Improvement In Maximum Flow Rate Research Articles

Uretroplastia femenina con injerto de mucosa oral en una etapa: resultados comunicados por las pacientes y tasas de éxito funcional a largo plazo

Introduction and objectivesFemale urethral strictures are a rare condition that significantly impacts patients’ quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center. Patients and methodsWe conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009–2023. We assessed objective (retreatment-free survival, improvement in maximum flow rate) and subjective outcomes (validated patient-reported outcomes). ResultsOf 12 women, 83 and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25 and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate was 10ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction. ConclusionsBuccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.

Long-term functional success and patient-reported outcomes after female one-stage buccal mucosal graft urethroplasty

Introduction and objectivesFemale urethral strictures are a rare condition that significantly impacts patients’ quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center. Patients and methodsWe conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009–2023. We assessed objective (retreatment-free survival, ΔQmax) and subjective outcomes (validated patient-reported outcomes). ResultsOf 12 women, 83% and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25% and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2 cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate (ΔQmax) was 10 ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction. ConclusionsBuccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.

Initial outcomes and surgical techniques of prostatic urethral lift for benign prostatic hyperplasia in Japan

ObjectivesThe prostatic urethral lift (PUL) has been used as a minimally invasive surgery for benign prostatic hyperplasia (BPH) since April 2022 in Japan. This study evaluated the initial outcomes and surgical techniques of PUL for BPH.MethodsIn this prospective, single‐center study, indications were based on the proper use guidelines for PUL in Japan. Preoperative patient status, postoperative progress at 1 and 3 months, and perioperative complications were evaluated. The surgical technique was changed twice, and the subgroup analysis and technique were evaluated.ResultsOf the 50 patients who underwent surgeries performed by a single surgeon, the median age and prostate volume were 71 years and 42.0 mL, respectively. Furthermore, the median operative time and number of implants used were 20 min and 5, respectively. No postoperative fever or severe hematuria requiring reoperation occurred. All patients were discharged from the hospital the day following the PUL, as scheduled. Postoperative International Prostate Symptom Score, quality of life score, maximum flow rate, and postvoid residual volume at 1 and 3 months were significantly improved compared with the preoperative values. A significant improvement in maximum flow rate was observed in the subgroup analysis from 1 month postoperatively in the group with an anterior channel creation focus.ConclusionsPUL is effective and safe in cases with prostate volumes of <100 mL. Lifting the bladder neck is important for opening an anterior prostatic urethral channel and improving urinary function during the early postoperative period.

MP13-14 ROBOT-ASSISTED SIMPLE PROSTATECTOMY VERSUS HOLMIUM LASER ENUCLEATION FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA IN LARGE (>100 ML) PROSTATES: UPDATED COMPARATIVE ANALYSIS FROM A HIGH-VOLUME CENTER

