Treatment Of BPH Research Articles

Greenlight laser (XPSTM) 180W prostatectomy for treatment of benign prostate hyperplasia in patients with uncorrectable bleeding tendency

ABSTRACT Objectives Safety of GreenLight™ laser prostatectomy (GL-LP) in patients with ongoing blood thinners has been proven. Yet, the possibility of drug manipulation makes it a less challenging situation compared to treating patients with uncorrectable bleeding tendency. Herein, we aim at evaluating the outcomes of XPS™-180 W GL-LP for treatment of BPH in patients who had uncorrectable bleeding tendency due to hepatic dysfunction. Methods A prospectively maintained database for all patients who underwent GL-LP for symptomatic BPH was reviewed. Patients were divided into two groups based on the degree of hepatic dysfunction using Fib-4 index: Group 1 (indexed patients; low-risk Fib-4) and Group 2 (non-indexed patients; intermediate-high-risk Fib-4) included those who had chronic liver disease associated with either thrombocytopenia and/or hypoprothrombinemia. Primary outcome was the difference in perioperative bleeding complications between the two groups. Other outcome measures included all perioperative findings and complications as well-functional outcome measures. Results The study included 140 patients (93 indexed patients and 47 non-indexed). There were no significant differences between both groups in operative time, laser time and energy, auxiliary procedures, catheter time, hospital stay, and hemoglobin deficit. The need for blood transfusion was significantly more in group 2 (two patients (4.3%) versus no patients in group 1, P = 0.045). Perioperative and late postoperative complications were comparable for both groups (P = 0.634 and 0.858, respectively). There were no significant differences in the postoperative uroflow, symptoms score, and PSA reduction between the two groups (P = 0.57, 0.87, and 0.05, respectively). Conclusions XPS™-180 W GL-LP is a safe and effective technique for treatment of BPH in patients with uncorrectable bleeding tendency due to hepatic dysfunction.

A clinical study on causes of small pupil and its management in Small incision cataract surgery

To evaluate the causes of small pupil and its intra-operative complications in SICS.A total of 50 patients presenting to OPD with Small pupil measured after maximal dilation using tropicamide (0.5%) with phenylephrine (1%) e/d administered 4 times at 15 minutes interval were enrolled in this study. Detailed clinical history, prior medication, presence of possible risk factors, underlying co-morbidities and history of trauma were noted for every case. The results drawn from the study out of 50 patients, revealed that 14 cases were associated with Pseudo-exfoliation syndrome, 16 cases with posterior synechiae (11 were associated with chronic uveitis And 5 cases had history of Trauma), 12 cases were associated with DM, 2 patients had history of intraocular surgery, 1 patient was on Tab. Tamsulosin for treatment of BPH. The remaining 5 cases were atonic pupil in old age patients.The current study discusses the causes of Small pupil and its intra-operative complications along with its management. It’s crucial for every cataract surgeon to cope with small pupil manifesting preoperatively and intra-operatively.

Evaluation of the Cost-Effectiveness of Surgical Treatment Options for Benign Prostatic Hyperplasia

ObjectiveTo compare the cost-effectiveness of surgical interventions for BPH. MethodsUsing a Markov model, a cost-utility analysis was performed comparing HoLEP, B-TURP, WVTT, and PUL for prostate size <80cc (index patient 1) and HoLEP and SP for prostate size >80cc (index patient 2). Model probabilities and utility values were drawn from the literature. Analysis was performed at a 5-year time horizon with extrapolation to a lifetime horizon. Primary outcomes included quality-adjusted life years (QALYs), 2021 Medicare costs, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY. Univariate and probabilistic sensitivity analyses were performed. ResultsAt 5 years, costs per patient for index patient 1 were $3292 (WVTT), $6532 (HoLEP), $6670 (B-TURP), and $10,257 (PUL). HoLEP resulted in the highest QALYs (4.66), followed by B-TURP (4.60), PUL (4.38), and WVTT (4.38). This translated to HoLEP being most cost-effective (ICER $11,847). For index patient 2, HoLEP was less costly ($6,585 vs $15,404) and more effective (4.654 vs 4.650) relative to SP. On sensitivity analysis for index patient 1, B-TURP became most cost-effective if cost of HoLEP increased two-fold or chronic stress incontinence following HoLEP increased ten-fold. When follow-up time was varied, WVTT was preferred at very short follow up (<1 year), and HoLEP became more strongly preferred with longer follow up. ConclusionAt 5 years follow up, HoLEP is a cost-effective surgical treatment for BPH- independent of gland size.

