Improvement In Qmax Research Articles

Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture.

Introduction:The aim of the study is to present our initial experience with ventral-inlay buccal mucosal graft urethroplasty (VI-BMGU) in female urethral stricture disease (USD).Methods:Between May 2016 and June 2018, 12 women with USD underwent VI-BMGU. All women were evaluated preoperatively with the American Urological Association (AUA) symptom score, uroflowmetry, calibration with a 12 Fr catheter, and ultrasonography with postvoid residual (PVR) urine measurement. Intraoperative confirmation of stricture was done with a 6 Fr cystoscope. Postoperatively, the women were followed at 3, 6, and 12 months after surgery with AUA symptom score, uroflowmetry, and PVR estimation. Increase in AUA symptom score, maximum flow rate (Qmax) <12 ml/s, and failure to calibrate with 18 Fr catheters were considered as indicative of recurrence of the disease.Results:The mean age of the patients was 41 years. The mean follow-up period was 18 months. All women voided successfully after catheter removal. There was an improvement in AUA symptom score and Qmax and a reduction in PVR at 3, 6, and 12 months. One woman had recurrence of stricture at 6 months and was treated by urethral dilatation followed by the institution of a self-dilatation regimen. The success rate was 92% in our case series.Conclusions:VI-BMGU is a simple and safe method of urethroplasty in women. Studies with a larger sample size and a longer follow-up are required to document the long-term success of this procedure.

Outcome prediction of prostatic artery embolization: post hoc analysis of a randomized, open-label, non-inferiority trial.

To identify predictors for different treatment outcomes after prostatic artery embolization (PAE) in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. A post hoc analysis of data derived from the 48 patients undergoing PAE in a randomized, open-label, non-inferiority trial was performed. Relative changes in the International Prostate Symptoms Score (IPSS), absolute changes in maximum urinary flow rate (Qmax ), and relative changes in magnetic resonance imaging-assessed prostate volume from baseline to 12 weeks were defined as the outcomes measures of interest. Their association with various baseline characteristics and measures, technical details of PAE, and early postoperative measures were analysed using Spearman rank correlations and Wilcoxon rank-sum tests. The most promising predictors were further evaluated in receiver-operating characteristic (ROC) curve analyses. Higher total prostate and central gland (i.e. central plus transitional zone) volumes were associated with more pronounced improvements in the IPSS (Spearman rank correlation [rs]: -0.35 and -0.34; P = 0.01 and P = 0.02, respectively) and the Qmax (rs: 0.31 and 0.39; P = 0.05 and P = 0.01, respectively). ROC curve analyses suggested that volumes of 39 and 38 mL for total prostate and central gland volume, respectively, would be the optimal thresholds with which to predict PAE success as measured by the IPSS. Other anatomical characteristics of the prostate, such as the central gland index, also showed an even more distinct correlation to the improvement in Qmax (rs: 0.46, P = 0.003). The relative changes in prostate volume were clearly dependent on the technical performance of PAE. Occurrence of postoperative pain and blood levels of prostate-specific antigen and C-reactive protein emerged as potential early-stage outcome predictors after PAE. Baseline and peri-operative findings might help to guide patient selection and outcome prediction for PAE. Patients with larger prostates have a higher chance of success with PAE. Larger-scale clinical trials including a longer follow-up are warranted to further elucidate the most suitable patients for PAE.

Prostatic Urethral Lift (PUL) for obstructive median lobes: 12 month results of the MedLift Study

Evidence indicating Prostatic Urethral Lift (PUL) delivers significant improvement in symptomatic BPH with low morbidity is based on subjects with lateral lobe (LL) enlargement only. MedLift was an FDA IDE extension of the L.I.F.T. randomized study designed to examine safety and efficacy of PUL for treatment of obstructive middle lobes (OML). Inclusion criteria for this non-randomized cohort were identical to the L.I.F.T. randomized study, except for requiring an OML: ≥ 50 years of age, IPSS ≥ 13, and Qmax ≤ 12 ml/s. Primary endpoint analysis quantified improvement in IPSS over baseline and rate of post-procedure serious complications. Quantification of symptom relief, quality of life, flow rate, and sexual function occurred through 12 months. Outcomes were compared to historical L.I.F.T LL results and were combined to demonstrate the full effectiveness of PUL. Of the 71 screened subjects, 45 were enrolled. At 1, 3, 6, and 12 months, mean IPSS improved from baseline at least 13.5 points (p < 0.0001). Quality of life and BPHII were similarly improved (>60% and >70%, respectively at 3, 6, and 12 months, p < 0.0001). Mean Qmax improvement ranged from 90 to 129% (p < 0.0001). At 1 month, 86% (CI 73–94%) reported ≥70 on the Quality of Recovery scale, 80% (CI 66–89%) reported being “much” or “very much better,” and 89% (CI 76–95%) would recommend the procedure. Compared to LL subjects, OML subjects’ symptoms improved at least as much at every time point (OML range 13.5–15.9, LL range 9.9–11.1, p ≤ 0.01). On combining OML with LL data, >70% (range CI 63–81%) of subjects demonstrated ≥ 8 point improvement in IPSS through 12 months. Analysis of the combined dataset indicates ≥ 40% (CI 30–51%) of sexually active men improved the minimal clinically important difference in erectile function through 12 months. Prostates, including those with middle lobe obstruction, can be treated with the PUL procedure safely and effectively.

