Benign Prostatic Obstruction Patients Research Articles

Functional Outcome and Safety of Endoscopic Treatment Options for Benign Prostatic Obstruction (BPO) in Patients ≥ 75 Years of Age.

Background: The selection of suitable patients for the surgical treatment of benign prostatic obstruction (BPO) is a challenge in persons ≥75 years of age. Methods: After a systematic literature search of PubMed, 22 articles were included in this review. Clinical and functional parameters were evaluated statistically. Results: The mean age of the patients was ≥79 years. The mean duration of postoperative catheterization ranged between 2 (d) (ThuLEP, thulium laser enucleation of the prostate) and 4.4 days (TURP, transurethral resection of the prostate). Complication rates ranged between 6% (HoLAP, holmium laser ablation of the prostate) and 34% (PVP, photoselective vaporization of the prostate); the maximum rate of severe complications was 4% (TURP). The mean postoperative maximal urinary flow (Qmax) in mL/sec. ranged between 12.9 mL/sec. (HoLAP) and 19.8 mL/sec (Hol-TUIP, holmium laser transurethral incision of the prostate). The mean quality of life (QoL) score fell from 4.7 ± 0.9 to 1.8 ± 0.7 (HoLEP), from 4.1 ± 0.4 to 1.9 ± 0.8 (PVP), from 5.1 ± 0.2 to 2.1 ± 0.2 (TURP), and from 4 to 1 (ThuVEP, thulium laser vapoenucleation of the prostate). Pearson's correlation coefficient (r) revealed a positive linear correlation between age and inferior functional outcome (higher postoperative International Prostate Symptom Score (IPSS) [r = 0.4175]), higher overall complication rates (r = 0.5432), and blood transfusions (r = 0.4474) across all surgical techniques. Conclusions: This meta-analysis provides the summary estimates for perioperative and postoperative functional outcome and safety of endoscopic treatment options for BPO in patients ≥ 75 years of age. Of particular importance is that all surgical techniques significantly improve the postoperative quality of life of patients in this age group compared to their preoperative quality of life.

Robot-assisted Simple Prostatectomy Is Better than Endoscopic Enucleation of the Prostate

Robot-assisted simple prostatectomy represents a solid treatment option for benign prostatic obstruction in patients with large prostate glands. This procedure offers multiple attractive features that make it a strong competitor against endoscopic enucleation of the prostate.

Efficacy and Safety of Surgery for Benign Prostatic Obstruction in Patients with Preoperative Urinary Catheter.

Purpose: To evaluate the efficacy and safety of benign prostatic obstruction (BPO) surgery in patients with preoperative urinary catheterization. Patients and Methods: We conducted a multi-institutional retrospective study including all patients who failed a trial without catheter (TWOC) after acute urinary retention (AUR) between January 2017 and January 2019. Patients with neurogenic bladder, prostate cancer, or urethral stricture were excluded from the analysis. Patients underwent either monopolar/bipolar transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), prostate artery embolization (PAE), open prostatectomy (OP), or endoscopic enucleation. The primary endpoint was 12-month urinary catheter-free survival without using benign prostatic hyperplasia medications. Results: One hundred seventy-one consecutive men (median age: 71 years; median prostate volume: 75 cm3) underwent BPO surgery, including 48 (28%) TURP, 62 (36.3%) PVP, 21 (12.3%) endoscopic enucleation, 15 (8.8%) PAE, and 25 (14.6%) OP. The median duration of preoperative urinary catheterization was 69 days (interquartile range 46-125). The 12-month urinary catheter-free survival rate was 84.8% (145/171). Satisfactory voiding returned to 121 patients (70.8%). On backward stepwise multivariable analysis, PVP (odds ratio [OR] 0.27 [0.10-0.69]; p = 0.008), PAE (OR 5.27 [1.28-27.75]; p = 0.03), endoscopic enucleation (OR 0.08 [0-0.49]; p = 0.023), OP (OR 0.10 [0.01-0.57]; p = 0.034), Charlson score (OR 1.36 [1.14-1.66]; p = 0.001), and number of preoperative TWOC failure (OR 2.53 [1.23-5.51]; p = 0.014) were significantly associated with catheter-free survival. Conclusions: In this multi-institutional retrospective study, including patients with preoperative catheterization, the overall success rate of BPO surgery was 70.8% after 1-year follow-up. Compared with TURP, enucleation methods and PVP were associated with better catheter-free survival, whereas PAE was associated with higher risk of AUR recurrence.

