Improvement In Urinary Function Research Articles

Transperineal MR Fusion Laser Ablation of Prostate Cancer in Office Setting: 1 Year Efficacy and Safety Outcomes in Intermediate-Risk Patients.

Introduction: Focal therapy (FT) is an emerging option for intermediate-risk prostate cancer (IR-PCa). Transperineal MRI fusion laser ablation of PCa (TPFLA) is a novel FT technique with limited data reported. We conducted a phase I clinical trial evaluating the safety, feasibility, and 1-year oncologic results for patients with IR-PCa treated with TPFLA in an office setting. Materials and Methods: NCT05241236 aimed to evaluate TPFLA for the International Society of Urological Pathology-grade 2 (ISUP-2) tumors. All procedures were performed in the office using MR/US fusion imaging. The diode interstitial laser system fibers were applied through the perineum using local anesthesia. The primary outcome was safety and tolerability. Pain scores were recorded using analog scales. Thirty-day adverse events and 1-year prostate biopsy oncologic outcomes were noted. Functional outcomes at 3 months and 1 year were compared with baseline as well. Results: Thirty patients accrued had TPFLA safely in the office with no complications. TPFLA median pain score was 1. At 30 days, one man required a transurethral resection of the prostate (TURP). There were no imaging demonstrable cancers at 3 months and a significant improvement in urinary function (p = 0.001) was noted and sustained for the year. No patient experienced urinary incontinence. No changes in sexual function were observed (p = 0.7). At 1 year, 25/30 (83%) had no clinically significant cancer. However, 14 had PCa, in 5 (17%) solely in treated areas, all ISUP-1. Seven had PCa outside the treated areas. Two had infield and outfield recurrences, both were ISUP 2. At study closure, 16 patients were free from PCa, 3 were on active surveillance, 9 were treated focally with cryoablation, and 2 were converted to radical surgical procedure. Conclusions: TPFLA appears to be a safe and an effective focal therapy for IR-PCa, offering a potential alternative to more radical treatments with a minimal periprocedural impact. Longer follow-up and larger studies are needed to confirm these results.

Surgical and patient-reported outcomes of staged urethroplasty for anterior urethral strictures: A comprehensive analysis.

To evaluate the efficacy of staged urethroplasty for complex anterior urethral strictures from both surgical and patient-reported outcome perspectives. This retrospective study included 100 patients who underwent staged urethroplasty for anterior urethral strictures between May 2011 and June 2023. Anatomical success was defined as the ability to pass cystourethroscopy without resistance and the patient's ability to void without additional interventions. Patient-reported outcomes were evaluated using validated questionnaires, including the urethral stricture surgery patient-reported outcome measure, sexual health inventory for men (SHIM), and EuroQol 5-dimension (EQ-5D), administered pre-and postoperatively. At a median follow-up of 53 months, the anatomical success rate was 89.0%. Seventeen (17.0%) required revision surgery between stages. Perioperative complications occurred in 13 (13.0%). Significant improvements were observed in maximum flow rate (p < 0.0001), postvoid residual volume (p = 0.0006), total lower urinary tract symptoms (LUTS) scores (p < 0.0001), LUTS-specific quality of life (QOL) score (p < 0.0001), EQ-5D index score (p < 0.0001), and EQ-5D visual analog scale score (p < 0.0001). SHIM scores showed no significant change (p = 0.59). Overall, 93.5% of patients reported being either "satisfied" or "very satisfied" with the outcomes. Staged urethroplasty demonstrates high anatomical success rates and significant improvements in urinary function and QOL without compromising erectile function. The high patient satisfaction rate supports its efficacy in treating complex anterior urethral strictures.

Different Neurogenic Bladders in Patients with Cervical and Thoracic Myelopathy: Direct Comparison from a Prospective Case Series.

Background/Objectives: This study aimed to identify the unique characteristics of neurogenic bladders and associated symptoms in patients with cervical or thoracic myelopathy using clinical surveys and urodynamic studies (UDSs). Methods: Patients with degenerative cervical (DCM) or thoracic (DTM) myelopathy and lower urinary tract symptoms (LUTSs) scheduled for decompressive surgery were prospectively enrolled. A UDS was performed one day preceding surgery to evaluate the preoperative urological function. Subjective symptoms were evaluated using the International Prostate Symptom Score (IPSS) and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire before surgery and one year postoperatively. Results: Sixty-two patients (DCM: 50, DTM: 12) with a mean age of 63.2 years (men: 30, women: 32) were enrolled. The UDS revealed that 5 (8.1%) patients, all with DCM, exhibited completely normal UDS results, and the remaining 57 had at least one abnormal finding. Based on the International Continence Society classification, an underactive bladder was significantly more common in patients with DTM compared to patients with DCM (75.0% vs. 18.0%, p < 0.001). The results of the questionnaire showed that the voiding symptom IPSS were significantly worse, preoperatively, in patients with DTM (5.0 ± 4.4 [DCM] vs. 8.7 ± 4.5 [DTM]; p = 0.013). One year postoperatively, the IPSS grade of 24.0% of patients with DCM improved, whereas only one (8.3%) patient with DTM showed improvement. Conclusions: Patients with DTM reported worse voiding symptoms and exhibited more underactive bladders on UDS than patients with DCM before decompression. One year postoperatively, more patients with DCM showed subjective improvements in urinary function than those with DTM.