You have accessJournal of UrologyCME1 Apr 2023MP13-14 ROBOT-ASSISTED SIMPLE PROSTATECTOMY VERSUS HOLMIUM LASER ENUCLEATION FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA IN LARGE (>100 ML) PROSTATES: UPDATED COMPARATIVE ANALYSIS FROM A HIGH-VOLUME CENTER Mottaran Angelo, Eleonora Balestrazzi, Carlo Andrea Bravi, Luigi Nocera, Marco Paciotti, Adele Piro, Maria Peraire Lores, Luca Sarchi, Federico Piramide, Pieter De Backer, Ruben De Groote, Geert De Naeyer, Peter Schatteman, and Alexandre Mottrie Mottaran AngeloMottaran Angelo More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Adele PiroAdele Piro More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Federico PiramideFederico Piramide More articles by this author , Pieter De BackerPieter De Backer More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Peter SchattemanPeter Schatteman More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with large benign prostatic hyperplasia (BPH), both Holmium Laser Enucleation of Prostate (HoLEP) and Robot-Assisted Simple Prostatectomy (RASP) are possible treatment options. While both techniques have advantages and disadvantages, comparative evidence on peri-operative outcomes of these operations for the treatment of large prostates (>100 ml) is still limited. Therefore, our aim was to update our comparative analysis of HoLEP vs. RASP for the treatment of BPH in patients with large (>100 ml) prostate volumes. METHODS: We analyzed data of 339 patients with symptomatic BPH due to large (>100 ml) prostates glands who underwent RASP (n=130, 35%) and Holep (n=239, 65%) at OLV Hospital, Aalst (Belgium) between 2011 and 2021. We collected pre-operative baseline characteristics and peri-operative outcomes; peri-operative complications were reported according to the Clavien-Dindo classification. Functional parameters were assessed postoperatively 3 months after surgery. We compared pre-operative characteristics, operative time and peri- and post-operative outcomes between the groups. RESULTS: Baseline characteristics – including age, BMI, preoperative IPSS score, preoperative maximum flow and post-voidal residue (PVR) – did not differ between patients receiving RASP vs. HoLEP (all p>0.05). As compared to HoLEP, patients treated with RASP had bigger prostates at preoperative imaging (median: 159 (115, 200) ml vs. 120 (110, 140) ml; p<0.001). Median operation time (100 min vs. 120 min), catheterization time (2 vs. 3 days) and length of stay (2 vs. 4 days) were slightly shorter in the HoLEP group (all p<0.001). On final pathology, median prostate weight was similar between the groups (100 gr vs. 105 gr; p=0.4). Complication rates were similar in both groups (rate of all Clavien-Dindo complications: 23% vs. 22%; p=0.2). At 3 months follow up, both groups showed an improvement of maximum flow rate (+12 vs. +13.3 ml/s; p=0.4), a reduction of PVR (-93 vs. -75 ml; p=0.9) and IPSS score (-16 vs. -12; p=0.2). CONCLUSIONS: Our study provided relevant data on peri-operative outcomes of RASP and Holep, and might help clinicians in preoperative counselling for men with large (>100 ml) prostates requiring surgery for BPH. While patients receiving RASP had slightly longer hospital stay, both techniques achieved excellent results in this patient population, and represent valuable treatment option according to physician preferences and expertise. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e178 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mottaran Angelo More articles by this author Eleonora Balestrazzi More articles by this author Carlo Andrea Bravi More articles by this author Luigi Nocera More articles by this author Marco Paciotti More articles by this author Adele Piro More articles by this author Maria Peraire Lores More articles by this author Luca Sarchi More articles by this author Federico Piramide More articles by this author Pieter De Backer More articles by this author Ruben De Groote More articles by this author Geert De Naeyer More articles by this author Peter Schatteman More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

Surgical outcome of male patients with chronic central nervous system disorders and voiding dysfunction due to bladder outlet obstruction.

Voiding dysfunction is common in patients with chronic central nervous system (CNS) diseases and has great impact on quality of life. Patients with chronic CNS disorders might have concomitant detrusor overactivity, detrusor underactivity, and voiding dysfunction. Although bladder outlet surgeries could relieve bladder outlet obstruction (BOO), patients might have persistent or exacerbated storage symptoms. This study investigated surgical outcome of patients with chronic CNS disorders after bladder outlet surgery. A total of 63 male patients with cerebrovascular accident (CVA, n = 44), Parkinson's disease (PD, n = 11), and early-stage dementia (n = 8), had received bladder outlet surgery after videourodynamic proven BOO refractory to medical treatment. The preoperative and postoperative lower urinary tract symptoms (LUTS) and uroflowmetry parameters were assessed. If the storage symptom subscore decreased or increased by 1, the outcome was considered improved or exacerbated after treatment. When patients had improvement in maximum flow rate (Qmax) and voiding efficiency (VE) and decreased voiding symptom subscore, they were considered having improvement of voiding dysfunction. The mean age was 71.1 ± 9.8years and mean duration from diagnosis of BOO to surgical intervention was 15.1 ± 25.0months. Overall, there was significant improvement in voiding LUTS and urinary retention after surgery. The post-void residual volume (PVR), corrected Qmax (cQmax), and VE significantly improved after surgery. In subgroup analysis, although voiding symptoms improved in CVA patients, urgency and exacerbated urgency incontinence persisted after surgery. In PD patients, there was improvement in voiding condition such as PVR, cQmax and VE, but the storage symptoms did not change after surgery. Patients with dementia had no improvement both in storage and voiding symptoms. Bladder outlet surgeries are effective to relieve voiding dysfunction in patients with CVA and PD, but have little effect on storage LUTS in patients with chronic brain lesions.

A Transition Toward a Faster Recovery in Single-Port Transvesical Simple Prostatectomy.