Minimally invasive prostatic urethral lift (PUL) efficacious in TURP candidates: a multicenter German evaluation after 2\xa0years

IntroductionSuccessful outcomes have been reported for the treatment of lower urinary tract symptoms (LUTS) with the prostatic urethral lift (PUL) in a number of clinical investigations. Our aim was to investigate PUL outcomes in patients treated in a day-to-day clinical setting without the rigid exclusion criteria of clinical studies.Materials and methodsWe investigated the outcome of the PUL procedure at five German departments during the initial period when PUL was approved for the clinic (10/2012–06/2014). All candidates for transurethral resection of the prostate (TURP) received PUL information and were given the choice of procedures. The only exclusion criterion was an obstructive median lobe. No patients were excluded because of high post-void residual volume (PVR), prostate size, retention history or LUTS oral therapy. Maximum urinary flow (Qmax), PVR, International Prostate Symptom Score (IPSS) and Quality of Life (QOL) were assessed at baseline, 1, 6, 12, and 24 months after surgery.ResultsOf 212 TURP candidates, 86 choose PUL. A mean of 3.8 (2–7) UroLift implants were implanted in patients of 38–85 years with a prostate size of 17–111 ml over 57 (42–90) min under general or local anesthesia. Thirty-eight (38.4%) patients had severe BPH obstruction and would have been denied PUL utilizing previously reported study criteria. Within 1 month 74 (86%) reported substantial symptom relief with significant improvements in Qmax, PVR, IPSS, and QOL (p < 0.001) that was maintained within the follow-up. Sexual function including ejaculation was unchanged or improved. No Clavien–Dindo Grad ≥ 2 was reported postoperatively. Eleven (12.8%) patients were retreated over 2 years. Twelve (86%) of 14 patients presenting with chronic urinary retention were catheter free at last follow-up.ConclusionPUL is a promising surgical technique that may alleviate LUTS, even in patients with severe obstruction.

Thulium Laser Enucleation of the Prostate (ThuLEP) as a Technique for Treatment of BPH: Evaluation of a Six-Year Experience at a Single Institution

Background and objective Transurethral resection of the prostate (TURP) has been the undisputed reference standard for elderly men with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE). However, morbidity after TURP remains significant, with increased risks of bleeding and TUR syndrome. In recent years, there has been a gradual increase in the role of laser technology for the treatment of symptomatic BPE. The aim of our study was to evaluate the efficacy and safety of the novel technique Thulim laser enucleation of prostate (ThuLEP) developed for the first time in 2009 by Imkamp et al. in treating symptomatic BPE. Materials and methods Analysis of the data from electronic records, case notes, clinic letters all the patients who had undergone ThuLEP using a 70 W thulium laser (Revolix) for symptomatic outflow obstruction over a 6-year period was done. We looked at the pre-procedure PSA, maximum urinary flow rate (Qmax), Post void residual (PVR) and haemoglobin, comparing it with the postoperative haemoglobin. Results Two-hundred twenty-two patients underwent ThuLEP procedure performed by 2 surgeons. We found a 159 % improvement in Q max, a 61 % improvement in PVR. No mortalities occurred and only 1 patient required post operative blood transfusion. ThuLEP represents a safe, effective surgical option in patients with symptomatic BPH with relatively little complications, producing significant improvements in both Qmax and PVR.

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.