Multi-dimensional measurements of long-term quality of life and recovery patterns of patients with cervical cancer after treatment.

e17533 Background: Cervical cancer is a prevalent malignancy affecting the female reproductive system globally, and its incidence among younger individuals is on the rise. This study employed the CC-PRO137 scale to evaluate the long-term quality of life and recovery patterns of cervical cancer patients post- treatment. Clinicians are guided to provide individualized treatment and psychological support. Methods: This study recruited patients with primary cervical cancer who underwent primary surgical treatment at the Obstetrics and Gynecology Hospital of Fudan University from October 2018 to June 2021. The CC-PRO137 (Cervical Cancer Patient Reported Clinical Outcome Assessment Scale) was used for follow-up to assess changes in the patients' physical, psychological, and social life states. The data was analyzed to examine variations in the recovery status of the patients across 13 modules: urinary function (URI), bowel function (BOW), pelvic organ prolapse (POP), ovarian function (OVA), lymphatic function (LYM), nervous function (NEU), sexual function (SEX), anxiety (ANX), depression (DEP), shame (SHA), belief (BEL), social support (SUP), and daily life (LIF). Subgroup analysis was conducted based on different stages, surgical methods, and adjuvant treatment plans. Results: A total of 304 participants were tested both 6 months and 12 months after the completion of treatment. The scores for URI, NEU, and SEX were significantly higher after one year compared to within 6 months (URI: t=-3.519, p=0.001; NEU: t=-2.138, p=0.033; SEX: t=-2.338, p=0.021). This suggests a notable improvement in urinary function, nervous function, and sexual function after 12 months. In terms of the psychological domain, DEP scores were significantly higher after 12 months compared to within 6 months ( t=-2.517, p=0.012). The LIF index showed a significant improvement after 12 months ( t=-5.224, p&lt;0.001). Subgroup analysis revealed that Stage II had worse outcomes compared to Stages I and III, particularly in terms of URI ( F(2,297) = 10.619, p &lt; 0.001) and POP ( F(2,299) = 8.559, p&lt; 0.001) indexes. The laparoscopy had a greater impact on the urinary system ( t = 2.157, p = 0.046). The adverse effects of concurrent chemoradiotherapy on URI ( F(2,297) = 11.497, p &lt; 0.001) and DEP ( F(2,299) = 4.149, p = 0.017) functions were more significant than those of chemotherapy. Conclusions: The recovery of patients following cervical cancer treatment is primarily observed in improvements in urinary, bowel, and nervous functions in the physiological domain. In the psychological domain, there is a noticeable improvement in depressive state, while the social life domain also shows signs of improvement over time. By focusing on the disease impact within a limited time frame, the scale helps clinicians provide targeted guidance and advice based on the main issues.

Animal models, treatment options, and biomaterials for female stress urinary incontinence.

In the quest to tackle stress urinary incontinence (SUI), the synthesis of cutting-edge biomaterials and regenerative materials has emerged as a promising frontier. Briefly, animal models like vaginal distension and bilateral ovariectomy serve as crucial platforms for unraveling the intricacies of SUI, facilitating the evaluation of innovative treatments. The spotlight, however, shines on the development and application of novel biomaterials-ranging from urethral bulking agents to nano-gel composites-which aim to bolster urethral support and foster tissue regeneration. Furthermore, the exploration of stem cell therapies, particularly those derived from adipose tissues and urine, heralds a new era of regenerative medicine, offering potential for significant improvements in urinary function. This review encapsulates the progress in biomaterials and regenerative strategies, highlighting their pivotal role in advancing the treatment of SUI, thereby opening new avenues for effective and minimally invasive solutions.