Objectives: To present the updated technique and evaluate the perioperative and postoperative outcomes of single-port transvesical simple prostatectomy (SP TVSP) Patients and Methods: Forty-two consecutive patients with benign prostatic hyperplasia indicated for surgery underwent SP TVSP in a single institution. Through direct suprapubic bladder access, the SP robot was docked. Prostatic enucleation was performed using the prostatic capsule as a landmark. Then a complete vesicourethral mucosal advancement flap was accomplished. Demographics, perioperative, and postoperative data were prospectively collected. Mean follow-up period was 12 months. Results: All procedures were effectively performed with no conversion, additional port placement, or intraoperative complication. The median prostatic volume was 170 cc. Ninety-five percent of the patients did not require opioids analgesia after discharge. Excluding planned admissions, 92% (21/23 patients) were discharged after a median (interquartile range) of 4.6 (4.1-5.7) hours after surgery. The median Foley catheter duration for all cohort was 7 days, and decreased to 3 days after technique adjustment for the last 19 consecutive patients. The median international prostate symptom score decreased from 23 before surgery to 2.5 after surgery. All patients had a significant postoperative improvement in maximum flow rate with a 200% improvement over baseline (19 vs 6.5 mL/sec). Conclusion: In our initial series, SP TVSP allows for favorable perioperative and early postoperative outcomes including low complication same-day discharge, short Foley catheter stay, minimal opioids use, and quick recovery.

MP29-07 FIVE-YEAR OUTCOMES AFTER AQUABLATION COMPARED TO TURP: THE FINAL WATER STUDY RESULTS

You have accessJournal of UrologyCME1 May 2022MP29-07 FIVE-YEAR OUTCOMES AFTER AQUABLATION COMPARED TO TURP: THE FINAL WATER STUDY RESULTS Peter Gilling Peter GillingPeter Gilling More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare five-year safety and efficacy outcomes after Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) related to benign prostate hyperplasia (BPH). METHODS: 181 patients with BPH were assigned at random (2:1 ratio) to either Aquablation or TURP. Patients and follow-up assessors at each site were blinded to treatment. Assessments included International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire (MSHQ), International Index of Erectile Function (IIEF) and uroflow (Qmax). RESULTS: The primary safety endpoint was successfully achieved at 3 months where the Aquablation group had a lower event rate compared to TURP (26% vs. 42%, p=.0149 for superiority). The rate of persistent grade 1 events (all of which were retrograde ejaculation) at month 3 was lower (7% vs. 25%, p=.0004) after Aquablation and the rate of grade 2 and above events was similar across groups (20% for Aquablation vs. 23% for TURP, p=.3038). The primary efficacy endpoint was successfully achieved at 6 months where the mean IPSS decreased from baseline by 16.9 points for Aquablation and 15.1 points for TURP; the mean difference in change score at 6 months was 1.8 points larger for Aquablation (p<.0001 for non-inferiority, p=.1346 for superiority).At five years, IPSS scores improved by 15.5 points in the Aquablation group and 13.5 points in TURP (p=.3768, 95% CI for difference -6.4 to 2.5 points). Improvements in maximum flow rate (Qmax) were large in both groups at 10.4 and 9.0 cc/sec for Aquablation and TURP, respectively (p=.9078, 95% CI for difference -4.3 to 7.0). PSA was reduced in both groups; the change in PSA at month 60 did not differ across groups (p=.9460). CONCLUSIONS: Aquablation data at five years has been shown to be durable and consistent across all years of follow-up and comparable to TURP. Retrograde ejaculation rates were less for Aquablation. *On behalf of WATER study investigators. Source of Funding: PROCEPT BioRobotics © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e471 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Gilling More articles by this author Expand All Advertisement PDF DownloadLoading ...

Pharmacological and interventional treatment of benign prostatic obstruction: An evidence-based comparative review.

IntroductionThe recommended treatment for bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) after the failure of behavioral therapy and fluid modification includes pharmacological, minimally invasive interventional, and surgical approaches. Each option has different risk and benefit profiles, and the urologist must be aware of the unique characteristics of each option in order to be able to accurately counsel the patients based on their individual values and preferences. We provide a comparative review of the commonest pharmacological and most widely performed interventional/surgical treatments for BPO, discussing the evidence for the treatment characteristics that are most useful for the practicing urologist.MethodsA search of the PubMed database was performed for articles reporting on the following treatments for LUTS due to BPO: α‐blockers, 5α‐reductase inhibitors, phosphpdiesterase‐5 inhibitors, prostatic urethral lift (Urolift), convective radiofrequency water vapor thermal therapy (Rezum), Temporary implantable Nitinol Device (iTIND), prostate artery embolization (PAE), transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), Aquablation, and anatomical endoscopic enucleation of the prostate (AEEP). We performed a narrative review focussing on the following outcomes: efficacy, safety, durability, duration of catheterization, length of stay, re‐treatment rate, efficacy in special situations (enlarged median lobe, prostate size, urinary retention, and anticoagulant use), and sexual adverse events.ResultsAEEP offers the greatest long‐term improvement in maximum flow rate, IPSS, and prostate volume reduction, with lowest re‐treatment rate, followed by PVP, TURP, and Aquablation. Urolift, Rezum, and PAE have similar efficacy for prostate volume up to 80cc, and all are more effective than the pharmacological treatment. Urolift offers the lowest rate of sexual dysfunction, followed by Rezum, and both can be performed as a day case under local anesthesia.ConclusionSeveral treatment options exist to treat voiding LUTS due to BPO. Newer minimally invasive treatments reduce the hospital stay and postoperative complications, whereas AEEP provides the greatest long‐term symptom improvement at the expense of higher morbidity and sexual dysfunction. Men should be counseled regarding all suitable treatment options as some may favor reduced efficacy in association with reduced side effects.

