Benign Prostatic Hypertrophy Research Articles

전립선 비대증 남성의 건강관련 삶의 질 예측요인

Objectives This study is a descriptive correlation study to confirm the predictive factors of lower urinary tract symptoms and disease-related characteristics perceived by the subject on the health-related quality of life of men with Benign prostate hypertrophy. Methods This study was conducted on a total of 113 patients aged 45 or older who were diagnosed with prostate hypertrophy at a general hospital urology out patient department in U-si, Gyeonggi-do, who could understand, respond to, and communicate with the questionnaire. The collected data were analyzed with SPSS/WIN 23.0. Results As a result of a Stepwise regression analysis to explore predictors of health-related quality of life of subjects, lower urinary tract symptoms (==-.65, p<000) as a predictor of health-related quality of life in men with Benign prostate hypertrophy was the highest, followed by sleep time (==.17 p<008). It was identified as (Adjusted R2=.57). Conclusions As a result of this study, the predictive factors affecting the health-related quality of life of men with prostate hypertrophy were investigated as lower urinary tract symptoms and sleep time. In order to improve the health-related quality of life of prostate hypertrophy cyst, it is believed that intervention and education programs for the management of lower urinary tract symptoms should be developed. In addition, it is necessary to approach the improvement of self-management capabilities for the prevention of symptoms and diseases of prostate hypertrophy men who help alleviate and improve lower urinary tract symptoms.

Correlation between prostate volume measured by ultrasound and symptoms severity score in patients with benign prostatic hypertrophy in Southeastern Nigeria.

Benign prostatic hypertrophy (BPH) is a common urological condition in men older than 50 years. It is important in the aetiologies of life-threatening obstructive uropathies. Ultrasound measurement of prostate volume is non-invasive, easily available, and a cost-effective method, useful in assessing bladder outlet obstruction (BOO). The International Prostate Symptoms Score (IPSS) on the other hand objectively assesses symptoms severity in BOO patients. This study was aimed at determining the correlation between ultrasound-measured prostate volume and IPSS in men with BPH. Following ethical approval from the Nnamdi Azikiwe University Teaching Hospital Ethical Committee, 100 patients who met the inclusion criteria and were diagnosed with clinical BPH were enrolled into the study. They had no other identifiable cause of BOO except BPH after clinical evaluation. The IPSS, Quality of life score (QOL), and prostate volumes were measured. Correlation between prostate volume, IPSS, and QOL were done using SPSS version 20. P value <0.05 was considered significant. The mean age of patients was 69.3 ± 10.6 years with a range of 48-100 years. The mean prostate volume, IPSS, and QOL were 96.0 ± 70.5 cm3, 15.63 ± 8.6, and 4.8 ± 1.3, respectively. The highest recorded IPSS was 35 and the lowest was 4, whereas the smallest and largest recorded prostate volumes were 19 cm3 and 350 cm3, respectively. Nocturia was the major IPSS subscore. There was a weak positive correlation between prostate volume and IPSS in men with BPH (r = +0.109; P = 0.28) and between prostate volume and QOL (r = +0.072; P = 0.45). There was also a weak positive correlation between patients with only severe symptoms and corresponding prostate volumes (r = +0.122; P = 0.125). The correlation between patients with severe symptoms and their corresponding QOL was strong (r = +0.537; P = 0.135, respectively). These findings were, however, not statistically significant. There is a weak positive correlation between prostate volume measured by ultrasound and symptoms severity scores in patients with BPH, although not statistically significant. This may be as a result of the small sample size. A larger sample size may be able to achieve statistical significance.