Holmium laser enucleation of the prostate: a 3-year single-center experience of 173 cases

BackgroundHolmium laser enucleation of the prostate (Holep) is a safe, effective, and prostate size-independent procedure for benign prostatic hyperplasia treatment (BPH). Holep has demonstrated comparable long-term outcomes with historical BPH mainstay treatments, namely open prostatectomy or transurethral resection of the prostate, as well as straightforward evidence of its low morbidity. In this study, we aimed to report our 3-year Holep experience based on 173 patients.MethodsWe conducted a retrospective descriptive single center study utilizing medical charts of 173 patients who underwent Holep between 2017 and 2020. Peri and postoperative measures included prostate volume, peak urinary flow rate (Qmax), prostate specific antigen, catheterization time, hospital stay, and complications.ResultsThe mean age and mean prostate weight at baseline were 71.3 ± 7.8 years and 64.2 g (17 and 380 g), respectively. Holep was associated with a short catheterization time and hospital stay (2.7 and 3 days, respectively). Qmax significantly improved after Holep (8.1 vs 20.4 ml/s, p < 0.05), and results sustained at 06 months postoperatively. Perioperative and postoperative complications were mainly represented by hematuria (29%). However, more than half of these patients were taking anticoagulation drug therapy at the time of surgery. Complications mostly occurred during the early years following Holep’s introduction and tended to decrease with time and experience.ConclusionHolep remains a safe and effective procedure for BPH treatment, with durable long-term results even in clinical settings where the procedure is new. The rate of complications, which is associated with the learning curve, improves with time and experience.

A Study on Bipolar Transurethral Resection of Prostate (TURP) versus Transurethral Resection and Electrovaporization (TURP-TUVP) Sandwich Procedure

Background: TURP is the gold standard for the endoscopic treatment of BPH. Nonetheless, it remains associated with significant morbidity, especially in terms of hemorrhage leading to possible blood transfusion and delayed hospital discharge. TUVP is associated with reported improvements in subjective and objective measures but a high rate of postoperative irritative symptoms and lack of tissue for histologic examination. The concept behind TURP and TUVP sandwich procedure is to overcome the drawbacks of the two procedures. Objective: To compare the outcome of bipolar transurethral resection of prostate (TURP) and bipolar transurethral resection and electrovaporization of prostate (TURP-TUVP) sandwich procedure in patient with benign prostatic hyperplasia. Methods: This quasi experimental study was conducted in the Department of Urology, National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh from July 2017 to June 2019 over a period of 2 years. Sixty patients with BOO caused by benign prostatic hyperplasia scheduled for transurethral resection of prostate were included in this study. Patients were selected first by purposive sampling and were grouped into A and B with randomization. Group A patients underwent bipolar TURP while group B patients underwent sandwich method. Perioperative findings as well as IPSS Qmax and PVR after 3 months of operation were compared. Results: Operative time was significantly longer in TURP-TUVP group than in TURP group (P value 0.036).Post operative hospital stay was significantly longer in TURP group (P value &lt;0.001). Catheterization time was significantly higher in TURP group (P value &lt;0.001).Intra-operative irrigation was significantly higher in TURP-TUVP group (P value 0.001). Post operative irrigation time was significantly longer in TURP group (P value &lt;0.001). Hemoglobin decrease was significantly higher in TURP group (P value &lt;0.001). Similarly, sodium decrease was higher in TURP group than that of TURP-TUVP group but not statistically significant (P value 0.81).Clot retention was 2 (6.7%) in TURP group. Short-term follow up at 3 month showed no significant difference in IPSS in TURP and TURP-TUVP groups (P value 0.349), significantly higher Qmax in TURP-TUVP group (P value 0.022) and significantly higher PVR in TURP group (P value0.005) Conclusion:. TURP-TUVP procedure has higher operative time and intraoperative irrigation, but has significantly lower catheterization time, postoperative irrigation time, hemoglobin change and hospital stay. Bangladesh J. Urol. 2021; 24(2): 161-165

