Improvement In Qmax Research Articles

Update on Prostatic Artery Embolization

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

Transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a feasibility study. Results at 6 and 12 months from a retrospective multi-centric study.

To investigate the effectiveness and safety of SoracteLite™-transperineal percutaneous laser ablation (TPLA) in the treatment of patients with symptomatic benign prostatic hyperplasia (BPH) at 6 and 12 months follow-up. Patients with urinary symptoms secondary to BPH underwent TPLA under local anesthesia in four centers. Under US guidance, up to four 21G applicators were inserted in the prostatic tissue. Each treatment was performed with diode laser operating at 1064 nm changing the illumination time according to prostate size. The primary end-points of this study were change in IPSS, PVR, Qmax, QoL, and prostatic volume at 6 an 12 months from SoracteLiteTM TPLA treatment. Secondary end-point was the assessment of complications. Analysis was performed on data 160 patients (mean age 69.8 ± 9.6 years) with at least 6 months follow and of 83 patients (mean age 67.9 ± 8.7 years) with at least 12 months follow-up. At 6 months, IPSS improved from 22.5 ± 5.1 to 7.7 ± 3.3 (P < 0.001), PVR from 89.5 ± 84.6 to 27.2 ± 44.5 ml (P < 0.001), Qmax from 8.0 ± 3.8 to 14.3 ± 3.9 ml/s (P < 0.001), QoL from 4.5 ± 1.1 to 1.8 ± 1.0 (P < 0.001), volume from 75.0 ± 32.4 to 60.3 ± 24.5 ml (P < 0.001). At 12 months, IPSS improved from 22.5 ± 4.5 to 7.0 ± 2.9 (P < 0.001), PVR from 71.7 ± 93.9 to 17.8 ± 51.0 ml (P < 0.001), Qmax from 8.6 ± 5.2 to 15.0 ± 4.0 ml/s (P < 0.001), QoL from 4.2 ± 0.6 to 1.6 ± 0.9 (P < 0.001), volume from 87.9 ± 31.6 to 58.8 ± 22.9 ml (P < 0.001). 7/160 (4.3%) grade I and 1/160 (0.6%) grade III complication occurred. SoracteLite™ TPLA allows significant improvement of IPSS, Qol, Qmax, PVR, and reduction of prostatic volume at 6 and 12 months.

The relation between baseline PSA and symptomatic progression in Egyptian BPH patients receiving tamsulosin monotherapy: an exploratory multicentric prospective study

BackgroundTo examine the relation of baseline serum prostatic-specific antigen (PSA) to symptomatic changes in men with benign prostatic hyperplasia (BPH) receiving tamsulosin through its relation to changes in international prostate symptom score (IPSS) and maximum urinary flow rate (Qmax) and the occurrence of acute urine retention (AUR).ResultsWe conducted a multicentric prospective cohort study. BPH patients were included from May 2015 till January 2018. We collected IPSS recording, prostate volume (PV) Qmax. After 2 years of medical treatment with tamsulosin 0.4 mg once daily, full initial evaluation was repeated for all patients. Improvement in IPSS and Qmax was recorded and compared to initial PSA levels. Follow-up was aborted for patients who developed AUR. Moreover, the data of AUR patients were recorded and compared to initial PSA levels. The study included 437 Egyptian patients, and 414 patients (94.7%) had symptomatic improvement through the 2 years of follow-up on tamsulosin monotherapy. In total, 23 patients (5.3%) developed AUR during follow-up. There was a significant association between AUR and higher baseline PSA level (p < 0.001). On the other hand, statistical analysis showed that there was no significant correlation between baseline serum PSA and the improvement in IPSS (r = − 0.02, p = 0.684) or Qmax (r = − 0.06, p = 0.267). The multivariate analysis showed that baseline PSA and PV were independent predictors for AUR (p < 0.001 for both).ConclusionsThere was a significant relation between baseline PSA and incidence of AUR. However, there was no significant relationship between the serum PSA level and symptoms improvement in BPH.

