Improvement In International Prostate Symptom Score Research Articles

Efficacy of the Rezūm System for lower urinary tract symptoms in patients with benign prostatic hyperplasia: Long term results from a single centre prospective study.

Benign prostatic hyperplasia (BPH) is a prevalent urological condition leading to lower urinary tract symptoms. Minimal invasive surgical treatment (MISTs) such as Rezūm System are emerging aiming to relieve symptoms. We present results from a single centre prospective study. We prospectively followed patients undergoing Rezūm between 2021 and 2023 from a single centre. International Prostate Symptom Score (IPSS), functional outcomes (maximum urinary flow rate (Qmax) and post-void urinary residual (PVR) and International Index of Erectile Function-5 (IIEF-5) were assessed at 3, 6, 12 and 24 months. Anterograde ejaculation was assessed at 12 months follow up. Linear mixed-effects models (LMMs) for repeated measures were applied to assess differences in the IPSS, maximum flow rate (Qmax), PVR, and International Index of Erectile Function-5 (IIEF-5) from baseline (t0) to 3, 6, 12 and 24 months. Results: After adjusting for prostate volume and symptoms severity, significant differences were observed at 3, 6, 12 and 24 months for IPSS (p < 0.001), Qmax (p < 0.001), PVR (p < 0.001) and IPSS-QoL (p < 0.001) from baseline. No statistically significant changes were found in the IIEF-5 scores at 3, 6, 12 and 24 months from baseline. Anterograde ejaculation remained in 98% of patients after treatment. In conclusion, the study's findings indicate that patients undergoing Rezūm treatment experience sustained improvements in IPSS, Qmax, PVR and IPSS-related quality of life up to 24 months following the intervention. Anterograde ejaculation remained in 98% of patients after treatment.

Transperineal Laser Ablation for Focal Therapy of Localized Prostate Cancer: 12-Month Follow-up Outcomes from a Single Prospective Cohort Study.

To evaluate the oncological and functional outcomes of transperineal laser ablation (TPLA) as the focal therapy for localized prostate cancer (PCa) after a 12-month follow-up. Patients with low- and intermediate-risk localized PCa were prospectively treated with focal TPLA between July 2021 and December 2022. The inclusion criteria were the following: clinical stage < T2b; PSA < 20 ng/mL; International Society of Urological Pathology (ISUP) grade ≤ 2; MRI-fusion biopsy-confirmed lesion classified as PI-RADS v2.1 ≥ 3. Intra-, peri-, and post-operative data were collected. Variables including age, PSA, prostate volume (PVol), Charlson's Comorbidity Index (CCI), International Prostate Symptom Score (IPSS) with QoL score, International Index of Erectile Function (IIEF-5), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD) were collected at baseline and at 3, 6 and 12 months after TPLA. Post-operative mpMRI was performed at 3 and 12 months. Finally, all patients underwent prostatic re-biopsy under fusion guidance at 12 months. The success of this technique was defined as no recurrence in the target treated lesion at the 12-month follow up. Twenty-four patients underwent focal TPLA. Baseline features were age [median 67 years (IQR 12)], PSA [5.7 ng/mL (3.9)], PVol [49 mL (27)], CCI [0 (0)], IPSS [11 (9)], IPSS-QoL [2 (2)], IIEF-5 [21 (6)], ICIQ-SF [0 (7)], MSHQ-EjD ejaculation domain [14 (4)] and bother score [0 (2)]. Median operative time was 34 min (IQR 12). Median visual analogue scale (VAS) 6 h after TPLA was 0 (IQR 1). The post-operative course was regular for all patients, who were discharged on the second post-operative day and underwent catheter removal on the seventh post-operative day. No patient had incontinence at catheter removal. A significant reduction in PSA (p = 0.01) and an improvement in IPSS (p = 0.009), IPSS-QoL (p = 0.02) and ICIQ-SF scores (p = 0.04) compared to baseline were observed at the 3-month follow-up. Erectile and ejaculatory functions did not show any significant variation during the follow-up. No intra- and peri-operative complications were recorded. Three Clavien-Dindo post-operative complications were recorded (12%): grade 1 (two cases of urinary retention) and grade 2 (one case of urinary tract infection). At the 12-month follow-up, eight patients showed mpMRI images referable to suspicious recurrent disease (PIRADS v2.1 ≥ 3). After re-biopsy, 7/24 patients' (29%) results were histologically confirmed as PCa, 3 of which were recurrences in the treated lesion (12.5%). The success rate was 87.5%. The focal TPLA oncological and functional results seemed to be encouraging. TPLA is a safe, painless, and effective technique with a good preservation of continence and sexual outcomes. Recurrence rate at 12 months was about 12.5%.