PD56-05 THREE-YEAR OUTCOMES AFTER AQUABLATION COMPARED TO TURP: EFFICACY AND EJACULATORY IMPROVEMENTS SUSTAINED

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD56)1 Apr 2020PD56-05 THREE-YEAR OUTCOMES AFTER AQUABLATION COMPARED TO TURP: EFFICACY AND EJACULATORY IMPROVEMENTS SUSTAINED Peter Gilling*, Neil Barber, Mo Bidair, Paul Anderson, Mark Sutton, Tev Aho, Eugene Kramolowsky, Andrew Thomas, Barrett Cowan, Ronald Kaufman, Andrew Trainer, Andrew Arther, Gopal Badlani, Mark Plante, Mihir Desai, Leo Doumanian, Alexis Te, Mark DeGuenther, and Claus Roehrborn Peter Gilling*Peter Gilling* More articles by this author , Neil BarberNeil Barber More articles by this author , Mo BidairMo Bidair More articles by this author , Paul AndersonPaul Anderson More articles by this author , Mark SuttonMark Sutton More articles by this author , Tev AhoTev Aho More articles by this author , Eugene KramolowskyEugene Kramolowsky More articles by this author , Andrew ThomasAndrew Thomas More articles by this author , Barrett CowanBarrett Cowan More articles by this author , Ronald KaufmanRonald Kaufman More articles by this author , Andrew TrainerAndrew Trainer More articles by this author , Andrew ArtherAndrew Arther More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , Mark PlanteMark Plante More articles by this author , Mihir DesaiMihir Desai More articles by this author , Leo DoumanianLeo Doumanian More articles by this author , Alexis TeAlexis Te More articles by this author , Mark DeGuentherMark DeGuenther More articles by this author , and Claus RoehrbornClaus Roehrborn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000966.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare three-year (last follow-up of the protocol) safety and efficacy outcomes after Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) related to benign prostate hyperplasia (BPH). METHODS: 181 patients with BPH were assigned at random (2:1 ratio) to either Aquablation or TURP. Patients and follow-up assessors at each site were blinded to treatment. Assessments included International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire (MSHQ), International Index of Erectile Function (IIEF) and uroflow. RESULTS: At three years, IPSS scores improved by 14.2 points in the Aquablation group and 15 points in TURP (p=.7050, 95% CI for difference –3.6 to 5.3 points). Three-year improvements in maximum flow rate (Qmax) were large in both groups at 10 and 9.7 cc/sec for Aquablation and TURP, respectively (p=.9078, 95% CI for difference –2.9 to 6.4). Sexual function as assessed by MSHQ-EjD was stable in the Aquablation group and decreased slightly in the TURP group; these changes persisted at year 3. At three years, PSA was reduced significantly in both groups but showed no difference between groups (p=.4074 for difference). The average annual retreatment occurrence was less than 2% in both treatment groups. CONCLUSIONS: Three-year efficacy outcomes after TURP and Aquablation were similar and the rate of surgical retreatment was low and similar to TURP. Efficacy results have maintained their improvement since the 90 day follow-up for both groups that are consistent with all other resective surgical techniques. Source of Funding: PROCEPT BioRobotics © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1189-e1189 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Gilling* More articles by this author Neil Barber More articles by this author Mo Bidair More articles by this author Paul Anderson More articles by this author Mark Sutton More articles by this author Tev Aho More articles by this author Eugene Kramolowsky More articles by this author Andrew Thomas More articles by this author Barrett Cowan More articles by this author Ronald Kaufman More articles by this author Andrew Trainer More articles by this author Andrew Arther More articles by this author Gopal Badlani More articles by this author Mark Plante More articles by this author Mihir Desai More articles by this author Leo Doumanian More articles by this author Alexis Te More articles by this author Mark DeGuenther More articles by this author Claus Roehrborn More articles by this author Expand All Advertisement PDF downloadLoading ...

