BPH surgery within five years of the first BPH diagnosis, which was analyzed using Kaplan-Meier methods. The influence of patient demographics, comorbidities, and medication use on the risk of BPH surgery was explored using a Cox proportional hazards model. ResultsFour thousand five hundred ten eligible men, 460 underwent BPH surgery within five years of BPH diagnosis. The most common surgical procedures were transurethral resection of the prostate and laser enucleation. The risk of BPH surgery over five years following BPH diagnosis was 10.2% (95% CI: 9.4% to 11.1%). In a multivariable Cox proportional hazards regression analysis, patient age was the primary factor associated with higher surgery risk. Compared to men aged 35 to 44 years, the hazard ratio for BPH surgery was 3.9 (95% CI: 1.9 to 8.4; p<0.001) among men aged 45 to 54 years, and 5.0 (95% CI: 2.4 to 10.6; p<0.001) among men aged 55 to 64 years.ConclusionsIn middle-aged men prescribed oral medication for LUTS secondary to BPH, the risk of BPH surgery was 10.2% over five years. This risk may be underappreciated and highlights the clinical need for surgical procedures with favorable risk-to-benefit profiles.

Prostate-Specific Antigen Velocity Predicts Surgical Outcome of Thulium Laser Enucleation of the Prostate.

Background: We determined the effect of prostate-specific antigen velocity (PSAV) on the surgical outcome of thulium laser enucleation of the prostate (ThuLEP) in patients with benign prostatic hyperplasia (BPH).Methods: A retrospective review was performed of prospectively collected data of patients with BPH who underwent ThuLEP at any time from 2017 to 2019. Patients who had undergone BPH surgery or had prostate cancer previously were excluded, and patients with prostate-specific antigen (PSA) > 4 ng/ml were examined through transrectal ultrasound-guided prostate biopsy to rule out prostatic malignancy. Furthermore, patients were excluded if prostatic malignancy was diagnosed during postsurgery follow-up.Results: The PSA level, International Prostate Symptom Score (IPSS), and quality of life (QoL) of 27 male patients at 3 and 15 months postsurgery differed significantly from those at presurgery; the maximum flow rate (Qmax) and postvoid residual (PVR) significantly differed between 3 months postsurgery and presurgery; and 22 and 5 patients had good to excellent and fair to poor outcomes, respectively, at 15 months postsurgery. Patients were divided into two groups (fair and poor vs. good and excellent outcomes at 15 months postsurgery), which significantly differed with respect to PSAV at 3 months postsurgery (P = 0.04), IPSS presurgery (P < 0.02), surgical length (P = 0.01), and hospitalization duration (P = 0.04). In a receiver operating characteristic (ROC) analysis, the optimal cutoff value of PSAV of −0.52 ng/ml characterized effectiveness at 15 months after ThuLEP, and the area under the curve (AUC), sensitivity, and specificity were 0.82 (P < 0.02), 0.80, and 0.82, respectively. For PSAV < -0.52 and ≥-0.52 ng/ml, the percentages of reduction for IPSS, QoL, Qmax, and PVR were −78.6 and −71.4%, −33.3 and 0.0%, 94.4 and 40.0%, and −85.1 and −38.7%, respectively.Conclusions: Postsurgical PSAV was positively correlated with surgical success, and the PSAV cutoff was −0.52 ng/ml. PSAV can, thus, be used to guide the postsurgical follow-up treatment at 3 months after BPH surgery.

A Review on Urinary Incontinence after Surgery for Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) is characterized by the abnormal proliferation of cells, leading to structural changes. It is one of the most common diseases in ageing men. Its clinical presentations are dominated by lower urinary tract symptoms (LUTS). The therapeutic methods can be grouped into two options: the medical option and the surgical option in which prostate enucleation is found. In recent years many studies have reported the onset of urinary incontinence (UI) after prostate enucleation. The management of UI occurring after prostate enucleation is embarrassing for both the practitioner and the patient, and generates additional costs. Purpose: Cite the causes of UI after prostate enucleation for BPH, as well as ways to prevent the onset of UI after this surgery, specifically by the study of the vesicosphincteric system aimed at improving the technique of enucleation; our review will also deal with the therapeutic means of UI. Method: We retrieved studies from Science Direct, Wiley and Pubmed. Results: There are multiple etiologies of UI after prostate enucleation including urethral sphincter insufficiency (USI) and bladder dysfunction (BD). The management of UI after surgery could be conservative, surgical, or use new technologies. Urodynamic assessment before prostate enucleation for BPH is relevant. Conclusion: UI is a common post-operative complication of prostate enucleation. The study of the vesicosphincteric system leads us to believe that prostate enucleation for BPH, partially sparing the mucosa and the external urethral sphincter could decrease the incidence of UI after surgery.