Waterjet Ablation Therapy for Treating Benign Prostatic Obstruction in Patients with Small- to Medium-size Glands: 12-month Results of the First French Aquablation Clinical Registry

BackgroundAquablation has emerged as a novel ablative therapy combining image guidance and robotics for targeted waterjet adenoma resection. ObjectiveTo describe a standardised technique of aquablation in the treatment of benign prostatic obstruction (BPO), and to report the perioperative and 1-yr functional outcomes obtained by multiple surgeons with no previous experience of the technique. Design, setting, and participantsBetween September 2017 and January 2018, patients referred to three different urological centres for BPO surgical management were prospectively enrolled to undergo an aquablation procedure. Surgical procedureAquablation was performed using the Aquabeam system (Procept BioRobotics, Redwood Shores, CA, USA) that combines transrectal prostatic image guidance and robotics bespoke tissue resection with a high-pressure saline jet. The surgeon defines the area of treatment, and the resection is executed automatically. MeasurementsThe primary endpoint was the change in total International Prostate Symptom Score (IPSS) score at 6 and 12mo. Functional outcomes were assessed at 1, 3, 6, and 12mo with IPSS, International Index of Erectile Function (IIEF)-15, Sexual Health Inventory for Men, and Male Sexual Health Questionnaire questionnaires and uroflowmetry. Results and limitationsThirty patients were enrolled in the study. The median operative time and resection time were 30.5 (24–35) and 4 (3.1–4.9)min, respectively. The median catheterisation time was 43 (23–49)h. The median hospitalisation stay was 2 (2–4)d. The IPSS score improved to 3 (1–6) at the 6mo, with a mean change of 15.6 points (95% confidence interval 13–18.2). IPSS improvements persisted at month 12. The maximum urinary flow rate improved to 20.4 (17–26)ml/s at 12mo. The 6-mo rates of Clavien-Dindo grade 2 and 3 events were 13.3%. There were no reports of incontinence or de novo erectile dysfunction. Postoperative de novo ejaculatory dysfunction was observed in 26.7% of patients. ConclusionsThis clinical registry confirmed that aquablation was feasible, safe, and effective, and provided immediate good functional results and similar outcomes to those of prior studies despite the lack of surgeons’ previous experience with the technique. Patient summaryAquablation is feasible, safe, and reproducible with promising outcomes for treating benign prostatic enlargement.

Validated uroflowmetry-based predictive model for the primary diagnosis of urethral stricture disease in men.

To define a uroflowmetry-based non-invasive predictive tool for the primary diagnosis of urethral stricture disease. A total of 300 male patients (150 with urethral stricture disease and 150 with benign prostatic obstruction), treated surgically between 2005 and 2015, and 75 healthy males were included in this study. Patients were randomly assigned to one of two groups (75 benign prostatic obstruction patients and 75 urethral stricture disease patients in each group). A model, able to objectively differentiate between benign prostatic obstruction and urethral stricture disease, was created by use of original and hybrid uroflowmetry variables in logistic regression in groupA (test group). Receiver operating characteristics curve analysis was used for validation in groupB (validation group) and to calculate cut-off values to distinguish healthy individuals from benign prostatic obstruction as a result of urethral stricture disease. Receiver operating characteristics area under the curve values of the created model were 0.841 (0.777-0.905) and 0.807 (0.735-0.879) in groups A and B, respectively. Optimal cut-off values were 2.2847 and 0.1182 to distinguish healthy individuals versus benign prostatic obstruction and benign prostatic obstruction versus urethral stricture disease. A triphasic uroflowmetry-based model is able to objectively distinguish voiding patterns of healthy individuals, benign prostatic obstruction and urethral stricture disease. The probability of urethral stricture disease can be objectively calculated for each individual patient based on a non-invasive uroflowmetry test. Uroflowmetry pattern interpretation by use of statistical models could become a new standard.

Impact of detrusor underactivity on the outcomes of transurethral resection of prostate in patients with benign prostatic obstruction

Objective To analyze the impact of detrusor underactivity(DU) on the outcomes of transurethral resection of prostate (TURP) in patients with benign prostatic obstruction(BPO). Methods A retrospective study was conducted in 157 BPO patients who underwent TURP from January 2013 to December 2016.Their ages ranged from 48 to 86 years with a mean age of 70 years. All patients underwent urodynamic study before surgery, bladder contraction index(BCI) ranged from 49.3 to 208.6, with a mean of 120.1. The patients were divided into two groups according to BCI. DU group(BCI 0.05 for each). The outcomes of TURP were assessed by the above mentioned parameters at 3 months postoperatively; IPSS、IPSS-S、IPSS-V were regarded as successful if they improved more than 50%, QOL was successful if it was improved more than 3, fQmax successful if it was improved 5ml/s.The change and successful improvement rates of the above mentioned parameters were compared between DU and non-DU group. Through receiver operating characteristic curve(ROC) analysis , patients were categorized into mild DU and severe DU group and compared the successful improvement rates between the two groups. Results Both DU group and non-DU group improved significantly in IPSS, IPSS-S, IPSS-V, QOL, fQmax, PVR at 3 months postoperatively(P 0.05 for each]. Conclusions Benign prostatic obstruction patients with DU can achieve improvement in both subjective and objective parameters after TURP, but patients without DU can get more improvement. BPO patients with severe DU patients show a worse improvement of the voiding symptom. Surgeons should have adequate communication with the patients and inform them of appropriate expectations. Key words: Benign prostatic obstruction; Transurethral resection of prostate; Urodynamics; Bladder contraction index; Detrusor underactivity