A Comparison of Safety and Efficacy between Silodosin Monotherapy Versus Silodosin with Tadalafil add on Therapy in Patients with Benign Prostatic Hyperplasia

Background: For relieving symptoms of LUTS due to BPH treatment modalities are watchful waiting, medical treatment and surgery. Among medical treatment, options are alpha 1 adrenoreceptor blockers, 5 alpha reductase inhibitors and recently introduced phospodiesterase 5 inhibitors or combination therapy. Objective: To compare the safety and efficacy of silodosin versus silodosin and tadalafil for treating patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Materials and Methods: This prospective observational study was conducted in the Department of Urology, BSMMU, Dhaka from April 2020 to March 2021. A total of 66 patients with LUTS due to BPH were selected by purposive sampling on the basis of selection criteria from OPD of Urology, BSMMU. They were randomly divided into two groups: according to odd or even hospital number and label as A group (odd no) and B group (even no). Group-A were provided with silodosin 8.0 mg daily and group-B were provided with silodosin 8.0 mg and tadalafil 5.0 mg daily (B group). Two patients from each group were excluded due to adverse effect and one patients from each group was lost to follow-up. Final analysis was done on sixty patients (30 from each group). The patients were assessed by IPSS, Qmax and PVR. The results were expressed as frequency &amp; percentage (categorical data) and mean ± SD (numerical data). Unpaired t-tests and paired t tests were performed as applicable using SPSS 22.0 and p &lt;0.05 was considered as the level of significance. Results: Out of sixty six patients, sixty patients completed the study. Two patients from group A was suffering from hypotension and headache and two patients from group B was suffering from ejaculatory dysfunction and dizziness, one patient from each group was lost after 1st follow up, so they were excluded from study. Maximum study subjects were within 51 to 70 years of age in both groups. Mean age of the study subjects was 57.13 ± 9.36 years in Group-A and 59.33 ± 7.09 years in Group-B. Mean prostate volume of the study subjects was 37.93 ± 13.19 ml in Group-A and 35.50 ± 10.57 ml in Group-B. IPSS was reduced to 21.90±3.68 after 6 weeks and 18.90 ± 3.79 after 12 weeks from 25.10 ± 3.96 prior to treatment in Group-A. Similarly, in Group-B, IPSS was reduced from 19.67 ± 3.45 after 6 weeks and 16.37 ± 2.03 after 12 weeks from 23.03 ± 4.16 prior to treatment. PVR decreased to 58.00 ± 20.41 after 6 weeks and 42.10 ± 17.40 after 12 weeks from 74.15 ± 26.40 prior to treatment in Group-A. Similarly, PVR in Group-B reduced to 52.70 ± 12.51 after 6 weeks and 33.57 ± 8.97 after 12 weeks from 66.17 ± 15.50 before treatment. After 6 weeks, Qmax increased to 15.67 ± 2.11 and at 12 weeks17.73 ± 2.66 from 13.39 ± 1.83 before treatment in Group-A. Similarly, after 6 weeks, Qmax in Group- B increased to 16.74 ± 1.14 and at 12 weeks18.94±1.31 from 14.17±1.28 before treatment. Conclusion: Improvements in both silodosin (alpha blocker) group and silodosin in combination with tadalafil (PDE 5 inhibitor) group were found to be effective, safe and satisfactory in treating patients with symptomatic BPH. Even though combination group showed better efficacy than silodosin monotherapy group but as per improvement rate it was not statistically significant. Bangladesh J. Urol. 2021; 24(2): 205-213