MP62-03 EJACULATION-PRESERVING GREENLIGHT PHOTOVAPORIZATION: SHORT- AND LONG TERM RESULTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2018MP62-03 EJACULATION-PRESERVING GREENLIGHT PHOTOVAPORIZATION: SHORT- AND LONG TERM RESULTS Steeve DOIZI and Bertrand LUKACS Steeve DOIZISteeve DOIZI More articles by this author and Bertrand LUKACSBertrand LUKACS More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2004AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Loss of antegrade ejaculation is a risk with benign prostatic obstruction relief surgery whatever the technique used. The aim of this study was to determine the short- and long-term preservation of antegrade ejaculation and functional results with ejaculation-preserving Greenlight photovaporization. METHODS All consecutive patients with LUTS and sexually active scheduled for BPO relief surgery in a tertiary reference center were included in this prospective evaluation between January 2010 and December 2013. All patients were offered a surgical treatment with preservation of the ejaculatory function and were informed of the risk of failure and early recurrence of LUTS with the need of medication or surgery. Endpoints were change in objective (uroflowmetry, postvoid residual [PVR]), and subjective (International Prostate Symptoms Score [IPSS], Life Quality Index [LQI]; Danish prostate symptom score sex questionnaire (DAN-PSSsex). Evaluation was performed at 1-3, 3-6, 6-12, 12-24, 24-36, >36 months. RESULTS Overall, 65 patients with mean age of 62.15 years were included. Antegrade ejaculation was preserved in 59 of 65 (90.7%) patients at 1-3 months (Table 1). This rate remained constant until 24-36 months. Significant improvements in maximum flow rate, micturition volume, and PVR were observed at 3 months. Micturition symptoms, as measured by IPSS and LQI, were also significantly reduced. Improvements were maintained up to 36 months (Table 2). No serious adverse events were reported. Seven (10.8%) patients received a second ejaculation-preserving Greenlight photovaporization due to recurrence in symptoms. CONCLUSIONS Antegrade ejaculation was preserved with the use of ejaculation-preserving Greenlight photovaporization with excellent outcome. Observed symptomatic and functional outcomes were comparable with conventional TURP. The results from this study underline the necessity of reviewing the old concept of ejaculation physiology. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e832-e833 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Steeve DOIZI More articles by this author Bertrand LUKACS More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of Detrusor Underactivity on Surgical Outcomes of Laser Prostatectomy: Comparison in Serial 12-Month Follow-Up Outcomes Between Potassium-Titanyl-Phosphate Photoselective Vaporization of the Prostate (PVP) and Holmium Laser Enucleation of the Prostate (HoLEP)

To evaluate impacts of preoperative detrusor underactivity (DU) on outcomes of photoselective vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia, and to compare them between the two surgeries. A total of 1423 men, who underwent PVP (group A) or HoLEP (group B), were categorized into four groups: A1 (239 without DU), A2 (432 with DU), B1 (329 without DU), and B2 (423 with DU). DU was defined as bladder contractility index of <100. Outcomes were assessed at 1, 3, 6, and 12 months postoperatively using International Prostate Symptom Score (IPSS), uroflowmetry, and prostate-specific antigen. Successful outcome was defined as reductions by ≥50% of total IPSS at 12 months postoperatively. In all four groups, almost all parameters of IPSS and uroflowmetry improved starting from 1 month. A1 or B1 had greater increases in maximum flow rate than A2 or B2. Decreases of total IPSS in A2 were less than in A1 starting from 1 month after PVP, whereas those in B2 were less than those in B1 as late as 12 months after HoLEP. B2 showed greater improvements in maximum flow rate, subtotal voiding symptom score, bladder voiding efficiency, and total IPSS than A2. In all patients, multivariate regression analysis revealed that the absence of DU, presence of bladder outlet obstruction, and higher baseline total IPSS were independent predictors of successful outcome after surgery, but the type of laser surgery (PVP vs HoLEP) was not. Our data suggest that micturition symptoms, maximum flow rate, bladder voiding efficiency, and quality of life improve starting from the early period after PVP or HoLEP, irrespective of DU. However, patients with DU may have less degree of improvement in micturition after PVP or HoLEP than those without DU.