294 - Results of laser Greenlight® 180-W XPS vaporization for benign prostatic obstruction in patients with antithrombotic therapy or platelet aggregation inhibitors: A multicentric study

294 - Results of laser Greenlight® 180-W XPS vaporization for benign prostatic obstruction in patients with antithrombotic therapy or platelet aggregation inhibitors: A multicentric study

Current Management in Transurethral Therapy of Benign Prostatic Obstruction in Patients on Oral Anticoagulation: A Worldwide Questionnaire.

To assess the current treatment of benign prostatic obstruction (BPO) in patients on ongoing oral anticoagulation (OA). An Internet survey was sent to all active members of the Endourological Society. The survey contained 32 questions regarding transurethral treatment of BPO in patients on ongoing OA, different techniques, and arising complications. Out of all members (n = 2000) of the Endourological Society, 133 participated in our survey. Eighty-eight percent of the participants indicated to perform transurethral therapy of BPO on ongoing OA, whereas 60% of this group temporarily pause the OA during the intervention. Sixteen percent perform >30 transurethral interventions of BPO on ongoing OA per year. Most operations are performed under continuation of aspirin (58.2%). The continuation of adenosine diphosphate (ADP)-receptor inhibitors (22.1%), vitamin K antagonists (18.9%), factor Xa inhibitors (15.6%), or the combination of two oral anticoagulants (16.4%) is continued less often. The decision for the operation on ongoing OA is usually approved by the cardiologist (58%) or it cannot be stopped in case of emergency (29%). GreenLight laser (39%) was the most frequently used technique on ongoing OA, followed by monopolar or bipolar transurethral resection of the prostate (35%) as well as other sources of laser [holmium (12%), thulium (12%), diode laser (2%)]. Although OA was continued during the interventions, cardiovascular complications were observed in 31.6%. Current practice shows that the majority of a representative group of the Endourological Society members perform transurethral therapy of BPO in patients on ongoing OA. The incidence of perioperative complications under transurethral therapy of BPO on ongoing OA is lower than previously assumed.

Treatment outcomes of benign prostate hyperplasia by thulium vapoenucleation of the prostate in aging men

PurposeTo analyze the outcomes of thulium vapoenucleation of the prostate (ThuVEP) in the management of benign prostatic hyperplasia. The outcomes of this increasingly popular procedure are yet to be confirmed in patients with various prostate sizes and health status. Materials and methodsThree hundred and three patients who underwent ThuVEP were included and stratified in subgroups according to prostate size and age. We analyzed patient demographics, preoperative disease-related parameters, and perioperative and follow-up results. Correlation of prostate size and operation time were also assessed. ResultsBaseline mean prostate volume was 61.0 mL (range 19.3–226 mL), mean urinary peak flow rate (Qmax) was 8.6 mL/second (range 1.4–23.25 mL/second), mean postvoid residual volume was 126.2 mL (range 0–649 mL) and mean International Prostate Symptom Score was 25.1 (range 8–35). The mean operation time was 84.0 minutes and 88.6 minutes for total and prostate volume >80 mL, respectively. After laser surgery, there were mean reductions of 5.3 ng/mL, 7.5 ng/mL, 3.7 ng/mL, and 3.5 ng/mL (38.0%, 49.7%, 30.3%, and 36.5% change from baseline) in prostate-specific antigen level among the four groups. As for postvoid residual volume, there was a significant reduction in volume in the total, prostate volume >80 mL and prostate volume <80 mL (−73.9 mL, −70.8 mL, and −67 mL, respectively) but not in the elderly group (−31.4 mL, p = 0.068). Similarly, Qmax improved significantly in all (6.7 mL/second, 5.9 mL/second, and 6.0 mL/second, respectively) except the elderly group (2.3 mL/second, p = 0.103). The operation time was highly correlated with the prostate size. ConclusionThis study indicates that ThuVEP is an effective treatment option for benign prostatic obstruction in patients with different prostate size and age. The technique allows an efficient surgical course with operation time highly correlated with prostate size.