Efficacy and outcome of holmium laser enucleation of prostate in patients with urinary retention due to advanced prostate cancer

To evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) for treating urinary retention in patients with advanced prostate cancer. Thirty-eight cases of advanced prostate cancer with urinary retention were enrolled in this retrospective study. All the 38 patients were treated with CAB as a basis. Among them, 21 cases chose HoLEP additionally (HoLEP group). Seventeen cases stuck to CAB alone (CAB group). Serum PSA level, International Prostate Symptom Score (IPSS), quality of life score (QoLs), maximal flow rate (Qmax), and post-void residual volume (PVR) at 3, 6, 12, and 18 months after treatment were comparatively analyzed. The perioperative and postoperative parameters of HoLEP were assessed. Both groups demonstrated significant improvement in IPSS, QoLs, Qmax, and PVR during follow-up. But these parameters of HoLEP group improved more rapidly, significantly, and durably than CAB group. No serious complications were observed during and after HoLEP. PSA level of patients in both groups declined dramatically after surgery. But PSA in HoLEP group showed more dramatic and continuous drop. Besides, 1 of 21 patients in HoLEP group transferred into castration-resistant prostate cancer (CRPC) at 18th month of follow-up. While in CAB group, 5 of 17 patients developed into CRPC at 12th month of follow-up (P = 0.02 < 0.05). HoLEP was minimally invasive, safe, and effective, and could serve as a palliative approach to rapidly restore the patients' urine and play a cytoreductive role in advanced PCa to improve the oncological prognosis.

Predictors Of Postoperative Lower Urinary Tract Symptoms Improvements In Patient With Small-Volume Prostate And Bladder Outlet Obstruction.

ObjectiveTo explore the factors associated with improvement of lower urinary tract symptoms (LUTS) after transurethral plasmakinetic enucleation of the prostate (PKEP) and transurethral resection of the prostate (TURP) in patients with a small-volume prostate and bladder outlet obstruction (BOO).MethodsThe clinicopathologic data of 257 patients with BOO and a small-volume prostate from January 2013 to January 2018 were retrospectively collected preoperatively, 3 months postoperatively, and 12 months postoperatively. Patients were divided into postoperative success and failure groups based on the IPSS, IPSS-v, and IPSS-s. The relationship between each parameter and the improvement of postoperative LUTS was analyzed. Subgroup analysis was performed to compare the differences between the TURP and PKEP groups.ResultsAmong patients followed up for 3 months postoperatively, multivariate analysis demonstrated that IPP, PUA, and post-PCB were significant predictors of postoperative IPSS improvement; TZI, IPP, and PUA were significant predictors of postoperative IPSS-v improvement; post-PCB and the surgical procedure were significant predictors of IPSS-s improvement; and IPP and PUA were significant predictors of postoperative Qmax improvement. Among patients followed up for 12 months postoperatively, multivariate analysis revealed that IPP, PUA, and post-PCB were significant predictors of postoperative IPSS improvement; PUA was a significant predictor of postoperative IPSS-v improvement; post-PCB was a significant predictor of IPSS-s improvement; and IPP and PUA were significant predictors of postoperative Qmax improvement. The post-PCB was significantly lower in the PKEP than the TURP group and the prostatic calculi removal rate was significantly higher in the PKEP than the TURP group.ConclusionPatients with a greater preoperative IPP and PUA and smaller post-PCB showed greater improvement of postoperative LUTS. PKEP might help to remove calculi from between the transitional and peripheral zones of prostate. Compared with conventional TURP, PKEP may improve the early postoperative storage symptoms of LUTS in patients with a small-volume prostate and BOO.

Extraperitoneal approach robotic-assisted urethra-sparing simple prostatectomy for large-gland benign prostatic hyperplasia: initial experience

