Improvement In Lower Urinary Tract Symptoms Research Articles

Nowoczesna terapia skojarzona tadalafilem i tamsulozyną jako schemat leczenia u mężczyzn z objawami ze strony dolnych dróg moczowych

Based on the available scientific research, tadalafil administered daily at a dose of 5 mg is safe and effective in the treatment of men with lower urinary tract symptoms and erectile dysfunction, compared to placebo or tamsulosin alone. The combination of 5 mg tadalafil and 0.4 mg tamsulosin daily allows for a better lower urinary tract symptoms improvement compared to monotherapy drugs, even with an increased, but acceptable and tolerable side effects. When tamsulosin or tadalafil is discontinued, lower urinary tract symptoms are significantly worsened compared to baseline in patients previously treated with combination therapy. Tadalafil 5 mg should be considered as one of the primary treatment options in lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction patients as it has an excellent tolerability, safety, and efficacy profile, both as monotherapy and in combination with 0.4 mg tamsulosin. Better effectiveness in alleviating lower urinary tract symptoms was observed with combination therapy while maintaining sexual function. Continuing to switch to monotherapy maintains lower urinary tract symptoms relief, but only tadalafil is able to maintain erectile dysfunction improvement. Our results support evidence of an increasingly tailored and modular lower urinary tract symptoms treatment.

Impact of Sleep Disturbance, Physical Function, Depression and Anxiety on Male Lower Urinary Tract Symptoms: Results from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN).

The impact of nonurological factors on male lower urinary tract symptoms (LUTS) remains unclear. We investigated cross-sectional and longitudinal associations among anxiety, depression, physical function, sleep quality and urinary symptom subdomains. Data from 518 men in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) study were analyzed to identify associations between Patient-Reported Outcomes Measurement Information System® (PROMIS®) depression, anxiety, sleep disturbance and physical function measures and LUTS subdomains, as derived from the American Urological Association Symptom Index and LUTS Tool. Multivariable linear regression was used to assess the relationships between PROMIS measures and LUTS subdomains at baseline and at 3- and 12-month followup. Baseline depression and anxiety were associated with urinary incontinence (p <0.001), voiding symptoms (p <0.001) and quality of life (p=0.002), whereas baseline sleep disturbance was associated with voiding and storage symptoms and quality of life (p <0.001 for all). Urinary symptom severity improved in all subdomains at 3 and 12 months. Similar associations between PROMIS measures and LUTS subdomains were observed at all time points, but baseline depression, anxiety, sleep disturbance and physical function measures were not associated with longitudinal trajectories of LUTS. Urinary symptom subdomains are independently associated with modifiable clinical variables including sleep quality and depression at all time points, but these variables do not predict the degree of improvement in LUTS following urological evaluation and treatment over the medium term. Bidirectional assessment and randomized experiments may improve our understanding of these relationships.

Prostatic Artery Embolization for Lower Urinary Tract Symptoms via Transradial Versus Transfemoral Artery Access: Single-Center Technical Outcomes.

ObjectiveTo evaluate the safety and feasibility of prostatic artery embolization (PAE) via transradial access (TRA) compared with transfemoral access (TFA).Materials and MethodsThis retrospective study included 53 consecutive men with lower urinary tract symptoms (LUTS) who underwent PAE between September 2018 and September 2021. Thirty-one patients (mean age ± standard deviation: 70.6 ± 8.4 years) were treated with TFA, including 14 patients treated before adopting TRA. Since December 2019, TRA has also been attempted with the procedure’s selection criteria of patent carpal circulation and a height ≤ 172 cm, with 22 patients treated via TRA (69.1 ± 9.6 years). Parameters of technical success (defined as successful bilateral embolization), clinical success (defined as LUTS improvement), procedural time, radiation dose, and adverse events were compared between the two groups using the Fisher’s exact test, independent sample t test, Wilcoxon signed-rank test, or Mann-Whitney test.ResultsAll patients received at least one-side PAE. Technical success of PAE was achieved in most patients (TRA, 21/22; TFA, 30/31; p > 0.999). No technical problem-related conversion from TRA to TFA occurred. The clinical success rate was 85% (11/13) in patients with TRA, and 89% (16/18) in patients with TFA for follow-up > 2 weeks post-PAE (median, 3 months) (p > 0.999). The median procedure time was similar in both groups (TRA, 81 minutes vs. TFA, 94 minutes; p = 0.570). No significant dose differences were found between the TRA and TFA groups in the dose-area product (median Gycm2, 95 [range, 44–255] for TRA and 84 [34–255] for TFA; p = 0.678) or cumulative air kerma (median mGy, 609 [236–1584] for TRA and 634 [217–1594] for TFA; p = 0.551). No major adverse events occurred in either of the groups.ConclusionPAE via TRA is a safe and feasible method comparable to conventional TFA. It can be safely implemented by selecting patients with patent carpal circulation and adequate height.