MP35-15 CLINICAL FEATURES OF HYDRONEPHROSIS IN PATIENTS WITH BENIGN PROSTATE HYPERPLASIA AND ACUTE URINARY RETENTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation1 Apr 2016MP35-15 CLINICAL FEATURES OF HYDRONEPHROSIS IN PATIENTS WITH BENIGN PROSTATE HYPERPLASIA AND ACUTE URINARY RETENTION Chin-Heng Lu, Howard Hong-Hao Wu, Yu-Hua Fan, Chih-Chieh Lin, Yi-Hsiu Huang, Tzu-Ping Lin, Hsiao-Jen Chung, Junne-Yih Kuo, William Jhih-Sian Huang, Yen-Hua Chang, Alex Tong-Long Lin, and Kuang-Kuo Chen Chin-Heng LuChin-Heng Lu More articles by this author , Howard Hong-Hao WuHoward Hong-Hao Wu More articles by this author , Yu-Hua FanYu-Hua Fan More articles by this author , Chih-Chieh LinChih-Chieh Lin More articles by this author , Yi-Hsiu HuangYi-Hsiu Huang More articles by this author , Tzu-Ping LinTzu-Ping Lin More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung More articles by this author , Junne-Yih KuoJunne-Yih Kuo More articles by this author , William Jhih-Sian HuangWilliam Jhih-Sian Huang More articles by this author , Yen-Hua ChangYen-Hua Chang More articles by this author , Alex Tong-Long LinAlex Tong-Long Lin More articles by this author , and Kuang-Kuo ChenKuang-Kuo Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1607AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Some benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) hesitated to receive surgical treatment till acute urinary retention (AUR) occurred. Part of them combined hydronephrosis which induced renal insufficiency. Many studies had analyzed risk factors for predicting acute urinary retention and other associated complications in benign prostatic obstruction (BPO) patients. This study aimed to predict what kind of patients who needed transurethral resection of the prostate (TURP) for AUR tended to accompany with hydronephrosis. METHODS We retrospectively evaluated 91 patients who had benign prostate obstruction (BPO) and received TURP for acute urinary retention from January 2014 to June 2015. Exclusion criteria including the patient had urolithiasis, prostate cancer, bladder cancer or gross hematuria. Parameters of intravesical prostatic protrusion (IPP), bladder wall thickness (BWT), serum PSA, total prostate volume, age, BMI, HTN, DM, CAD, serum creatinine and the results from the pressure-flow study (UFR) and cystometrogram (CMG) results were compared between the hydronephrosis group (n=24) and non-hydronephrosis group (n=67). RESULTS The There were significant differences in BWT (p<0.001), IPP (p<0.001) and Cr (p<0.001) between the hydronephrosis and non-hydronephrosis groups. For BWT, the area under the curve was 0.947 (95% confidence interval, 0.888 to 1.000, P<0.0001) and the cutoff value to indicate hydronephrosis was 0.75 mm with 88.0% sensitivity and 91.9% specificity. The odds ratio was 83.6 (95% confidence interval, 18.403 to 379.774). For IPP, the area under the curve was 1.950 (95% confidence interval, 0.720 to 0.344, P<0.0001) and the cutoff value to indicate hydronephrosis was 1.95 mm with 72.0% sensitivity and 65.6% specificity. The odds ratio was 4.909 (95% confidence interval, 1.781 to 13.533) There were no significant differences in age, BMI, DM, HTN, CAD, pre-TURP, PSA, UFR between the 2 groups. IPP was weakly correlated with total prostate volume (p=0.423). There was no significant differences for a specific type of CMG result but 42.3% AUR patients showed overactivity bladder. CONCLUSIONS Clinical parameters of BWT and IPP were significant risk factors for predicting hydronephrosis in BPO patients. If patients’ BWT exceeding 0.75 cm or IPP exceeding 1.95 cm, they have highly risk for combination of hydronephrosis when AUR occurred. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e486 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Chin-Heng Lu More articles by this author Howard Hong-Hao Wu More articles by this author Yu-Hua Fan More articles by this author Chih-Chieh Lin More articles by this author Yi-Hsiu Huang More articles by this author Tzu-Ping Lin More articles by this author Hsiao-Jen Chung More articles by this author Junne-Yih Kuo More articles by this author William Jhih-Sian Huang More articles by this author Yen-Hua Chang More articles by this author Alex Tong-Long Lin More articles by this author Kuang-Kuo Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Current Practice in the Transurethral Treatment of Benign Prostatic Obstruction under Oral Anticoagulants : ANation-wide Survey