Single-port Transvesical Robot-Assisted Simple Prostatectomy: Surgical Technique and Clinical Outcomes

BackgroundSurgical management of large prostatic adenomas can be performed via open, endoscopic, or robotic approaches. A low-profile single-port (SP) robot was built to work in confined areas (ie, the bladder) and regionalize surgery. ObjectiveTo describe the novel SP transvesical (TV) robot-assisted simple prostatectomy (RASP) and report clinical outcomes. Design, setting, and participantsSP TV RASP cases were performed in an academic hospital by two surgeons from 2019 to 2023. A total of 117 cases were performed, and data from patients with at least 12 mo of follow-up were analyzed. The inclusion criterion was severe obstructive urinary symptoms or catheter-dependent urinary retention due to large prostates with volume >80 ml. Surgical procedureThe procedure consisted of two main steps through a single 3-cm suprapubic incision: first, enucleation of the adenoma, and second, a 360° bladder mucosal flap reconstruction. No drains or continuous bladder irrigation was used routinely. MeasurementsIntraoperative parameters, pre- and postoperative uroflowmetry, and 1-yr clinical outcomes were assessed. We used descriptive statistics to analyze the data. Results and limitationsAll procedures were completed successfully without additional ports or conversions. The median console time and estimated blood loss were 107 min and 100 ml, respectively. Transfusion rate was 0%. Intraoperative complications included two suspected air emboli attributed to high insufflation pressures. There were no major postoperative complications. In total, 95.8% were discharged within the first 24 h, with a median length of stay and pain score of 5 h and 3/10, respectively. There was persistent improvement in the median International Prostate Symptom Score and flow rate after 1 yr. The median Sexual Score Inventory for Men score was 20 at 12 mo. Our study is limited by its retrospective nature and cohort size. ConclusionsSP TV RASP is a feasible alternative for the management of severe benign prostatic hyperplasia that promotes fast recovery and demonstrates 1-yr improvement in urinary function. Patient summarySingle-port transvesical robot-assisted simple prostatectomy is a minimally invasive alternative for the treatment of large benign prostatic growth. A single robotic arm goes through a small incision in the skin and bladder to extract the obstructive prostatic tissue. Afterward, reconstruction of the area is done to decrease bleeding and improve postoperative symptoms. We found that patients recover quickly and have excellent clinical results with a low risk of complications.

TGF-β inhibitor treatment of H₂O₂-induced cystitis models provides biochemical mechanism for elucidating interstitial cystitis/painful bladder syndrome patients.

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic disease for which no effective treatment is available. Transforming growth factor-β (TGF-β) is thought to be involved in the pathogenesis of IC/PBS, and previous studies have suggested that administrations of a TGF-β inhibitor significantly ameliorated IC/PBS in a mouse model. However, the molecular mechanisms underlying the therapeutic effect of a TGF-b inhibitor on IC/PBS has not been comprehensively analyzed. TGF-β has a variety of actions, such as regulation of immune cells and fibrosis. In our study, we induced IC/PBS-like disease in mice by an intravesical administration of hydrogen peroxide (H₂O₂) and examined the effects of three TGF-β inhibitors, Repsox, SB431542, and SB505124, on the urinary functions as well as histological and gene expression profiles in the bladder. TGF-β inhibitor treatment improved urinary function and histological changes in the IC/PBS mouse model, and SB431542 was most effective among the TGF-β inhibitors. In our present study, TGF-β inhibitor treatment improved abnormal enhancement of nociceptive mechanisms, immunity and inflammation, fibrosis, and dysfunction of bladder urothelium. These results show that multiple mechanisms are involved in the improvement of urinary function by TGF-β inhibitor.

Do Surgeons Anticipate Women’s Hopes and Fears Associated with Prolapse Repair? A Qualitative Analysis in the PROSPERE Trial

Women's preoperative perceptions of pelvic-floor disorders may differ from those of their physicians. Our objective was to specify women's hopes and fears before cystocele repair, and to compare them to those that surgeons anticipate. We performed a secondary qualitative analysis of data from the PROSPERE trial. Among the 265 women included, 98% reported at least one hope and 86% one fear before surgery. Sixteen surgeons also completed the free expectations-questionnaire as a typical patient would. Women's hopes covered seven themes, and women's fears eleven. Women's hopes were concerning prolapse repair (60%), improvement of urinary function (39%), capacity for physical activities (28%), sexual function (27%), well-being (25%), and end of pain or heaviness (19%). Women's fears were concerning prolapse relapse (38%), perioperative concerns (28%), urinary disorders (26%), pain (19%), sexual problems (10%), and physical impairment (6%). Surgeons anticipated typical hopes and fears which were very similar to those the majority of women reported. However, only 60% of the women reported prolapse repair as an expectation. Women's expectations appear reasonable and consistent with the scientific literature on the improvement and the risk of relapse or complication related to cystocele repair. Our analysis encourages surgeons to consider individual woman's expectations before pelvic-floor repair.