Office-based therapies for benign prostatic hyperplasia: Update on new minimally invasive surgery therapies

Several minimally invasive surgical therapies have been developed for the treatment of Lower Urinary Tract Symptoms (LUTS) associated with Benign Prostate Hyperplasia (BPH). The objective was to report an update on these new office-based therapies. This simple review is based on the data available in the literature on office-based minimally invasive surgical techniques for treating BPH. A PubMed search and narrative review of the data were performed in July 2021. Only articles in French or English were reviewed. The most studied office-based minimally invasive treatments for BPH are water vapor thermal therapy (Rezum® system, Boston Scientific Corporation, Marlborough, MA), prostatic urethral lift (UroLift® system, NeoTract, Inc., Pleasanton, California, USA) and the Temporarily Implanted Nitinol Device (iTind®, Medi-Tate Ltd, Hadera, Israel). Each treatment appears to provide rapid and lasting improvement in LUTS and quality of life, preservation of sexual and ejaculatory functions, rapid postoperative recovery with a minimal adverse event profile, thus allowing outpatient care. Compared to conventional BPH surgeries, these benefits would be offset by higher retreatment rates and less overall improvement in LUTS. New minimally invasive therapies are promising options that are well tolerated and preserve sexual and ejaculatory functions in men with BPH. Although standard surgical approaches may be more effective, these benefits are valuable for certain patient populations.

Abstract No. 61 Prostatic artery embolization with 100- to 300-μm microspheres to treat lower urinary tract symptoms attributable to benign prostatic hyperplasia: a single-center analysis of 4-year outcomes

To present safety and efficacy data for up to 4 years of follow-up after 100-to 300-μm microsphere prostatic artery embolization (PAE) to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). 135 consecutive patients who underwent PAE with 100- to 300-μm microspheres from April 2014 through February 2020 were retrospectively reviewed. Exclusion criteria included technical failure (unilateral or no embolization, n = 8), dementia (n = 3), new onset prostate cancer (n = 1), or loss to follow-up (n = 2). Subjects (n = 121, mean age = 72.3 ± 7.6, mean Charlson comorbidity index = 3.5 ± 1.6, mean prostate gland volume (PGV) = 128 ± 77mL) had mean pre-procedure International Prostate Symptoms Score (IPSS) = 21.7 ± 6.1, mean Quality of Life score (QoL) = 4.5 ± 1.2, and mean post-void residual (PVR) = 172 ± 165mL. After PAE, patients were evaluated at 1, 3, 6, 12, 24, 36, and 48 months. Comparisons to baseline values used Wilcoxon signed rank tests (IPSS, QoL) or T-tests (PGV, PVR). 30-day adverse events were recorded using Clavien-Dindo classification. Follow-up compliance was 68-85%. Substantial and statistically significant improvements were seen in IPSS and QoL through 48 months of follow-up. Post-treatment PVR and PGV were measured from 3 months onward, with substantial and statistically significant improvements seen through 24 months. Insufficient PVR and PGV data were available beyond 24 months. Within 30 days, 17 self-limited grade-1 adverse events occurred; 21 grade-2 adverse events occurred (retention < 1wk = 8, UTI = 9, DVT = 1, bladder ischemia = 1); there was 1 unrelated death. PAE with 100- to 300-μm microspheres produced sustained substantial improvements in LUTS, PVR, and PGV through 48 months. Outcomes were similar to transurethral surgeries with few serious adverse events, despite large pre-embolization gland volumes and substantial patient co-morbidities.

One-year outcomes after treatment with a drug-coated balloon catheter system for lower urinary tract symptoms related to benign prostatic hyperplasia

BackgroundThis is the first report of the 1-year outcomes of the EVEREST-I study evaluating the safety and efficacy of the Optilume® BPH Catheter System, a prostatic paclitaxel-coated balloon catheter system, for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH).MethodsSubjects were men >50 years old with moderate-to-severe LUTS secondary to BPH, peak urinary flow rate of 5–15 ml/s, prostatic urethra length 30–55 mm, and prostate volume 20–80 g. All were treated with the Optilume BPH Catheter System and followed at Foley removal, 2 weeks, 30 days, 3, 6, and 12 months after treatment. The primary endpoint was the proportion of subjects with ≥40% improvement in International Prostate Symptom Score (IPSS). The rate of post-procedural complications was evaluated.ResultsEighty subjects were treated at six sites in Latin America and 75 completed the 1-year follow-up. The percent of subjects with an improvement ≥40% in IPSS from baseline was 81% at 3 months and 1 year. IPSS improved from 22.3 at baseline to 7.9 at 1 year, Qmax improved from 10.9 to 18.4 ml/s, and IPSS QoL improved from 4.6 to 1.3. Post-procedural complications included common urologic events and the rate of complications was significantly impacted by device diameter.ConclusionsTreatment with the minimally invasive Optilume BPH Catheter System is safe and showed subjective and objective improvements in LUTS. Benefits were rapid and persisted through 1 year. The initial results warrant further evaluation of this therapy as a treatment option for patients with LUTS related to BPH.

Preserving ejaculatory function in young patients with lower urinary tract symptoms: medium- to long-term follow-up of prostatic urethral lift at a single center.