Only few studies have assessed the safety and efficacy of transurethral surgery (TS) for the treatment of benign prostatic obstruction (BPO) in patients on oral anticoagulants. The aim of our study was to evaluate current treatment strategies and complication rates of TS for the treatment of BPO in patients on OA using an online survey. Atotal of 300 German departments of urology received an e‑mail with alink for the online survey. The items of the questionnaire assessed the present practice of TS for BPO in patients on OA and the occurrence of complications. Seventy-five (23.4 %) departments responded to the online questionnaire. Of the respondents, 94.7 % performed TS in patients with BPO on OA and 42.7 % answered that they perform more than 30prostate surgeries per year under OA. The respondents indicated that surgeries were carried out under aspirin (96 %), clopidogrel (46.7 %) or phenprocoumon (26.7 %). Indications for surgeries under OA were made by cardiologist recommendation (82.7 %), the surgeon (37.3 %), a need for emergency surgery (52 %), or the patient's will (10.7 %). Sixty-two (82.7 %) of the respondents perform bipolar or monopolar transurethral resection of the prostate (TUR-P) in patients on OA. In addition, 69.3 % of the respondents indicated that they use laser prostatectomy in patients on OA (thulium 24 %, Greenlight 24 %, holmium 16 %, and diode laser 5.3 %). Cardiovascular complications occurred in 12 % of the respondents. Despite the poor evidence for performing TS of BPO under OA, our survey showed surprising results: TS of BPO under OA is frequently performed, especially bipolar and monopolar TUR-P. Although our data were obtained using an online survey, the complication rates appear to be lower than previously thought.

Expression of 5-Hydroxytryptamine Receptors in Human Urinary Bladders with Benign Prostatic Hyperplasia

This study investigated the mRNA expression pattern and distribution of 5-hydroxytryptamine (5-HT) receptors 5-HT2A, 5-HT2B, 5-HT3A, 5-HT4, and 5-HT7 within the urothelium and detrusor of normal bladder tissue and in the urothelium of bladders from patients with benign prostatic hyperplasia (BPH). Normal urinary bladder specimens were obtained from 13 patients undergoing radical cystectomy due to bladder cancer (normal group) and BPH specimens were obtained from 27 benign prostatic obstruction patients receiving transurethral prostatectomy or retropubic prostatectomy. Receptor subtype mRNA expression was determined by real-time reverse transcription polymerase chain reaction on urothelium, detrusor, and whole mucosal preparations. Receptor distribution was determined by immunohistochemistry. In normal tissues, expressions of 5-HT2B and 5-HT7 receptor mRNAs in the urothelium, detrusor, and whole mucosa were greater than the average expression for all receptor subtype mRNAs. 5-HT2B receptor protein was distributed in the apical urothelium and among the detrusor smooth muscle layers. In contrast, the 5-HT7 receptors were within the urothelium middle cell layers and detrusor smooth muscle cells. The expression pattern of each 5-HT receptor subtype mRNA within the BPH urothelium was similar to that in the normal urothelium. The expression level of 5-HT2A receptor mRNA in the BPH group was significantly lower than the normal group; however, the expressions of both 5-HT3A and 5-HT7 mRNAs were significantly higher. The expressions of both 5-HT2B and 5-HT4 mRNAs were not significantly different between the normal and BPH groups. In normal urinary bladders, the expressions of both 5-HT2B and 5-HT7 mRNAs were higher compared to the 5-HT2A, 5-HT3A, and 5-HT4 mRNAs. The distributions of 5-HT2B and 5-HT7 receptors were different in the urothelium and detrusor layers. The 5-HT3A and 5-HT7 receptor mRNAs in the BPH group were significantly higher compared to the normal urothelium, while the 5-HT2A mRNA was significantly lower. Asahi Kasei Pharma Corporation.

Relationships between Prostatic Volume and Intravesical Prostatic Protrusion on Transabdominal Ultrasound and Benign Prostatic Obstruction in Patients with Lower Urinary Tract Symptoms

The objective of this study is to determine the relationships between prostatic volume (PV) and intravesical prostatic protrusion (IPP) with benign prostatic obstruction (BPO). A total of 408 males (aged 50 years and above) who presented with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) were recruited. All had International Prostate Symptoms Score (IPSS), quality of life (QOL) index, uroflowmetry (Qmax) and postvoid residual urine (PVR) measured by transabdominal ultrasonography (TAUS). The PV and the degree of IPP were also measured by TAUS in the transverse and sagittal planes respectively. The PV is classified as Grade a, (20 ml or less), Grade b, (more than 20 ml to 40 ml) and Grade c, (more than 40 ml), while the IPP is graded as Grade 1 (5 mm or less), Grade 2 (more than 5 mm to 10 mm) and Grade 3 (more than 10 mm). There was a fair positive correlation between the PV and IPP (Spearman, r(s) = 0.62, P <0.001) with important clinical exceptions. There was negative correlation between the PV and Qmax (rs = -0.20, P = 0.022), IPP and Qmax (r(s) = -0.30, P <0.001). PV and IPP were good predictors of BPO. However, IPP was slightly better (r(s) of -0.30 vs -0.20) than PV. PV is related to IPP with important clinical exceptions. IPP is a better predictor of BPO than PV.