Objective To report our initial experience with extraperitoneal approach Robotic-Assisted Urethra-sparing simple prostatectomy(US-RASP)on large-gland (>100 ml) benign prostatic hyperplasia(BPH). Methods From August 2015 to April 2018, 32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed. The patient's median age was 73 (range 59-80) years, and median BMI was 24.9 (19.3-34.8 ) kg/m2, The estimated prostate volume(V), postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0(119.0-223.1)ml, 145(0-280)ml and 13.7(5.2-27.3)ng/ml, respectively. Four of 32 patients underwent preoperative urinary catheterization. The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire, maximum flow rate (Qmax), maximum voided volume(Vmax), quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33), 5.9 (2.5-7.8) ml/s, 110 (80-210)ml, 5(3-6), and 27(26-29), respectively. Functional parameters including IPSS, QOL, Qmax, Vmax, PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up. Results The US-RASP was completed in all 32 patients and no open conversion. Median operation time was 180 (115-240) min, the estimated blood loss was 300(range 100 to 400)ml, Hemoglobin loss was 17(5-38)g/L. The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days. Median specimen weight on pathological examination was 107.7 (79.8-147.4)g with median of 64.2% (49.4%-86.2%) resection ratio. At 3-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 6(4-18), 17.3 (13.8-21.1)ml/s, 167(140-310)ml, 50(0-61)ml, 1(0-3) , respectively. At 12-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 4(1-9), 20.1 (17.9-24.1)ml/s, 205(176-305)ml, 24(0-35)ml and 1(0-2) , respectively. All patients showed great improvement of IPSS, Qmax, Vmax, PV and QOL after median 17 (12-44) months follow-up compared with preoperative parameters (P<0.05). Erectile function was not impaired in 17 patients who have normal erectile function pre-operatively and 14 cases (82.4%) preserved satisfactory anterograde ejaculation. No significant complication occurred during the procedure. No patient developed permanent urinary incontinence. Conclusions US-RASP is a safe and effective treatment option for selected patients with large-gland obstructive BPH(>100 ml). Our data showed significant improvement in voiding function and maintaining satisfactory anterograde ejaculation following urethral-sparing technique. It may be a new alternative method in the future for large-volume symptomatic BPH. Key words: Prostatic hyperplasia; Prostatectomy; Robotic-assisted surgery; Extraperitoneal approach; Urethra-sparing

Meta-Analysis of Efficacy and Safety of Tadalafil Plus Tamsulosin Compared with Tadalafil Alone in Treating Men with Benign Prostatic Hyperplasia and Erectile Dysfunction.

This meta-analysis was performed to evaluate the efficacy and safety of tadalafil plus tamsulosin compared with tadalafil alone in treating men with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) after 12 weeks’ treatment. Systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched to collect randomized controlled trials. The references of related articles were also searched. Four articles including 621 patients were involved in the analysis. The study identified that combination-therapy had significant improvements in total international prostate symptom score (IPSS), quality of life (QoL) and maximum urine flow rate (Qmax) compared with monotherapy, and there were no obvious significance in respects of post-void residual volume, international index of erectile function and IPSS storage. The difference of total IPSS was mainly reflected in the change of IPSS voiding. For safety, combination-therapy had a higher incidence rate of any adverse events (AEs) and discontinuation due to AEs than monotherapy with the exception of pain. In conclusion, the combination of tadalafil and tamsulosin provided a better improvement of IPSS voiding, QoL and Qmax compared with tadalafil alone in treating men with BPH and ED, and the former therapy appeared to show a higher incidence of AEs.

Modified transurethral resection of the prostate for the management of BPH-related refractory lower urinary tract symptoms in patients with a history of pelvic fracture urethral injury reconstruction.

To evaluate the impact of a modified transurethral resection of prostate (mTURP) in patients with a history of pelvic fracture urethral injury (PFUI) status post-urethroplasty, and subsequent lower urinary tract symptoms (LUTS) refractory to medical therapy caused by benign prostatic hyperplasia (BPH). Five patients were identified with a history of PFUI and a successful reconstruction of the urethra, who developed severe LUTS. After maximal medical therapy failed, these patients underwent a mTURP. Their continence status and voiding parameters were recorded before and after surgery. Significant improvements in both post-void residual (172 ± 137.36mL vs. 26.6 ± 24.44mL), p = 0.026, and International Prostatic Symptom Score (23.6 ± 4.82 vs. 7.6 ± 4.30), p = 0.002 were observed in the study. Although maximum flow rate was not statistically significant, there was an overall improvement in Qmax in all patients (8.92 ± 3.71 vs. 16.78 ± 6.44mL/sec). Furthermore, all patients remained continent after this modified intervention. Our modified TURP provides an adjunctive option in the management of severe LUTS secondary to BPH in patients with a history of PFUI urethroplasty who are refractory to medical management. In our experience, the patients experienced a lasting response with no incontinence.