MP04-02 ANALYSIS OF EX-VIVO HUMAN BPH TISSUE TREATED BY HISTOTRIPSY: DOSE AND PARAMETER EFFECTS

You have accessJournal of UrologyCME1 May 2022MP04-02 ANALYSIS OF EX-VIVO HUMAN BPH TISSUE TREATED BY HISTOTRIPSY: DOSE AND PARAMETER EFFECTS Zorawar Singh, Yashwanth N. Kumar, Yak-Nam Wang, Adam Maxwell, Matthew Bruce, Rishi Sekar, Eli Vlaisavljevich, Lawrence D. True, and George R. Schade Zorawar SinghZorawar Singh More articles by this author , Yashwanth N. KumarYashwanth N. Kumar More articles by this author , Yak-Nam WangYak-Nam Wang More articles by this author , Adam MaxwellAdam Maxwell More articles by this author , Matthew BruceMatthew Bruce More articles by this author , Rishi SekarRishi Sekar More articles by this author , Eli VlaisavljevichEli Vlaisavljevich More articles by this author , Lawrence D. TrueLawrence D. True More articles by this author , and George R. SchadeGeorge R. Schade More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Histotripsy is a promising alternative to more invasive procedures for the treatment of benign prostatic hyperplasia (BPH). However, in a phase 1 clinical trial, histotripsy failed to provide objective improvements in urinary function. One explanation may be that the clinical trial pulse parameters, optimized in a canine model, do not translate to more fibrotic human prostates. We aimed to evaluate the efficacy of different histotripsy parameter settings to identify a more efficacious exposure in ex-vivo human BPH tissue (EVHP). METHODS: Deidentified EVHP tissue specimens (n=17) were treated with an 18 element 700kHz cavitation histotripsy transducer, which approximated the device used in the prior clinical trial, and a 1.5MHz boiling histotripsy (BH) transducer. Three different histotripsy exposures were compared: 1) a high pulse repetition frequency (PRF) (approximating the clinical system cavitation cloud histotripsy [CCH]), 2) low PRF CCH and 3) 1Hz PRF BH. Treatment effectiveness was evaluated by measuring pre vs. post treatment Young’s modulus through shear wave elastography (SWE) and histologic analysis (H&E, Masson’s Trichome) of the targeted area. The dose was standardized at 30s/mm and escalated as required to note a significant change in SWE. RESULTS: At the given dose of 30s/mm, BH treatments resulted in a significant 40.1% reduction in SWE Young’s modulus (Figure 1A) p < 0.001. At this dose, neither of the CCH parameter settings (500Hz and 10Hz) resulted in a significant reduction in the Young’s modulus with % changes of differences of 3.1% (p = .83) and -5% (p = .08), respectively. For CCH settings, greater exposure times (up to 90s) did result in significant stiffness reduction of 12.5% (p = 0.04) and 41.1% (p < 0.001) for 500Hz and 10Hz parameter settings, respectively. On histology (Figure 1B), at 30s/mm, the CCH parameter settings resulted in minimal intermittent damage while BH treatments caused near complete ablation. At increasing doses, CCH was also capable of causing complete liquefactive cavity formation. CONCLUSIONS: BH parameters applied in this study resulted in more complete ablation of EVH tissue in comparison to CCH parameters. Additionally, histotripsy treatment parameters similar to those applied with a previous clinical system did not produce consistent ablation of EVHP possibly explaining trial results. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e56 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zorawar Singh More articles by this author Yashwanth N. Kumar More articles by this author Yak-Nam Wang More articles by this author Adam Maxwell More articles by this author Matthew Bruce More articles by this author Rishi Sekar More articles by this author Eli Vlaisavljevich More articles by this author Lawrence D. True More articles by this author George R. Schade More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Effects of Robotic Walking and Activity-Based Training on Bladder Complications Associated with Spinal Cord Injury

Background: Traditional Activity-based Training (ABT) and novel Robotic Locomotor Training (RLT) demonstrate promising results for reducing secondary complications associated with SCI, including bladder dysfunction. However, there is a need for increased evidence through randomised controlled trials (RCTs). This study aimed to determine the effect of RLT compared to ABT on bladder function in individuals with incomplete SCI involved in a pilot randomised controlled trial. Methods: Sixteen participants with motor incomplete tetraplegia (&gt;1 year) were recruited. The RLT and ABT involved 60-minute sessions, 3× per week for 24 weeks. The International Lower Urinary Tract Function Basic Data Set was used to assess self-reported bladder health and function over 24 weeks. Results: Across participants, intermittent catheterization, either by self or attendant was used by most of the participants (44%), followed by indwelling catheters (31%). No significant group differences were found for the bladder outcomes over time, except for improvements in urinary function (p = 0.04) at week 24. The odds ratio of 0.26, indicated that the RLT group was less likely to have an improvement in bladder function compared to the ABT group. Both groups tended to show a pattern of decreasing urinary incontinence over time. Conclusions: The ABT group experienced greater benefits in bladder function, but both groups showed a tendency of decreased urinary incontinence over time. Both RLT and ABT interventions may positively benefit the neural circuitries controlling urogenital functions in persons with SCI. RCTs involving larger sample sizes are warranted to further examine these preliminary results.