Role of Bladder Neck and Urethral Sphincter Dysfunction in Men with Persistent Bothersome Lower Urinary Tract Symptoms after α‐1 Blocker Treatment

To analyze the video-urodynamic results of voiding dysfunction in men of all ages with bothersome lower urinary tract symptoms (LUTS) after α-1 adrenoceptor blocker therapy. A total of 930 consecutive men over 45 years of age with LUTS who were failure treated with α-1 blocker therapy for at least one month were retrospectively studied. Patients underwent video-urodynamic studies to evaluate the cause of lower urinary tract dysfunction (LUTD). Clinical symptoms, prostatic measurements, and video-urodynamic findings were compared among different LUTD groups. After video-urodynamic studies, 653 (70.2%) men were diagnosed with voiding dysfunction and 277 (29.8%) were with bladder dysfunction. Among patients with voiding dysfunction, bladder neck dysfunction (BND) occurred in 242 (37.1%), benign prostatic obstruction (BPO) in 298 (45.6%), and poor relaxation of the external sphincter (PRES) in 113 (17.3%). The symptom score did not differ significantly among the three subgroups. The mean age, total prostate volume (TPV), transition zone index, and prostate-specific antigen were also significantly higher in BPO patients compared with the other two subgroups, but no difference was noted between BND and PRES patients. BPO patients had significantly higher voiding pressure, higher Abrams-Griffiths number, lower Qmax, and a higher rate of detrusor overactivity than did patients in the other two subgroups. Bladder neck dysfunction and PRES play important roles in male LUTS. In men younger than 70 years with small TPV and persistent LUTS after α-1 blocker therapy, video-urodynamic studies should be performed to make an accurate diagnosis before invasive surgery is planned.

Safety and effectiveness of Thulium VapoEnucleation of the prostate (ThuVEP) in patients on anticoagulant therapy

To evaluate the safety and efficacy of Thulium VapoEnucleation of the prostate (ThuVEP) for patients on oral anticoagulants (OA) with symptomatic benign prostatic obstruction (BPO). Fifty-six patients, undergoing ThuVEP at two institutions, were evaluated from May 2009 until June 2011. All patients were at high cardiopulmonary risk and presented with a median American Society of Anesthesiology score of 3 [interquartile range (IQR) 2-3]. Thirty-two patients were on aspirin, 8 were on clopidogrel or clopidogrel and aspirin, and 16 on phenprocoumon at the time of surgery. Patient demographic, perioperative, and follow-up data were analyzed. Median prostate volume was 50 (IQR 34-76) cc, and resected tissue weight was 32 (IQR 20-50) g. The median operative time was 61.5 (IQR 40-100.75) min, and the catheter time 2 (IQR 2-3) days. There were no perioperative thromboembolic events. Five patients (8.9%) required a second-look operation in the immediate postoperative course (hemorrhage n = 4, residual adenoma n = 1) and four (7.1%) blood transfusions. Complications within the first 30 days included urinary tract infections (1.7%), urinary retention (3.6%), and delayed bleeding (7.1%). These complications were managed conservatively. At 12-month follow-up, median QoL [5 (IQR 3.75-5) vs. 1 (IQR 1-2)], IPSS [21.5 (IQR 15.5-23.75) vs. 5 (IQR 3-8)], Qmax [7.7 (IQR 6.3-10) vs. 28.3 (IQR 21.25-39.2) ml/s], and postvoiding residual urine [100 (IQR 46-200) vs. 17.5 (IQR 0-36) ml] improved significantly (p < 0.002). Thulium VapoEnucleation of the prostate seems to be a safe and efficacious procedure for the treatment of symptomatic BPO in patients at high cardiopulmonary risk on OA.