Preliminary study of absorption of irrigation fluid occurs during 1470nm diode laser enucleation of the prostate

Objective To investigate absorption of irrigation fluid occur during 1470 nm diode laser enucleation of the prostate, and evaluate the safety of the operation. Methods We retrospectively analyzed the clinical data about 20 cases of benign prostate hyperplasia (BPH) treated by 1470 nm diode laser enucleation from July 2016 to October 2016.Intraoperative use of isotonic saline contained 1% ethanol as irrigation fluid, breath ethanol concentration of patients was observed, and irrigation fluid absorption was calculated. Results The operation time was 30-160 min, average(56.2±32.3 )min , irrigation fluid volume was 9-48 L, average(17.1±9.6)L, absorptive amount of Irrigation fluid absorption was 2089 mL in 10 cases.There was no significant difference in serum potassium or serum sodium before and after surgery of 20 patients, preoperative haemoglobin was(133.8±14.4)g/L, haemoglobin in postoperative 24 h was(121.2±18.7)g/L. Postoperative hemoglobin was decline (P=0.000) , especially postoperative hemoglobin of patients with irrigation fluid absorption was significantly decline. Three cases of sinus open and two cases prostate capsule perforate occurred during operation. One of them was happened dysphoric and shortness of breath at the end of the operation. Twenty patients were followed up for 3 months, which revealed that 3 patients with urinary incontinence in two months healing and significant reduction in IPSS and improvement in Qmax and PVR (P<0.05). Conclusions Transurethral enucleation of the prostate using 1470 nm diode laser is an effective method. But there is a certain proportion of irrigation fluid absorption, especially for patients with cardiopulmonary insufficiency, intraoperative monitoring has a necessity. Key words: Prostatic Hyperplasia; Lasers, Semiconductor; Perfusion

Подходы к медикаментозному лечению пациентов с высоким риском прогрессирования доброкачественной гиперплазии предстательной железы в зависимости от сопутствующей эректильной дисфункции

To investigate the efficacy and safety of various medical treatment schemes in the management of patients at high risk of progression of benign prostatic hyperplasia (BPH), depending on concomitant erectile dysfunction (ED). The study comprised 247 men with an I-PSS score of 8 or more, a prostate volume of more than 40 cm3, and a prostate specific antigen level of 1.5-4.0 ng/ml. Patients were divided into 2 groups: group 1 included patients without ED (IIEF-5 score >21); patients of group 2 had ED (IIEF-5 score less or equal 21). Within the groups, two subgroups of patients with a maximum flow rate (Qmax) >10 ml/s were identified (subgroup A), and with Qmax less or equal 10 ml/s (subgroup B). Patients of subgroup A of group 1 received a 5-reductase inhibitor, subgroup B of group 1received an 1-adrenoblocker, and 5-reductase inhibitor, subgroup A of group 2 were treated with a 5-reductase inhibitor and a phosphodiesterase type 5 inhibitor (PDE-5), subgroup B of group 2 received an 1-adrenoblocker, 5-reductase inhibitor, and PDE-5 inhibitor. The results were evaluated at 3, 6, and 12 months. All schemes of combination therapy showed a significant improvement in I-PSS, QoL, Qmax and residual urine volume after three months of treatment, while in patients receiving monotherapy with 5-reductase inhibitor improvement occurred at six months after treatment initiation. There were no significant differences in the incidence of side effects between these treatment options. The use of the PDE-5 inhibitor can successfully compensate the negative effect of the 5-reductase inhibitor on male sexual function. The most effective treatment option for BPH patients without ED is a combination of 1-adrenoblocker and 5-reductase inhibitor. In BPH patients with ED, a two- and a three-component combination including a PDE-5 inhibitor provides a significant improvement in both erectile function and lower urinary tract symptoms secondary to BPH. Multicomponent therapy schemes are not accompanied by a significant increase in the incidence of adverse reactions.

MEDICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA AFTER CYSTOLITHOTRIPSY