The use of botulinum toxin (BoNT) in urology - review

Introduction and purpose&#x0D; Botulinum neurotoxin (BoNT) prevents the release of acetylcholine into the synaptic cleft of the neuromuscular junction, which causes flaccid muscle paralysis. A non-obvious specialization that uses botulinum toxin is urology. The aim of this article is to present a literature review regarding the use of botulinum toxin in the treatment of urological diseases.&#x0D; Description of the state of knowledge&#x0D; In the overactive bladder syndrome, with resistance to oral medications, an alternative is botox injections into the bladder wall, which reduce the intensity of urgency and pollakiuria.&#x0D; Treatment of BPH with botulinum toxin injection may be an alternative to surgical and pharmacological treatment. Intra-articular botox injection causes smooth muscle relaxation and gland atrophy through prostate tissue apoptosis.&#x0D; Clinical studies show promising therapeutic effects of using Botox injections in the treatment of intramural cystitis. It reduces the feeling of bladder pain and the worsening of other symptoms.&#x0D; Panunzio et al. Presented a meta-analysis of prospective studies that showed a statistically significant improvement in pain perception after injection of botulinum toxin into the pelvic structures, compared with baseline values ​​for CPPS, in all cohorts evaluated.&#x0D; Summary&#x0D; Urology uses the entire spectrum of botox possibilities, from myocrelation in the bladder hyperresponsiveness syndrome, through neuromodulation and apoptosis induction in benign prostatic hyperplasia, ending with anti-inflammatory and analgesic properties in bladder pain syndrome and chronic pelvic pain syndrome.

Abstract No. 65 Prostate artery embolization: single-center experience of 807 patients with 6 years of follow-up

PAE has emerged as an effective minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) and urinary retention of prostatic origin. The purpose of this study is to evaluate the efficacy and safety of PAE for the treatment of BPH with LUTS and urinary retention.

Abstract No. 68 Comparison of prostate artery embolization for benign prostatic hyperplasia on prostate gland size less than 80 g versus greater than 80 g: retrospective review of short and mid-term outcomes

PAE is an effective minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) and urinary retention of prostatic origin. The purpose of this study is to compare the efficacy and safety of PAE for the treatment of BPH with LUTS and urinary retention in prostate glands < 80 g with prostate glands > 80 g.

The effect of nettle root extract on urinary problems in older men with benign prostatic hyperplasia: A randomized clinical trial

BackgroundBenign prostatic hyperplasia is one of the most common benign tumor in men. Due to frequent side effects associated with medications used to treat prostatic hyperplasia, the use of herbal plants such as nettle has increased for the management of this ailment. PurposeThe purpose of the present study was to determine the effect of nettle root extract on urinary problems, prostatic specific antigen level, and prostate volume in older men with benign prostatic hyperplasia. Study designThe present study was a randomized clinical trial. MethodsThis study was conducted on 80 participants with benign prostatic hyperplasia referred to a urology clinic in Kashan, Iran. The participants were randomly assigned into experimental (n = 40) and control (n = 40) groups. The participants in the experimental and control groups received a tablet containing 300 mg of nettle root extract or a placebo (starch), respectively, twice a day for eight weeks. Before and after the intervention, the participants were assessed regarding their prostatic specific antigen level, prostate volume, and the American Urological Association Symptoms Scores associated with urinary problems. Data was analyzed using the Fisher’s exact test, the Chi-square test, the Paired t-test, and the independent samples t-test. ResultsAfter the intervention, there were significant differences between the groups in terms of urinary frequency (control: −0.17 ± 0.74 versus experimental: −0.5 ± 0.67; p = 0.04), urinary urgency (control: 0.12 ± 0.91 versus experimental: −0.32 ± 0.69; p = 0.01), and nocturia (control: 0.0 ± 0.65 versus experimental: −0.28 ± 0.64; p = 0.05). The group comparisons showed that there was no significant difference between the groups in terms of changes in the prostate-specific antigen level (p = 0.44), prostate volume (p = 0.22), feeling of incomplete emptying (p = 0.72), intermittency (p = 0.26), weak urine stream (p = 0.44), straining (p = 0.85), and quality of life (p = 0.91) associated with urinary problems. ConclusionThe use of nettle root extract in combination with conventional medical treatment of BPH was effective in decreasing the severity of urinary problems, including urinary frequency, urgency, and nocturia in participants. However, the nettle extract was not effective in modifying prostate-specific antigen level, prostate volume, feeling of incomplete emptying, intermittency, urine stream, straining, and quality of life associated with urinary problems. Nettle extract is recommended for use as a complementary intervention along with traditional medical treatments of benign prostatic hyperplasia.

