Difference In Qmax Research Articles

The Role of Remote Diagnostics to Better Assess Uroflow Variability: Insights From Combining at Home Uroflows and Frequency Volume Charts From 19,868 Voids Using a Novel, Hand Held, Cellular Embedded Device

ObjectiveTo examine how representative 24-hour data collection is of the overall patient experience utilizing a home uroflow device in men with benign prostatic hyperplasia. Materials and MethodsHome uroflow data was collected with the iO Urology CarePath device from men at a single urology clinic and retrospectively analyzed. Void characteristics were summarized for data collected over 24-hours compared to data collected over several days or weeks with the device (overall study excludes the 24-hour data). A linear mixed effects model was used to evaluate differences in average Qmax from voids collected during a single 24-hour period compared to the overall study. ResultsA total of 486 men (mean age 67.4) used the device resulting in 465 included in the analysis with a total of 15.521 voids in the overall study and 4,347 voids in the single day analysis. Average Qmax from the model was 11.2 ml/s (95% CI: 10.80, 11.65) and 11.2 ml/s (95% CI: 10.81, 11.64) in the 24-hour and overall study groups, respectively. Both groups had similar between- (20.3% vs 20.4%) and within-subject (12.0% vs 11.9%) variance. The difference in Qmax was not significantly different (p=0.970). A subgroup analysis including voids >150 ml yielded similar results. ConclusionsData shows variability in voiding parameters, but similar average Qmax collected in 24-hours as compared to several days/weeks. The combination of home uroflowmetry with frequency-volume chart information can provide objective data and a unique perspective on uroflow variability for clinician review to support the development of individualized patient treatment plans.

Management Modalities of Primary Bladder Neck Obstruction in Young Adult Men: A Systematic Review and Meta-analysis.

This systematic review was done to critically appraise the various evidence available in the literature for the presenting symptoms, diagnosis, and management modalities for primary bladder neck obstruction diagnosed on invasive urodynamics in young adult men 18-50 years of age. A search was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials databases until July 2022 to find English-language studies relevant to the topic. A total of 10 studies were included. The estimated difference in International Prostate Symptom Score between baseline and 3 months in the subgroup of medical and surgical treatment was found to be -8.82 and -11.25, respectively (P = .37), and after 12 months, it was found to be -7.69 and -17.70 respectively (P .001). The pooled estimate for the difference in Qmax between baseline and 3 months after medical and surgical treatments in the subgroup was found to be 2.92 and 7.03, respectively (P = .18), and after 12 months, it was found to be 4.54 and 7.74, respectively (P .001). The pooled estimate of the difference in post-void residue before and after 3 months of medical and surgical treatments in a subgroup was found to be -31.15 and -70, respectively (P .001), and after 12 months, it was found to be -31.49 and -156.00, respectively (P .001). Quality of life scores improved in both subgroups. The alpha-blockers are effective in managing primary bladder neck obstruction in the short term, while bladder neck incision is preferred for better longterm outcomes.

MP59-03 THULIUM LASER ENUCLEATION (ThuLEP) VERSUS TRANSURETHRAL BIPOLAR PROSTATE RESECTION (TURP): PROSPECTIVE RANDOMIZED STUDY: EARLY INTRA- AND POSTOPERATIVE RESULTS