Лечение больных с симптомами нижних мочевых путей и эректильной дисфункции после трансуретральных операций на предстательной железе

Objective: to assess the clinical utility of a comprehensive multimodal treatment including phosphodiesterase type 5 (PDE5) inhibitors + extracorporeal shockwave therapy (ESWT) + inhalations with a heated mixture of helium and oxygen (Thermogeliox technology) in patients with urination disorders and erectile dysfunction that had undergone transurethral surgery for benign prostatic hyperplasia (BPH). Patients and methods. This prospective single-blind randomized study was conducted at the Medical Research and Educational Center, M.V.Lomonosov Moscow State University and included 60 patients aged 50 to 80 years that were randomly assigned to one of the two groups matched for the main characteristics. Patients in the experimental group received basic pharmacotherapy (tamsulosin 0.4 mg and tadalafil 5 mg daily) plus courses of anti-ischemic treatment (10 procedures in each course; two procedures per week). The anti-ischemic treatment included ESWT using the Dornier MedTech ARIES device (Germany) and oxygen-helium therapy using the BreezeLite device (InertGaz medical, Russia). Arterial blood flow in the peripheral prostate was assessed using the rectal probe of the Philips EPIQ 7 ultrasound scanner (USA); peak systolic velocity (Vps, cm/sec) and the arterial resistance index (RI) were measured in the right and left prostatic arteries. The severity of the disease was evaluated by assessing both subjective (International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF)) and objective parameters (frequency and quality of nocturnal penile tumescences using the Androscan MIT recorder and maximum urine flow at uroflowmetry). Data analysis was conducted using the Statistica 10 software; differences were considered significant at р &lt; 0.05. Results. Patients in both groups reported a significant improvement of their condition (both IPSS and IIEF scores decreased) and maximum urine flow. Treatment also improved arterial blood flow in the peripheral prostate in both groups: in the experimental group, Vps increased from 7.95 ± 0.12 cm/sec to 14.05 ± 0.16 cm/sec; in the control group, Vps increased from 8.07 ± 0.11 cm/sec to 11.42 ± 0.17 cm/sec. Patients in the experimental group had a more pronounced treatment effect 3 months after its completion (13.01 ± 0.20 cm/sec vs 10.40 ± 0.20 cm/sec; p &lt; 0.05). Erectile function (IIEF and androscan) was restored in 10 patients (33.3%) from the experimental group and 5 patients (16.7%) from the control group. The ratios of patients with ED of varying severity also changed: in the experimental group, the number of patients with grade I disease increased to 14 (46.7%), while the number of patients with grade II and grade III disease decreased to 5 (16.67%) and 1 (3.3%), respectively. In the control group, these numbers were 13 (43,3%), 9 (30%), and 3 (10%), respectively. Conclusion. Patients may develop prostatic ischemia in the late postoperative period due to infravesical obstruction and concomitant diseases. Further development of treatment techniques aimed to prevent the consequences of such ischemia will reduce the incidence of complications, improve the outcomes of transurethral surgeries for BPH, and significantly improve the quality of life of patients.

Assessment of the Balloon Dilation Efficiency in Bladder Neck Contracture after Transurethral Interventions on the Prostate

Purpose: The aim was to assess the results of balloon dilation in patients with bladder neck contracture (BNC) after endoscopic surgery for benign prostatic hyperplasia (BPH). Materials and Methods: The study involved 120 patients with recurrent BNC after transurethral interventions for BPH. All patients underwent transurethral resection (TUR) of the bladder neck and were divided into two groups: Group A (n = 45) included men who, after TUR, additionally underwent repeated balloon dilation, whereas the control group B (n = 75) included men who were treated with alpha-blockers alone. Results: In 9 months after TUR and 3 months after the 4th balloon dilation procedure in Group A, the mean international prostate symptom score (IPSS) decreased from 20.1 ± 8.4 to 17.2 ± 7.4, and the IPSS-quality of life was 4.2 ± 1.2 (P &gt; 0.05). In Group B, they were 21.7 ± 7.7 and 4.7 ± 1.1 (P &gt; 0.05), respectively. In addition, the mean flow rate in Group A was 13.2 ± 5.4 ml/s, whereas in Group B, it was 8.7 ± 4.9 ml/s (P &lt; 0.05). There was a significant decrease in the postvoid residual urine volume from 76.2 ± 96.1 ml to 37.6 ± 55.1 ml in Group A, whereas, in Group B, it increased from 63.0 ± 36.9 ml to 79.4 ± 71.6 ml (P &gt; 0.05). Furthermore, 28.0% of patients of Group B and 13.3% of patients of Group A underwent repeated TUR of the bladder neck in 9 months follow-up period (P &lt; 0.05). Conclusion: Balloon dilation is a safe less invasive procedure and can reduce the possibility of BNC recurrence and thus the rate of repeated transurethral interventions.