Nocturia and sleep quality after transurethral resection of the prostate

To evaluate the clinical efficacy of transurethral resection of the prostate on nocturia and sleep disorders in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. A prospective multicenter study including lower urinary tract symptoms suggestive of benign prostatic obstruction patients with nocturia (twice or more) undergoing transurethral resection of the prostate was carried out. All patients were assessed using the International Prostate Symptom Score and the Pittsburgh Sleep Quality Index at baseline, and 6 months after transurethral resection of the prostate. Overall, 49 patients were included in the study. A total of 20 of them (41%) had a sleep disorder defined as a score of 5.5 or more on the Pittsburgh Sleep Quality Index global score. The nocturia score significantly correlated with component 4 of the Pittsburgh Sleep Quality Index (habitual sleep efficiency). Nocturia significantly decreased after transurethral resection of the prostate from 3.0 ± 1.2 to 1.9 ± 0.8, whereas the global Pittsburgh Sleep Quality Index score did not. In 20 patients with a sleep disorder before transurethral resection of the prostate, subjective sleep quality (component 1) and habitual sleep efficiency (component 4) significantly decreased after transurethral resection of the prostate, but this was not the case for the global Pittsburgh Sleep Quality Index score. In 16 patients with a persistent sleep disorder after transurethral resection of the prostate, International Prostate Symptom Score, voiding and storage symptoms score were higher than those of patients without a sleep disorder, although the nocturia score improved equivalently in both groups. Transurethral resection of the prostate diminishes nocturnal urinary frequency and partly improves sleep quality in patients with nocturia and lower urinary tract symptoms suggestive of benign prostatic obstruction. A persistent sleep disorder after transurethral resection of the prostate is associated with persistent voiding and storage symptoms.

2178 SAFETY AND EFFECTIVENESS OF THULIUM VAPOENUCLEATION OF THE PROSTATE IN PATIENTS WITH ONGOING ORAL ANTICOAGULATION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (III)1 Apr 20132178 SAFETY AND EFFECTIVENESS OF THULIUM VAPOENUCLEATION OF THE PROSTATE IN PATIENTS WITH ONGOING ORAL ANTICOAGULATION Christopher Netsch, Michael Stöhrer, Sophie Knipper, Thorsten Bach, Thomas Herrmann, and Andreas Gross Christopher NetschChristopher Netsch Hamburg, Germany More articles by this author , Michael StöhrerMichael Stöhrer Hannover, Germany More articles by this author , Sophie KnipperSophie Knipper Hamburg, Germany More articles by this author , Thorsten BachThorsten Bach Hamburg, Germany More articles by this author , Thomas HerrmannThomas Herrmann Hannover, Germany More articles by this author , and Andreas GrossAndreas Gross Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2087AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated the safety and efficacy of Thulium VapoEnucleation of the prostate (ThuVEP) in patients with ongoing oral anticoagulation (OA) and symptomatic benign prostatic obstruction (BPO). METHODS Fifty-six patients, undergoing ThuVEP at two institutions, were evaluated prospectively from May 2009 until June 2011. All patients were at high cardiopulmonary risk and presented with a mean American Society of Anesthesiology score of 2.7±0.5. Thirty-two patients were on aspirin, 8 were on clopidogrel or clopidogrel and aspirin, and 16 on phenprocoumon at the time of surgery. Patient demographic, perioperative, and 12-month follow-up data were analyzed. The complications were assessed. RESULTS Mean prostate volume was 57.15±30.75 cc and resected tissue weight was 37.72±22.91 gm. The mean operative time was 74.92±46.81 minutes and the catheter time 2.14±0.36 days, respectively. The mean postoperative haemoglobin decrease was 1.4±1.18 g/dL. There were no perioperative thromboembolic events. Five (8.9%) patients required a second-look operation in the immediate postoperative course (haemorrhage n=4, residual adenoma n=1) and four (7.1%) patients received blood transfusions. Complications within 30 days included urinary tract infection (n=1, 1.7%), acute urinary retention (n=2, 3.6%), and delayed bleeding (n=4, 7.1%). These complications were managed conservatively. At 12-month follow-up, Quality of Life (4.38±0.93 vs. 1.47±0.95), international prostate symptom score (20.25±5.25 vs. 5.29±3.28), maximum urinary flow rate (8.22±3.15 vs. 29.4±11.08 ml/s), and post-void residual urine (123.6±98.67 vs. 22.4±25.35 ml) improved significantly (p<0.002). None of the patients were re-treated during follow-up for recurrent prostatic tissue, urethral strictures or bladder neck contractures. CONCLUSIONS ThuVEP is a safe and efficacious procedure for the treatment of symptomatic BPO in patients at high cardiopulmonary risk with ongoing OA. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e893 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Netsch Hamburg, Germany More articles by this author Michael Stöhrer Hannover, Germany More articles by this author Sophie Knipper Hamburg, Germany More articles by this author Thorsten Bach Hamburg, Germany More articles by this author Thomas Herrmann Hannover, Germany More articles by this author Andreas Gross Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Correlation Between Bladder Mucosal Alpha-1D/Alpha-1A Adrenoceptor mRNA Ratio and Lower Urinary Tract Function in Benign Prostatic Obstruction Patients.