ABSTRACT Background: Benign prostatic hyperplasia (BPH) is a noncancerous increase of the size of the prostate gland. The two main medication classes for BPH management are alpha blockers and 5α -reductase inhibitors .Urinary bladder stones account for 5% of all urinary stone disease. Lithotripsy with the holmium: YAG laser started with making small perforations on the stone surface. the laser fiber should be moved over the surface of the stone vaporizing the stone rather than fragmenting it till fragments become small enough to pass spontaneously or can be safely retrieved. The aim: This study was conducted to investigate the outcomes of Cystolithotripsy with medical Treatment for Benign Prostatic Hyperplasia as an option for treatment of Patients with Bladder Stone and Benign Prostatic Hyperplasia. Methods: prospective short term cohort study. 44 Patients with urinary bladder stone and benign prostatic hyperplasia BPH who are programmed for endoscopic removal of bladder stone with subsequent medical management of BPH, including alpha-blocker (Silodosin 8mg).from January 2017 – June 2017. All laboratory investigation within normal level no renal Hydronephrosis detected by radiological imaging and no malignancy in urinary bladder. Results: In our study shows significant improvement in IPSS which started 17.89±2.35 preoperative to 8.48±0.84 after six months, also significant improvement in PVR which started 90.62±.13.30 Before operation to become 27.27±14.3 After operation and lastly significant improvement in Q-max which started 11.93±1.64 Before operation to become 16.46±0.77 after six month. Conclusion: Medical treatment of benign prostatic hyperplasia after endoscopic removal of bladder stone is an appropriate option for managing patients with bladder stone and benign prostatic hyperplasia. Lithotripsy with Holmium: YAG laser is an appropriate line in management of bladder stone associated with Benign prostatic hyperplasia. Key words. Holmium YAG laser, cystolithotripsy, Benign prostatic hyperplasia, alpha- blocker.

Comparing the effect of Alpha blocker (Silodosin) and Phosphodiesterase type 5 inhibitor (Tadalafil) in benign prostate hyperplasia patients with lower urinary tract symptoms: a single centre study

Background: Benign prostatic hyperplasia (BPH) is a histologic diagnosis that refers to the proliferation of smooth muscle and epithelial cells within the prostatic transition zone. The aim of this systematic review is to determine the comparative effectiveness and safety of phosphodiesterase 5 inhibitors (PDE5-Is) and alpha blockers used alone or in combination for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Methods: We analyzed 54 patients of BPH with LUTS with baseline IPSS, Qmax and PVR over one-year period. They were randomized equally in three groups i.e. group receiving alpha blocker, group receiving phosphodiesterase 5 inhibitors and group receiving combination of the two drugs. These patients were followed up at the end of 1st month and 3rd month and IPSS, Qmax and PVR was compared.Results: Out of 54, 45 patients completed the study. At the end of the study all the three groups showed significant improvement in IPSS, PVR and Qmax, all p &lt;0.05, but the combination group showed much better improvement in terms of percentage. Two patients on alpha blockers had episode of hypotension.Conclusions:Thus, we summarize that phosphodiesterase 5 inhibitors should be preferred over alpha blockers in patients with LUTS/BPH as it has, firstly, outcome similar to alpha blockers. Secondly, have no documented side effect. Third, can be given in any patient, irrespective of the fact that whether the patient is suffering from erectile dysfunction or not.