P0531 - Improvement of urinary function in men with hypogonadism and obesity receiving long-term treatment with testosterone in comparison to a control group – Experience of 4367 patient-years in a urological office

P0531 - Improvement of urinary function in men with hypogonadism and obesity receiving long-term treatment with testosterone in comparison to a control group – Experience of 4367 patient-years in a urological office

26 - An update on the improvement of urinary function in hypogonadal men receiving long-term treatment with testosterone compared to a hypogonadal control group totalling 7116 patient-years of clinical experience

26 - An update on the improvement of urinary function in hypogonadal men receiving long-term treatment with testosterone compared to a hypogonadal control group totalling 7116 patient-years of clinical experience

Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide

BackgroundRetzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to improve continence. However, questions remain regarding feasibility and generalizability of technique and outcomes. ObjectiveTo compare the outcomes of 140 consecutive standard robot-assisted radical prostatectomy (S-RARP) versus RS-RARP. Design, setting, and participantsA total of 70 S-RARPs were performed followed by 70 RS-RARPs. Demographic, pathologic, and functional outcomes were compared preoperatively and through 12 mo. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) was used to compare functional outcomes. Logistic and linear regression analyses were utilized to analyze variables associated with EPIC-CP urinary incontinence and overall quality of life (QOL) scores, and oncologic outcomes. Cox regression analysis was used to analyze incontinence at 12 mo. Surgical procedureRS-RARP versus S-RARP. MeasurementsPatient and tumor characteristics (age, body mass index, prostate-specific antigen, Charlson Comorbidity Index, Gleason group, clinical stage, and Prostate Imaging Reporting and Data System score), perioperative outcomes (console time, estimated blood loss, postoperative complications, and length of stay), oncologic outcomes (positive surgical margin [PSM], and biochemical recurrence), overall and 12-mo continence rates (zero pads and zero to one safety pad), time to continence, potency (erection sufficient for sexual activity), EPIC-CP urinary incontinence, sexual function, and overall QOL scores. Results and limitationsMedian follow-up for S-RARP versus RS-RARP was 46.3 versus 12.3 mo. RS-RARP versus S-RARP had improved overall continence rates at total follow-up (95.7% vs 85.7%, p = 0.042) and 12-mo follow-up (97.6% vs 81.4%, p = 0.002), and faster return to continence (zero to one safety pad, 44 vs 131 d, p < 0.001). RS-RARP EPIC-CP urinary incontinence and overall QOL scores remained significantly better at 12 mo. There were no differences in overall PSM rates, although RS-RARP had lower rates of nonfocal PSMs. There were no differences in sexual function. In multivariate analysis, RS-RARP was significantly associated with improved 12-mo EPIC-CP urinary incontinence and improved QOL scores, but was not associated with PSM or biochemical recurrence. Limitations include retrospective study design and unequal follow-up; however, significantly better RS-RARP continence at 12 mo is striking despite fewer patients attaining 12-mo follow-up. ConclusionsRS-RARP significantly improves early and long-term continence without compromising oncologic outcomes and leads to overall improved QOL. Patient summaryRetzius-sparing robot-assisted radical prostatectomy is an emerging technique for robotic radical prostatectomy that improves urinary function and quality of life without compromising cancer control.

314 Improvement of Urinary Function Improves in Hypogonadal Men Receiving Long-term Treatment with Testosterone Compared to a Hypogonadal Control Group: 7116 Patient-years of Clinical Experience

In the most recent version of the EAU Guidelines on Male Hypogonadism, the contraindication severe LUTS due to BPH has been removed. In an ongoing registry study we monitored urinary function for a maximum of 12 years. We report data from 823 men with symptomatic hypogonadism participating in a registry study started in 2004. 428 men received testosterone undecanoate (TU) injections 1000 mg/12 weeks following an initial 6-week interval (T-group), 395 opted against TTh serving as controls (CTRL). Changes over time between groups were compared by a mixed effects model for repeated measures with a random effect for intercept and fixed effects for time, group and their interaction and adjusted for age, weight, waist circumference, blood pressure, fasting glucose, lipids and quality of life to account for baseline differences between groups. Mean (median) follow-up: T-group 8±3 (9), CTRL 9±2 (10) years. Total observation time: T-group 3594, CTRL 3522 years. Baseline age: 58±7 (T-group) vs. 64±5 years (CTRL).