Preliminary results of a national multicenter study on the treatment of LUTS secondary to benign prostatic hyperplasia using the Rezūm® steam system

Introduction and objectiveRezūm® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice. Material and methodsProspective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezūm® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported. Results137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50 cm3 (15−131). At 3 months follow-up, significant improvement was observed in IPSS (−6.37 points), Qmax (+4.95 mL/s) and QoL (−1.29); and was maintained until 12 months: −10.78 points, +4.62 mL/s and −2.73 respectively (p < 0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤ Clavien II). Retreatment rate at one year was 4%. ConclusionShort-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments.

MP01-12 PHARMACOTHERAPY VS MINIMALLY INVASIVE THERAPIES AS INITIAL THERAPY FOR PATIENTS WITH BENIGN PROSTATE HYPERPLASIA: A MICROSIMULATION MODEL

You have accessJournal of UrologyCME1 May 2022MP01-12 PHARMACOTHERAPY VS MINIMALLY INVASIVE THERAPIES AS INITIAL THERAPY FOR PATIENTS WITH BENIGN PROSTATE HYPERPLASIA: A MICROSIMULATION MODEL Yeva Sahakyan, Aysegul Erman, Naeem Bhojani, Bilal Chughtai, Kevin C. Zorn, Beate Sander, and Dean Elterman Yeva SahakyanYeva Sahakyan More articles by this author , Aysegul ErmanAysegul Erman More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Kevin C. ZornKevin C. Zorn More articles by this author , Beate SanderBeate Sander More articles by this author , and Dean EltermanDean Elterman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study evaluated the effectiveness of MITs (Rezum and Urolift) compared to pharmacotherapy as initial treatment option for patients with moderate-to-severe BPH. METHODS: We developed a simulation model (image_a) to estimate the impact of Rezum and Urolift compared to pharmacotherapy as initial treatment on International Prostate Symptom Score (IPSS) progression, retreatment rates and quality-adjusted life years (QALYs), discounted at a 1.5% rate. We simulated males with a mean age of 65 years and an average IPSS of 16 over their lifetime. BPH progression and treatments effects were modeled through the IPSS score. Patients could receive up to two additional lines of therapy: i) patients who started with pharmacotherapy could receive MIT as a second-line, and TURP or pharmacotherapy as a third-line of therapy; ii) patients who started with MIT (Rezum or UroLift) could receive repeated MIT or TURP or pharmacotherapy as a second-line, and TURP as a third line of therapy. Therapy-specific adverse events were applied. The model was informed by data from the published literature. RESULTS: Simulated health outcomes compared well to the reported trials data (image_b). Over 20 years the proportion of patients who were retreatment free were 49% for Rezum, 39% for Urolift and 50% for pharmacotherapy. Over the patients’ lifetime initial treatment with Rezum was the most effective option (15.18 QALYs), pharmacotherapy followed by Rezum was the second most effective option (15.08 QALY), followed by Urolift (14.99 QALYs) as initial treatment, and, lastly, pharmacotherapy followed by UroLift (14.98 QALY). CONCLUSIONS: MITs are effective treatment options for moderate-to-severe BPH. These findings will be beneficial for clinicians and health policy makers to further define the implementation of MITs in treatment for BPH. Source of Funding: Not applicable © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e5 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yeva Sahakyan More articles by this author Aysegul Erman More articles by this author Naeem Bhojani More articles by this author Bilal Chughtai More articles by this author Kevin C. Zorn More articles by this author Beate Sander More articles by this author Dean Elterman More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP39-06 EVALUATING THE REAL-WORLD PAYER AND PATIENT COSTS OF BPH SURGICAL MANAGEMENT