MP62-11 HOLMIUM LASER ENUCLEATION VERSUS BIPOLAR RESECTION FOR LARGE PROSTATE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2018MP62-11 HOLMIUM LASER ENUCLEATION VERSUS BIPOLAR RESECTION FOR LARGE PROSTATE Ahmed Yehia, Enmar Habib, Mohammed ElSheemy, Hussein Aly, Samir Morsy, A Hossam, and M Abdelazeem Ahmed YehiaAhmed Yehia More articles by this author , Enmar HabibEnmar Habib More articles by this author , Mohammed ElSheemyMohammed ElSheemy More articles by this author , Hussein AlyHussein Aly More articles by this author , Samir MorsySamir Morsy More articles by this author , A HossamA Hossam More articles by this author , and M AbdelazeemM Abdelazeem More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare safety and efficacy of bipolar resection (BPR) vs holmium laser enucleation (HOLEP) for large prostate. METHODS 141 patients with BPH (larger or equal to 75 gm) indicated for surgical intervention were included in this prospective cohort study. Patients were classified into 2 groups. Group A (71 cases) treated by HOLEP (Versa pulse 100 W; Lumenis; Germany) using 550 micron laser fibers (2 J - 50 Hz for enucleation and 1.5 J - 30 Hz for hemostasis). Enucleation was followed by use of morcellator (Versa cut). Group B (70 cases) was treated by BPR using bipolar resectoscope (Karl Storz) and its generator (AUTOCON® II 400 ESU). Power output was set at 5 for resection and 6 for coagulation. Preoperative criteria, operative and postoperatiove findings were compared between both groups using Mann-Whitney test, Chi-Square test, Student-t test or Fisher-Exact test as appropriate. Preoperative vs postoperative findings were compared in each group using Wilcoxon-signed rank test. RESULTS Perioperative and follow-up findings are presented in Table 1. Adenoma size and patients on anticoagulants were significantly higher in HOLEP group. Hospital stay, catheterization time and hemoglobin loss were significantly better in HOLEP group. Follow up was done for 6 months in all patients. There was significant postoperative improvement in IPSS score and Qmax in each group. Qmax improvement was significantly better in Group A. There was no significant difference in postoperative complications between both groups but blood transfusion was clinically higher in group B (and near significance, p = 0.058). CONCLUSIONS HOLEP and bipolar resection are safe and effective for treatment of large prostate. Although patients on anticoagulants or with larger adenoma sizes were significantly present in a higher rate in HOLEP group, HOLEP provided a better voiding pattern, hemoglobin loss, hospital stay and catheterization time. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e836 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ahmed Yehia More articles by this author Enmar Habib More articles by this author Mohammed ElSheemy More articles by this author Hussein Aly More articles by this author Samir Morsy More articles by this author A Hossam More articles by this author M Abdelazeem More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD64-11 THULIUM:YAG LASER VAPORESECTION VERSUS BIPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA: COMPARATIVE STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2018PD64-11 THULIUM:YAG LASER VAPORESECTION VERSUS BIPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA: COMPARATIVE STUDY Mohamed Rokba, Mohamed Selim, Mohamed Abdallh, Alaa Elmahdy, and Mohamed Omr Mohamed RokbaMohamed Rokba More articles by this author , Mohamed SelimMohamed Selim More articles by this author , Mohamed AbdallhMohamed Abdallh More articles by this author , Alaa ElmahdyAlaa Elmahdy More articles by this author , and Mohamed OmrMohamed Omr More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2983AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare the safety and effectiveness of Thulium:YAG laser vaporesection (ThuVaRP) versus bipolar transurethral resection of the prostate (B-TURP) for the treatment of patients with symptomatizing large prostates ( > 60 gm); in terms of surgical efficacy and perioperative morbidity. METHODS From January 2016 to October 2017, this study was conducted in 177 patients diagnosed with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH).The perioperative parameters, therapeutic effects and complications were compared between the two groups before and 3 months after surgery. Preoperative evaluation included detailed medical history, thorough clinical examination, International Prostate Symptom Score (IPSS), digital rectal examination (DRE), prostate volume, post-voiding residual urinary volume (PVR), PSA level and maximum flow rate (Qmax). Intraoperative evaluation included operative time, resected tissue weights, irrigating fluid volume, blood loss, and intraoperative complications. Postoperative evaluation included the mean hemoglobin and hematocrit differences, catheterization period, hospital stay, postoperative complications and follow up IPSS, PVR and Qmax. RESULTS A total of 177 patients were randomly divided into two groups and managed by ThuVaRP (59, group 1) or B-TURP (118, group 2) with mean age ± SD: ThuVaRP 66 ± 7 and B-TURP 69 ± 7 with no significant difference. There was no significant statistical difference in preoperative variables such as medical condition, IPSS, prostate volume, PVR, PSA and Qmax between the two groups. There were significant statistical differences in the following parameters between the two groups (ThuVaRP vs B-TURP [mean ± SD]): calculated intraoperative blood loss 91 ± 35 vs 260 ± 143 ml (P=0.0001), operative time 117 ± 24 vs 101 ± 29 min (P=0.017), catheterization time 2.7 ± 0.5 vs 3.3 ± 0.8 days (P=0.001) and hospital stay 2.5 ± 0.6 vs 3.2 ± 0.4 days (P=0.0001) respectively. Postoperative hemoglobin, hematocrit drops, hematuria and irrigation time were less in ThuVaRP but with no significant statistical differences. In both groups, there was no need for blood transfusion. Also, TUR syndrome did not occur in any patient. All patients in both groups showed marked improvement in IPSS, Qmax, and PVR after 3 months postoperative. CONCLUSIONS ThuVaRP represents a valuable option for the management of BPH with satisfactory outcomes in terms of safety, blood loss and acceptable complications, but with longer operative time in comparison to B-TURP. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1223-e1224 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mohamed Rokba More articles by this author Mohamed Selim More articles by this author Mohamed Abdallh More articles by this author Alaa Elmahdy More articles by this author Mohamed Omr More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP04-06 POLYMORPHISMS OF NOS3 G894T ARE ASSOCIATED WITH RESPONSIVENESS TO DOXAZOSIN IN BPH/LUTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation1 Apr 2018MP04-06 POLYMORPHISMS OF NOS3 G894T ARE ASSOCIATED WITH RESPONSIVENESS TO DOXAZOSIN IN BPH/LUTS Yung-Chin Lee, Chia-Chu Liu, and Shu-Pin Huang Huang Yung-Chin LeeYung-Chin Lee More articles by this author , Chia-Chu LiuChia-Chu Liu More articles by this author , and Shu-Pin Huang HuangShu-Pin Huang Huang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.156AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nitric oxide (NO) has recently gained increasing recognition as an important neurotransmitter of functions in the lower urinary tract. This prospective study firstly investigated the association of eNOS G894T gene polymorphism with the responsiveness to a1-blocker in men with benign prostatic hyperplasia related lower urinary tract symptoms (BPH/LUTS). METHODS 136 patients with BPH/LUTS were recruited from urology outpatient clinics in a university hospital. Oral therapy with doxazosin- GITS 4 mg once-daily was given for 12 weeks. The drug efficacy was assessed by the changes from baseline in the total International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax) and post-void residual urine volume (PVR) at 12 weeks of treatment. The responders to doxazosin GITS were defined as those who had a total IPSS decrease of more than 4 points from baseline. The eNOS G894T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS Patients had statistically significant improvements in total IPSS, QoL and Qmax (P<0.01) for a 12-week period of treatment. Using multiple logistic regression analysis adjusted for age and IPSS, our results showed that eNOS 894T allele carrier was an independent factor for drug non-responder (p=0.03, OR=4.19). Besides, the decreased responder rate (p=0.01), as well as the lower improvements of IPSS (p=0.02) and Qmax (p=0.03), were significantly associated with an increment of the T allele number. CONCLUSIONS The presence of eNOS 894T allele had a significantly negative impact on responsiveness to a1-blocker in BPH/LUTS treatment, suggesting that eNOS G894T gene polymorphisms may play an implication as a genetic susceptibility factor for drug efficacy in men with BPH/LUTS. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e34 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Yung-Chin Lee More articles by this author Chia-Chu Liu More articles by this author Shu-Pin Huang Huang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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 ...