733 Rezum Water Vapour Thermal Therapy for Treatment of Lower Urinary Tract Symptoms: A Prospective Single-Centre Analysis

Abstract Aim Benign prostatic enlargement (BPE) is a chronic disorder of the prostate with an increasing prevalence. In recent years, different minimally invasive treatment options for lower urinary tract symptoms (LUTS) secondary to BPE have been introduced. One of these technologies, Rezum, uses heat from radiofrequency generated water vapour to ablate prostatic tissue. Our study aims to investigate the safety and efficacy of Rezum through a consecutive series of patients who underwent the procedure in our department. Method A prospective study was conducted involving thirty-eight men with moderate-severe LUTS undergoing Rezum between January 2022 and February 2023. To measure efficacy, quantitative data was collected through pre-and post-operative international prostate symptom score (IPSS), quality of life score (QoL), simplified international index of erectile function (IIEF-5) checklists, and uroflowmetry to measure maximum flow rate (Qmax) and post-void residual (PVR). Patients were followed up to determine if there had been any side effects. Results The mean number of Rezum injections was 3.8 to each lateral lobe, and 0.81 to the median lobe. The results show a significant improvement in IPSS (24.1 to 9.8), QoL (4.8 to 2.0), and Qmax (10.4 to 16.8). There was no reduction in erectile function with the IIEF-5 actually slightly increasing (13.4 to 15.2). Conclusions Our single-centre prospective analysis shows that Rezum is a safe and effective minimally invasive treatment option for men with troublesome LUTS secondary to BPE. Rezum is a promising technology that could be offered to patients who wish to preserve their sexual function and discontinue their BPE medications.

A Systematic Review and Single-Arm Meta-Analysis on the Efficacy of High-Intensity, Focused Ultrasound for Benign Prostatic Hyperplasia Treatment: A Forgotten Option?

Benign prostatic hyperplasia (BPH) is a non-cancerousenlargement of prostate tissue, commonly affecting older men. This condition leads to lower urinary tract symptoms (LUTS), which significantly affect the quality of life. Over time, extensive research has been conducted regarding BPH treatment, exploring various treatment options. High-intensity focused ultrasound (HIFU) is a non-invasive treatment modality that has shown promise in initial studies. However, evidence regarding its long-term efficacy and safety remains inconclusive. This study evaluates HIFU's safety and efficacy for BPH treatment, identifying gaps for future research. The study conducted comprehensive searches across the PubMed, Google Scholar, Cochrane Central, and ClinicalTrials.gov databases, covering English-language articles from 1994 to 2023. Inclusion criteria focused on peer-reviewed studies, with more than 10 patients utilizing ultrasound image-guided HIFU for BPHwhile excluding other HIFU modalities lacking ultrasound image guidance. Data extraction targeted primary outcomes (peak flow rate, International Prostate Symptom Score(IPSS), postvoid residual volume) and secondary outcomes (treatment time, follow-up duration). Statistical analysis utilized a random effects model with heterogeneity assessed by I² statistics and the Q test, alongside subgroup analysis based on study design. The risk of bias assessment employed the Cochrane Collaboration tool for randomized controlled trials and the methodological index for nonrandomized studies. Among 560 identified articles, 12 studies with 522 patients met the inclusion criteria. Primary outcomes showed improvements in Qmax (1 month: 2.50 ml/s, 12 months: 6.22 ml/s) and IPSS (1 month: -9.37 points, 12 months: -11.60 points). Reported complications included transient hematuria, hematospermia, and urinary retention. HIFU presents significant clinical improvements in treating BPH, albeit with slow progression attributed to specific techniques and the ablative approach. Manageable complication profiles are observed, yet study design flaws hinder a comprehensive evaluation of HIFU efficacy. The authors suggest areas for clinical optimization, emphasizing the necessity of further research.