En bloc greenlight laser enucleation of prostate (GreenLEP): about the first hundred cases.

To report the functional outcomes, perioperative morbidity and surgical learning curve key points using "en bloc" greenlight enucleation of prostate (EB-GreenLEP) for patients with refractory lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Between December, 2015 and May, 2018, all consecutive patients with refractory LUTS due to BPH in our institution were included and underwent EB-GreenLEP by a single surgeon. Perioperative data, complications and functional outcomes at 1-, 6- and 12-month follow-ups were collected and retrospectively analyzed. One hundred patients were included whose median age was 69years. The median prostate volume (PV) was 84mL and median enucleated PV was 45.5mL. Mean irrigation, catheterization and hospitalization times were 1.3, 1.4 and 1.6days, respectively. Average follow-up was 9.3months. A single high-grade Clavien-Dindo complication occurred. No urinary retention was reported. Two conversions to conventional resection of the prostate were noted. Three patients had postoperative urinary incontinence at 6months, only one at 1year (1%). At 1, 6 and 12months, there was a significant improvement in IPSS score, QoL and Qmax. Enucleation and energy efficiency ratios were shorter after the 30th procedure. We demonstrated a linear correlation between enucleation time and PV (r = 0.53, p < 0.0001). Our study shows that the mid-term functional results of EB-GreenLEP are comparable to other laser sources for the endoscopic enucleation of the prostate but with a shorter learning curve. We showed that, with (a) low rates of complications and a short hospital stay, EB-GreenLEP can manage medium-size glands (60-90mL).

Urodynamic effects of elongated needle on patients with urinary retention after spinal cord injury

To explore the clinical significance of elongated needle in the treatment of urinary retention after spinal cord injury. From January 2016 to June 2018, 60 patients with urinary retention after spinal cord injury were divided into elongated needle acupuncture group and needle acupuncture group, 30 cases in each group. The Shuidao(ST28) and Zhibian(BL54) were selected as the treatment of acupoints. In the elongated needle group, there were 23 males and 7 females, with a mean age of(52±9) years old. The patients in this group were treated on both sides, and the electro-acupuncture apparatus was used for 30 minutes at frequencies of 3 Hz for 30 minutes. In needle group, there were 24 males and 6 females, with a mean age of (56±10) years old. After treatment, the needles were retained for 30 minutes. The treatment frequencies of both groups were once every other day and passed for 2 months. After 2 months of treatment, the clinical significances of the treatment of the disease were explored by analyzing the time between the two groups of patients to reach the equilibrium bladder, diary urinary diary, urodynamics and urinary tract infection between the two groups. (1)Time to reach the equilibrium bladder:(39.5±1.2) days in elongated needle group and (46.5±2.1) days in needle group; the time to reach the equilibrium bladder in the two groups was significantly different(P<0.05). (2)Comparison of urination diary between the two groups:the daily number of catheterization, the amount of each catheterization, the number of daily urination, and the amount of urine per urination after treatment were better than those before treatment by intra-group comparison(P<0.05); the number of daily catheterization, the amount of daily catheterization, the number of daily urination, and the amount of urine output per patient in elongated needle group were better than those in needle group by comparison between two groups(P<0.05). (3)Comparison of improvement of urinary tract infection between the two groups:the urinary tract infection were better than that before treatmant in each group by intra-group comparison; the improvement rate of urinary tract infection in awn needle group (1/3.3%) was higher than that in needle group(5/16.7%), with significantly differences. (4)Comparison of urodynamic index between two groups:by intra-group comparison, the VH2O, Pves, Pdet, Qave, Qmax, and BC of the two groups were better than those before treatment(P<0.05); By comparison between two groups, the improvement of VH2O, Pves, Pdet, Qave, Qmax and BC were better than those of the needle group (all P<0.05). The elongated needle is better than conventional needle in improving urinary retention, urinary tract infection and urodynamic index in patients with urinary retention after spinal cord injury. It has positive significance in improving patients' quality of life and is worth applying to clinical.

What's New in Rezum: a Transurethral Water Vapour Therapy for BPH.