MP62-12 THE 3 YEARS' TEST OF TIME IN LARGE PROSTATE SURGERY – BIPOLAR PLASMA VAPORIZATION, RESECTION AND ENUCLEATION VERSUS OPEN PROSTATECTOMY IN A PROSPECTIVE, RANDOMIZED-CONTROLLED CLINICAL SETTING

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2018MP62-12 THE 3 YEARS' TEST OF TIME IN LARGE PROSTATE SURGERY – BIPOLAR PLASMA VAPORIZATION, RESECTION AND ENUCLEATION VERSUS OPEN PROSTATECTOMY IN A PROSPECTIVE, RANDOMIZED-CONTROLLED CLINICAL SETTING Bogdan Geavlete, Cosmin Ene, Catalin Bulai, Georgiana Balan, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete More articles by this author , Cosmin EneCosmin Ene More articles by this author , Catalin BulaiCatalin Bulai More articles by this author , Georgiana BalanGeorgiana Balan More articles by this author , and Petrisor GeavletePetrisor Geavlete More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The study compared the transurethral resection in saline (TURis), transurethral vaporization in saline (TUVis), bipolar plasma enucleation of the prostate (BPEP), and open prostatectomy (OP) in a single center, prospective, randomized-controlled clinical setting exclusively involving severe lower urinary tract symptoms' large prostate patients. METHODS During a 4½ year enrollment period, 320 cases of prostate volume over 80 mL, maximum flow rate (Qmax) below 10 mL/second, International Prostate Symptom Score (IPSS) over 19 or urinary retention were included in the trial and equally randomized in the four study arms. Patients were assessed preoperatively, at the 1-, 3-, 6- and 12-month follow-up checkups and every 6 months up to 3 years after surgery using the IPSS, quality of life (QoL) score, Qmax, postvoiding residual urinary volume (PVR) and prostate-specific antigen (PSA). RESULTS Similar preoperative parameters were established in the four series. OP and BPEP were characterized by resembling operating times, while TURis and TUVis displayed prolonged surgical durations. TURis emphasized a substantially decreased mean resected tissue weight. TUVis showed the lowest mean hemoglobin level drop, followed by TURis and BPEP (equivalent results) and finally OP (highest bleeding). OP described the longest mean catheterization period and hospital stay, followed by TURis and afterwards by TUVis and BPEP (similar data). During the 3 years' follow-up period, statistically equivalent IPSS, QoL, Qmax and PVR outcomes were established for OP, BPEP, and TURis. TUVis displayed significantly smaller long term Qmax improvements but otherwise similar functional features. Significantly lower mean PSA levels were determined secondary to OP and BPEP when compared to bipolar resection and subsequently to vaporization up to the 36 months' postoperative assessment. CONCLUSIONS OP and BPEP emphasized the highest surgical efficiency (with prolonged postoperative recovery for open surgery), while TUVis displayed the lowest hemorrhagic risks. On the medium and long term, generally resembling functional outcomes were determined for the 4 techniques, with significantly decreased mean PSA values secondary to OP and BPEP. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e836-e837 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Bogdan Geavlete More articles by this author Cosmin Ene More articles by this author Catalin Bulai More articles by this author Georgiana Balan More articles by this author Petrisor Geavlete More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Alpha-1 adrenergic antagonists, 5-alpha reductase inhibitors, phosphodiesterase type 5 inhibitors, and phytotherapic compounds in men with lower urinary tract symptoms suggestive of benign prostatic obstruction: A systematic review and meta-analysis of urodynamic studies.