Prostate volume: does it predict patient outcomes following prostate artery embolisation? A retrospective cohort study

Prostate artery embolisation (PAE) is a minimally invasive procedure commonly performed to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. International Prostate Symptom Score (IPSS) is a validated patient questionnaire quantifying LUTS and is used for patient selection for PAE, but it is largely subjective. Prostate volume is an easily estimated objective parameter across multiple imaging modalities. No strict threshold of prostate volume is established as a selection criterion for PAE, but it is generally accepted that prostate volume should be over 40 to 50 mL.We looked at a sample of 65 cases performed at a large teaching hospital between 2017 and 2019 with a minimum of four years follow up. Embospheres between 100 to 500 microns were injected into the prostatic arteries bilaterally (if technically feasible). A ‘bullet shape’ model was used to estimate prostatic volume from initial CT. N = 13 had an estimated volume < 51 mL (range 31-50 mL). IPSS before and at 3 months post-procedure were collected.80% of patients indicated a beneficial response to PAE (IPSS improvement > 5). 23% of patients required further PAE procedure or surgery. No major complications were recorded. The mean change in IPSS under 51 mL compared to over 51 mL cohort was 10.2 versus 11 (standard deviation 7.5 versus 7.3) (p = 0.44, 2 tailed Student’s T-test).There was no statistically significant difference in the IPSS improvement or outcome of small volume prostates under 51 mL compared to large volume. Our results suggest that prostate volume should not be used to exclude patients for PAE.

Machine Learning to Predict Prostate Artery Embolization Outcomes

PurposeThis study leverages pre-procedural data and machine learning (ML) techniques to predict outcomes at one year following prostate artery embolization (PAE).Materials and MethodsThis retrospective analysis combines data from the UK-ROPE registry and patients that underwent PAE at our institution between 2012 and 2023. Traditional ML approaches, including linear regression, lasso regression, ridge regression, decision trees and random forests, were used with leave-one-out cross-validation to predict international prostate symptom score (IPSS) at baseline and change at 1 year. Predictors included age, prostate volume, Qmax (maximum urinary flow rate), post-void residual volume, Abrams-Griffiths number (urodynamics score) and baseline IPSS (for change at 1 year). We also independently confirmed our findings using a separate dataset. An interactive digital user interface was developed to facilitate real-time outcome prediction.ResultsComplete data were available in 128 patients (66.7 ± 6.9 years). All models predicting IPSS demonstrated reasonable performance, with mean absolute error ranging between 4.9–7.3 for baseline IPSS and 5.2–8.2 for change in IPSS. These numbers represent the differences between the patient-reported and model-predicted IPSS scores. Interestingly, the model error in predicting baseline IPSS (based on objective measures alone) significantly correlated with the change in IPSS at 1-year post-PAE (R2 = 0.2, p < 0.001), forming the basis for our digital user interface.ConclusionThis study uses ML methods to predict IPSS improvement at 1 year, integrated into a user-friendly interface for real-time prediction. This tool could be used to counsel patients prior to treatment.

Comparative study of tamsulosin, tadalafil, and combination of tamsulosin with tadalafil in the treatment of patients with lower urinary tract symptoms

Purpose: Benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) commonly coexist in aging men. Tamsulosin and tadalafil are widely used for lower urinary tract symptoms (LUTS) and ED, respectively. A combination of these 2 drugs might be useful to design new management strategies, as treatment of LUTS might affect ED. Furthermore, the effect of tadalafil alone or in combination with tamsulosin on LUTS has not been widely studied, especially in our country. We conducted a study to compare the effects of tamsulosin, tadalafil, and a combination of tamsulosin and tadalafil in patients with LUTS with or without ED. Materials and methods: In this observational study, 81 men with LUTS due to BPH were included. Patients were divided into 3 groups of 27 patients each. Group A received tamsulosin 0.4 mg/d alone, group B tadalafil 5 mg/d alone, and group C combination therapy (tamsulosin and tadalafil both). All patients were evaluated for the International Prostate Symptom Score (IPSS), the International Index of Erectile Function 5 score, the maximum urinary flow rate, and postvoid residual urine volume. Results: IPSS improvement was seen in all groups (−50.90%, P &lt; 0.05; −28.57%, P &lt; 0.05; and −54.83%, P &lt; 0.05, respectively). An improvement in International Index of Erectile Function 5 was also seen in all 3 groups (+39.28%, P &lt; 0.05; +45.9%, P &lt; 0.05; and +55.4%, P &lt; 0.05, respectively). Maximum urinary flow rate and postvoid residual also showed improvement in all 3 groups (33.9%, P &lt; 0.05; 29.92%, P &lt; 0.05; and 39.71%, P &lt; 0.05 and −60.60%, P &lt; 0.05; −48.51%, P &lt; 0.05; and −62.18%, P &lt; 0.05, respectively). Conclusion: In patients with LUTS due to BPH, tadalafil and tamsulosin, either alone or in combination, significantly reduce LUTS. In addition, these drugs significantly enhance erectile function in males with LUTS, whether taken alone or in combination. We found no statistically significant improvement in either the IPSS or the ED scores when comparing the combination group to the tamsulosin-alone and the tadalafil-alone groups.