Background and aims:Prostatic urethral lift (Urolift™) is a minimally invasive technique to treat male lower urinary tract symptoms (LUTSs) due to benign prostatic hyperplasia (BPH). The aim of the present study was to assess safety and medium- to long-term outcomes in the relief of urinary symptoms.Methods:We included 35 men, affected by severe symptomatic BPH evaluated by International Prostate Symptom Score (IPSS), with normal erectile function (EF) and ejaculatory function (EjF) evaluated by the International Index of Erectile Dysfunction (IIEF-5) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD-SF). Exclusion criteria were prostate larger than 70 cm3, bladder neck sclerosis, concomitant third prostatic lobe, and/or other cervical urethral obstruction or cancer. All patients, preoperatively, performed uroflowmetry (UFM) with peak flow (Q-max) and post void residual volume (PVR), digital rectal exam, transrectal prostate ultrasound to measure prostate volume, PSA, and cystoscopy. Follow-up was scheduled at 1–3–6 months, then yearly, evaluating UFM, IPSS, IIEF-5, and MSHQ-EjD-SF.Results:All procedures were performed by a single senior surgeon and follow-up was 33.8 ± 12 months. Preoperative PSA was 0.82 ± 0.4 ng/ml and mean operative time was 19.6 ± 10 min and 3 (2–4) implants per patient were used. Parameters reported at last follow-up schedule were: Q-max increase of 68% (p = 0.001), PVR reduction 68% (p = 0.005), and IPSS reduction 55% (p < 0.0001). EF and EjF were similarly preserved, and no patients presented retrograde ejaculation. A total of 88.6% of patients were satisfied with LUTSs improvement and 100% satisfied with EjF.Conclusion:Urolift can improve urinary disorders secondary to BPH, preserving EjF and EF. It is a safe and easy method, reproducible, and with low incidence of complications. Careful selection of patients is mandatory. The main reason for dissatisfaction is the higher expectation of better BPH symptoms relief although patients with high bladder neck and/or prostate volume >45 cm3 were aware of the possible failure.

The effect of bariatric surgery on the improvement of lower urinary tract symptoms in morbidly obese male patients.

Lower urinary tract symptoms (LUTS) are strongly linked with obesity. Whether bariatric surgery can effectively alleviate LUTS in morbidly obese men is unknown. The objective of the present study was to evaluate the effectiveness of bariatric surgery in reducing the prevalence and severity of male LUTS in obese patients. This was a prospective observational study on consecutive morbidly obese men undergoing bariatric surgery. The International Prostate Symptom Score (IPSS) was used to assess for LUTS before and at 1-3 years after surgery. The 3-year changes in IPSS, the changes in LUTS severity, and the factors associated with LUTS improvement were evaluated. This study recruited 143 morbidly obese men (mean age 43.0 ± 10.4 years) undergoing sleeve gastrectomy (n = 89) and Roux-en-Y gastric bypass (n = 54). The rates of follow-up after surgery were 94.4% (n = 119/126) at 1 year, 90.6% (n = 96/106) at 2 years, and 81.2% (n = 69/85) at 3 years. After surgery, there was significant body mass index reduction from 39.1 ± 5.2 kg/m2 preoperatively to 30.1 ± 4.8 kg/m2 at 1 year and 31.5 ± 4.9 kg/m2 at 3 years (P < 0.001). There was significant reduction in IPSS total symptom score, quality of life score, frequency score, and nocturia score (P < 0.05). The prevalence of moderate to severe LUTS reduced from 35.0% (29.4% moderate; 5.6% severe) preoperatively to 21.8% (19.3% moderate; 2.5% severe) at 1 year and 30.4% (24.6% moderate; 5.8% severe) at 3 years (P < 0.001). LUTS improvement was significantly associated with body fat percentage reduction (P = 0.012) and was not associated with weight loss or improvement of metabolic parameters. Bariatric surgery was an effective and durable intervention for alleviating the prevalence and severity of LUTS in morbidly obese men for up to 3 years.