You have accessJournal of UrologyCME1 Apr 2023MP59-03 THULIUM LASER ENUCLEATION (ThuLEP) VERSUS TRANSURETHRAL BIPOLAR PROSTATE RESECTION (TURP): PROSPECTIVE RANDOMIZED STUDY: EARLY INTRA- AND POSTOPERATIVE RESULTS Matteo Zanoni, Giuseppe Chiarelli, Paola Arena, Edoardo Beatrici, Maria Chiara Clementi, Cinzia Mazzieri, Paolo Vota, Giovanni Lughezzani, Nicolò Buffi, Milan, Gianluigi Taverna, and Castellanza Matteo ZanoniMatteo Zanoni More articles by this author , Giuseppe ChiarelliGiuseppe Chiarelli More articles by this author , Paola ArenaPaola Arena More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Maria Chiara ClementiMaria Chiara Clementi More articles by this author , Cinzia MazzieriCinzia Mazzieri More articles by this author , Paolo VotaPaolo Vota More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Nicolò BuffiNicolò Buffi More articles by this author , Milan Milan More articles by this author , Gianluigi TavernaGianluigi Taverna More articles by this author , and Castellanza Castellanza More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim is the comparison of early intra- and postoperative clinical results between transurethral enucleation of the prostate with thulium laser (ThuLEP) and transurethral bipolar resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH) in a prospective randomized trial. METHODS: In the study 650 consecutive patients with BPH were randomized: ThuLEP (n=350) and TURP (n=300). The parameters evaluated were: blood loss, catheterisation time, irrigation volume, hospital stay and operating time. At 6 months after surgery they were evaluated: International Prostate Symptom Score (IPSS), maximum flow (Qmax) and postmintional residue (RPM). RESULTS: Patients in each study arm did not show any significant differences in preoperative parameters compared to TURP, ThuLEP required the same operating time (53.69±31.44 vs 61.66±18.7 minutes, p=.123) but resulted in a reduction in lower hemoglobin values (0.45 vs 2.83 g/dL, p=0.005). ThuLEP also determined less non statistically significant catheterisation time, lower irrigation volume (29.4 vs 69.2 L, p=0.002) and lower non-significant hospital stay (1.7 vs 2.5 days). During the 6-month follow-up, procedures did not show a significant difference in Qmax, IPSS, PVR and Quality of life Scale (QOLS). CONCLUSIONS: ThuLEP and TURP reduce both symptoms of the lower urinary tract with efficacy and safety. ThuLEP is statistically superior to TURP in terms of blood loss, irrigation volume. However, procedures do not differ significantly in Qmax, IPSS, RPM and QOLS for up to 6 months of follow-up. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e806 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matteo Zanoni More articles by this author Giuseppe Chiarelli More articles by this author Paola Arena More articles by this author Edoardo Beatrici More articles by this author Maria Chiara Clementi More articles by this author Cinzia Mazzieri More articles by this author Paolo Vota More articles by this author Giovanni Lughezzani More articles by this author Nicolò Buffi More articles by this author Milan More articles by this author Gianluigi Taverna More articles by this author Castellanza More articles by this author Expand All Advertisement PDF downloadLoading ...

Role of Bladder Emptying on Outcomes of Transurethral Resection of the Prostate

To assess the role of bladder emptying on outcomes of males undergoing transurethral resection of the prostate (TURP). This prospective study involved candidates for TURP (January 2017-2018) with a follow-up of 3 years. Preoperative and follow-up evaluation comprised: UF, simple PVR (S-PVR), PVR-Ratio (PVR-R) as the ratio of PVR to bladder volume (BV: voided volume (VV)+PVR), Bladder voiding efficiency (BE) as the ratio between VV and BV -(voided volume/total bladder capacity)×100 - and the IPSS. Patients were stratified for S-PVR, PVR-R, and BVE. Patients recruited were 100 (mean ± SD age: 68.8 ± 8.7 years). No patient had severe complications, re-admission, nor needed blood transfusion. At baseline, 38% of the patients showed S-PVR ≤ 50 mL, 62% a S-PVR ≤ 100 mL, and 25% a S-PVR >150 mL. In both pre- and postoperative evaluation there were no significant differences in Qmax and IPSS score among the groups. In each group we found a significant improvement in Qmax, IPSS score, and S-PVR, PVR-R and BVE after TURP (except for PVR in group with lowest preoperative S-PVR). Analysing a preoperative S-PVR threshold >100 mL, PVR-R significantly increased, and BVE significantly decreased after TURP. Conversely, when preoperative S-PVR was >100 mL, PVR-R, and BVE relevantly but non significantly improved after surgery. Bladder emptying is only partially related to TURP outcomes and other preperative parameters. Patients with baseline S-PVR lower than 100 mL had the chance of greater recovery of bladder emptying after TURP.

Comparative effect of intraurethral clobetasol and tacrolimus in lichen sclerosus-associated urethral stricture disease.