Evaluation of the clinical indications, adverse drug reactions, and finasteride use in patients with benign prostatic hyperplasia in Poland

BackgroundBenign prostatic hyperplasia (LUTS/BPH) is one of the most common urinary disorders in elderly men. The symptoms of the disease include prostate gland enlargement, bladder outlet obstruction, and lower urinary tract symptoms (LUTSs). BPH predisposes patients to bladder infections and bladder stone formation and increases their risk of urinary retention, which in turn causes renal failure. Hence, the disease requires surgical treatment. However, over the recent years, the number of surgical interventions performed in pharmacotherapy has significantly reduced because of the increased efficacy of conservative therapy, including combination treatment mostly with 2 groups of drugs, namely, alpha-1-adrenolitics and other 5-alpha-reductase blockers, with a different pharmacological activity [5].The aim of this study was to evaluate the clinical indications, adverse drug reactions, and finasteride use in patients with diagnosed BPH in Poland. Materials and methodsWe conducted a clinical trial from November 2009 to November 2010 that included 5751 patients who were enrolled in 46 urological centres in Poland. The researchers who conducted the clinical trial were urologists from different regions of Poland. The clinical trial involved 6 follow-up visits. The mean age of the patients was 67 years (range, 45–93 years; median, 67.00; SD, 8.507). The inclusion criteria were as follows: LUTSs, finasteride therapy for at least 2 weeks, age>40 years, and BPH. ResultsPatients self-reported data on LUTSs, the symptom frequency, concurrent diseases, and intensification of urinary system symptoms. In addition, additional examinations were performed, including prostate-specific antigen test, urinary tract ultrasonography with evaluation of residual urine and prostate, and uroflowmetry. The study did not exclude data on the combined treatment with finasteride and alpha-1-adrenolitics. ConclusionFinasteride was demonstrated to be effective, as evidenced by the significant decrease in TPV by 40% even after 12 months. It was also found to contribute to the attenuation of LUTSs, improvement in maximum flow rate, decrease in nocturia, and improvement in QoL.

Efficacy and tolerability of tamsulosin 0.4 mg in Asian patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia refractory to tamsulosin 0.2 mg: a randomized placebo controlled trial.

To evaluate the efficacy and safety of tamsulosin dose increase to 0.4 mg daily in Asian patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia refractory to tamsulosin 0.2 mg treatment. We carried out a 12-week, single-center, randomized, placebo-controlled trial in 220 patients. Patients treated with 0.2 mg tamsulosin daily without other lower urinary tract symptoms secondary to benign prostatic hyperplasia medication for more than 3 months and refractory to this treatment were enrolled. We defined "refractory" as an International Prostate Symptom Score of 13 or greater and a maximum flow rate of 15 or under despite medication. Patients with a surgical history related to lower urinary tract symptoms secondary to benign prostatic hyperplasia or a postvoid residual of 150 mL or greater were excluded. Eligible patients were randomly assigned to the 0.4 mg group (two tablets of 0.2 mg tamsulosin once daily) or the 0.2 mg group (one tablet of 0.2 mg tamsulosin and one tablet of placebo once daily). International Prostate Symptom Score, maximum flow rate, blood pressure, heart rate, and adverse events were compared between the two groups at 4 weeks and 12 weeks. A total of 220 patients were enrolled and analyzed. There were no differences in baseline characteristics between the two groups. After 12 weeks of medication, the International Prostate Symptom Score was not different between the two groups. However, the improvement in maximum flow rate was greater in the 0.4 mg group than the 0.2 mg group (3.0 ± 0.48 mL/s vs -0.25 ± 0.30 mL/s, P < 0.01). The proportion of patients who showed an increase in maximum flow rate of more than 5 mL/s was 10.9% in the 0.2 mg group versus 16.3% in the 0.4 mg group (P = 0.209). There were no significant differences in bother score or postvoid residual between the two groups. Systolic and diastolic blood pressure, and heart rate were also not different between the two groups. The incidence of adverse events was 10.9% in the 0.2 mg group (dizziness 5.5%; abnormal ejaculation 1.8%; palpitation 1.8%; and headache 1.8%) and 9.09% in the 0.4 mg group (dizziness 3.6%; abnormal ejaculation 1.8%; palpitations 1.8%; and headache 1.8%). Tamsulosin 0.4 mg appears to be a safe treatment regimen for treating lower urinary tract symptoms secondary to benign prostatic hyperplasia in Asian patients who do not respond to 0.2 mg treatment. Increasing the dose of tamsulosin results in a significant improvement in maximum flow rate without any increase in cardiovascular complications.