PD61-03 EVEREST- I: ONE YEAR OPTILUME BPH CATHETER SYSTEM EFFICACY AND SAFETY EXPERIENCE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV (PD61)1 Apr 2020PD61-03 EVEREST- I: ONE YEAR OPTILUME BPH CATHETER SYSTEM EFFICACY AND SAFETY EXPERIENCE Steven Kaplan*, Merycarla Pichardo, Edwin Rijo, Ramon Rodriguez Lay, Gustavo Espino, and Rafael Estrella Steven Kaplan*Steven Kaplan* More articles by this author , Merycarla PichardoMerycarla Pichardo More articles by this author , Edwin RijoEdwin Rijo More articles by this author , Ramon Rodriguez LayRamon Rodriguez Lay More articles by this author , Gustavo EspinoGustavo Espino More articles by this author , and Rafael EstrellaRafael Estrella More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000978.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Data includes the initial 1 year EVEREST– I Study experience with the Optilume BPH Catheter System, with minimally invasive urethral prostatic balloon dilation, anterior commissurotomy and localized transfer of paclitaxel with a drug coated balloon (DCB) for treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). METHODS: The prospective non-randomized study included 5 Latin American centers and 49 subjects treated with the Optilume BPH Catheter. Follow-up (f/u) included Foley removal, 2 weeks, 1, 3, 6 and 12 months (mo) post dilation. Baseline transrectal ultrasound included prostate measurement to size DCB catheter. Primary endpoints included International Prostate Symptom Score (IPSS) improvement of ≥ 40% and major device or procedure related adverse events @ 3 mo. Secondary endpoints included 1) mean decrease of IPSS at each f/u, 2) change in peak urinary flow rate (Qmax) 3) change in post void residual urine volume (PVR) and 4) % of subjects with IPSS improvement ≥ 30, 40, 50, and 75%. RESULTS: 75.5% of subjects had IPSS improvement of ≥ 40% from baseline at 3 mo. Severe LUTS symptoms at baseline improved to mild or moderate. Average IPSS QOL improved through 12 mos. Qmax improved from 11 ml/sec at baseline to 19.4 ml/sec at 12 mo f/u. PVR decreased from 71.8 ml at baseline to 28.7 ml at 12 mos. BPH impact scores reported improved QOL through 12 mos. Prostatic DCB use had no significant effects on erectile function. One subject (2%) met the primary safety endpoint due to stress urinary incontinence. CONCLUSIONS: Results demonstrate significant subjective and objective improvement in LUTS 2° to BPH. These data serve as a gateway to a pivotal trial versus sham now underway. Long term efficacy and safety will determine the role of the Optilume BPH Catheter as a therapy option for BPH. Source of Funding: Urotronic © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1281-e1281 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Kaplan* More articles by this author Merycarla Pichardo More articles by this author Edwin Rijo More articles by this author Ramon Rodriguez Lay More articles by this author Gustavo Espino More articles by this author Rafael Estrella More articles by this author Expand All Advertisement PDF downloadLoading ...

Tamsulosin and placebo vs tamsulosin and tadalafil in male lower urinary tract symptoms: a double-blinded, randomised controlled trial.

To compare the efficacy and safety of tamsulosin vs the combination of tamsulosin and tadalafil in male lower urinary tract symptoms (LUTS). This was a double-blinded, parallel-arm randomised controlled trial. Men aged >45years with moderate LUTS and a maximum urinary flow rate (Qmax ) of 5-15mL/s were included. One arm received 0.4mg tamsulosin only (Group-A), while the second received 5mg tadalafil with tamsulosin (Group-B). The primary outcome was the International Prostate Symptom Score (IPSS). Secondary outcomes were IPSS quality of life (QoL) score, five-item version of the International Index of Erectile Function (IIEF-5) score, Qmax , and post-void residual urine (PVR). Block randomisation was used. Placebo was used for blinding and allocation concealment. Intention-to-treat analysis was used for outcome measures. Of the 183 men screened, 140 were randomised (71 in Group-A, 69 in Group-B); 116 (82.85%) (61 in Group-A, 55 in Group-B) completed the study. Baseline characteristics were comparable. The improvements in the IPSS, IPSS QoL score, IIEF score and Qmax were -1.69 (95% confidence interval [CI] -1.4 to -2.0), -0.70 (95% CI -0.60 to -0.80), 3.8 (95% CI 3.4-4.2) and 1.8mL/s (95% CI 1.1-2.4) respectively, in favour of the combination group. The difference in PVR was not significant. There were no serious adverse events (AEs). The dropout rate due to AEs was 2.85%. Myalgia (five patients) was the commonest AE in the combination group. The combination of tamsulosin and tadalafil produced significantly better improvements in LUTS, QoL, erectile function and Qmax compared to monotherapy with tamsulosin, without an increase in AEs.

Update on Prostatic Artery Embolization

Background: Prostatic artery embolization (PAE) has emerged as a treatment option in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Management guidelines addressing PAE remain mixed with recommendations for more long-term trials comparing the procedure to standard therapies. Materials and Methods: This review presents PAE indications and technical considerations. To evaluate recent updates to the PAE evidence base, a limited literature search of the last 2 years was conducted. Three recent randomized controlled trials (RCTs), comparing PAE to either transurethral resection of the prostate (TURP) or sham procedure, were identified and analyzed. Results: PAE and TURP performed similarly in significant reductions in international prostate symptoms score (IPSS) and Quality of life (QoL) scoring at 3 and 12 months. The majority of improvement after PAE occurred within a few months, with potentially greater effect in patients with larger prostates and severe symptoms. TURP was generally superior in functional outcomes such as peak urinary flow (Qmax), prostate volume (PV) reduction and post void residual (PVR), although TURP patients underperformed in Qmax improvement in one trial. PAE was superior to sham procedure in all relevant outcomes at 6 months. Overall, complication rates were lower with PAE than with TURP. Conclusions: PAE and TURP produced similar significant improvements in LUTS. Functional improvements favored TURP while complication rates favored PAE. Clinical improvement after PAE significantly surpassed initial placebo effects of sham procedure. Further comparative studies with longer term follow-up are still needed.