Sonographic Evaluation of Prostate Size and its Correlation with Age and PMRV in Patients with Benign Prostatic Hyperplasia

Background: The enlargement of prostate is known as benign prostatic hypertrophy (BPH). It begins when the cells of the prostate gland begin to proliferate. BPH is caused by increased age and other factors associated with it. Objective: To determine the correlation of prostate volume with age and post-micturating residual (PMR) volume in patients with benign prostatic hyperplasia (BPH). Methods: This cross-sectional study was conducted on 100 patients of BPH that fulfilling inclusion criteria for 4 months, selected from Gondal Medical Complex Gujranwala during 14 January to 15 May 2022. Patients with prostate cancer, mild urinary tract or prostate surgery, and those with UTI or stone in bladder were excluded. Ultrasound was used to perform a transabdominal scan. Age, prostate volume (PV), and PMRV were the outcome parameters. Results: In this study hundred BPH positive patients were included. The mean age of patients with BPH, prostate weight, post-void residual volume of the participants was found to be 64.89±14.12 years, 54.68±29.42g, and 22.47±14.75ml respectively. In this study the correlation value of age of patients with BPH and prostate volume was 0.212 and P-value was 0.035 which was significant but the correlation between PV and PMRV was not significant because the correlation value of PV and PMRV was 0.032 and P-value was 0.751. Conclusion: This study concluded that there was significant correlation between Age and BPH but no significant correlation between BPH and PMRV.

Effectiveness and Safety of a New Nutrient Fixed Combination Containing Pollen Extract Plus Teupolioside, in the Management of LUTS in Patients with Benign Prostatic Hypertrophy: A Pilot Study.

Benign prostatic hyperplasia (BPH) is a common cause of male lower urinary tract symptoms (LUTS) that can reduce quality of life. Even if several drugs can be used in its treatment, the development of adverse drug reactions (ADRs) represents the most common cause of low adherence. In the present study, we evaluate both the efficacy and the safety of a new nutrient fixed combination of Pollen Extract plus Teupolioside, named Xipag®, in patients with LUTS. We conduct a pilot single center open label clinical study between 1 March 2020 and 30 June 2020 in patients with BPH referred to general practitioner’s ambulatories. Male patients > 45 years, sexually active, with clinical symptoms of LUTS and with a diagnosis of HPB were enrolled and received one tablet/day of Xipag® (T0), for three months (T1: end of treatment). The IPSS and IIEF-5 questionnaires were carried out at T0 and T1 and represent the first end point, whereas the primary safety end point was considered the absence of ADR or of drug–drug interactions related to Xipag® administration. During the study period, 25 subjects aged 43 to 76 years (mean 62.7 ± 9) were enrolled and completed the study. The clinical evaluation in T1 documented that Xipag® induced a statistically significant improvement (p < 0.01) in symptoms, as documented by the IPSS questionnaire (range 22.7–88.9; mean 55.2 ± 23.6), without the development of ADRs. In conclusion, this is the first real-world study that showed the efficacy and the safety of Xipag® in the BPH patients with LUTS.

Fever of Unknown Origin: A Hot Diagnosis in the Outpatient Setting

A 63-year-old man presents to the primary care office with a productive cough, myalgias, fatigue, and a temperature ranging from 100.1 to 101 F for a one-week duration. He has atrial fibrillation, hypertension, benign prostatic hypertrophy, and a history of pancreatic cancer status post partial pancreatectomy and splenectomy three months prior, resulting in uncontrolled, post-surgical diabetes. He is taking amiodarone, carvedilol, hydrochlorothiazide, and metformin. He denies any other recent procedures, hospital admissions, or sick contacts.

Pattern of Pelvic Ultrasound Request and Findings in Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi

Background: Pelvic ultrasonography involves the evaluation of pelvic organs and structures. It is valuable in the diagnosis of pathological conditions which are likely causes of pelvic pain.Purpose: The objective of this study was to evaluate the pattern of pelvic ultrasound request and findings in Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi.Methods: A retrospective study was conducted in the radiology department of ATBUTH. A total of 1,320 ultrasonography records of patients for pelvic examination were reviewed from January 2016 to February 2017,and tabulated according to age, sex, clinical indication and ultrasound findings. Data were analyzed using SPSS version 20.0 to determine the mean, frequency and percentages. Pearson’s correlation was used to determine the relationship between clinical indication and ultrasound findings.Results: The age group of 21-30 years and 31- 40 years had the highest frequency (n = 627, 47.5 %) and (n = 321, 24.3%), respectively. Gender distribution were 1158 (87.7 %), for females and 162 (12.3 %) for males. Pelvic pain had the highest indication, 72.3% (n = 955), followed by PID, 9.2% (n = 121), then BPH, 3.4% (n=45) and, ovarian cyst, 2.7 % (n = 36). Conclusion: The highest indication and findings are pelvic pain and pelvic inflammatory diseases, among females while benign prostatic hypertrophy was the highest in males.