Management of urethral stricture related to lichen sclerosus (LS) is now gradually changing from surgical to nonsurgical due to availability of anti-inflammatory agents such as corticosteroids and calcineurin inhibitors. We determined the clinical impact of these agents in such patients on outpatient department basis in terms of improvement in symptoms on International Prostate Symptom Score (IPSS), external skin appearance, and maximum urinary flow rate (Qmax). Eighty patients of meatal stenosis and penile urethral stricture with histopathologically proven LS were divided into two groups, and clinical and predetermined parameters such as Qmax, IPSS, and changes in external appearance were compared between these groups after 3 months of topical and intraurethral application of clobetasol and tacrolimus with self-calibration. A significant intragroup difference was noted in IPSS (P < 0.001) as well as Qmax (P < 0.001); postintervention intergroup difference in IPSS was not significant (P = 0.94) and however postintervention intergroup difference in Qmax was significant in favor of clobetasol (P = 0.007). A significantly increased number of additional procedures were done in the group receiving intraurethral tacrolimus (P = 0.0473) with significantly less number of skin complication in the group with topically applied clobetasol (P = 0.003). Though both clobetasol and tacrolimus, improved symptom score, Qmax and local external appearance yet topical and intra-urethral clobetasol application via urethral self calibration seems to be better option for lichen sclerosus related urethral stricture in terms cost and local complications.

MP18-16 VOIDING TIME AS A PROXY FOR URINARY OBSTRUCTION IN MEN WITH LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyCME1 May 2022MP18-16 VOIDING TIME AS A PROXY FOR URINARY OBSTRUCTION IN MEN WITH LOWER URINARY TRACT SYMPTOMS Gaurav Pahouja, Parth Patel, Enrique Blanco Martinez, and Kevin T. McVary Gaurav PahoujaGaurav Pahouja More articles by this author , Parth PatelParth Patel More articles by this author , Enrique Blanco MartinezEnrique Blanco Martinez More articles by this author , and Kevin T. McVaryKevin T. McVary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to investigate voiding time (VT) in asymptomatic and symptomatic men, and compare VT to other uroflowmetric parameters such as maximum flow rates (Qmax) as a possible solution to disparity related lack of access to more standard urodynamic testing in LUTS patients. METHODS: We conducted a controlled prospective study on a total of 30 patients. Adults age ≥18 were included. Exclusion criteria were those with ongoing medical therapy for LUTS or a history of invasive therapy for LUTS. Patients completed the International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry, and post-void residual (PVR) testing. Symptomatic LUTS was defined as an IPSS ≥8. RESULTS: On univariate analysis, men with a symptomatic LUTS had a significantly longer VT than asymptomatic men (30.60 seconds (Interquartile rage [IQR] 24.2-42.4) vs 20.50 seconds (IQR 16.6-40.5), p=0.043). When controlling for all other factors, VT was not otherwise associated with age, race, or BMI. There was no significant difference in Qmax between symptomatic and asymptomatic patients (13.40 seconds (IQR 8.7-19.9) vs 20.5 seconds (IQR 11.7-31.8), p-0.07). No differences were found based on PVR (p=0.51). Our study also demonstrated that the sensitivity of a VT ≥23.5 seconds, or probability of observing a VT exceeding 23.5 seconds when the patient has a symptomatic IPSS, is 85%. On sensitivity and specificity analysis, there was no difference between the abilities of Qmax and VT to predict that a patient would have symptomatic LUTS (p=0.80). CONCLUSIONS: We found that VT was as accurate as Qmax in predicting symptomatic IPSS scores. This novel finding can improve the ability to diagnose and treat LUTS, especially in primary care offices and underserved areas. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e302 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gaurav Pahouja More articles by this author Parth Patel More articles by this author Enrique Blanco Martinez More articles by this author Kevin T. McVary More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP04-16 THULIUM YAG VS THULIUM FIBER LASER ENUCLEATION OF THE PROSTATE (THULEP VS TFLEP): A MULTI-INSTITUTION TRIAL TO COMPARE INTRA AND EARLY POSTOPERATIVE OUTCOMES