Oral preparation of hyaluronic acid, chondroitin sulfate, N-acetylglucosamine, and vitamin C improves sexual and urinary symptoms in participants with recurrent urinary tract infections: a randomized crossover trial.

Intravesical instillation of hyaluronic acid (HA) has been associated with reduced sexual dysfunction in participants with recurrent urinary tract infections (rUTIs), but the efficacy of an oral treatment has never been investigated. To investigate the efficacy of an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C in improving sexual and urinary symptoms in a cohort of reproductive-age participants with rUTI. In a monocentric randomized crossover pilot trial, participants with rUTI who were referred to our institute between March 2022 and April 2023 were randomized 1:1 in 2 groups: intervention vs control. All participants had an oral preparation of cranberry, D-mannose, propolis extract, turmeric, and Boswellia twice a day for 3 months. The intervention group also included an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C once a day for 3 months. Crossover of treatment occurred at 3 months for an additional 3 months. At baseline and 3 and 6 months, participants were evaluated clinically and with the International Prostate Symptom Score (IPSS) and Female Sexual Function Index (FSFI). Descriptive statistics and logistic regression models tested the impact of the intervention on urinary and sexual symptoms at each follow-up assessment. Improvement in sexual and urinary symptoms as measured by the FSFI and IPSS. Overall, 27 (54%) participants had an FSFI score <26.5 at enrollment. At 3 months, FSFI scores were higher in the intervention group vs control (P < .001), but IPSS scores were lower (P = .03). After crossover of treatment, FSFI and IPSS scores remained stable in the intervention group. However, after crossover, the control group showed a significant improvement in IPSS and FSFI scores (all P < .01) vs the 3-month assessment. At last follow-up, urinary and sexual symptoms were comparable between groups. In logistic regression analyses, the intervention group was associated with early improvement in sexual symptoms (odds ratio, 3.9; P = .04) and urinary symptoms (odds ratio, 5.1; P = .01) after accounting for clinical confounders. Combination treatment with HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C is effective if started immediately or even after a few months from symptoms in participants with rUTI. The main limitation is the lack of long-term follow-up. The oral formulation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C could be an effective therapy against urinary and sexual distress in participants with rUTI (NCT06268483; ClinicalTrials.gov).

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery.

This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes. We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery. The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor. In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.

COMPARISON OF EFFICACY OF PDE5 INHIBITORS (SILDENAFIL) VERSUS ALPHA-BLOCKERS (TAMSULOSIN) IN TREATMENT OF LOWER URINARY TRACT SYMPTOMS (LUTS) SECONDARY TO BENIGN PROSTATIC HYPERPLASIA

Benign prostatic hyperplasia (BPH) is a prevalent condition leading to lower urinary tract symptoms (LUTS) in men, affecting their quality of life. Various medications, including phosphodiesterase five inhibitors (PDE5-Is) and alpha-blockers (ABs), are used for treatment, but direct comparison studies between these drugs are limited. This study aimed to compare the efficacy of sildenafil (PDE5 inhibitor) versus tamsulosin (alpha-blocker) in patients with LUTS secondary to BPH. A randomized controlled trial was conducted at the Department of Urology, KEMU/Affiliated Hospital, Lahore. A sample size of 100 patients (50 in each group) was calculated using the WHO calculator based on expected efficacy rates. Patients aged 40-70 years with BPH and LUTS were included. Exclusion criteria included high PSA levels, history of prostatic surgery, acute urinary retention, or active urinary tract infection. Patients were randomly assigned to receive sildenafil 25mg OD or tamsulosin 0.4mg HS for three months. Efficacy was assessed by changes in the International Prostate Symptom Score (IPSS) after treatment. The demographic characteristics of the study population showed a mean age of 60 years with a similar distribution of comorbidities between the groups. After three months of treatment, 80.9% of patients in the sildenafil group showed a significant improvement in IPSS compared to 55.5% in the tamsulosin group. The chi-square test indicated a significant difference in efficacy between the two groups (p &lt; 0.05). Sildenafil demonstrated superior efficacy compared to tamsulosin in reducing LUTS secondary to BPH. These findings suggest that sildenafil may be considered as a first-line treatment option for patients with BPH and LUTS.