Alpha-1 adrenoceptor (AR) antagonists are commonly used as therapeutic agents for patients with benign prostatic obstruction (BPO). Our objective was to investigate the correlation between the ratio of bladder mucosal alpha-1D/alpha-1A adrenoceptor mRNA and lower urinary tract function in BPO patients. In 20 BPO patients, the expression level of alpha-1 AR mRNAs in the bladder mucosal biopsies was investigated by reverse transcriptase polymerase chain reaction. The subjects were divided into two groups. In Group 1, the ratio of alpha-1D mRNA to alpha-1A mRNA was greater than one. In Group 2, the ratio was less than one. We determined the correlation by Schäfer nomogram between Group 1 and Group 2 patients and lower urinary tract function as determined by a video urodynamic study. Two patients were excluded due to inability to void. Another was excluded because the alpha-1D/alpha-1A mRNA ratio was one. On the Schäfer nomogram, six of nine Group 1 cases had obstructions less than IV and normal or weak detrusor contractility. For Group 2, six of eight cases had obstructions more than IV and normal or strong detrusor contractility. Patients with higher levels of alpha-1D AR mRNA were distinct from those with higher alpha-1A AR mRNA levels with regard to obstruction and detrusor activity. The results suggest that the Schäfer nomogram might be useful in determining which alpha-1 AR antagonists are better for BPO patients suffering from storage symptoms.

Relationship between expression of β3‐adrenoceptor mRNA in bladder mucosa and urodynamic findings in men with lower urinary tract symptoms

To investigate the relationship between urinary bladder mucosal expression of β3-adrenoceptor (AR) mRNA and urodynamic findings in patients with lower urinary tract symptoms and benign prostatic obstruction (BPO). During surgical prostate resection of 32 BPO patients, mucosal biopsies were collected and analyzed by reverse transcriptase polymerase chain reaction to determine the expression level of β3-AR mRNA. First desire to void (FDV) and strong desire to void (SDV), detrusor overactivity (DO), and bladder outlet obstruction (BOO) were measured pre-operatively. Patients with FDVs < 200 ml or SDVs < 300 ml were assigned to the small capacity group (n = 19). Patients with FDVs > 201 ml and SDVs > 301 ml were assigned to the large capacity group (n = 13). The same patients with positive DO were also assigned to the DO+ group (n = 11), and those with negative DO were assigned to the DO- group (n = 21). Finally, patients whose position on the Schäfer nomogram was greater than degree V were assigned to the severe BOO group (n = 17), while those with less than degree IV were assigned to the mild BOO group (n = 15). The expression level of β3-AR mRNA was similar in both bladder capacity groups and both DO groups. However, the expression level in the severe BOO group was significantly less than in the mild BOO group (P = 0.043). The expression of bladder mucosal β3-AR mRNA was significantly decreased in patients with severe BOO, suggesting that β3-ARs might be affected by the degree of BOO.

Benign Prostatic Obstruction and Parkinson's Disease—Should Transurethral Resection of the Prostate be Avoided?

According to the literature transurethral resection of the prostate in patients with Parkinson's disease has an increased risk of postoperative urinary incontinence. However, this conclusion might have been reached because some patients with multiple system atrophy incorrectly diagnosed as Parkinson's disease were included in these reports. Therefore, we investigated the outcome of transurethral prostate resection in patients with a secure neurological diagnosis of Parkinson's disease. A total of 23 patients with Parkinson's disease who underwent transurethral prostate resection for benign prostatic obstruction were evaluated retrospectively. Subsequent neurological developments in patients were followed, ensuring that those with multiple system atrophy had not been included in analysis. At transurethral prostate resection median patient age was 73 years, median duration of Parkinson's disease before the resection was 3 years, and median Hoehn and Yahr scale was 2. Of the 14 patients with a preoperative indwelling urinary catheter transurethral prostate resection restored voiding in 9 (64%) and only 5 (36%) required catheterization postoperatively. Of the 10 patients with preoperative urge urinary incontinence, continence was restored in 5 and improved in 3 following transurethral prostate resection. There were no cases of de novo urinary incontinence after transurethral prostate resection. At a median postoperative followup of 3 years transurethral prostate resection was successful in 16 of the 23 patients (70%). Transurethral prostate resection for benign prostatic obstruction in patients with Parkinson's disease may be successful in up to 70% and the risk of de novo urinary incontinence seems minimal. Thus, Parkinson's disease should no longer be considered a contraindication for transurethral prostate resection provided that preoperative investigations including urodynamic assessment indicate prostatic bladder outlet obstruction.