To perform a systematic review and meta-analysis of studies evaluating the urodynamic outcomes of alpha-1 adrenergic antagonists (ABs), 5-alpha reductase inhibitors (5-ARIs), phosphodiesterase type 5 inhibitors (PDE5is), and phytotherapic compounds in patients with lower urinary tract symptoms related to benign prostatic obstruction (LUTS/BPO). A systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in June 2017. We included full papers that met the following criteria: original research; English language; human studies; enrolling LUTS/BPO patients; reporting maximum urinary flow (Qmax), and detrusor pressure at maximum urinary flow (PdetQmax). The primary endpoint was variation in bladder outlet obstruction index (BOOI). Secondary endpoints were variations in Qmax and PdetQmax. Twenty-three studies involving 1044 patients were included in the final analysis. Eighteen, three, two, and one study evaluated the urodynamic outcomes of ABs, 5-ARIs, PDE5is, and phytotherapic compounds, respectively. BOOI, PdetQmax, and Qmax improved in a statistically significant manner in patients receiving ABs and in those receiving 5-ARIs. The overall pooled data showed a mean BOOI change of -15.40 (P < 0.00001) and of -10.55 (P = 0,004) for ABs and 5-ARIs, respectively. Mean PdetQmax and Qmax changes were:12.30 cm H2 O (P < 0.00001) and +2.27 ml/s (P < 0.00001) for ABs and -9.63 cm H2 O (P = 0.05), and +1.18 mL/s (P = 0.04) for 5-ARIs. PDE5is and phytotherapic compounds had no significant effects on urodynamic parameters. ABs and 5-ARIs efficiently improve BOOI in men with LUTS/BPO. Both treatments are associated with a clinically significant decrease in PdetQmax but only marginal improvements in Qmax.

339 Testosterone Replacement Therapy Contributes to Improving Lower Urinary Tract Symptoms in Men with Testosterone Deficiency Syndrome

There has long been a concern among clinicians that testosterone replacement therapy (TRT) might have an adverse effect on lower urinary tract symptoms (LUTS). We investigated the effect of TRT on LUTS and prostate-specific antigen (PSA) levels in patients with testosterone deficiency syndrome (TDS). Fifty two patients with TDS without BPH medication received testosterone (injection with 1000mg testosterone undecanoate) every 3 months. We compared digital rectal examination, serum testosterone levels, PSA levels, International Prostate Symptoms Scores (IPSS), maximal flow rates (Qmax) and post-voiding residual volumes (PVR) at baseline and 12 months after treatment. Mean follow-up periods were 12.6 months. TRT significantly increased serum testosterone levels (p<0.05). IPSS decreased significantly and Qmax increased significantly over the study period (p<0.05). PSA levels and PVR showed no significant changes (p>0.05). No patients experienced urinary retention, BPH-related surgery, or admission for urinary tract infection. A considerable improvement in serum testosterone levels, IPSS and Qmax were found but PSA levels and PVR were not changed significantly after mean 12.6 months follow up periods. TRT improved LUTS in TDS patients with mild BPH.