You have accessJournal of UrologyCME1 May 2022MP39-06 EVALUATING THE REAL-WORLD PAYER AND PATIENT COSTS OF BPH SURGICAL MANAGEMENT Kevin Wymer, Gopal Narang, Austen Slade, Vidit Sharma, Viengneesee Thao, Bijan Borah, Marcelino Rivera, Scott Cheney, and Mitchell Humphreys Kevin WymerKevin Wymer More articles by this author , Gopal NarangGopal Narang More articles by this author , Austen SladeAusten Slade More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Viengneesee ThaoViengneesee Thao More articles by this author , Bijan BorahBijan Borah More articles by this author , Marcelino RiveraMarcelino Rivera 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.0000000000002599.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A multitude of surgical treatment options exist for BPH - with differences in the level of invasiveness, complications, and durability. Despite the high prevalence of BPH treatment and its significant economic impact, limited data are available comparing the financial burden of specific surgical interventions. We therefore sought to compare out-of-pocket (OOP) and health plan paid (HPP) costs of common surgical treatments for BPH. METHODS: We conducted a retrospective cohort study using administrative claims data from the OptumLabs Data Warehouse, which includes data for commercially insured and Medicare Advantage enrollees. Our cohort consisted of patients with a BPH diagnosis who underwent simple prostatectomy (SP), TURP, HoLEP, PVP, UroLift, or Rezum from 2015-2019. Unadjusted average OPP and HPP costs for different follow-up timeframes by treatment type were included. Our analysis was limited to patients continuously enrolled in their health plan for at least 1 year pre- and post-procedure, ages 30-80. Costs were inflation-adjusted to 2020 U.S. dollars using the Consumer Price Index. One-way ANOVA was performed to evaluate for differences in cost. RESULTS: In total, 21,946 patients were included in the analysis. Total HPP and OOP costs for each treatment type by follow-up year are shown in Figure 1. For year 1 (which included the index procedure), there was significant variation in both HPP and OPP costs, with SP associated with highest costs followed by TURP, HoLEP, PVP, UroLift, and Rezum (p <.001). These differences decreased with longer follow up in year 2 and years 3–5, with minimal differences in costs for all procedures except for Rezum which was associated with significantly lower HPP costs (p <.01). There was no significant difference in patient OOP costs among all procedures at 3-5 years (p=.055). CONCLUSIONS: BPH treatment modality has a significant impact on patient and system level costs. These differences are most pronounced within the first year of surgical management, likely related to index procedural costs, complications, and convalescence, and decrease with further follow up. Minimally invasive options, such as Rezum, may offer initial cost reductions; however, such data must be interpreted cautiously without correlation to clinical information, including gland size. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e666 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Wymer More articles by this author Gopal Narang More articles by this author Austen Slade More articles by this author Vidit Sharma More articles by this author Viengneesee Thao More articles by this author Bijan Borah More articles by this author Marcelino Rivera More articles by this author Scott Cheney More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement PDF DownloadLoading ...

V03-09 THULIUM FIBER LASER: A UNIVERSAL DEVICE IN UROLOGY. FROM BENCH TO BEDSIDE

You have accessJournal of UrologyCME1 May 2022V03-09 THULIUM FIBER LASER: A UNIVERSAL DEVICE IN UROLOGY. FROM BENCH TO BEDSIDE Dmitry Enikeev, Mark Taratkin, Camilla Azilgareeva, Anastasia Shpikina, Leonid Rapoport, Roman Sukhanov, and Petr Glybochko Dmitry EnikeevDmitry Enikeev More articles by this author , Mark TaratkinMark Taratkin More articles by this author , Camilla AzilgareevaCamilla Azilgareeva More articles by this author , Anastasia ShpikinaAnastasia Shpikina More articles by this author , Leonid RapoportLeonid Rapoport More articles by this author , Roman SukhanovRoman Sukhanov More articles by this author , and Petr GlybochkoPetr Glybochko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002539.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A new thulium fiber laser (TFL) has been recently developed as a novel surgical tool with multiple applications in urology. The latest modification of the device incorporates two modes for surgery – quasi-continuous (QCW, for soft tissue surgery) and SuperPulsed (SP, for lithotripsy). Evaluation of the utility of the novel device began with in-vitro comparison of TFL with conventional Ho:YAG. After clinical approval, device efficacy was assessed for soft tissues (BPH, NMIBC) and stones. METHODS: This prospective clinical trial started following local IRB approval. For TFL enucleation of the prostate (ThuFLEP), TFL (NTO IRE-Polus, Russia) in QCW mode with 600-μm laser fiber and 26 Ch resectoscope (Karl Storz, Germany) with continuous irrigation (0.9% saline) was used. TFL en bloc resection of bladder tumor (TFL-ERBT) was performed using the following settings: QCW; 1.0 J; 10 W. Lithotripsy was performed with TFL using 200-, 400- and 600-μm fibers in SP mode. Stone-free rate (SFR) was assessed with low-dose computed tomography 3 months after. RESULTS: ThuFLEP was performed in 1392 patients, TFL-ERBT in 118 cases, and TFL lithotripsy (PCNL, RIRS, URS, bladder) was performed in 321 patients. In the ThuFLEP group median prostate volume was 80 (IQR 60; 105) cc. Qmax and IPSS before surgery were 9.6±2.6 and 22.9±1.8, respectively. Mean surgery duration was 70.5±31.0 min, whereas the mass of resected tissue was 69.8±34.7 g. Mean catheterization time was 1.7±0.8 days; mean hospital stay was 3.7±1.0 days. PVR, Qmax, IPSS and QOL all significantly improved at 3 months after surgery (p <0.001). TFL-ERBT was performed in 118 patients with detrusor rate of 91.6%. RFS at 6 months was 91.5%. Of 321 patients with urinary calculi treated with TFL, 153 had kidney stones (median stone volume – 279.6 (IQR, 139.4–615.8) mm3, mean density – 1020±382 HU), 149 had ureter stones (median stone volume - 179 (IQR, 94–357) mm3, mean density – 985±360 HU) and 19 had bladder stones (mean size 22.2 mm, mean density – 1050 HU). Stone-free rate was 92%. CONCLUSIONS: TFL shows high efficiency and acceptable safety profile in the treatment of urinary stones, NMIBC and BPH. The combination of SuperPulsed and quasi-continuous modes within a single device allowed for developing a universal tool for urologic surgery. However, further studies are necessary to assess the comparative efficacy of this surgical modality with standard options offered by guidelines. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e204 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dmitry Enikeev More articles by this author Mark Taratkin More articles by this author Camilla Azilgareeva More articles by this author Anastasia Shpikina More articles by this author Leonid Rapoport More articles by this author Roman Sukhanov More articles by this author Petr Glybochko More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD41-02 DIAGNOSIS OF PROSTATE CANCER IN MEN TREATED WITH 5-ALPHA-REDUCATES INHIBITORS WITH MULTIPARAMETRIC MRI: RESULTS OF A MULTICENTER INTERNATIONAL COLLABORATION