Early removal of urethral catheter after endoscopic extraperitoneal radical prostatectomy

Background. Extraperitoneal radical prostatectomy (RP) in patients with prostate cancer is useful when there are no oncological indications to lymph node dissection (e.g. in low and intermediate-low risk of the disease), and allows to perform precise anastomosis and facilitates the early postoperative period. However, even minimally invasive approach does not avoid such factors as a urinary catheter that may disturb patients.Objective. We assessed the possibility to remove the urinary catheter as early as possible.Materials and methods. 28 patients with low (n = 22) and low-intermediate (n = 6) prostate cancer risk (according to NCCN (National Comprehensive Cancer Network) criteria) underwent an extraperitoneal laparoscopic RP from March 2017 to November 2018. All operations were performed by the same surgeon (A. Nosov). The inclusion criteria were the following: localized prostate cancer, prostate specific antigen (PSA) &lt;10 ng/ml, ISUP group 1–2, life expectancy of more than 10 years and preoperative patient’s counseling (awareness about early catheter removal and discharge). All patients were continent before surgery. During surgery, the prostate and seminal vesicles were removed extraperitoneally without peritoneal cavity opening and conversion. Bladder neck sparing was performed in all cases but nerve-vascular bundles were spared according to indication (preoperative International Index of Erectile Function (IIEF), oncological reasons). Vesicourethral anastomosis was performed by two V-Loc circular sutures. No drainage tubes were inserted to control bleeding/urinary leakage. A urinary catheter Foley 20 Fr was inserted into the bladder after anastomosis completion. No other urinary drainage (suprapubic tubes, etc) was used. Anastomosis resistance and completeness were checked at the end of surgery by filling the bladder with 150 ml of saline through the catheter. Except for cases with macroscopic hematuria, urinary catheters were removed on the 1st postoperative day’s morning (&lt;24 hours) with an active followup (daily voiding assessment, pelvic ultrasound and postvoided residual volume assessment) on Day 1. Immediately after the catheter removal, alpha-blockers (for urination alleviation) and PDE-5 inhibitors (in patients with neurovascular sparing) were prescribed. All patients were available for a 3-month follow-up. During the follow-up, a monthly combined assessment was performed, including IPSS, QoL, PSA analysis, pelvic ultrasound and urofloumetry.Results. The average patient’s age was 63 years (52–71 years). The median preoperative PSA level was 7.6 ng/ml. The intraoperative technique was unremarkable with no blood transfusion or conversion. All early postoperative complications were classified as minor – grade I, II and IIIa in 2 (7.2 %), 5 (17.8 %) and 1 (3.6 %) patients, respectively. Related to the early catheter removal complications included 1 (3.6 %) patient with urinary leakage (resolved by repeated prolonged urinary catheter insertion) and 4 (14.3 %) with urinary obstruction – resolved by single catheterization (n = 2), percutaneous suprapubic cystostomy (n = 2). No major complications were noticed during the follow-up. Totally, 22 (78.6 %) patients were discharged on the next day after the catheter removal – on the 2nd postoperative day. All discharged patients did not need readmission during the follow-up. Remained 6 (21.4 %) patients stayed at the hospital for 5–18 days. The pathological investigation showed upgrading in 9 (32.1 %) patients with low risk and in 1 (3.6 %) patient with low-intermediate risk. Upstaging to locally advanced forms was noticed in 6 (21.4 %) patients. All patients had the PSA level of &lt;0.2 ng/ml 30–90 days after surgery. Postoperative assessment showed improvement in urinary function and erectile function sparing in selected patients, with no compromising functional results due to the early catheter removal.Conclusion. Despite the common widespread of minimally invasive RP, there is no consensus on the terms of a urinary catheter removal. According to our data, we suggested it might be of some benefit to remove a urinary catheter early in selected and well-informed patients. A thorough vesicourethral anastomosis pursuance, nerve-sparing, bladder neck sparing and Retzius sparing procedure, intraand postoperative assessment is necessary in all cases.