You have accessJournal of UrologyCME1 May 2022MP04-16 THULIUM YAG VS THULIUM FIBER LASER ENUCLEATION OF THE PROSTATE (THULEP VS TFLEP): A MULTI-INSTITUTION TRIAL TO COMPARE INTRA AND EARLY POSTOPERATIVE OUTCOMES Matteo Maltagliati, Lorenzo Berti, Salvatore Micali, Umberto Besana, Carlo Buizza, Bernardo Rocco, Maria Chiara Sighinolfi, Andrea Pacchetti, Jean Baptiste Roche, and Giorgio Bozzini Matteo MaltagliatiMatteo Maltagliati More articles by this author , Lorenzo BertiLorenzo Berti More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , Umberto BesanaUmberto Besana More articles by this author , Carlo BuizzaCarlo Buizza More articles by this author , Bernardo RoccoBernardo Rocco More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Andrea PacchettiAndrea Pacchetti More articles by this author , Jean Baptiste RocheJean Baptiste Roche More articles by this author , and Giorgio BozziniGiorgio Bozzini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare clinical intra and early postoperative outcomes between Thulium laser Enucleation of the Prostate (ThuLEP) and Thulium Fiber Laser Enucleation of the Prostate (TFLEP) in the treatment of benign prostatic hyperplasia (BPH). METHODS: 240 patients suffering from lower urinary tract symptoms due to BPH were consecutively enrolled and randomized to either BPH to ThuLEP (n=117) or TFLEP (n=123). Patients were evaluated preoperatively using the International Prostate Symptom Score (IPSS), Quality of Life score (QoL), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). Preoperative prostate volume, PSA and haemoglobin were also recorded. All the patients were evaluated postoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. 3 months after surgery micturition improvement was evaluated using the IPSS, Qmax and PVR. RESULTS: No significant differences were found between the patients in the two study arms. Compared with TFLEP, ThuLEP determined a shorter operative time (63.69 ± 41.44 vs 79.66 ± 48.70 minutes, p=0.045). No significant differences were found between ThuLEP and TFLEP in terms of haemoglobin decrease (0.45 vs 0.47 g/dl, p=0.32), catheterization time (1.9 vs 2.1 days, p=0.37), irrigation volume (29.4 vs 32.8 l, p=0.43), and hospital stay (2.2 vs 2.6 days, p=0.22). During the 3 months of follow-up, the procedures did not demonstrate significant differences in Qmax, IPSS, PVR, and QoL. CONCLUSIONS: ThuLEP and TFLEP both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TFLEP in terms of duration of the procedure. Catheterization time, irrigation volume, hospital stay and operative time were comparable. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e64 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matteo Maltagliati More articles by this author Lorenzo Berti More articles by this author Salvatore Micali More articles by this author Umberto Besana More articles by this author Carlo Buizza More articles by this author Bernardo Rocco More articles by this author Maria Chiara Sighinolfi More articles by this author Andrea Pacchetti More articles by this author Jean Baptiste Roche More articles by this author Giorgio Bozzini More articles by this author Expand All Advertisement PDF DownloadLoading ...

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

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

Through the zipper or pants down: Does it change uroflowmetry parameters in healthy males?

To evaluate if voiding through the zipper or voiding pants down would make any difference with regard to uroflowmetry parameters and postvoiding residual urine (PVR) volumes in healthy males with no lower urinary tract symptoms (LUTS). Healthy males over 18 years of age with no LUTS were prospectively evaluated using a uroflowmetry test. Each individual was asked to void through the zipper (group 1) and pants down (group 2) at different times. The uroflowmetry test was repeated if the voided volume did not exceed 150 mL. Uroflowmetry results such as voided volume, maximum flow rate (Qmax), average flow rate (Qave), and duration of voiding were noted. PVR volume was assessed using ultrasonography. Electromyography was not used. Data are shown as mean ± standard deviation. For statistical analysis, a paired t test was used to analyze parametric parameters. A total of 44 males were enrolled. The median age of the individuals was 24 (range 18-44 years). There were no statistically significant differences between the two measurements in terms of voided volume (307 ± 121 mL vs 325 ± 145 mL, P=.365) and duration of voiding (25 ± 11 s vs 23.8 ± 11.6 s, P=.526). However, there were statistically significant differences in Qmax (26.6 ± 6.7 mL/s vs 30.0 ± 8.2 mL/s, P=.001), Qave (14.4 ± 3.6 mL/s vs 16.2 ± 5.1 mL/s, P=.009), and PVR volumes (23.9 ± 19.4 mL vs 3.9 ± 9.6 mL, P=.0001). Voiding pants down shows higher flow rates and lower PVR than voiding through the zipper in individuals with no LUTS. Future studies with a larger number of individuals (including those with LUTS) and a broader age range cohort are required for solid conclusions.