PD41-02 DIAGNOSIS OF PROSTATE CANCER IN MEN TREATED WITH 5-ALPHA-REDUCATES INHIBITORS WITH MULTIPARAMETRIC MRI: RESULTS OF A MULTICENTER INTERNATIONAL COLLABORATION

MP01-15 SEDATION AS AN ALTERNATIVE ANESTHETIC TECHNIQUE FOR FRAGILE PATIENTS IN TRANSURETHRAL RESECTION OF THE PROSTATE

You have accessJournal of UrologyCME1 May 2022MP01-15 SEDATION AS AN ALTERNATIVE ANESTHETIC TECHNIQUE FOR FRAGILE PATIENTS IN TRANSURETHRAL RESECTION OF THE PROSTATE Christian Ayoub, Nassib Abou Heidar, Adnan El-Achkar, Hani Tamim, and Albert El Hajj Christian AyoubChristian Ayoub More articles by this author , Nassib Abou HeidarNassib Abou Heidar More articles by this author , Adnan El-AchkarAdnan El-Achkar More articles by this author , Hani TamimHani Tamim 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.0000000000002513.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although novel treatments have been introduced to treat benign prostatic hyperplasia, TURP remains the gold standard. TURP is mostly performed using general (genTURP) or spinal (spTURP) anesthesia. Monitored Anesthesia Care MAC/Sedation (macTURP) anesthesia is a safer and infrequently used anesthesia technique reserved for high-risk patients. The aim of this study is to compare 30-day post-operative outcomes of TURP using the three types of anesthesia techniques from the ACS-NSQIP database. METHODS: The ACS-NSQIP database was queried for male patients who underwent TURP for BPH treatment between the years 2005-2017. Demographics, clinical, operative characteristics, and 30-day outcomes were compared. Univariate and multivariate regression models were constructed for selected outcomes. RESULTS: 37,410 patients underwent TURP for BPH treatment of which 73.3% underwent genTURP, 24% spTURP and 2.4% macTURP anesthesia. Older patients (73) with hypertension (64%), history of COPD (8.1%) and of ASA II/III (51.2%, 6.3% respectively) were more likely to undergo macTURP as compared to genTURP (p-value <0.013). Regarding postoperative outcomes, macTURP showed lower rates of readmission (4.7%) as compared to spTURP and genTURP (p-value= 0.06). MacTURP also showed shorter operative times (50 min) and was more likely to be used in emergency cases (2.3%) as compared to genTURP but longer operative times as compared to spTURP (48 min) (p-value <0.01). MacTURP showed shorter length of hospital stay (2.15 days) as compared to spTURP (2.67 days), but longer length of hospital stays as compared to genTURP (1.85 days) (p-value <0.01). In terms of return to operative room, occurrence of pneumonia, urinary tract infection, sepsis and bleeding requiring transfusion there was no significant difference between the 3 anesthetic techniques. Multivariate analysis showed macTURP had lower operative time by 4 mins and spTURP by 2.7 mins as compared to genTURP. No other significant difference was seen in the multivariate analysis. CONCLUSIONS: TURP under sedation was found to be feasible with a good safety profile. Sedation could be used in elderly, fragile and co-morbid patients providing them less post-operative complications and shorter operative times as compared to more invasive anesthetic techniques. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e7 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Ayoub More articles by this author Nassib Abou Heidar More articles by this author Adnan El-Achkar More articles by this author Hani Tamim More articles by this author Albert El Hajj More articles by this author Expand All Advertisement PDF DownloadLoading ...