Propensity score-matched analysis comparing perioperative, functional, and safety outcomes between thulium fiber laser and bipolar enucleation of the prostate performed by a single surgeon with two years of follow-up.

To compare perioperative, functional, and safety outcomes between thulium fiber laser enucleation of the prostate (ThuFLEP) and bipolar enucleation of the prostate performed by a single surgeon with use of propensity score (PS)-matched analysis. Data were from 675 patients, 422 of whom underwent ThuFLEP and bipolar enucleation by a single highly experienced surgeon. ThuFLEP was performed with Fiberlase U1 (IRE Polus Ltd.). Perioperative parameters, safety, and functional outcomes, such as International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual volume (PVR), and maximum urinary flow rate (Qmax) were assessed. To control for selection bias, a 1:1 PS-matched analysis was carried out using the following variables as covariates: total prostate volume, preoperative IPSS and early sphincter release. Of 422 patients, 370 (87.7%) underwent ThuFLEP and 52 (12.3%) underwent bipolar enucleation. Operation, enucleation, and morcellation time were comparable between groups before and after PS-matched analysis (p=0.954, p=0.474, p=0.362, respectively). Functional parameters (IPSS, QoL, PVR, Qmax) were also comparable between groups at every time point before and after PS matching. Significant improvements in IPSS, QoL score, Qmax, and PVR were observed during the 24-month follow-up period for both ThuFLEP and bipolar enucleation without any significant differences between groups. Early and late postoperative complications before and after PS-matched analysis were similar. ThuFLEP was comparable to bipolar enucleation in perioperative characteristics, improvement in voiding parameters, and complication rates. Both procedures were shown to be effective and safe in the management of benign prostatic hyperplasia.

Efficacy of Prostatic Artery Embolization in Symptomatic Benign Enlargement of Prostate (&gt;100 cc): A Hospital-based Prospective Study in a Tertiary Care Center

Abstract Background: Prostatic artery embolization (PAE) has recently emerged as an effective minimally invasive procedure for the treatment of patients with symptomatic benign enlargement of prostate (BEP). Aim and Objective: The objective of the study was to evaluate the efficacy of PAE in BEP patients. Materials and Methods: A prospective observational clinical study was conducted at tertiary care hospital over 1-year from April 2022 to March 2023. This study included patients with lower urinary tract symptoms indicative of BEP and a prostate volume of 100 cc or more. The primary endpoints of the study were determining the International Prostate Symptom Score (IPSS), Q-max, prostate volume, intraprostatic resistive index, and prostate-specific antigen (PSA). Results: A total of 21 patients, with a mean age of 72 years were included in the study. After a 6-month follow-up, 15 patients were catheter-free, while 6 patients required adjunctive surgical treatment in the form of transurethral resection of prostate or holmium enucleation of prostate. The mean IPSS significantly decreased from 22 to 8 after PAE (P = 0.0394 Mean Q-max significantly increased from 8 mL/s to 16 mL/s (P = 0.05), while prostate volume decreased significantly at 6 months’ follow-up (122.0 cc vs. 58.0 cc, P = 0.0334). Intraprostatic resistive index showed a statistically significant increase after embolization of unilateral/bilateral prostatic arteries. 0.62 versus 1.34, P = 0.0317, and serum PSA values were comparable pre- and post- PAE. Conclusion: PAE effectively treats symptomatic BEP with a prostatic volume of 100cc or more, achieving a success rate of 71.5% with improvements in IPSS, increased Q-max values, and reduced prostate size.

Predictors of achieving a minimal clinically important difference in lower urinary tract symptoms 3 months after Rezum therapy.