Hystoric aspects of introduction of transbladder and retropubic simple prostatectomy in surgical urological practice

The article presents the main stages of transvesical and retropubic prostatectomies on benign prostatic hyperplasia in hystorical aspects, beginning from open intervention to minimally invasive laparoscopic and robotic techniques. The development of hemostatic methods during the transvesical and retropubic prostatectomies are highlighted, in particular by Ukrainian urologists. The aim of the study is to present the main stages of transvesical and retropubic prostatectomies in the surgical urological practice according to the literary data. Research methodology and methods. Literature sources were searched using the Medline database from PubMed and Google Scholar using the phrases “open simple transbladder and retropubic prostatectomy”, “hemostasis for open simple transbladder and retropubic prostatectomy”. Presentation of the main research material. According to the obtained data in scientific databases, it becomes clear that the problem of prostate bed hemostasis during transvesical and retropubic prostatectomies in the world was and remains quite relevant. Although interest in a laser enucleation and laparoscopic prostatectomies for the large hyperplastic prostate nodes (more than 80 ml) continues to grow in the world, open transvesical and retropubic prostatectomies are also widely used today. Therefore, individual stages of these operations, which are improved over time, deserve the special attention in order to reduce the risks of complications and improve the results of treatment. Conclusions. Transvesical and retropubic prostatectomies in benign prostatic hyperplasia surgery count more than 125 years of development and improving. These interventions have passed through the period from open intervention to the minimally invasive laparoscopic and robotic techniques in Ukraine and in the world, but even today the choice of the best option for prostatectomy remains with the operating urologist.

Bladder Decompensation in Patients with Benign Prostatic Hyperplasia: Causes, Complications, Rehabilitation

Background Despite the high efficiency of surgical methods in correction of bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH), a significant proportion of patients (up to 35%) remains after surgery with impaired contractile function of the bladder and lower urinary tract symptoms (LUTS). Both are consequences of structural and functional changes of the detrusor due to long-term exposure to obstructive factor. Today there is a lack of systematic reviews that provide a specialist with an integrative conception of pathological changes in the bladder wall caused by BPH associated prolonged BOO and evidence based methods of detrusor rehabilitation. The objective: systematization of modern conceptions about structural and functional changes in the bladder of patients with BPH caused by prolonged BOO, and methods of their correction. Materials and methods. An analytical review of the literature covering pathogenesis of bladder remodeling due to BPH associated long-term BOO and methods of bladder rehabilitation was performed. Literature sources were searched in PubMed, Google Scholar, Scopus and Web of Science databases by keywords. The search depth was 40 years. 74 relevant publications were selected for analysis. Results. Bladder remodeling due to obstructive factor is a complex staged process that involves all layers of the wall at the tissue, cellular and subcellular levels, affecting not only the executive structures (urothelium, smooth-muscle syncytium, fibrous connective tissue matrix), but also the system metabolism. Depending on the nature of the changes, there are 3 stages of this process: compensation, subcompensation and decompensation. In the compensatory stage, an increase of the load on the bladder leads to hypertrophy of smooth muscle fibers. At the same time, there is a reorganization of the vascular bed – neoangiogenesis, which should provide increased energy needs of muscles. In the stage of subcompensation, vicarious hypertrophy and neoangiogenesis cease. The most prominent disorders of the structure and function of the bladder are observed in the stage of decompensation. It includes a number of pathological processes: hypoxia, anaerobic metabolism, oxidative stress, inflammation, changes in the paracrine environment (increased levels of HIF-1α, vascular endothelial growth factor (VEGF) and angiopoietin-1). It is characterized by progressive loss of contractile function of the detrusor due to the death of smooth muscle cells and neurons, deterioration of viscoelastic characteristics of the bladder wall due to excessive collagen synthesis by fibroblasts, loss of barrier properties of the mucous membrane due to dystrophy. It was found that the severity of these pathological changes correlates with the severity of LUTS in patients who underwent surgery for BPH. The current arsenal of measures for bladder rehabilitation is quite diverse and includes periodic sterile catheterization, pharmacotherapy (cholinesterase inhibitors, antioxidants), physiotherapy (electrical stimulation, muscles training) and plastic surgery. However, there is still a lack of high-level studies to prove their effectiveness in patients who have undergone prostate surgery for BOO caused by BPH. Conclusions. Persistence of LUTS in patients who have undergone prostate surgery due to BOO may be caused by bladder decompensation. Long-term bladder decompensation due to prolonged exposure to obstructive factor is a complex process that includes decreased contractile activity, deterioration of the viscoelastic characteristics of the bladder, and impaired mucosal barrier function. Further research is needed to develop an effective bladder rehabilitation protocol.