Rezum is a new minimally invasive treatment for benign prostate enlargement using thermal transurethral water vapour therapy. We review the evidence with advantages and disadvantages of this technique. There are five studies reported including a randomised control trial looking at the outcomes of Rezum. The outcomes show an IPSS reduction by 45-60%, QoL improvement with a score reduction of 37-59%, the Qmax improvement by 44-72% and the PVR reduction by 20-38%. Convective water vapour therapy using the Rezum system has been shown to have successful outcomes in the treatment of LUTS resulting from BPH. The reported complications are infrequent and often minor, and it seems to be relatively cost-effective.

Bipolar Plasma Enucleation of the Prostate: 5 Years Outcomes.

Background: Aim of our study is to assess outcomes and safety of button bipola transurethral enucleation of the prostate (B-TUEP) in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE) in a single-center cohort study. Materials and Methods: All patients with LUTS caused by BPE undergoing button B-TUEP between May 2012 and December 2013 were prospectively enrolled in our study. Data on clinical history, physical examination, urinary symptoms, erectile function, uroflowmetry, and prostate volume were collected at 0, 1, 3, 6, 12, 24, 36, 48, and 60 months. Early and long-term complications were recorded. Results: Overall 50 patients were enrolled at baseline. Nine patients were excluded during the 5 years. All patients completed the procedure without severe complications. In terms of outcomes, improvement in International Prostate Symptom Score (IPSS) were sustained for all 5 years and mean difference from baseline at 5 years was 17 points. As well, improvements in Qmax (maximum urinary flow rate) were sustained for all 5 years and mean improvement at 5 years was 16 mL/second. Erectile function was slightly improved after surgery and maintained for the following 5 years. Conclusions: Our single-center study suggests that B-TUEP may have excellent outcomes at 5 years with no recurrence. Further multicentre studies should confirm our results.

Efficacy of bipolar transurethral resection of the prostate using TURIS: our short term experience

Background: Objective of the study was to report our short term experience regarding efficacy of bipolar transurethral resection of prostate using TURIS (transurethral resection in saline) system.Methods: Between May 2016 to April 2017 49 consecutive patients underwent bipolar transurethral resection of prostate (B-TURP) at our institute. All patients were evaluated preoperatively by physical examination, ultrasonography and laboratory studies, including measurement of hemoglobin, serum sodium, and prostate specific antigen levels. Patients were assessed postoperatively at three, six and 18 months.Results: The mean age of the patients was 64.83±7.47 years and mean preoperative prostate volume was 64.73±13.59 ml. The mean preoperative hemoglobin was 13.32±0.9 g/l and mean postoperative hemoglobin was 12.09±1.11 g/l. The mean resection time was 57.02±14.37 minutes and mean resected specimen weight was 41.69±12.15 gm. The mean preoperative maximum urinary flow rate (Qmax) was 8.6±1.17 ml/s and mean Qmax at three, six and 18 months follow up was 18.85±2.15, 19.43±1.49 and 18.98±1.6 ml/s respectively. The mean preoperative international prostate symptom score (IPSS) was 26.32±2.69 and mean IPSS at three, six and 18 months follow up was 6.68±1.36, 6.47±0.79 and 6.30±0.9 respectively. Only one patient developed urethral stricture during follow up.Conclusions: The B-TURP is efficacious and results in significant improvement in IPSS and Qmax. The urethral stricture rate after B-TURP is not different from monopolar TURP.

Modified and Simple Single-Lobe (En Bloc) Technique for Holmium Laser Enucleation of Prostate: Our Experience with Short-Term Results