Is There a Minimally Invasive Day Case Operation to Treat LUTS Secondary to BPH and Avoid Sexual Dysfunction? UroLift A Case Report

A 75 year old Caucasian male with a prolonged history of lower urinary tract symptoms and sexual dysfunction was referred to the urology department. Assessment revealed a diagnosis of benign prostatic hypertrophy (BPH) and the patient was reassessed by flexible cystoscopy revealing a large occlusive 80cc prostate. Baseline symptoms of BPH were measured using the International Prostate Symptom Score (IPSS), urinary function was quantified by measuring post void residual (PVR) volume and QMAX flow rates were also recorded. The patient underwent the Urolift procedure and urological parameters were reassessed at 4 months post-operatively. There was an improvement in the patients IPSS by 14 points (IPSS Before =22, at 4 months =8), with a reduction in quality of life by 3 points (QoL before = 5, at 4 months =2).PVR volume decreased by almost a third (29.4 %) (Before = 390ml, at 4 months = 275 ml) and QMAX improved by 8 ml/s (Before =14ml/s, at 4 months= 22ml/s). The patient reported a slight improvement in sexual function (IIEF-5 Before = 14, at 4 months = 15) and was very satisfied with the result. The improvement in IPSS, PVR volume and QMAX show Urolift is an appropriate treatment for symptomatic BPH.

Лазерная энуклеация гиперплазии простаты (HOLEP и THULEP): сравнительный анализ эффективности при лечении рецидивов гиперплазии простаты

The estimated recurrence rate of benign prostatic hyperplasia (BPH) after transurethral resection of the prostate is about 5 to 15%. Laser enucleation of the prostate results in a much lower recurrence rate (not exceeding 1-1.5%). At the same time, laser enucleation of the prostate is still not widely used for recurrent prostatic hyperplasia since it believed to be technically difficult in cases. To describe the distinctive features of thulium and holmium laser enucleations of the prostate in the management of recurrent BPH and show that the technical difficulties are not an obstacle to the wide application of this technique. This was a retrospective study comprising 676 patients aged 54 to 87 years with clinically pronounced infravesical obstruction due to prostatic hyperplasia (IPSS>20, Qmax<10). All patients were divided into four groups. Groups 1 (n=489) and 3 (n=153) underwent holmium (HoLEP) and thulium (ThuLEP) laser enucleations of the prostate, respectively. Groups 2 (n=23) and 4 (n=11) included patients with BPH recurrence after HoLEP (group 2) and ThuLEP (group 4). All patients underwent diagnostic evaluation at baseline and at 6 months after surgery. The mean ThuLEP operating time was shorter than that of HoLEP (p=0.02). The mean duration of repeat and primary ThuLEP and HoLEP did not differ statistically significantly (p>0.05). There was no difference in the length of hospitalization and catheterization between the four groups (p>0.05). At six months after surgery, a statistically significant improvement in I-PSS, Qmax, QoL, and RUV was observed in all groups compared with preoperative values (p>0.05)). We found that the technical difficulties of the re-operation, such as the difficult separation of adenomatous tissue from the prostate capsule, the multinodular nature of the adenoma, increased tissue density are easy to overcome and do not confer a significant complexity. In turn, better completeness of resection, low complication and recurrence rates and the possibility of surgery, even in elderly patients with multiple comorbidities - these features allow us to conclude that laser enucleation of the prostate is not only an effective treatment for infravesical obstruction due to benign prostatic hyperplasia, but is also a method of choice in the treatment of patients with recurrent BPH.

AB058. Therapeutic efficacy of trans-rectal triple physiotherapy combined with pharmacotherapy in comparison with pharmacotherapy alone in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

BackgroundTo evaluate the therapeutic effect of the combination of trans-rectal triple physiotherapy plus pharmacotherapy in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and to compare this combinatorial effect with the effect of pharmacotherapy alone retrospectively.MethodsA total of 73 patients with CP/CPPS were divided into two groups: the first group was treated with drugs, and the second group received a combination of the same drugs and trans-rectal triple physiotherapy. All the patients were evaluated by the NIH-CPSI, HADS, PVR and Qmax, before and after therapy.ResultsAt the termination of therapy, significant improvements in NIH-CPSI total and subscale scores, PRV and HADS were observed in both groups, with better outcomes with the second group. Patients in the first group did not exhibit an improvement in Qmax, while the second group showed a significant increase.ConclusionsThe combination of trans-rectal triple physiotherapy and pharmacotherapy may be an effective therapeutic strategy for patients with CP/CPPS. Thus, there is a need for more prospective, randomized, controlled studies to confirm our results.