The feasibility of endourological surgery in low-resource settings.

One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa (SSA) has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients that established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically or restricted by the abilities of the surgeons in SSA. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them, and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. However, they are largely dependent upon the supply of equipment from non-governmental organisations in high-income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.

Abstracts 8th PCNE working symposium ‘Navigating research on pharmaceutical care’. 11–12 February 2022, Lisbon, Portugal

Abstracts 8th PCNE working symposium ‘Navigating research on pharmaceutical care’. 11–12 February 2022, Lisbon, Portugal

Abstract No. 63 Effect of prostatic artery embolization on reduction or cessation of preprocedural benign prostatic hypertrophy medication: single-center experience

PAE is an effective procedure for treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hypertrophy (BPH). Often patients undergo PAE to reduce or eliminate their dependence on BPH medications. The purpose of this study is to evaluate the effect of PAE on reduction of preprocedural medications.

Abstract No. 108 Prostate artery embolization versus transurethral resection of the prostate for benign prostatic hypertrophy: a cost-effectiveness analysis

Abstract No. 108 Prostate artery embolization versus transurethral resection of the prostate for benign prostatic hypertrophy: a cost-effectiveness analysis

Tier-based antimicrobial stewardship metrics for genitourinary-related antibiotic use in Veterans’ Affairs outpatient settings

Background: Tracking antibiotic use is a core element of antimicrobial stewardship. We developed a set of metrics based on electronic health record data to support an outpatient stewardship initiative to improve management of urinary tract infections (UTIs) in Veterans’ Affairs (VA) emergency departments (EDs) and primary care clinics. Because UTI diagnostic codes only capture a portion of genitourinary (GU)-related antibiotic use, a tier-based approach was used to evaluate practices. Methods: Metrics were developed to target practices related to antibiotic prescribing and diagnostic testing (Table 1). GU conditions were divided into 3 categories: tier 1, conditions for which antibiotics are usually or always indicated; tier 2, conditions for which antibiotics are sometimes indicated; and tier 3, conditions for which antibiotics are rarely or never indicated (eg, benign prostatic hypertrophy with symptoms). Patients with visits related to urological procedures, nontarget providers, and concomitant non-GU infections were excluded. Descriptive analyses included calculation of the correlation matrix for the 7 metrics and the construction of box plots to display interfacility variability. Results: Metrics were calculated quarterly for 18 VA medical centers, including affiliated clinics, in a western VA network, from July 2018 to June 2020 (Table 1). Tier 3 GU conditions accounted for 1,276 of 11,840 (11%) of GU-related antibiotic use. Metrics 1 and 6b were strongly correlated with each other and were also positively correlated with metrics 2 and 5 (coefficients &gt; 0.5) (Fig. 1). Substantial interfacility variation was observed (Fig. 2). Conclusions: Stewardship metrics for suspected or documented UTIs can identify opportunities for practice improvement. Broadly capturing GU conditions in addition to UTIs may enhance utility for performance feedback. Antibiotic prescribing for tier 3 GU conditions is analogous to unnecessary antibiotic use for acute, uncomplicated bronchitis and upper respiratory tract infections.Funding: NoneDisclosures: None

Pre-Anaesthetic Consultation at the National Hospital of Zinder: Epidemiological Aspect and Fate of those Consulted