Gaining insight into patient characteristics to predict the success of procedures is crucial for improving outcomes and for preoperative counselling. We identified predictors of achieving a minimal clinically important difference (MCID) in lower urinary tract symptoms (LUTS) 3 months after Rezūm. A retrospective study was conducted on patients treated with Rezūm. Patients with moderate or severe LUTS and a recorded International Prostate Symptom Score (IPSS) at 3 months were included and categorised into 2 cohorts based on experiencing a MCID at 3 months (≥ 25% improvement in IPSS). Predictors were identified through multivariate logistic regression analysis. Out of 174 patients, 134 (77%) achieved a MCID at 3 months, and those who did had a higher median baseline IPSS (20 [16-26] vs 15 [10-21], P <0.001) and were more likely to have severe LUTS at baseline (53.0% vs 35.0%, P = 0.046) when compared to those who did not experience a MCID at 3 months. Higher baseline IPSS (OR: 1.10, 95% CI 1.04-1.17) and larger baseline prostate volumes (OR: 1.03, 95% CI 1.0-1.05) were predictors of achieving a MCID at 3 months. More specifically, a significantly greater proportion of patients with severe LUTS (83.5 vs 70.8%, P = 0.046) and prostate volume ≥60 cc (94.6 vs 71.4%, P = 0.003) achieved MCID at 3 months when compared to patients with moderate LUTS and prostate volumes <60 cc, respectively. More than three-quarters of patients treated with Rezūm achieved a MCID at 3 months. Patients with severe LUTS and prostate volumes ≥ 60 cc may be optimal candidates for experiencing early relief in LUTS following Rezūm.

Clinical outcome and safety of holmium laser prostate enucleation after transrectal prostate biopsies for benign prostatic hyperplasia.

This study aimed to assess the clinical outcome and safety of holmium laser enucleation of the prostate (HoLEP) following transrectal ultrasound-guided prostate biopsy (TR biopsy) in the treatment of benign prostate hyperplasia. We retrospectively analyzed data from 556 patients who underwent HoLEP between 2014 and 2021. The patients were categorized into six groups: Group 1-A (n=45) underwent HoLEP within four months post TR biopsy. Group 1-B (n=94) underwent HoLEP more than four months post TR biopsy. Group 1-C (n=120) underwent HoLEP after a single TR biopsy. Group 1-D (n=19) underwent HoLEP after two or more TR biopsies. Group 1-total (n=139, group 1-A+group 1-B or group 1-C+group 1-D) underwent HoLEP post TR biopsy. Group 2 (control group, n=417) underwent HoLEP without prior TR biopsy. We examined perioperative parameters, safety, and functional outcomes. The age, body mass index, International Prostate Symptom Score (IPSS), uroflowmetry, and comorbid diseases between group 1-total and group 2 were comparable. However, group 1-total exhibited significantly elevated prostate-specific antigen levels and larger prostate volumes (p<0.01). Perioperative factors like enucleation time, enucleation weight, and catheterization duration were notably higher in group 1-total (p<0.01). All groups showed significant improvements in IPSS, postvoid residual urine, and maximum flow rate during the 1-year postoperative period (p<0.05). The rates of postoperative complications were similar between group 1-total and group 2. Enucleation time and catheterization duration were significantly longer in the TR biopsy group. However, postoperative complications were not significantly different between TR biopsy and non-TR biopsy groups.

Multi-pharmacological treatment for young subfertile males with chronic prostatitis/chronic pelvic pain syndrome.

This study evaluated the effectiveness of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) treatments using multiple pharmaceutical agents that could simultaneously preserve or enhance fertility capability. This was a single-center-based, randomized controlled study, whereas the final analysis evaluated a total 350 CP/CPPS patients (age range, 28-40 years) and 50 patients were randomly allocated to each therapeutic group, with a 1:1 ratio. The therapeutic groups consist of tadalafil (group 1, 5 mg daily), L-carnitine (group 2, 2 g daily), Serenoa repens extract (group 3, 320 mg daily), group 4 (tadalafil+L-carnitine), group 5 (tadalafil+S. repens), group 6 (L-carnitine+S. repens), and group 7 (tadalafil+L-carnitine+S. repens). The treatment outcomes at 3 months post-therapy were analyzed. At 3 months post-therapy, the mean total sperm motility was significantly improved in all groups. A normal morphology improvement was observed in L-carnitine receiving groups. The mean total score on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the mean International Prostate Symptom Score (IPSS) showed the greatest reduction in intensity in group 7. Logistic regression analyses showed that group 5 and group 7 were significantly associated with improvements in total IPSS and total NIH-CPSI scores at 3 months post-therapy. Group 7 was a significant predictor for improving total sperm motility, leukocytospermia and normal form of sperm. Tadalafil, carnitine, and S. repens combination therapy could be considered a feasible treatment option for CP/CPPS males with subfertility.

Optilume drug-coated balloon for anterior urethral stricture: 2-year results of the ROBUST III trial.