Comparison of Self-Conducted and Assistant-Supervised Uroflowmetry Methods.

ObjectiveThis study aims to compare the results and patient satisfaction scores between uroflowmetry performed under the patient's control and assistant-supervised conventional uroflowmetry.MethodsA total of 120 patients who had previous experience with uroflowmetry were included in the study. Patients were evaluated in two even groups of 60 patients each - those not receiving medical treatment (group 1) and those receiving medical treatment (group 2). Maximum flow rate (Qmax), average flow rate (Qave), voided volume, voiding time, post-void residual volume (PVR), and patient satisfaction survey scores were compared between the two separate uroflowmetry methods.ResultsThere was a significant difference between assistant-supervised and self-conducted uroflowmetry in terms of Qmax, Qave, voiding time, and patient satisfaction scores. While comparing all patients, no significant difference was found in terms of PVR and voiding volume values. There was a significant difference in Qave, Qmax, PVR, and voiding time in both assistant-supervised and self-conducted uroflowmetry. As for voided volume, there was no significant difference between the groups in either procedure. When groups were evaluated within themselves, in group 1, there was a significant difference in voided volume, Qave, and PVR, while there was no significant difference in Qmax and voiding time. In Group 2, there was a significant difference in voided volume, Qave, and PVR, although there was no significant difference in Qmax and voiding time.ConclusionMaximum urine flow rate and mean urine flow rate measured by self-conducted uroflowmetry are higher than assistant-supervised (conventional) uroflowmetry, which can ensure patient privacy.

Study on the effect of completely preserving the ejaculatory duct during prostatectomy on reducing postoperative retrograde ejaculation in benign prostatic hyperplasia patients.

Preserving the sexual function of benign prostatic hyperplasia (BPH) patients and reducing the incidence of postoperative retrograde ejaculation are critical for BPH patients with sexual needs. To explore the effect of complete preservation of the seminal tract during transurethral prostatectomy (TURP) on reducing retrograde ejaculation in BPH patients. BPH patients meeting the inclusion criteria were randomly divided into the Control group (traditional TURP) and the Experimental group (complete reserved ejaculatory duct) in a ratio of 1 : 1. Finally, data of 64 BPH patients - 34 in the Control group and 30 in the Experimental group - were analyzed. We measured the preoperative and postoperative maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), Quality of Life (QOL) score, semen volume, and ejaculation function. Compared with pre-operation values, patients in the two groups exhibited increased Qmax and decreased IPSS and QOL scores after the operation. However, there was no significant difference in Qmax, IPSS, or QOL between the Control and Experimental groups after the operation. The two groups of patients had a significant reduction in postoperative ejaculation. Compared with the Control group, the semen volume of patients was higher, and the incidence of retrograde ejaculation was lower in the Experimental group. Prostatectomy with complete preservation of the seminal tract is not different from conventional electrosurgical resection in improving urination symptoms, while the incidence of retrograde ejaculation is significantly lower.

A Prospective Comparative Study of Mobile Acoustic Uroflowmetry and Conventional Uroflowmetry.

PurposeThe aim of this study was to assess the performance of a mobile acoustic Uroflowmetry (UFM) application compared with standard UFM in the pediatric population.MethodsA mobile acoustic UFM application represents a noninvasive method to estimate the urine flow rate by recording voiding sounds with a smartphone. Male pediatric patients who were undergoing UFM testing were prospectively recruited, and the voiding sounds were recorded and analyzed. The intraclass correlation coefficient (ICC) was used to compare the maximum flow rate (Qmax), average flow rate (Qavg), voiding time (VT), and voiding volume (VV) as estimated by acoustic UFM with those calculated by standard UFM. Differences in Qmax, Qavg, VT, and VV between the 2 UFM tests were determined using 95% Bland-Altman limits of agreement.ResultsA total of 16 male patients were evaluated. Their median age was 9 years. With standard UFM, the median Qmax, Qavg, VT, and VV were 18.7 mL/sec, 11.1 mL/sec, 15.2 seconds, and 157.8 mL, respectively. Strong correlations were observed between the 2 methods for Qmax (ICC=0.755, P=0.005), VT (ICC=0.974, P<0.001), and VV (ICC=0.930, P<0.001), but not for Qavg (ICC=0.442, P=0.135). The Bland-Altman plot showed good agreement between the 2 UFM tests. Flow patterns recorded by acoustic UFM and conventional UFM showed good visual correlations.ConclusionsAcoustic UFM was comparable to standard UFM for male pediatric patients. Further validation of its performance in different toilet settings is necessary for broader use.