Aims and Objectives: Holmium laser enucleation of prostate (HoLEP) is one of the important modalities in surgical treatment for obstructive benign prostatic hyperplasia (BPH). Classically it was described as three-lobe technique by Peter Gilling et al.1 One of its significant drawbacks is steep learning curve. We hereby describe a single-lobe technique simplified in four easy steps for enucleation of adenoma. Methods and Patients: Forty patients were included in our study of single-lobe technique for HoLEP between December 2014 and July 2016. All procedures were done by a single surgeon (A.D.B.) who had vast experience of >2000 cases. Average volume of prostate in our study was 79.82 cc (35–195 cc). All patients were evaluated preoperatively by International Prostate Symptom Score (IPSS), uroflowmetry, sonography of prostate and urinary tract for prostate volume and postvoid residual volume estimation, prostate-specific antigen and quality of life score. Postprocedure follow-up was done at 1 month, 3 months, 6 months, and 1 year. Procedure was done by 550 µm quartz fiber, 100 W holmium-YAG laser (Lumenis) at the settings of 2 J × 40 Hz frequency and 26 F Karl Storz continuous irrigation resectoscope set. Morcellation of enucleated adenoma was done by Wolf morcellator. Procedure was divided into four steps: (1) apical lobe enucleation around verumontanum, (2) incision at 12 o'clock and defining anterior capsule, (3) lateral lobe enucleation, and (4) peeling off adenoma from bladder neck and “en bloc” enucleation. Results: Mean enucleation time for the prostate was 30.88 minutes (10–80 minutes) and estimated blood loss during the procedure was 49 mL (16–350 mL). Mean catheterization time was 45.25 hours and mean hospital stay was 47.65 hours. None of the patients required blood transfusion. Only one patient needed two-stage procedure. Clavien grade 1 complications were seen in five patients, grade 2 in three, and one patient needed prolonged irrigation for intermittent hematuria. Four patients had transient (<2 weeks) stress urinary incontinence. Two patients needed cystoscopy+visual dilatation of membranous urethral stricture. Significant improvement in IPSS, Qmax, and QoL was seen on follow-up of 3, 6, and 12 months. Conclusions: HoLEP significantly relieves obstructive changes occurring because of BPH. Modifying technique of enucleation to single lobe helps in reducing operative time of enucleation. One may argue that vast experience of our operating surgeon (A.D.B.) may have contributed to lower morbidity in our study. We hypothesize that our simplified technique described in four steps can become useful in reducing the learning curve. Single-lobe technique with early recognition of important landmarks and repeating same steps for all sizes of prostate can ease the learning of this wonderful procedure. No competing financial interests exist. Runtime of video: 9 mins

Outcome of Modification of Dose and Time of Administration of Tamsulosin in Men with Abnormal Ejaculation

Introduction: Alpha-adrenergic blockers are now the cornerstone medication in management of lower urinary tract symptom (LUTS); however, the associated treatment-related abnormal ejaculation could be a bothersome event. This is a comparative study among different methods of tamsulosin administration in terms of efficacy, recoverability of ejaculatory function, and quality of life (QoL) in men with tamsulosin-related abnormal ejaculation. Patients and Methods: Sexually active men receiving tamsulosin for LUTS who were bothered by treatment-related abnormal ejaculation following initiation of tamsulosin were randomized into 3 groups; group A received intermittent-full-standard-dose, group B received low-dose-tamsulosin, and group C received full-standard-dose tamsulosin The status of ejaculatory function, IPSS, QoL score, and Q-Max were measured at baseline and 3 months later. Results: A total of 93 men with mean age of 53.1 years were included in the study, 3-months after randomization, statistically significant improvements in IPSS, QoL index, and Q-Max in comparison to pre-treatment levels were noted. Restoration of normal ejaculation was reported by 74.1 and 90.3% of patients in group A and B, respectively, versus none in group C. The QoL score was significant when comparing group A to the other groups; finally, the Q-Max was significant when comparing group C to the other groups. Conclusion: For patients bothered by tamsulosin-related abnormal ejaculation, a significant improvement in the QoL, without deviation from the therapeutic purpose of treatment, can be achieved by administration of 0.4 mg tamsulosin every other day.

A Substrate Model for On-Chip Tapered Spiral Inductors With Forward and Reverse Excitations

In this brief, closed-form analytical expressions are obtained to accurately calculate the oxide and substrate (both lateral/vertical) capacitances of the $\pi $ -equivalent circuit model for on-chip tapered spiral inductors. A lateral RC substrate network using the above-mentioned expressions is shown to significantly improve the model accuracy, especially with lower substrate resistivities. Furthermore, improvement in Qmax with reverse excitation in tapered spirals is also accurately predicted by the proposed model. The accuracy of the proposed model is validated till 15 GHz using several inductor geometries across process parameters suitable for the design of RF circuits. Excellent agreement is observed between the model, electromagnetic simulations, and measurements.

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.