The aim of this study is to report the updated 2-year results of the intervention arm of the ROBUST III randomized trial evaluating the safety and efficacy of the Optilume drug-coated balloon (DCB) versus standard endoscopic management of recurrent male anterior urethral stricture. Eligible patients included men with recurrent anterior urethral stricture ≤3cm in length and ≤12Fr in diameter, International Prostate Symptom Score (IPSS) ≥11 and peak flow rate (Qmax) <15 mL/s. Patients were randomized to treatment with the Optilume DCB or standard-of-care endoscopic management. Primary efficacy endpoints measured at 2years included freedom from re-intervention and changes in IPSS, Qmax and post-void residual (PVR). Secondary endpoint was impact on sexual function using the International Index of Erectile Function (IIEF). Primary safety endpoint was freedom from serious procedure- or device-related adverse events (AEs). A total of 127 patients enrolled at 22 sites in the United States and Canada (48 randomized to standard-of-care dilation and 79 to DCB dilation). Seventy-five patients in the DCB arm entered the open-label phase after 6 months. Participants averaged 3.2 prior endoscopic interventions (range 2-10); most (89.9%) had bulbar strictures with an average stricture length of 1.63 cm (SD 0.76). Significant improvements in IPSS, average Qmax and PVR were maintained at 2years. Freedom from repeat intervention was significantly higher in the Optilume DCB arm at 2years versus the Control arm at 1year (77.8% vs. 23.6%, p < 0.001). During the follow-up period, there were 15 treatment failures and two non-study-related deaths. Treatment-related AEs were rare and generally self-limited (haematuria, dysuria and urinary tract infection). The Optilume DCB shows sustained improvement in both objective and subjective voiding parameters at 2-year follow-up. Optilume appears to provide a safe and effective endoscopic treatment alternative for short recurrent anterior urethral strictures among men who wish to avoid or delay formal urethroplasty.

Prospective Trial of Water Vapor Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia in Subjects with a Large Prostate: 6- and 12-month Outcomes

BackgroundCurrent guidelines recommend Rezūm water vapor thermal therapy for the treatment of benign prostatic hyperplasia (BPH) for prostate glands ranging in volume from 30 to 80 cm3. Few prospective studies have specifically evaluated the use of Rezūm for larger prostates. ObjectiveTo evaluate the safety and efficacy of water vapor thermal therapy in patients with a prostate gland >80 cm3 and ≤150 cm3. Design, setting, and participantsIn this prospective, single-arm study at seven centers in the USA, subjects were males aged >50 yr with symptomatic BPH and prostate volume of >80 cm3 and ≤150 cm3. InterventionRezūm was used to deliver sterile water vapor via a transurethral approach to ablate targeted areas of prostate tissue. Outcome measurements and statistical analysisThe primary efficacy outcome was response to therapy, defined on a per-patient basis as a ≥30% improvement in International Prostate Symptom Score (IPSS) from baseline to 6 mo. The primary safety outcome was a composite of serious device-related safety events. Secondary outcomes included catheterization for device-related retention. IPSS outcomes over time were analyzed via generalized estimating equations. Results and limitationsAmong 47 eligible patients, prostate volume ranged from 80.8 to 148.1 cm3. All patients completed 6-mo follow-up, and 40/47completed 12-mo follow-up. At 6 mo, 83% were treatment responders according to the primary efficacy endpoint. The mean IPSS improvement at 6 mo was 11.9 ± 7.5 points, reflecting significant improvement. The primary safety outcome was met, with no occurrence of device-related composite safety events. The study is limited by the nonrandomized design and early termination, unrelated to safety or effectiveness. ConclusionsOur results are consistent with previous findings for prostate glands of up to 80 cm3, and indicate the safety and efficacy of Rezūm for BPH in patients with a larger prostate. Patient summaryRezūm therapy, in which water vapor is used to treat targeted areas of the prostate, is currently recommended for patients with benign enlargement of the prostate and a prostate size of up to 80 cm3. We found that this treatment was also effective and safe in patients with a larger prostate of 80–150 cm3.

High-Intensity Focused Ultrasound (Sonablate®) for Prostate Cancer: Preliminary Outcomes in Taiwan.