The Advantages of DiLEP Operation in the Treatment of BPH Patients and the Observation of Postoperative Urinary Control Effect

Objective: To evaluate the efficacy of Semiconductor laser trefoil enucleation of the prostate (DiLEP) in the treatment of patients with benign prostatic hyperplasia (BPH). Methods: 120 BPH patients scheduled for prostate surgery in our hospital were randomly divided into two groups: study group (DiLEP treatment) and control group (transurethral plasma bipolar resection of the prostate treatment), with 60 cases in each one. Surgical process indicators, postoperative rehabilitation indicators, Qmax before and after surgery, post-void residual volume (PVR), international prostate symptom score (IPSS), hemoglobin (Hb), urinary control and surgical complications for two groups were compared. Results: The operation time, intraoperative blood loss, bladder irrigation time, urinary catheter indwelling time and hospital stay in the study group were lower than those in the control group (P&lt;0.05). The weight of resected tissue in the study group was higher than that in the control group (P &lt;0.05). The difference in Qmax, PVR, IPSS scores and Hb between the study group and the control group before operation and one month after operation had no statistical significance (P&gt;0.05). The Qmax and Hb scores in the study group were higher than those in the control group (P&lt;0.05), while the PVR and IPSS scores were lower than those in the control group (P&lt;0.05); five days and two weeks after operation, the urinary control rates in the study group were all higher than that in the control group (P&lt;0.05); one month after operation, the difference in the urinary control rates between the two groups had no statistical significance (P&gt;0.05); the difference in the surgical complication rate between the study group and the control group had no stastiscal significance (P&gt;0.05). Conclusion: DiLEP is beneficial for early recovery of urodynamics in patients with BPH, with less trauma and faster recovery of urinary control after surgery.

&lt;p&gt;Comparison of Outcome and Success Rate of Onlay Island Flap and Dorsal Inlay Graft in Hypospadias Reconstruction: A Prospective Study&lt;/p&gt;

BackgroundChordee correction, urethroplasty, and tissue reconstruction are performed to correct and retain standard functionality of the penis in hypospadias. Conventional reconstruction techniques, such as onlay island flap and the dorsal inlay graft, can be performed based on the classification of hypospadias. However, the outcomes and complication rates have not been widely studied. Thus, we aimed to provide preliminary evidence regarding the efficacy and safety of both approaches in hypospadias reconstruction.Patients and MethodsA prospective study with two time evaluations of 14 and 180 days post-operatively was performed at the Urology outpatient clinic from October 2014 to September 2019. A proportion comparison of success rate, time to the complication, operation time, catheterization duration, uroflowmetry parameter post-surgery, and mean scores comparison of PPPS were measured as the intended outcomes.ResultsIn a total of 59 pediatric hypospadias, patients who had undergone reconstruction are included in this study. Higher subjects’ age and severe chordee severity were more common in the dorsal inlay graft group (age=7.50 [1–26] months; severe chordee 45.8%) compared to the onlay island flap group (age=4.0 [1–67] months; severe chordee 31.4%), both groups showed similar satisfaction regarding meatal shape and position (P=0.618), glands shape (P=0.324), penile skin shape (P=0.489), and general cosmetic appearance (P=0.526). Complication occurrence and time to complication duration of both groups were also not statistically significant (P=0.464 and P=0.413). There are no significant differences in Qmax, Qmean, voided volume, and PVR of both groups (P=0.125, 0.136, 0.076, 0.260, respectively). Significant differences in operation times and catheterization duration are found in this study (P<0001).ConclusionOutcome evaluation regarding functional, complication and patient satisfaction comparing onlay flap and dorsal inlay graft for hypospadias patients is scarce. This study found that both procedures can be considered safe with comparable incidence of complications.

