Including International Prostate Symptom Score Research Articles

Focal therapy with high-intensity focused ultrasound for the localized prostate cancer for Asian based on the localization with MRI-TRUS fusion image-guided transperineal biopsy and 12-cores transperineal systematic biopsy: prospective analysis of oncological and functional outcomes.

We evaluated clinical outcomes of region target focal therapy with high-intensity focused ultrasound (HIFU) for the localized prostate cancer (PCa) based on magnetic resonance imaging-based biopsy and systematic prostate biopsy for Asian. We prospectively recruited patients with localized PCa, located their significant tumors using MRI-transrectal ultrasound (TRUS) elastic fusion image-guided transperineal prostate biopsy and 12-cores transperineal systematic biopsy, and focally treated these regions in which the tumors were located in the prostate using HIFU. Patients' functional and oncological outcomes were analyzed prospectively. We treated 90 men (median age 70years; median PSA level 7.26ng/ml). Catheterization was performed within 24h after the treatment in all patients. Biochemical disease-free rate was 92.2% during 21months follow-up when use of Phoenix ASTRO definition. In follow-up biopsy, significant cancer was detected in 8.9% of the patients in un-treated areas. Urinary functions, including international prostate symptom score (IPSS) (P < 0.0001), IPSS quality of life (QOL) (P = 0.001), overactive bladder symptom score (OABSS) (P < 0.0001), EPIC urinary domain (P < 0.0001), maximum urinary flow rate (P < 0.0001), and IIEF-5 (P = 0.001), had significantly deteriorated at 1month after treatment, but improved to preoperative levels at 3 or 6months. Rates of erectile dysfunction and ejaculation who had the functions were 86% and 70%, respectively, at 12months after treatment. The present treatment for Asian would have similar oncological and functional outcomes to those in previous reports. Further large studies are required to verify oncological and functional outcomes from this treatment for patients with localized PCa.

Quality of life among patients with multiple sclerosis and voiding dysfunction: a cross-sectional study

BackgroundEvaluating the usefulness of treatment requires a direct measurement of the health-related quality of life (QOL). Therefore, this study was carried out aiming to determine the QOL of patients with MS and voiding dysfunction.MethodsThis cross-sectional study was carried out using multi-stage random cluster sampling method on 602 patients with MS in Isfahan, Iran. All data were collected through interviews using standard questionnaires including International Prostate Symptom Score (IPSS), and the Multiple Sclerosis Quality of Life-54 (MSQOL-54). Data were analyzed using descriptive and inferential statistical tests.ResultsThe prevalence rate of mixed, irritative, and obstructive urinary symptoms was 52.2, 25.5, and 6.5%, respectively. The mixed symptom had the highest prevalence among men and women with rates of 56.5 and 51.1%, respectively. The prevalence of irritative and obstructive symptoms was, respectively, higher and statistically significant among women alone and men alone (P < 0.05). The prevalence of irritative symptoms was higher among patients with MS, EDSS score ≤ 3, disease duration of less than 5 years, and with clinically isolated syndrome. In addition, the prevalence of mixed symptoms was higher among patients with MS of over 30 years of age with a Pre-high school degree, severe disability, disease duration of over 10 years, and progressive MS; the difference was statistically significant (P < 0.05). There was a difference in the combined dimensions of physical and mental health of QOL between the two groups with and without urinary symptoms (P < 0.05). Logistic regression analysis revealed that there was a higher probability of a urinary problems among patients with MS and high age [3.273 (1.083–9.860); P = 0.035].ConclusionsMixed urinary symptoms are highly prevalent among MS patients and affect QOL dimensions. In order to improve QOL, more attention and focus should be paid to urinary problems in MS patients.

Comprehensive Prospective Assessment of Patient-reported Outcomes Following Urethroplasty