Introduction: The pre anesthetic consultation is the essential element of the continuity of peri and post interventional care. In fact, it gathers all the information concerning the pre, per operative anesthetic period. For any patient whose condition requires anesthesia, the health structures must provide a preanesthesia consultation. General objective: To highlight the importance of a preanesthetic consultation through the profile and prognosis of the patients as well as the operative indications recorded. Patients and method: This was a prospective and descriptive study conducted over a period of six months from January 1 to June 30, 2021 in the anesthesia and intensive care unit of the national hospital of Zinder. Patients consulted by a surgeon, scheduled for surgery and having a preoperative workup were included. Age, sex, history, ASA class, anesthetic technique, operative indication and outcome of the patent were the variables studied. The data analysis was done by Excel. Results: During the study 401 patients were registered with a sex ratio of 3.6%. The mean age was 42 years with extremes from 02 months to 84 years. Medical history represented 08.72% including hypertension (68.57%) and diabetes (11.42%). ASA II class represented 73.81% (n= 296) and ASA I class 26.18% (n= 105). General anesthesia was the chosen technique in 63.34% (n=254) versus 36.5% (n=147) for spinal anesthesia. Hernia and restoration of digestive continuity were the main surgical indications with respectively 17.45% (n=70) and 10.47% (n=42) followed by benign prostatic hypertrophy for 10.47% (n=42). Visceral surgery occupied the first place with 21.19% (n=85) followed by urology with 15.96% (n= 64). The per and post operative evolution was generally favorable, no case of death was recorded. Conclusion: The pre-anaesthetic consultation remains the essential element of the continuity of pre- and post-anaesthetic care. It should be popularized in health structures with high-risk patients.

Copy number variation of urine exfoliated cells by low-coverage whole genome sequencing for diagnosis of prostate adenocarcinoma: a prospective cohort study.

BackgroundNon-invasive, especially the urine-based diagnosis of prostate cancer (PCa) remains challenging. Although prostate cancer antigen (PSA) is widely used in prostate cancer screening, the false positives may result in unnecessary invasive procedures. PSA elevated patients are triaged to further evaluation of free/total PSA ratio (f/t PSA), to find out potential clinically significant PCa before undergoing invasive procedures. Genomic instability, especially chromosomal copy number variations (CNVs) were proved much more tumor specific. Here we performed a prospective study to evaluate the diagnostic value of CNV via urine-exfoliated cell DNA analysis in PCa.MethodsWe enrolled 28 PSA elevated patients (≥ 4 ng/ml), including 16 PCa, 9 benign prostate hypertrophy (BPH) and 3 prostatic intraepithelial neoplasia (PIN). Fresh initial portion urine was collected after hospital admission. Urine exfoliated cell DNA was analyzed by low coverage Whole Genome Sequencing, followed by CNV genotyping by the prostate cancer chromosomal aneuploidy detector (ProCAD). CNVs were quantified in absolute z-score (|Z|). Serum free/total PSA ratio (f/t PSA) was reported altogether.ResultsIn patients with PCa, the most frequent CNV events were chr3q gain (n = 2), chr8q gain (n = 2), chr2q loss (n = 4), and chr18q loss (n = 3). CNVs were found in 81.2% (95% Confidence Interval (CI) 53.7–95.0%) PCa. No CNV was identified in BPH patients. A diagnosis model was established by incorporating all CNVs. At the optimal cutoff of |Z|≥ 2.50, the model reached an AUC of 0.91 (95% CI 0.83–0.99), a sensitivity of 81.2% and a specificity of 100%. The CNV approach significantly outperformed f/t PSA (AUC = 0.62, P = 0.012). Further analyses showed that the CNV positive rate was significantly correlated with tumor grade. CNVs were found in 90.9% (95% CI 57.1–99.5%) high grade tumors and 60.0% (95% CI 17.0–92.7%) low grade tumors. No statistical significance was found for patient age, BMI, disease history and family history.ConclusionsUrine exfoliated cells harbor enriched CNV features in PCa patients. Urine detection of CNV might be a biomarker for PCa diagnosis, especially in terms of the clinically significant high-grade tumors.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12920-022-01253-5.