Expanding indication of padeliporfin (WST11) vascular-targeted photodynamic therapy: Results of prostate cancer Latin-American multicenter study

ObjectivesTo explore the proportion of patients with higher risk localized prostate cancer (PCa) that would become safely biopsy negative 12 months after non-thermal focal therapy with padeliporfin vascular-targeted photodynamic therapy (VTP). MethodsMulticenter study in a scenario of prostate-specific antigen (PSA)≤20ng/ml and variable PCa target volumes Gleason pattern 3 or low-volume secondary Gleason pattern 4, all patients received VTP, consisting of intravenous 4mg/kg padeliporfin activated by light-diffusing fibers in the prostate. The prostate was biopsied at baseline, months 6 and 12, PSA, patient-reported functional outcomes and quality of life (QoL) questionnaires were recorded at baseline, months 3, 6, and 12 and adverse events (AE) throughout the study. ResultsIn the intention-to-treat population (n=81), the proportion of patients with negative biopsies at month 12 was 74% (60/81 patients; 95% CI: 63.1%, 83.2%). In the per-protocol population, the proportion was 79% (58/73 patients; 95% CI: 68.4%, 88.0%). Questionnaire results indicated a slight improvement in urinary function and limited deterioration in sexual function. No difference in QoL was observed over time. A total of 42/81 (52%) patients reported mild or moderate and 4 of 81 (4.9%) experienced serious AE, all resolved without sequelae. No phototoxicity, cardiovascular event, fistula or prolonged urinary incontinence, secondary cancer or death was reported. ConclusionsResults support the efficacy, safety, and QoL associated with padeliporfin focal treatment for low/intermediate risk localized PCa.

Conséquences sexuelles des traitements de l’HBP

To review the literature on the sexual adverse effects of pharmacological, instrumental and surgical treatments of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH). A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review. Sexual dysfunction and SBAU/BPH are intimately linked by a cross-over effect in the population of men over 50, a possible common pathophysiology and treatments for BPH with sexual consequences. Evaluating the sexuality of patients in care for SBAU/BPH is therefore essential. Patients should be informed of potential adverse drug effects of BPH, including ejaculation disorders with alpha blockers and loss of libido and erectile dysfunction with 5alpha reductase inhibitors. After BPH surgery, loss of antegrade ejaculation is common, although preservation possibilities exist. The improvement of urinary function and the decrease of possible ejaculatory pains have a beneficial effect on the sexuality of the BPH patients operated. More rarely, patients may experience orgasmic dysfunction or even erectile dysfunction with a possible thermal effect on the vasculo-nerve bundles. Consensus d'experts.

Extensión de la indicación de terapia fotodinámica dirigida vascular con padeliporfina (WST11): resultados de un estudio multicéntrico latinoamericano del cáncer de próstata

ObjectivesTo explore the proportion of patients with higher risk localized prostate cancer (PCa) that would become safely biopsy negative 12 months after non-thermal focal therapy with padeliporfin vascular-targeted photodynamic therapy (VTP). MethodsMulticenter study in a scenario of prostate-specific antigen (PSA) ≤20ng/ml and variable PCa target volumes Gleason pattern 3 or low-volume secondary Gleason pattern 4, all patients received VTP, consisting of intravenous 4mg/kg padeliporfin activated by light-diffusing fibers in the prostate. The prostate was biopsied at baseline, months 6 and 12, PSA, patient-reported functional outcomes and quality of life (QoL) questionnaires were recorded at baseline, months 3, 6, and 12 and adverse events (AE) throughout the study. ResultsIn the intention-to-treat population (n=81), the proportion of patients with negative biopsies at month 12 was 74% (60/81 patients; 95% CI: 63.1%,83.2%). In the per-protocol population, the proportion was 79% (58/73 patients; 95% CI: 68.4%,88.0%). Questionnaire results indicated a slight improvement in urinary function and limited deterioration in sexual function. No difference in QoL was observed over time. A total of 42/81 (52%) patients reported mild or moderate and 4 of 81 (4.9%) experienced serious AE, all resolved without sequelae. No phototoxicity, cardiovascular event, fistula or prolonged urinary incontinence, secondary cancer or death was reported. ConclusionsResults support the efficacy, safety, and QoL associated with padeliporfin focal treatment for low/intermediate risk localized PCa.

Clinical and Patient-reported Outcomes of 1-sided Anterior Urethroplasty for Long-segment or Panurethral Strictures