ObjectiveTo better define patient-reported outcomes after urethroplasty. While urethroplasty is the most effective treatment for urethral stricture, the majority of outcomes are reported using surgeon-defined endpoints. MethodsPatients were enrolled in a prospective study evaluating patient-reported outcomes after urethroplasty from 2012 to 2018. A number of domains were assessed preoperatively and 6 months postoperatively using both validated and nonvalidated measures including satisfaction, voiding function, urinary quality of life, erectile/ejaculatory function, penile appearance/curvature, and genitourinary pain. ResultsOf 357 patients completing the study, mean age was 49.7 years with mean stricture length of 4.4 cm. Total 95.9% of patients were stricture-free on 6-month cystoscopy. Eighty percent of patients reported being satisfied with surgery, while 7.3% of patients were unsatisfied. Voiding function was globally improved after urethroplasty including International Prostate Symptom Score (19.3 vs 6.0; P < .0001), urinary quality of life (4.7 vs 1.6; P < .0001), postvoid dribbling (2.7 vs 2.5; P = .04), and sitting to void (2.4 vs 1.9; P < .0001). Additionally, genitourinary pain improved postoperatively (2.2 vs 1.6; P < .0001). Mean erectile function remained unchanged (17.7 vs 17.2; P = .46) but 12.0% of patients reported new onset erectile dysfunction. Reported ejaculatory dysfunction did not change significantly postoperatively (P = .13) but 7.1% of patients reported new ejaculatory dysfunction. Total 6.7% and 3.1% of patients complained of bothersome loss of penile length or curvature, respectively. ConclusionUrethroplasty improves voiding function and genitourinary pain associated with urethral stricture. While sexual function is preserved for the majority of patients, a small proportion of patients describe new onset erectile dysfunction, penile shortening or curvature and should be counselled accordingly.

PD61-03 EVEREST- I: ONE YEAR OPTILUME BPH CATHETER SYSTEM EFFICACY AND SAFETY EXPERIENCE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV (PD61)1 Apr 2020PD61-03 EVEREST- I: ONE YEAR OPTILUME BPH CATHETER SYSTEM EFFICACY AND SAFETY EXPERIENCE Steven Kaplan*, Merycarla Pichardo, Edwin Rijo, Ramon Rodriguez Lay, Gustavo Espino, and Rafael Estrella Steven Kaplan*Steven Kaplan* More articles by this author , Merycarla PichardoMerycarla Pichardo More articles by this author , Edwin RijoEdwin Rijo More articles by this author , Ramon Rodriguez LayRamon Rodriguez Lay More articles by this author , Gustavo EspinoGustavo Espino More articles by this author , and Rafael EstrellaRafael Estrella More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000978.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Data includes the initial 1 year EVEREST– I Study experience with the Optilume BPH Catheter System, with minimally invasive urethral prostatic balloon dilation, anterior commissurotomy and localized transfer of paclitaxel with a drug coated balloon (DCB) for treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). METHODS: The prospective non-randomized study included 5 Latin American centers and 49 subjects treated with the Optilume BPH Catheter. Follow-up (f/u) included Foley removal, 2 weeks, 1, 3, 6 and 12 months (mo) post dilation. Baseline transrectal ultrasound included prostate measurement to size DCB catheter. Primary endpoints included International Prostate Symptom Score (IPSS) improvement of ≥ 40% and major device or procedure related adverse events @ 3 mo. Secondary endpoints included 1) mean decrease of IPSS at each f/u, 2) change in peak urinary flow rate (Qmax) 3) change in post void residual urine volume (PVR) and 4) % of subjects with IPSS improvement ≥ 30, 40, 50, and 75%. RESULTS: 75.5% of subjects had IPSS improvement of ≥ 40% from baseline at 3 mo. Severe LUTS symptoms at baseline improved to mild or moderate. Average IPSS QOL improved through 12 mos. Qmax improved from 11 ml/sec at baseline to 19.4 ml/sec at 12 mo f/u. PVR decreased from 71.8 ml at baseline to 28.7 ml at 12 mos. BPH impact scores reported improved QOL through 12 mos. Prostatic DCB use had no significant effects on erectile function. One subject (2%) met the primary safety endpoint due to stress urinary incontinence. CONCLUSIONS: Results demonstrate significant subjective and objective improvement in LUTS 2° to BPH. These data serve as a gateway to a pivotal trial versus sham now underway. Long term efficacy and safety will determine the role of the Optilume BPH Catheter as a therapy option for BPH. Source of Funding: Urotronic © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1281-e1281 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Kaplan* More articles by this author Merycarla Pichardo More articles by this author Edwin Rijo More articles by this author Ramon Rodriguez Lay More articles by this author Gustavo Espino More articles by this author Rafael Estrella More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-07 USEFULNESS OF COMPUTER-AIDED DIAGNOSIS SYSTEM IN EVALUATING SEVERITY OF BENIGN PROSTATIC HYPERPLASIA, USING A SUPER-ELLIPSE MODEL TO CHARACTERIZE CHANGES IN PROSTATE CONTOURS