V02-06 FUNCTIONAL OUTCOMES OF EXTRAPERITONEAL LAPAROSCOPIC ADENOMECTOMY

You have accessJournal of UrologyCME1 May 2022V02-06 FUNCTIONAL OUTCOMES OF EXTRAPERITONEAL LAPAROSCOPIC ADENOMECTOMY Roberto Hugo Martinez Rodriguez, Alberto Robles Samaniego, Cristina Gutierrez Ruiz, Leire Portilla Maediavilla, Alejandro Garcia Viña, and Jose H. Amon Sesmero Roberto Hugo Martinez RodriguezRoberto Hugo Martinez Rodriguez More articles by this author , Alberto Robles SamaniegoAlberto Robles Samaniego More articles by this author , Cristina Gutierrez RuizCristina Gutierrez Ruiz More articles by this author , Leire Portilla MaediavillaLeire Portilla Maediavilla More articles by this author , Alejandro Garcia ViñaAlejandro Garcia Viña More articles by this author , and Jose H. Amon SesmeroJose H. Amon Sesmero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both prostatic enucleation and adenomectomy can be considered gold treatments for benign prostatic hypertrophy (BPH) of large volume with obstructive clinic. Nowdays trend to minimally invasive surgery and/or the anatomical impossibility for enucleation have motivated the laparoscopic approach to conventional adenomectomy. We present the objective and subjective functional outcomes of our initial series of laparoscopic adenomectomies while surgical steps are shown. METHODS: Surgical tips are shown while functional outcomes are described.We prospectively analyzed patients undergoing extraperitoneal laparoscopic adenomectomy between April - December 2020 for infravesical obstruction due to BPH. We evaluated objective functional outcomes using flowmetry and post-voiding residue and subjective with sexual and quality of life questionnaires (IPSS AND IIEF) before and after surgery. Demographic data on age, weight and height were collected; prostate size estimated by ultrasound; surgical time, intraoperative bleeding, days of hospital stay, subjective pain measured by visual EVA scale, weight and anatomy of the surgical piece, and postoperative complications according to Clavien Dindo gradation.Descriptive analysis is performed. RESULTS: 50 laparoscopic procedures were performed on patients with a mean age of 70 years (range 60-78) and a mean ultrasound prostate size of 120cc (80-180). 19 of these patients were bladder catheter carriers at the time of surgery. Mean surgical time: 90min (80-150);decreased hemoglobin test 1.2gr/dl (0.5-3.8). Postoperative pain was 0/2 according to EVA scale, and mean hospital stay 2 days (1-7). We recorded 5 complications grade 3 Clavien Dindo scale (urinary tract infections) and one grade 2 (tube obstruction). The IPSS questionnaires showed a mean decrease of 19.41 points in the questions referring to voiding symptoms and 3.92 in the quality of life index. Peak flow was increased by >10 ml/sg and no patient had significant post-voiding residue. The IIEF showed an average increase of 4.45 points. CONCLUSIONS: Functional results, objectified through the use of validated questionnaires, support the laparoscopic approach in those selected cases. Laparoscopic adenomectomy represents a reasonable, safe and effective alternative in the treatment of high-volume prostatic hypertrophy with associated voiding clinic. Decreases the rate of transfusions, postoperative analgesic requirement and hospital stay, maintaining a satisfactory functional result. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e112 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Hugo Martinez Rodriguez More articles by this author Alberto Robles Samaniego More articles by this author Cristina Gutierrez Ruiz More articles by this author Leire Portilla Maediavilla More articles by this author Alejandro Garcia Viña More articles by this author Jose H. Amon Sesmero More articles by this author Expand All Advertisement PDF DownloadLoading ...

Bipolar versus monopolar transurethral resection for benign prostatic hypertrophy: a prospective comparative study

Background: The transurethral resection of the prostate (TURP) is a well-known surgical procedure for treating benign prostatic hypertrophy in males. Monopolar TURP (MTURP) has been used in the past, however the morbidity associated with MTURP has led to the development of new surgical procedures. Energy is restricted between electrodes at the resectoscope site in bipolar TURP (BTURP), permitting the use of physiological irrigation medium. In terms of patient outcomes, there is still some doubt about the distinctions between various surgical procedures. This study aims to evaluate the efficacy of monopolar (M-TURP) and bipolar (B-TURP) TURP.Methods: In this prospective comparison trial, 100 patients were enrolled and table randomized to either M-TURP or B-TURP surgery for prostatic hyperplasia. Prostate size, post-void volume and hemoglobin were recorded pre and postoperatively. Resection time was noted.Results: Patients were divided into two groups, namely M-TURP and B-TURP. The mean age of patients was comparable between both groups. There is a significantly lower mean resection time in M-TURP compared to B-TURP. Drop-in hemoglobin levels (g/dl) in M-TURP patients were higher than in B-TURP. The M-TURP group showed a higher reduction in post-void residual volume than the B-TURP group. B-TURP group had a larger reduction in gland size than the M-TURP group.Conclusions: M-TURP and B-TURP are safe and effective procedures for treating BPH.