To evaluate clinical and patient-reported urinary and sexual outcomes after a long-segment stricture repair using the 1-sided urethral dissection, penile invagination, and dorsal buccal mucosa graft onlay technique described by Kulkarni etal. Patients from 4 institutions after single-stage repairs for long-segment urethral strictures (>8 cm) from January 2002 to April 2016 were reviewed. Technique described by Kulkarni etal was used in all cases. Clinical outcomes included uroflowmetry (Qmax) and post-void residuals. Patient-reported outcome measures included International Prostate Symptom Score survey, Sexual Health Inventory for Men, Male Sexual Health Questionnaire, and Global Response Assessment questionnaire to measure voiding, sexual, ejaculatory symptoms, and overall improvement, respectively. Seventy-three patients with a minimum of 12 months' follow-up were included. The mean age and stricture length were 56 (21-80) years and 13.6 (8-21) cm, respectively. At a mean follow-up of 44 (12-162) months, 9 of 73 (12%) strictures recurred. The mean baseline International Prostate Symptom Score of 23 (7-24) decreased to 10 (1-17) on follow-up (P <.001). Eight of 42 patients (21.4%) reported an increase, and 6 of 42 patients (14.3%) decreased in Sexual Health Inventory for Men following urethroplasty. Ejaculatory function on Male Sexual Health Questionnaire improved after urethroplasty from 8 preoperatively to 11 postoperatively (P <.004). All patients reported improvement after urethroplasty on Global Response Assessment questionnaire. Post-void dribbling and chordee occurred in 45% and 25% of patients, respectively. Durable patency in most patients is demonstrated in this study. PROMs indicate an improvement in urinary function and moderate effect on sexual function. Transient penile chordee was evident in 25% of patients.

PD50-02 EFFECTS OF LONG-TERM TESTOSTERONE UNDECANOATE INJECTIONS (TU) ON URINARY AND SEXUAL FUNCTION IN HYPOGONADAL MEN: REAL-LIFE DATA FROM A CONTROLLED REGISTRY STUDY

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II1 Apr 2016PD50-02 EFFECTS OF LONG-TERM TESTOSTERONE UNDECANOATE INJECTIONS (TU) ON URINARY AND SEXUAL FUNCTION IN HYPOGONADAL MEN: REAL-LIFE DATA FROM A CONTROLLED REGISTRY STUDY Ahmad Haider, Karim Sultan Haider, Gheorghe Doros, and Abdulmaged Traish Ahmad HaiderAhmad Haider More articles by this author , Karim Sultan HaiderKarim Sultan Haider More articles by this author , Gheorghe DorosGheorghe Doros More articles by this author , and Abdulmaged TraishAbdulmaged Traish More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2792AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A registry was established to assess long-term effectiveness and safety of TU in a urological setting in comparison to an untreated hypogonadal control group. METHODS Observational, cumulative registry study in 656 men (age: 60.72 ± 7.15 years) with testosterone (T) levels ≤ 12.1 nmol/L and symptoms of hypogonadism. 360 men received TU 1000 mg/12 weeks with an initial 6-week interval for up to 10 years. 296 men had opted against TTh and served as controls (CTRL). Median follow-up in both groups was 7 years. Measurements were taken at least twice a year, and 8-year data were analysed. Mean changes over time between the two groups were compared by means of a mixed effects model for repeated measures with a random effect for intercept and fixed effects for time, group and their interaction. Changes were adjusted for age, weight, waist circumference, blood pressure, and lipids to account for baseline differences between the two groups. RESULTS Total T rose from 9.8 ± 1.3 to trough levels between 16 and 17 nmol/L in the T group and decreased slightly but significantly from 9.6 ± 1.2 to 9.0 ± 1.4 nmol/L in the CTRL group. Prostate volume increased from 29.2 ± 10.4 to 31.1 ± 11.5 ml (p=0.0114) in the T group and decreased from 34.5 ± 5.9 to 33.5 ± 12.0 ml (p<0.0001) in CTRL. The difference between groups was 4.1 ml (p=0.0012). Post-voiding residual volume decreased in the T group from 47.3 ± 22.8 to 13.7 ± 4.6 ml and increased in CTRL from 48.3 ± 16.3 to 64.5 ±22.2 ml. The difference between groups was 54.0 ml (p<0.0001 for all). The IPSS decreased in the T group from 6.4 ± 4.0 to 2.0 ± 1.0 and increased in CTRL from 4.5 ± 2.0 to 6.5 ± 2.6. The difference between groups was 4.7 (p<0.0001 for all). In the T group, IIEF-EF (max. score: 30) increased from 19.51 ± 4.99 to 25.94 ± 3.01 with a change from baseline by 6.02 points. The improvement was statistically significant for the first four years and remained stable in the remaining years. In CTRL, IIEF-EF decreased from 20.47 ± 3.13 to 11.7 ± 1.64 after 8 years by 9.52 points. The difference between groups was 14.26 (p<0.0001 for all). There were two deaths in the T group and 21 in CTRL. No patient dropped out. Treatment compliance in the T group was 100 per cent as all injections were administered in the office. CONCLUSIONS Long-term TTh with TU in an unselected cohort of hypogonadal men resulted in improvements in urinary function while untreated controls experienced a worsening which was independent of prostate size. Long-term TU was well tolerated and excellent adherence suggested a high level of patient satisfaction. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1186 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ahmad Haider More articles by this author Karim Sultan Haider More articles by this author Gheorghe Doros More articles by this author Abdulmaged Traish More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...