Transurethral resection in women with symptomatic keratinizing squamous metaplasia of urinary bladder: A retrospective study of 92 cases.

ObjectivesTo investigate the efficacy of transurethral resection (TUR) on relieving urinary symptoms in patients with keratinizing squamous metaplasia (KSM) of the urinary bladder.MethodsData were analyzed from a retrospective study of patients receiving transurethral bipolar plasma resection (bi‐TUR) treatment for symptomatic KSM. Urinary symptoms were assessed by the International Prostate Symptom Score (IPSS) and a numeric rating scale pain score. Efficacy was assessed using the IPSS to determine changes from baseline in lower urinary tract symptoms (LUTS). Self‐reported quality of life (QoL) was assessed by the last question of the IPSS questionnaire.ResultsA total of 92 female patients were included in the analysis. The median age was 42 years. LUTS, pain, and hematuria were the most common symptoms that affected patients. The median follow‐up duration was 51 months. There were significant improvements in LUTS from baseline IPSS after TUR (P < .001). The percentage of the patients with moderate to severe LUTS went down from 52.2% to 18.5%. The median Numeric Rating Scale (NRS)‐11 pain score reduced from 3 at baseline to 0 at the last visit. Twenty‐one out of 40 patients reported that the pain symptoms disappeared completely. No patients reported hematuria symptoms at the final follow‐up. Improvement of self‐reported QoL was significant (P < .001). A total of 57.6% of patients reported an improvement, 26.1% of patients reported no improvement, and 16.3% reported deterioration.ConclusionsBi‐TUR therapy significantly relieved urinary symptoms in women with KSM. Improvement of QoL was acceptable with a success rate of 57.6%. Considering the very low complication rate, our study supported bi‐TUR as an alternative treatment for patients who are resistant to medical therapy.

Prostatic Artery Embolization Using 100-300-μm Trisacryl Gelatin Microspheres to Treat Lower Urinary Tract Symptoms Attributable to Benign Prostatic Hyperplasia: A Single-Center Outcomes Analysis with Medium-Term Follow-up.

To report medium-term outcomes of prostatic artery embolization (PAE) using 100-300-μm trisacryl gelatin microspheres to treat lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) and to evaluate how cone-beam computed tomography-measured prostate gland volume (PGV), median lobe enlargement (MLE), age, and Charlson Comorbidity Index (CCI) affect these results. Seventy-four consecutive patients who underwent PAE from April 2014 through August 2018 were retrospectively reviewed. Patients had International Prostate Symptom Score (IPSS) >12, Quality of Life (QoL) score >2, prostate gland volume (PGV) >40 mL, age older than 45 years, and medical therapy failure. Twelve patients were excluded for bladder pathology or prostate cancer. Patients (n= 62, age= 71.8 ± 9.3 years, CCI= 3.5 ± 1.7, PGV= 174 ± 110 mL) had pre-procedure IPSS= 22.4 ± 5.6, QoL score= 4.4±0.9, and post-void residual (PVR)= 172 ± 144 mL. Post-procedure values were compared to baseline at 1, 3, 6, 12, and 24 months. Associations between outcomes and PGV, MLE, age, and CCI were evaluated. Adverse event recording used Clavien-Dindo classification. One month after PAE (n= 37), IPSS improved to 7.6 ± 5.2 (P < .0001) and QoL score improved to 1.7 ± 1.4 (P < .0001). At 3 months (n= 32), improvements continued, with IPSS= 6.4 ± 5.1 (P < .0001), QoL score= 1.2 ± 1.2 (P < .0001), PVR= 53 ± 41 mL (P < .001), and PGV= 73 ± 38 mL (P < .0001). Results were sustained at 6 months (n= 35): IPSS= 6.4 ± 4.1 (P < .0001), QoL score= 1.2 ± 1.2 (P < .0001), PVR= 68 ± 80 mL (P < .0001), PGV= 60 ± 19 mL (P < .001). At 12 months, patients (n= 26) had IPSS= 7.3 ± 5.5 (P < .0001), QoL score= 1.2 ± 0.8 (P <.0001), PVR= 89 ± 117 mL (P < .0001), PGV= 60 ± 48 mL (P < .01). At 24 months, patients (n= 8) had IPSS= 8.0 ± 5.4 (P < .0001), QoL score= 0.7 ± 0.5 (P < .0001), PVR= 91 ± 99mL (P= 0.17), and PGV= 30 ± 5mL (P= .11). Improvements were independent of PGV, MLE, age, and CCI. Two grade II urinary infections occurred. PAE with 100-300-μm microspheres produced sustained substantial improvements in LUTS, PGV, and PVR, which were independent of baseline PGV, MLE, age, or CCI.