Management of New Complications from Prostatic Urethral Lift

ABSTRACT Introduction Prostatic urethral lift (PUL) is a minimally invasive treatment for men with benign prostatic hypertrophy (BPH). This entails placing non-absorbable sutures with a nitinol prostate capsular anchor and a stainless-steel urethral end piece to mechanically open the intraurethral prostate for lower urinary tract symptoms (LUTS). There is a 12% incidence of complications from PUL. Here we present a single center experience with PUL along with management of the first known complication of PUL injuring the penile prosthesis reservoir and also a patient presenting with prostatic urethral adhesion following PUL. Objective To present the data of a single center experience with PUL and to document the first known injury of penile prosthesis reservoir from PUL and to discuss techniques and management of prostatic urethral adhesions from PUL. Methods A retrospective chart review was performed from the last two years of a single physician andrologic practice. Images and video was taken of the various rare complications encountered. Results A total of 63 PUL were performed. 1 patient had sepsis after the procedure. 2 patients had urinary retention that resolved after 7 days of catheterization. Ages ranged from 43-88 years, and prostate size ranges from 22- 90grams with a mean of 44 grams. IPSS score improved by 8 points. One patient was found to have a non-working penile implant 2 weeks after PUL. He underwent penile prosthesis revision and was found to have the PUL in the reservoir. 0 patients had retrograde or anejaculation after PUL. Three patients needed re-treatment after PUL, one opting for PUL the other opting for another modality. One patient who had PUL at another facility underwent intra-urethral prostatic stricture ligation for refractory (LUTS). Conclusions PUL is both safe and effective in the treatment of BPH. Caution should be taken in men with penile prosthesis and space of retzius reservoir placement as here we document the first PUL injury of the penile implant reservoir. Prostatic urethral stricture while rare can also occur and is best handled using an athermal technique to open the prostatic fossa. Disclosure No

Potential of pre-interventional magnetic resonance angiography for optimization of workflow and clinical outcome of prostatic arterial embolization

PurposeImpact of pre-interventional magnetic resonance angiography (MRA) on prostatic artery embolization (PAE) regarding workflow, radiation dose, and clinical outcome. MethodRetrospective evaluation of 259 patients (mean age 68 ± 9, range 41–92) with benign prostatic hypertrophy (BPH) undergoing PAE between January 2017 and December 2020. MRA was performed in 137 cases. In 122 patients, no pre-interventional MRA was performed. Origin of the PA, volumetry of the prostatic gland and ADC values were evaluated. International Prostate Symptom Score (IPSS), Quality of Life (QoL) and International Index of Erectile Function (IIEF) were evaluated before and after PAE. ResultsOrigin of the PA was identified in all cases. Significant differences regarding volume reduction (−20 ± 13 ml with MRA vs −17 ± 9 ml without MRA) and ADC value reduction were found (−78 ± 111 10−6 mm2/s with MRA vs −45 ± 99 10−6 mm2/s without MRA). PAE workflow was modified in 16 patients due to MRA findings. Radiation dose (5518.54 ± 6677.97 µGym2 with MRA vs 23963.50 ± 19792.25 µGym2 without MRA) and fluoroscopy times (19.35 ± 9.01 min. with MRA vs 27.45 ± 12.54 min. without MRA) significantly differed. IPSS reduction improved (−11 ± 8 points with MRA vs −7 ± 9 points without MRA, p < 0.001), while QOL (−2 ± 1 points with MRA and −2 ± 2 points without MRA) and IIEF (+2 ± 10 points with MRA and +1 ± 11 points without MRA) showed no significant differences (p > 0.05). ConclusionsPre-interventional MRA facilitates improved workflow and patient safety of PAE while reducing radiation dose and intervention time.

13: Effects of buprenorphine and dexmedetomidine as adjuvants to low dose 0.5% heavy bupivacaine in spinal anaesthesia in patients undergoing transurethral resection of prostate – A comparative study.