A0880 - Comparing three surgical techniques for BPH treatment: Transurethral resection, laser vaporization and laser enucleation of the prostate

A0880 - Comparing three surgical techniques for BPH treatment: Transurethral resection, laser vaporization and laser enucleation of the prostate

Resultados preliminares de un trabajo multicéntrico a nivel nacional para el tratamiento de STUI secundario a hiperplasia benigna de próstata mediante el sistema con vapor de agua Rezūm®

Introduction and objectiveRezūm® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice. Material and methodsProspective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezūm® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported. Results137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50cm3 (15-131). At 3 months follow-up, significant improvement was observed in IPSS (−6,37 points), Qmax (+4,95mL/s) and QoL (−1,29); and was maintained until 12 months: −10,78 points,+4,62mL/s and −2,73 respectively (p<0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤Clavien II). Retreatment rate at one year was 4%. ConclusionShort-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments.

Protein hydrolysates from boarfish (Capros aper) and Atlantic salmon (Salmo salar) skin gelatin improve metabolic control in genetically obese diabetic (ob/ob) mice

There is increasing interest in dietary protein for management of Type 2 diabetes mellitus (T2DM) and obesity. The effects of twice-daily oral administration of a salmon skin gelatin hydrolysate (SSGH, 50 mg/kg), boarfish protein hydrolysate (BPH, (50 mg/kg), metformin (200 mg/kg), or saline control, were investigated in ob/ob mice. Non-fasting blood glucose was significantly reduced with SSGH (p&lt;0.01), BPH (p&lt;0.001) and metformin (p&lt;0.001), which were reflected in reductions in glycated haemoglobin (HbA1c) (p&lt;0.001, p&lt;0.01 and p&lt;0.01, respectively). Responses to oral and intraperitoneal glucose tolerance were improved (p&lt;0.05-0.01), as well as circulating plasma lipid profiles (p&lt;0.05-0.001). Chronic BPH treatment increased circulating plasma insulin (p&lt;0.01), whereas SSGH improved insulin sensitivity (p&lt;0.05), versus respective controls. All treatments significantly reduced energy intake (p&lt;0.05-&lt;0.001) versus (ob/ob) controls, without affecting overall bodyweight. These findings suggest that fish hydrolysates mediate potent anti-diabetic actions similar to metformin and might be suitable for the management and prevention of T2DM.

Results of endoscopic treatment of benign prostatic hyperplasia in patients with metabolic syndrome

The present paper is about the research conducted on the patients with metabolic syndrome and its results of endoscopic treatment of benign prostatic hyperplasia in these patients. It is generally accepted that the size and volume of the prostate gland is the main prognostic factor affecting the intraoperative and postoperative outcomes of endoscopic treatment of BPH. However, with the rapid development of endoscopic instruments and surgical techniques, the size of the prostate tends to have a lesser influence on the outcome of endoscopic BPH treatment. Currently, MS is becoming an increasingly common disease, which in most cases predicts a poor prognosis for treatment of patients with LUTS.