We reported preliminary outcomes of high-intensity focused ultrasound (HIFU) [Sonablate®] in the combination of transurethral resection of the prostate for localized prostate cancer in Taiwan. Seventy-seven patients using Sonablate® HIFU for localized prostate cancer were enrolled in this study from April 2021 to December 2022. Prostate-specific antigen biochemical recurrence, International Index of Erectile Function (IIEF)-5 scores, International Prostate Symptom Score (IPSS), quality of life (QoL) scores, and postoperative complications were recorded during follow-up. Overall, 19.5% of patients were low-risk, 36.4% were intermediate-risk, and 44.1% were high-risk according to the D'Amico risk classification. The median follow-up was 12.09±5.85 months, and the biochemical-free survival rates for the low-, intermediate-, and high-risk groups were 100% (15/15), 96.4% (27/28), and 79.4% (27/34), respectively. Four patients (5.2%) received salvage radiotherapy and all maintained biochemical-free survival. The mean IPSS and QoL scores before versus after HIFU were 10.4 versus 6.8 (p=0.003) and 3.2 versus 3.0 (p=0.096), respectively. There was no statistically significant change in preoperative and postoperative IIEF scores (20.6 vs. 19; p=0.062) in patients who had an IIEF score of >15 at baseline and received nerve-sparing procedures (subtotal ablation). The results of Sonablate® HIFU in Taiwan indicated adequate short-term cancer control, excellent potency, and continence preservation. HIFU can achieve improvement of IPSS with low complication rates.

Real-world four-year functional and surgical outcomes of Rezum therapy in younger versus elderly men.

Management of urinary symptoms in elderly patients with benign prostatic hyperplasia (BPH) is complex given challenges with medications and invasive surgeries. Rezum, a minimally invasive water vapor therapy, is an emerging alternative. We compare real-world Rezum outcomes between young and elderly patients over 4 years. We retrospectively analyzed a multiethnic population treated with Rezum at a single center between 2017-2019. Patients were stratified into young (<65 years) or elderly (≥65 years) cohorts. International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), decisional regret scores, and adverse events (AEs) were assessed at baseline, 1-, 3-, 6-, 12-, and/or 48-months. Descriptive statistics were compared using t-tests, Chi-squared, or Mann-Whitney U tests. Changes in outcomes were assessed using Wilcoxon signed-rank tests, stratified by age. 256 patients - 146 (57%) young and 110 (43%) elderly - were included. The majority were Asian (33.2%) or non-Hispanic Black (28.9%). Significant improvements were observed in the combined cohort at 4-years in IPSS, QoL, and Qmax when compared to baseline (all p < 0.05). Between the age cohorts, there were no significant differences in IPSS, QoL, or Qmax at any follow-up. Within both cohorts, significant improvements in IPSS and QoL were found from baseline to all follow-ups. In the young cohort, Qmax was significantly improved from baseline to all follow-ups while in the elderly cohort, this was observed only at the 3-month follow-up. No significant differences in AEs or regret was found between cohorts. There was no significant difference in 4-year surgical retreatment rates between cohorts (elderly 4.0% vs young 4.4%, p = 0.86). There were no significant differences in IPSS, QoL, or AEs between elderly and younger men over 4 years following Rezum, suggesting comparable benefits and risks. Future research is warranted to clarify the impact of Rezum on Qmax in elderly men.

Transurethral resection of the prostate (TURP) versus transperineal laser ablation (TPLA) due to benign prostatic hyperplasia (BPH): prospective and comparative study.

We aimed to compare the first-year results of Transurethral resection of the prostate (TURP), the gold standard method, and Transperineal laser ablation (TPLA) techniques. This study was designed as a prospective, randomized, controlled, and single-center and was conducted between November 2021 andFebruary 2023. TURP candidates were included in the study. Demographic data and perioperative data were recorded. Preoperative and first-year International Prostate Symptom Score (IPSS), International Erectile Function Index (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD), QoL, peak urinary flow rate (Qmax), prostate volume (PV) and postvoid residual (PVR) data were recorded. Fifty patients were included in the study and were assigned to equal numbers of groups. TPLA group had a higher ASA score (p = 0.03). There was improvement in IPSS, Qmax, and PVR parameters compared to baseline values in both groups at 1year (p < 0.01). The improvement in Qmax was better in the TURP group (p < 0.01). IIEF-5 score was similar between groups (p = 0.83 and p = 0.12, respectively). The MSHQ scores in the first year did not change according to their baseline values in the TPLA group (p = 0.54 and p = 0.34, respectively). According to the first-year results of TPLA, the symptomatic improvement effect without sacrificing ejaculatory functions is comparable to TURP. We think that this method will can be an alternative, especially for patients who want to avoid ejaculatory dysfunction, who have a high risk of anesthesia, and whose anticoagulant/antiplatelet therapy cannot be discontinued.