Ejaculation-Preserving Transurethral Resection of Prostate and Bladder Neck: Short- and Long-Term Results of a New Innovative Resection Technique

Loss of antegrade ejaculation is a risk with conventional resection of the prostate (transurethral resection of the prostate [TURP]). The aim of this study was to determine the short- and long-term preservation of antegrade ejaculation and functional results with the novel ejaculation-preserving TURP (epTURP). Prospective evaluation of 89 consecutive patients with bladder outlet obstructions aged 27 to 78 years, enrolled from June 2001 to January 2005. Endpoints were change in objective (uroflowmetry, postvoid residual [PVR]), and subjective (International Prostate Symptoms Score [IPSS], Life Quality Index [LQI]; International Index of Erectile Function-5 [IIEF-5+] with two additional questions) measures of function. All patients received follow-up examinations at 3 and ≥60 months. Overall, 87 and 63 patients were evaluated after 3 and 60 months, respectively. Antegrade ejaculation was preserved in 79 of 87 (90.8%) patients at 3 months. Significant improvements in maximum flow rate (+14.3 mL/s), micturition volume (+71.6 mL), and PVR (-59 mL; p≤0.002 for all) were observed at 3 months. Micturition symptoms, as measured by IPSS and LQI, were also significantly reduced (mean change of 18.3 and 2.9, respectively; p<0.001). Improvements were maintained at 60 months. No serious adverse events were reported. Eight (12.7%) patients received a second epTURP due to the development of bladder neck scar tissue during long-term follow-up. Antegrade ejaculation was preserved with the use of epTURP with excellent outcome. Observed symptomatic and functional outcomes were comparable with conventional TURP. The results from this study underline the necessity of reviewing the old concept of ejaculation physiology.

BPH: State of the Art in the Surgical Treatment

TURP has been considered the gold standard for surgical treatment of BPH for many years. Symptoms relief, improvement in maximum flow rate and reduction of post void residual urine have been reported in several experiences. Nevertheless, concerns have been reported in terms of safety outcomes: intracapsular perforation, TUR syndrome, bleeding. In the recent years the use of new forms of energy and devices such as bipolar resector, Ho: YAG and potassium-titanyl-phosphate laser are challenging the role of traditional TURP for BPH surgical treatment. In 1999 TURP represented 81% of surgical treatment for BPH versus 39% in 2005. We have analyzed guidelines and recent literature to evaluate the role of the most relevant new surgical approaches compared to TURP for the treatment of BPH.

Recent advances in the surgical treatment of benign prostatic hyperplasia

TURP for many years has been considered the gold standard for surgical treatment of BPH. Symptoms relief, improvement in Maximum flow rate and reduction of post void residual urine have been reported in several experiences. Notwithstanding a satisfactory efficacy, concerns have been reported in terms of safety outcomes:intracapsular perforation, TUR syndrome, bleeding with a higher risk of transfusion particularly in larger prostates have been extensivelyreported in the literature.IN THE RECENT YEARS THE USE OF NEW FORMS OF ENERGY AND DEVICES SUCHAS BIPOLAR RESECTOR, HO: YAG and potassium-titanyl-phosphate laserare challenging the role of traditional TURP for BPH surgical treatment.In 1999 TURP represented the 81% of surgical treatment for BPHversus 39% of 2005. Is this a marketing driven change or is there areal advantage in new technologies?We analyzed guidelines and higher evidence studies to evaluate therole of the most relevant new surgical approaches compared to TURPfor the treatment of BPH.In case of prostates of very large size the challenge is ongoing, withminimally invasive laparoscopic approach and most recently roboticapproach. We will evaluate the most recent literature on thisemerging field.

Androgen replacement therapy contributes to improving lower urinary tract symptoms in patients with hypogonadism and benign prostate hypertrophy: a randomised controlled study

Purpose. We performed a randomised controlled study regarding the effects of androgen replacement therapy (ART) on lower urinary tract symptoms (LUTS) in hypogonadal men with benign prostate hypertrophy (BPH).Methods. Fifty-two patients with hypogonadism and BPH were randomly assigned to receive testosterone (ART group) as 250 mg of testosterone enanthate every 4 weeks or to the untreated control group. We compared International Prostate Symptom Score (IPSS), uroflowmetry data, post-voiding residual volume (PVR) and systemic muscle volume at baseline and 12 months after treatment.Results. Forty-six patients (ART group, n = 23; control, n = 23) were included in the analysis. At the 12-month visit, IPSS showed a significant decrease compared with baseline in the ART group (15.7 ± 8.7 vs. 12.5 ± 9.5; p < 0.05). No significant changes were observed in the control group. The ART group also showed improvement in maximum flow rate and voided volume (p < 0.05), whereas no significant improvements were observed in the controls. PVR showed no significant changes in either group. In addition, the ART group showed significant enhancement of mean muscle volume (p < 0.05), whereas no significant changes were seen in the controls.Conclusion. ART improved LUTS in hypogonadal men with mild BPH.