03:09 PM Abstract No. 4 Prostatic artery embolization with 100- to 300-μm particles to treat lower urinary tract symptoms attributable to benign prostatic hyperplasia: a single-center analysis of 2-year outcomes

To present medium-term safety and efficacy data for prostatic artery embolization (PAE) using 100- to 300-μm particles to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). 74 patients who underwent PAE with 100μm-300μm particles from April 2014 through August 2018 were retrospectively reviewed. Exclusion criteria were dementia preventing symptom evaluation and technical failure. Subjects (n=60, mean age=71.4, mean Charlson comorbidity index=3.3, mean prostate gland volume (PGV)=183mL) had a mean pre-procedure International Prostate Symptom Score (IPSS) of 21.5, mean Quality of Life score (QOL) 4.3, and mean post-void residual (PVR) 163mL. After PAE, subjects were evaluated at 1, 3, 6, 12 and 24 months. Comparisons to baseline values used T-tests (PGV, PVR) or Wilcoxon signed rank tests (IPSS, QOL). Adverse events were recorded using the Clavien-Dindo classification. One month after PAE, mean IPSS dropped from 21.5 to 7.7 (↓64%) and mean QOL improved from 4.3 to 1.8 (↓58%) (n=42, P<0.001 for both). At 3 months, there was further improvement: mean IPSS was 6.2 (↓71%) and mean QOL 1.1 (↓74%); also mean PVR was 64mL (↓61%) and mean PGV 62mL (↓66%) (n=34, P<0.001 for all). At 6 months, results were sustained with mean IPSS of 6.3 (↓71%), mean QOL 1.1 (↓74%), mean PVR 61mL (↓63%), and mean PGV 75mL (↓59%) (n=41, P<0.001 for all). At 12 months, mean IPSS was 6.7 (↓69%), mean QOL 1.0 (↓77%), mean PVR 64mL (↓61%), and mean PGV 71mL (↓62%) (n=29, P<0.001 for all). At 24 months (n=8), mean IPSS was 7.8 (↓64%, P<0.001), mean QOL 0.6 (↓86%, P<0.001), mean PVR 89mL (↓45%, P=NS), and mean PGV 44mL (↓76%, P=NS). Two significant adverse events occurred: one urinary tract infection (grade 2) and one case of painful necrotic tissue that was transurethrally resected (grade 3B). Ten (17%) self-limited grade 1 adverse events occurred. PAE with 100- to 300-μm particles produced sustained significant improvements in LUTS, PVR, and PGV in the range of transurethral procedures. Safety was similar and efficacy superior to most PAE series using larger size particles. PAE is a viable option for patients who are not good surgical candidates.

Predictive value of the immediate effect of first dose of tamsulosin on lower urinary tract symptoms improvement in benign prostatic hyperplasia patients.

Objectives:The objective is to study the effect of tamsulosin within hours after the first dose and its prediction of the future improvement of LUTS.Materials and Methods:From May 2016 until August 2017, 340 patients aged over 40 years with benign prostatic hyperplasia (BPH)-related symptoms were prospectively enrolled; 0.4 mg tamsulosin for 3 months was given. The first visit was before beginning of tamsulosin; uroflowmetry (UFM), postvoid residual urine volume (PVR), international prostate symptom score (IPSS), and quality of life (QoL) were measured. The second visit was after 6 h from the administration of tamsulosin. UFM and PVR were measured. The third visit was after 1 month and the fourth visit was after 3 months, on which UFM, PVR, IPSS, and QoL were also measured.Results:The mean patients’ age was 63 ± 6.18 and the mean prostate volume was 52.23 ± 24.59 cc. The mean Qmax at 1st, 2nd, 3rd, and 4th visits was 10.28 ± 3.06 s, 14.58 ± 4.84 s, 14.46 ± 4.94 s, and 14.28 ± 5.07 s, respectively, P = 0.04. The mean voiding time at 1st, 2nd, 3rd, and 4th visits was 41.24 ± 27.18 s, 33.84 ± 18.14 s, 31.96 ± 22.02 s, and 30.14 ± 17.52 s, respectively, P = 0.03. The mean PVR at 1st, 2nd, 3rd, and 4th visits was 46.40 ± 22.14 ml, 27.76 ± 26.10 ml, 25.16 ± 28.36 ml, and 25.58 ± 28.10 ml, respectively, P = 0.001. The first dose of tamsulosin significantly increases Qmax and decreases voiding time and residual urine (RU); there was no statistical significant difference between 1st dose, 1 and 3 months in Qmax, voiding time, and RU. QOL and IPSS were significantly improved after 1 and 3 months, P < 0.001.Conclusion:The first dose of tamsulosin improves UFM and predicts the mid-term change in UFM as well as IPSS and QoL indices in the treatment of BPH-related LUTS.