Effect of SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at governor vessel on urodynamic for neurogenic bladder after spinal cord injury

To observe the clinical efficacy of SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at the governor vessel for neurogenic bladder after spinal cord injury. A total of 64 patients with neurogenic bladder after spinal cord injury were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with routine acupuncture and rehabilitation of bladder function; based on the treatment in the control group, the patients in the observation group were treated with SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at the governor vessel, twice a week for 8 weeks. Urodynamic test, including residual urine volume (RUV), maximum flow rate of urination (Qmax), bladder pressure at filling phase (Pves), maximum detrusor pressure (Pdet-max) and maximum urinary bladder volume (VMCC), was performed before and after 8-week treatment. The urodynamic indexes in the two groups were improved compared with before treatment (P<0.01, P<0.05); after treatment, VMCC in the observation group was significantly higher than the control group (P<0.01), while RUV and Pves in the observation group were significantly lower than the control group (P<0.05). After treatment, there was no significant difference in Qmax and Pdet-max between the two groups (P>0.05). Based on routine acupuncture and rehabilitation of bladder function, SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at the governor vessel could effectively improve urodynamic indexes, reduce residual urine, reduce bladder pressure and increase the maximum capacity of bladder, thereby improving bladder compliance and bladder function.

Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): A randomized prospective trial to compare intra and early postoperative outcomes

ObjectiveTo compare clinical intra and early postoperative outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) and transurethral bipolar resection of the prostate (TURis) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial. MethodsThe study randomized 208 consecutive patients with BPH to ThuLEP (n=102) or TURis (n=106). For all patients were evaluated preoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. At 3 months after surgery they were also evaluated by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). ResultsThe patients in each study arm each showed no significant difference in preoperative parameters. Compared with TURIS, ThuLEP had same operative time (53.69±31.44 vs 61.66±18.70minutes, P=.123) but resulted in less hemoglobin decrease (0.45 vs 2.83g/dl, P=.005). ThuLEP also needed less catheterization time (1.3 vs 4.8 days, P=.011), irrigation volume (29.4 vs 69.2l, P=.002), and hospital stay (1.7 vs 5.2 days, P=.016). During the 3 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS. ConclusionThuLEP and TURis both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TURis in blood loss, catheterization time, irrigation volume, and hospital stay. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through 3 months of follow-up.

PD23-04 THULIUM LASER ENUCLEATION (THULEP) VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE IN SALINE (TURIS): A RANDOMIZED PROSPECTIVE TRIAL TO COMPARE COSTS PER PROCEDURE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2017PD23-04 THULIUM LASER ENUCLEATION (THULEP) VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE IN SALINE (TURIS): A RANDOMIZED PROSPECTIVE TRIAL TO COMPARE COSTS PER PROCEDURE Giorgio Bozzini, Stefano Casellato, Serena Maruccia, giovanni saredi, paolo parma, and Gianluigi Taverna Giorgio BozziniGiorgio Bozzini More articles by this author , Stefano CasellatoStefano Casellato More articles by this author , Serena MarucciaSerena Maruccia More articles by this author , giovanni saredigiovanni saredi More articles by this author , paolo parmapaolo parma More articles by this author , and Gianluigi TavernaGianluigi Taverna More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1068AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare the costs per procedure between thulium laser transurethral enucleation of the prostate (ThuLEP) and transurethral bipolar resection of the prostate (TURIS) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial. METHODS The study randomized 208 consecutive patients with BPH to ThuLEP (n = 102) or TURIS (n =106). For all patients were evaluated preoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. At 3 months after surgery they were also evaluated by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR) to see if a cost reduction could be correlated with a worst outcome. RESULTS The patients in each study arm each showed no significant difference in preoperative parameters. Compared with TURIS, ThuLEP had same operative time (53.69±31.44 vs 61.66±18.70 minutes, P = .123) but resulted in less hemoglobin decrease (0.45 vs 2.83 g/dL, P = .005). ThuLEP also needed less catheterization time (1.3 vs 4.8 days, P = .011), irrigation volume (29.4 vs 69.2 L, P = .002), and hospital stay (1.7 vs 5.2 days, P = .016). Average cost for a ThuLEP was 1181 euros while was 1761,16 for a TURIS (p< .005). During the 3 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS. CONCLUSIONS ThuLEP and TURIS both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TURIS as a cheaper procedure. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through 3 months of follow-up. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e448 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Giorgio Bozzini More articles by this author Stefano Casellato More articles by this author Serena Maruccia More articles by this author giovanni saredi More articles by this author paolo parma More articles by this author Gianluigi Taverna More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Adsorption of beta-lactoglobulin in anion exchange membrane chromatography versus the contacting mode and temperature