Bipolar versus monopolar TURP: a prospective controlled study at two urology centers

We compared bipolar and monopolar TURP in a prospective controlled study at two urology centers. The objective of the study was to establish whether there were differences between the two methods with regard to frequency of the transurethral resection (TUR) syndrome, amount of fluid absorbed during surgery, risk of hemorrhage, duration of postoperative catheterization and duration of hospitalization. The duration of surgery, improvement in maximum flow rate (Q-max), residual urine volume, International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score were also compared. Overall, our study showed that there were no major differences between bipolar and monopolar TURP. During follow-up, the clinical efficacy of bipolar TURP has been maintained to the same degree as with the traditional method, with no significant differences for Q-max, IPSS and QoL scores after 1 year. Although the risk of developing TUR syndrome seemed to be smaller with bipolar resection (serum sodium change bipolar versus monopolar: +1.2 versus -0.1 mmol l(-1)), the bleeding tendency with both methods was the same (14.0 g l(-1) hemoglobin loss after 1 day in both groups). On the basis of our findings, we think that the monopolar technique has still a place in TURP.

Sustained beneficial effects of intraprostatic botulinum toxin type A on lower urinary tract symptoms and quality of life in men with benign prostatic hyperplasia

To present a comprehensive experience with intraprostatic botulinum toxin-type A (BoNT-A) injection in men with symptomatic benign prostatic hyperplasia (BPH) and to assess the efficacy on lower urinary tract symptoms (LUTS) and quality of life (QoL). In all, 41 men (mean age 69.1 years, sd 7.1 ) with an International Prostate Symptom Score of > or = 8, peak flow rate of < 12 mL/s, and who were refractory to medical treatment were injected with BoNT-A (Botox, Allergan, Inc., CA, USA) at 100 U (21 men, for prostate volume < 30 mL) or 200 U (20, for prostate volume > 30 mL) into the prostate transperineally under transrectal ultrasonography guidance. Study exclusion criteria were confirmed or suspected malignancy, previous pelvic surgery or trauma and previous invasive treatment for BPH. The clinical effects were evaluated at baseline and at 1, 3 and 6 months after treatment. There were no significant local or systemic side-effects in any men. LUTS and QoL indices improved by > 30% in 31 of the 41 men (76%), and four of five men with urinary retention for > 1 month could void spontaneously at 1 week to 1 month after the BoNT-A injection. In 12 of 41 men (29%) there was no change in prostate volume, yet seven of these men still had a > 30% improvement in maximum flow rate, LUTS and QoL. The efficacy was sustained at 12 months. BoNT-A injected into the prostate is safe and effective for men with symptomatic BPH. The mechanisms of relief of symptoms might not depend totally on the volume shrinkage; the inhibitory effect on the smooth muscle tone and aberrant sensory function might also be important.

Transurethral Needle Ablation of the Prostate: An Alternative Minimally Invasive Therapeutic Concept in the Treatment of Benign Prostate Hyperplasia

Alternative minimally invasive methods treating benign prostate hyperplasia (BPH) have become more and more important. Transurethral needle ablation (TUNA^TM) has been demonstrated to be effective in both canine and the human prostate. The goal of our study was to prove the safety, feasibility and tolerance of this new procedure. In this prospective nonrandomized study, 33 patients underwent TUNA^TM-treatment. One, 3 and 6 months postoperatively, follow-up examinations were carried out assessing urodynamic parameters such as urinary flow rates, residual urine levels, and IPSS-scores. During the last visit additional cystomanometry and urethrocystoscopy were done. Six months postoperatively IPSS-score and residual urine volumes were decreased by 50% (range: 1–72%) and 75% (range: 12–97%). Improvement in maximum flow rate was 63% (range: 5–125%). No serious postoperative complications occurred. After a short ‘learning period’ most of the treatments where performed as an out-patient-procedure so the patients could leave the hospital without the need for indwelling catheters. The TUNA^TM appears to be a minimally invasive and safe out-patient procedure for the treatment of selected cases of BPH.