Pharmacological treatment of BPS

Pharmacological treatment of BPS is often considered the first therapeutic approach for patients who experience progression in lower urinary tract symptoms (LUTS).α1-adrenoceptor antagonists are often chosen as the first line pharmacological treatment, due to their rapid onset of action, as well as their significant impact on LUTS and Qmax and post-void residual. Adverse effects appear to be low.With larger prostate volume and LUTS, long term treatment with 5α-reductase inhibitors (5ARIs) significantly improves LUTS and post-void residual. In addition, 5ARIs have a significant impact on the reduction in disease progression.Patients with LUTS who mainly suffer from bladder storage symptoms appear to respond to treatment with muscarinic receptor antagonists and beta-3 agonists. Both of these drug classes significantly improve LUTS, but beta-3 agonists seem to be superior with respect to adverse effects.Treatment with phosphodiesterase-5 inhibitors, which are well established in the treatment of erectile dysfunction (ED) gives significant improvement in LUTS and post-void residual and can therefore be recommended for patients with LUTS and ED.Phytotherapies have low rates of adverse effects, which has made them increasingly popular, but effects on LUTS, Qmax and post-void residual remain to be proven.New substances and therapeutic approaches are continuously expanding the options for pharmacological treatment of BPS. As regards adverse effects, therapeutic schemes can increasingly be customised to a patient profile.

Prostate Artery Embolization for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Results From a Prospective FDA-Approved Investigational Device Exemption Study

ObjectiveTo evaluate the safety and efficacy of prostate artery embolization (PAE) for lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH). MethodsA prospective, single-center, open-label FDA-approved study was conducted to evaluate the safety and efficacy of PAE for LUTS secondary to BPH. We enrolled men ≥ 45, prostate volume > 40 g, International prostate symptom score (IPSS) > 13, peak flow rate (Qmax) ≤ 12 mL/s, and voided volume ≥ 125 mL. Patients were evaluated with questionnaires (IPSS, quality-of-life [QoL], International index of erectile function, and male sexual health questionnaire for ejaculatory dysfunction) and clinical measures (postvoid residual volume and Qmax at baseline 1, 3, and 12 months) after PAE. Baseline and 6-month total prostate (TV) and central gland (CG) volumes were obtained. Results45 patients (mean volume: 99 cc, range: 30-214 g) were treated over the course of the 3-year study. At 1 month, there were improvements in IPSS (23.6 ± 6.1 to 12.0 ± 5.9, P < .0001), QoL (4.8 ± 0.9 to 2.6 ± 1.6, P < .0001), Qmax (5.8 ± 1.0 to 12.4 ± 6.8,P < .0001). At 3 months, there were improvements in IPSS (10.2 ± 6.0, P < .0001), QoL (2.4 ± 1.6, P < .0001) and Qmax (15.3 ± 12.3, P < .0001). At 6 months, there were improvements in IPSS (11.0 ± 7.6, P < .0001) and QoL (2.3 ± 1.7, P < .0001). At 1 year, there were improvements in IPSS (12.4 ± 8.4,P < .0001) and QoL (2.6 ± 1.6, P < .0001). There were reductions in postvoid volume residues: baseline 157 ± 45, 1 month 123 ± 47, P = .057, 3 months 127 ± 114, P = .34, 6 months 112±116, P = .002 and 1 year 109±116 P = .025. Median decreases in TV and CG were 18% (CI: 13-27) (P = 0.0001) and 27% (CI: 20-36)(P = 0.0001), respectively. Self-limited adverse events included dysuria (n = 13), hematuria (n = 6), hematospermia (n = 2), urinary frequency (n = 3) and retention (n = 2). No severe adverse events, nontarget embolization, or adverse effects on erectile function or sexual health. ConclusionThis prospective clinical trial demonstrates that PAE is safe and efficacious for BPH, with significant improvement in LUTS and reduction in TV and CG volumes.

Comparison of UpholdTM Vaginal Mesh Procedure with Hysterectomy or Uterine Preservation for the Treatment of Pelvic Organ Prolapse

Hysterectomy is the empirical treatment for female pelvic organ prolapse (POP) without robust evidence to prove its efficacy. Uphold transvaginal mesh (TVM) system is an innovated device with smaller area, superior anterior/apical support with single incision to treat POP. The prospective cohort study aims to evaluate Uphold TVM’s performance with or without concomitant hysterectomy. Inclusion criteria specify patients suffering from stage 2 or more anterior/apical prolapse without previous hysterectomy. Exclusion criteria specify those with contraindications to uterine preservation, such as leiomyomas, adenomyosis, endometrial hyperplasia, abnormal uterine bleeding, postmenopausal bleeding, cervical dysplasia, receiving tamoxifen treatment, family history of gynecology cancer, or colon cancer and incapability to be routinely followed. Thirty patients are recruited in the hysterectomy group and 66 patients in the hysteropexy group. The results demonstrate that patients with Uphold mesh only experience longer vaginal length, shorter operation duration, less blood loss and less post-operation pain. The performance in anatomical correction, lower urinary tract symptoms improvement, de novo dyspareunia, urodynamic study parameters and mesh extrusion rates are comparable with or without uterus preservation. The information is useful in pre-operation counseling, when the patient can make an educated choice whether or not to receive concomitant hysterectomy.