Adsorption of beta-lactoglobulin to strong anion exchange membranes was investigated using three different contacting modes (batch adsorption, radial and tangential flow), and by equilibrium adsorption isotherm, as a function of temperature. The maximum binding capacity (qmax) was: (1) higher at lower temperature for the isotherm where qmax = 1.08 mg/cm2 at 10 °C versus qmax = 0.82 mg/cm2 at 50 °C, (2) independent of temperature for batch adsorption where the average qmax = 0.82 mg/cm2, (3) higher at lower temperature for radial flow where qmax = 0.87 mg/cm2 at 15 °C versus qmax = 0.38 mg/cm2 at 50 °C. For tangential flow at 10 °C, qmax = 0.65 mg/cm2. Differences in qmax between the three contacting modes were minor compared to the differences in the mass transfer coefficients that were tenfold higher for tangential flow than for batch adsorption. This was attributed to convective flow in the membrane pores closest to the flow channel, and diffusive mass transfer in the membrane pores farthest from the flow channel. The present work is the first report of mass transfer coefficients in tangential flow adsorbers, and the first report on the effect of temperature on the binding capacity of beta-lactoglobulin to adsorptive membranes.

Enucleación con láser de tulio (ThuLEP) frente a resección transuretral de la próstata en solución salina (TURis): un ensayo prospectivo aleatorizado para comparar resultados intra y postoperatorios tempranos

ObjectiveTo compare clinical intra and early postoperative outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) and transurethral bipolar resection of the prostate (TURis) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial. MethodsThe study randomized 208 consecutive patients with BPH to ThuLEP (n=102) or TURis (n=106). For all patients were evaluated preoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. At 3 months after surgery they were also evaluated by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). ResultsThe patients in each study arm each showed no significant difference in preoperative parameters. Compared with TURIS, ThuLEP had same operative time (53.69±31.44 vs 61.66±18.70minutes, P=.123) but resulted in less hemoglobin decrease (0.45 vs 2.83g/dL, P=.005). ThuLEP also needed less catheterization time (1.3 vs 4.8 days, P=.011), irrigation volume (29.4 vs 69.2 L, P=.002), and hospital stay (1.7 vs 5.2 days, P=.016). During the 3 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS. ConclusionThuLEP and TURis both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TURis in blood loss, catheterization time, irrigation volume, and hospital stay. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through 3 months of follow-up.

Monopolar versus bipolar transurethral resection of the prostate: a Meta analysis

Objectives To systematic review the efficacy and safety of monopolar versus bipolar transurethral resection of the prostate using Meta analysis. Methods PubMed, Embase, the Cochrane Library, Chinese biomedical literature database, Chinese Scientific Journals full-text database, Chinese Journal full-text database, and major conference proceeding for randomized controlled trials comparing monopolar with bipolar transurethral resection of the prostate for patients with benign prostatic hyperplasia were searched . Meta anlysis was carry out according to Cochrane handbook. The data were analyzed using Review Manager 5.2 provied by Cochrane collaboration. Results 16 randomized controlled trials (a total of 1986 patients) were included. The Meta analysis showed that there was not significant difference between monopolar group and bipolar group in Qmax[MD=0.34, 95%CI(-0.15, 0.82)]and clot retention incidence rate [RD=0.00, 95%CI(-0.01, 0.02)]. While bipolar group provided lower transurethral resection syndrome rate [RD=0.01, 95%CI(0.00, 0.03)] and clot retention [RD=0.03, 95%CI(0.01, 0.05)]. Conclusions Current clinical evidence indicates that no clinically relevant differences in Qmax exists between the two techniques, bipolar technology is superior to monopolar technology in safety. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate; Meta-Analysis