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP42)1 Apr 2020MP42-07 USEFULNESS OF COMPUTER-AIDED DIAGNOSIS SYSTEM IN EVALUATING SEVERITY OF BENIGN PROSTATIC HYPERPLASIA, USING A SUPER-ELLIPSE MODEL TO CHARACTERIZE CHANGES IN PROSTATE CONTOURS Sunao Shoji*, Yuka Shigenari, Izumi Hanada, Tatsuya Otaki, Takahiro Ogawa, Takahiro Ogawa, Masayoshi Kawakami, Hakushi Kim, Masanori Hasegawa, Yoshiaki Kawamura, Norihiro Koizumi, and Akira Miyajima Sunao Shoji*Sunao Shoji* More articles by this author , Yuka ShigenariYuka Shigenari More articles by this author , Izumi HanadaIzumi Hanada More articles by this author , Tatsuya OtakiTatsuya Otaki More articles by this author , Takahiro OgawaTakahiro Ogawa More articles by this author , Takahiro OgawaTakahiro Ogawa More articles by this author , Masayoshi KawakamiMasayoshi Kawakami More articles by this author , Hakushi KimHakushi Kim More articles by this author , Masanori HasegawaMasanori Hasegawa More articles by this author , Yoshiaki KawamuraYoshiaki Kawamura More articles by this author , Norihiro KoizumiNorihiro Koizumi More articles by this author , and Akira MiyajimaAkira Miyajima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000891.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the usefulness of a computer-aided diagnosis system (CAD) in evaluating the severity of benign prostatic hyperplasia (BPH) using a super-ellipse model to characterize changes in prostate contours. METHODS: We prospectively recruited 60 patients who were scanned with T2-weighted MRI (T2WI). A super-ellipse model was used to obtain structural features of their prostates. The super-ellipse shape can be characterized by parameter vector p= (lx, ly, r, sy, sq, xy, t, b) (Figure), and expressed by (x/ax)2/ɛ+(y/ay)2/ɛ=1. We used a learning algorithm in a support vector machine to learn the features of the prostate, and the BPH severity data, which included International Prostate Symptom Score (IPSS), IPSS quality of life (QOL), Over-Active Bladder Symptom Score (OABSS), maximum flow rate (ml/s), and residual urine volume (ml). We then analyzed the predictive effect of the learning model, from the structure of the prostate to BPH severity. RESULTS: To train the learning model, we used data from the T2WI and features of 20 patients, included 10 with severe BPH and 10 with normal prostates. The BPH severity of the other 40 patients were predicted from their T2WI, using the learning model; results were accuracy: 87.5%, precision: 84.6%, recall: 92.0% and F1 score: 88.0%. The area under curve for predicting BPH severity with the learned model was 0.98 (P<0.0001). However, classifying BPH severity was somewhat difficult due to similar features of prostates with different sizes. CONCLUSIONS: The present learning model can potentially predict BPH severity using the structural data from patients’ T2WI. However, scale information would be useful to predict with more high accuracy in addition to the learned model. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e605-e606 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunao Shoji* More articles by this author Yuka Shigenari More articles by this author Izumi Hanada More articles by this author Tatsuya Otaki More articles by this author Takahiro Ogawa More articles by this author Takahiro Ogawa More articles by this author Masayoshi Kawakami More articles by this author Hakushi Kim More articles by this author Masanori Hasegawa More articles by this author Yoshiaki Kawamura More articles by this author Norihiro Koizumi More articles by this author Akira Miyajima More articles by this author Expand All Advertisement PDF downloadLoading ...

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

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

Association between Inflammation and Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia.

To evaluate the association between inflammation in prostatic tissue/serum sample and BPH-LUTS Patients and methods: The prostatic tissue and serum sample were collected from 183 patients who underwent transurethral plasmakinetic resection of the prostate (TUPKRP). The association between inflammation detected on prostatic tissues/ serum sample and LUTS related parameters, including International Prostate Symptom Score (IPSS) and peak flow rate (Qmax) were analyzed with SPSS version 13.0, and P-value <0.05 was chosen as the criterion for statistical significance. There was a positive association between prostate tissue inflammation and LUTS. The differences of IPSS, VSS and SSS were seen with the increasing in grade of prostate tissue inflammation (P<.001; .001; =.014, respectively). Qmax and IPSS 12months after surgery were better in no inflammation group (P=.016; .031).Logistic regression analysis revealed a statistically association between the NEUT%?NLR and prostate tissue inflammation (P=.010; .004), but ROC curve showed the NEUT%, NEUT and NLR area under curve (.526; .452; .513, respectively) were calculated as <0.600. Patients with Qmax over 7.12 had more WBC count in peripheral blood (7.56±1.77 VS 6.37±1.86, P=.026). The NLR was significantly higher in the group of IPSS over 20 and AUR presence (P=.018; .017).The NEUT%, LYMPH%, LYMPH and NLR showed a statistically significance in different obstruction classification (P=.047; .046; .028; .014, respectively). There was correlation between chronic Inflammation and LUTS related to BPH. The patient without inflammation could acquire more sustained and steady relief than those with inflammation in LUTS related to BPH after TUPKRP.