<bold>Background and Aim:</bold>Benign prostatic hypertrophy is common in elderly men. Spinal anaesthesia is preferred in transurethral resection of prostate (TURP). This study compares sensory, motor effects and haemodynamics of buprenorphine and dexmedetomidine as adjuvants to low dose 0.5% heavy bupivacine in spinal anaesthesia .Methods:fter Institutional Ethics Committee approval, a comparative study was conducted which included 30 elderly male patients in the age group 55-75 years belonging to American Society of Anesthesiologists (ASA) grades I and II physical status scheduled for TURP. Patients were randomised into two groups using computer generated random numbers. Group B (n-15) received 2ml 0.5% heavy bupivacine with 45µg buprenorphine and Group D(n-15) received 2ml 0.5% heavy bupivacine with 5µg dexmedetomidine intrathecally.Intra-operatively,following parameters were recorded: Time of onset of T10 , Highest level of motor block sensory analgesia , Time to regression of motor block to Bromage 0 , Duration of analgesia and haemodynamics .Results:A total of 30 patients were included in the study. The demographic data was comparable between the groups .The duration of analgesia in Group-B was 297±43.3 min and in Group-D 412±74.7 min with P value 0.002). There was low incidence of any perioperative complication such as hypotension, bradycardia,nausea and vomiting.Conclusion:Addition of buprenorphine 45µg or dexmedetomidine 5µg to 0.5% heavy bupivacaine intrathecally in TURP resulted in prolonged duration of analgesia with haemodynamic stability. Dexmedetomidine has prolonged duration of analgesia with significant p value (0.002).Variables (min)Group B (mean±SD)Group D (mean±SD)Onset of T10 block6±2.325.7±3.19Highest sensory levelT6T8Regression of motor blockade to Bromage 0223±25.5333±83.99Duration of Analgesia297±43.3412±74.7

An early trial of catheter removal after transurethral resection of the prostate at Sindh Institute of Urology and Transplant.

Background: Transurethral resection of the prostate gland (TURP) is considered a gold standard in Benign Prostatic Hypertrophy. This study aimed to determine the effectiveness of early catheter removals at 48 hours after TURP in patients with mild to moderate enlargement of the prostate.&#x0D; Methodology: A single interventional study was conducted on 79 male subjects with mild to moderate prostate enlargement, and moderate to severe lower urinary tract symptoms. The outcome was measured six hours after trial without a catheter.&#x0D; Results: The mean age of participants was 64.9 ± 7.8 years, and the mean size of the prostate was 54.8 ± 5.9 gm. The frequency of procedural success was 91% (72) and patients with age &lt; 60 years, 24(96%) had procedural success compared to 48(88.9%) age ≥ 60 years.&#x0D; Conclusion: Early catheter removal trial was found successful in most of the study participants at 48 hours after TURP.

Application of Radial Acquisition Multishot sequence in Multiparametric MRI of prostate

The purpose of our study is to evaluate the T2 weighted sequence with multishot radial sampling (Radial Acquisition Multi-shot) also known as Multivane sequence in Philips Healthcare, introduced by J.Pipe with the aim to minimize motion artifacts in Magnetic Resonance Imaging (MRI). In the field of prostate MRI the Multivane sequence is useful in non-cooperating patients and/or patients who, due to their clinical conditions (such as glaucoma, arrhythmia, and severe benign prostatic hypertrophy), have not been receiving intravenous antispasmodic agents, administered for limiting the motility of intestinal loops, particularly rectum. The Multivane sequence is based on the collection of data throughout parallel multiple lines in periodic rotation around the center of k-space and advanced mathematical reconstruction. As the data at the center of k-space (low frequency) containing signals with maximum amplitude will be continuously sampled, this trajectory will provide an excellent contrast-noise ratio (CNR) and spatial resolution, without motion artifacts responsible of "blurring" in the final image. Specifically, each given point of the periphery of the k-space will be sampled by a certain line and the next one and so on, and for the final image reconstruction, once multiple data will be estimated, different algorithms will be used to compensate for motion artifacts. In this study we compared the Radial Acquisition Multishot TSE Multivane (Philips Healthcare) with the classic T2W TSE sequences with linear Cartesian sampling. Multivane sequences have proven to be superior and therefore of greater utility compared to sequences with linear Cartesian data sampling, in patients who can not receiving spasmolytic agents.