PUK20 - Comparison of Costs Associated with Turp and Prostatic Urethral Lift for Benign Prostatic Hyperplasia

To compare outcomes and costs associated with treatment of benign prostatic hyperplasia (BPH) by monopolar or bipolar transurethral resection of the prostate (TURP) or prostatic urethral lift (PUL). We searched the literature for reports on PUL (from 2010 onwards) and TURP, and were allowed access to the National Health Service Hospital Episode Statistics (HES) database (Copyright NHS Digital 2018) and The Health Improvement Network (THIN) to search at the record level for hospitalisation and treatment rates for TURP in England, from January 2009/10 onwards. In 2016/17, 18,362 TURP procedures were performed. The mean procedure cost was £2,869 (IQR £2,422–3,138; total ~£43 million) and the average hospital stay was 2.7 days. Complications of TURP include ejaculatory dysfunction (≥65%), erectile dysfunction (10%), urethral stricture (4%), infection (4%), bleeding requiring transfusion (2%), and urinary incontinence (2%). Around 20% of patients restart drug therapy for lower urinary tract symptoms (LUTS) within 3 years. Among all recipients of TURP for BPH in 2009/10, cumulative HES data to 2014/15 showed 70,000 post-procedure hospital spells, incurring payer costs of £109 million. The mean PUL procedure cost in 2015/16 was £2,405. Typically, no hospital stay or catheterisation are required. Most adverse events (mainly dysuria, discomfort, urgency, and haematuria) are mild to moderate and resolve in 2–4 weeks without hospital treatment. Erectile and ejaculatory function are preserved. LUTS improvement is comparable to that for TURP but is more rapid and remains stable at 5 years. If we assume, based on this complication profile, that the £109 million spending on complications could be halved and that 50% of TURP recipients would be candidates for PUL, we estimate a saving of £27 million per year. PUL could reduce complications, improve quality of life, and substantially reduce costs currently associated with current standard TURP practice.

PD59-04 A DOUBLE BLINDED, RANDOMIZED CONTROLLED TRIAL COMPARING TAMSULOSIN AND PLACEBO VERSUS TAMSULOSIN AND TADALAFIL IN MALE LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Medical & Non-surgical Therapy1 Apr 2018PD59-04 A DOUBLE BLINDED, RANDOMIZED CONTROLLED TRIAL COMPARING TAMSULOSIN AND PLACEBO VERSUS TAMSULOSIN AND TADALAFIL IN MALE LOWER URINARY TRACT SYMPTOMS Santhosh Nagasubramanian, Nirmal Thampi John, Belavendra Antonisamy, Chandrasingh J, Santosh Kumar, Antony Devasia, and Nitin Sudhakar Kekre Santhosh NagasubramanianSanthosh Nagasubramanian More articles by this author , Nirmal Thampi JohnNirmal Thampi John More articles by this author , Belavendra AntonisamyBelavendra Antonisamy More articles by this author , Chandrasingh JChandrasingh J More articles by this author , Santosh KumarSantosh Kumar More articles by this author , Antony DevasiaAntony Devasia More articles by this author , and Nitin Sudhakar KekreNitin Sudhakar Kekre More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2804AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lower urinary tract symptoms (LUTS) and erectile dysfunction increase with age and have a negative impact on quality of life. We aimed to compare efficacy and safety of tamsulosin versus combination of tamsulosin and tadalafil in male LUTS. METHODS This was a double blinded, parallel arm randomized controlled trial. Men >45 years with moderate LUTS, peak flow rate (Qmax) of 5-15ml/s were included. One arm received 0.4mg tamsulosin only (Group-A) while the second received 5mg tadalafil with tamsulosin (Group-B). Primary outcome was International Prostate Symptom Score (IPSS). Secondary outcomes were IPSS QoL (quality of life), International Index for Erectile Function (IIEF-5) scores, Qmax and post void residual urine (PVRU). Block randomization was used. Placebo was used for blinding and allocation concealment. RESULTS Of 183 screened, 140 were randomized [70(Group-A), 70(Group-B)]; 116 - 82.85% [61(Group-A), 55(Group-B)] completed the study. Baseline characteristics were comparable. Difference in improvement in IPSS, IPSS QoL, IIEF and Qmax were 3 points (95% CI 0.7-5.3), 2 points (95% CI 1.5 - 2.5), 5 points (95% CI 3.4 - 6.6) and 2ml/s (95% CI 0.9 - 3.1) respectively in favour of the combination group. Difference in PVRU was not significant. There were no serious adverse events. Dropout rate due to adverse events was 2.85%. Myalgia (5 subjects) was the commonest adverse event in the combination group. CONCLUSIONS Combination of tamsulosin and tadalafil produced significantly better improvements in LUTS, QoL, erectile function and Qmax compared to only tamsulosin without significant increase in adverse events. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1140-e1141 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Santhosh Nagasubramanian More articles by this author Nirmal Thampi John More articles by this author Belavendra Antonisamy More articles by this author Chandrasingh J More articles by this author Santosh Kumar More articles by this author Antony Devasia More articles by this author Nitin Sudhakar Kekre More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...