Effect of transition zone index on the outcome after transurethral resection of prostate

Objective: To investgate the effect of properative transitional zone index (TZI) on the outcome of transurethral resection of prostate (TURP). Methods: A retrospective analysis was performed on 206 patients with TURP who were admitted to our hospital from January 2016 to September 2018. All patients underwent transrectal ultrasound (TRUS) to determine the total prostate volume (TPV) and the transition zone volume (TZV). Patients were divided into two groups according to TZI (TZV/TPV) (group A: TZI<0.5, group B: TZI≥0.5). We collected data 6-months after surgery including international prostate symptom score (IPSS), quality of life score (QOL), maximum flow rate (Qmax), and postvoiding residue (PVR) to compare the difference of the postoperative outcome of two groups, while the IPSS was subdivided into voiding (IPSS-v) and storage(IPSS-s) symptoms, and the changes of IPSS, IPSS-v, IPSS-s, QOL, Qmax and PVR before and after surgery were analyzed. The treatment efficacy was determined as the changes of IPSS (post/preoperative IPSS: %IPSS), QOL (preoperative QOL-postoperative QOL: ΔQOL) and Qmax(preoperative Qmax-postoperative Qmax: ΔQmax). Pearson linear correlation analysis was employed to estimate the correlation of TZI and %IPSS, ΔQOL and ΔQmax, respectively. Results: A total of 126 patients were in Group A, and 80 patients were in group B. 1. The preoperative clinical data of the two groups were compared. There were no significant differences regarding age, IPSS, IPSS-v, IPSS-s, QOL, Qmax, and PVR between two groups (all P>0.05). However, the TPV of patients in group B (74.57±29.25) ml was significantly larger than that in group A (46.25±24.56) ml, P<0.001. While the postoperative follow-up outcomes of the two groups were compared, we found that IPSS-s (P=0.079), QOL (P=0.710), and PVR (P=0.651) were not statistically different between the two groups, but the postoperative IPSS, IPSS-v, and Qmax (8.50±5.75 vs 6.38±4.36, 4.03±3.75 vs 2.63±2.5, and (16.54±4.43) ml/s vs (18.94±4.84) ml/s, all P<0.05) were significantly different between the two groups. 2. Postoperative IPSS, IPSS-v, IPSS-s, QOL, Qmax and PVR were significantly different from those before surgery in two groups, respectively. 3. Pearson linear correlation analysis showed a significant positive correlation between TZI and ΔQmax (r=0.32, P<0.01), a weaker negative correlation between TZI and %IPSS (r=-0.22, P<0.01), and no correlation between TZI and ΔQOL (r=0.08, P=0.238). Conclusion: There may be a correlation between the outcome of TURP and TZI, and the outcome of TURP may be better in patients with TZI ≥ 0.5.

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

Assessment of Return to Baseline Urinary and Sexual Function Following Primary Focal Cryotherapy for Nonmetastatic Prostate Cancer

BackgroundThe oncological outcomes in men with clinically significant prostate cancer following focal cryotherapy are promising, although functional outcomes are under-reported. ObjectiveTo determine the impact of focal cryotherapy on urinary and sexual function, specifically assessing return to baseline function. Design, setting, and participantsBetween October 2013 and November 2016, 58 of 122 men who underwent focal cryotherapy for predominantly anterior clinically significant localised prostate cancer within a prospective registry returned patient-reported outcome measure questionnaires, which included International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-15) questionnaires. InterventionStandard cryotherapy procedure using either the SeedNet or the Visual-ICE cryotherapy system. Outcome measurements and statistical analysisPrimary outcome was return to baseline function of IPSS score and IIEF erectile function (EF) subdomain. Cumulative incidence and Cox-regression analyses were performed. Results and limitationsProbability of returning to baseline IPSS function was 78% at 12 mo and 87% at both 18 and 24 mo, with recovery seen up to 18 mo. For IIEF (EF domain), the probability of returning to baseline function was 85% at 12 mo and 89% at both 18 and 24 mo, with recovery seen up to 18 mo. Only the preoperative IIEF-EF score was associated with a poor outcome (hazard ratio 0.96, 95% confidence interval 0.93–0.999, p = 0.04). The main limitation was that only half of the patients returned their questionnaires. ConclusionsIn men undergoing primary focal cryotherapy, there is a high degree of preservation of urinary and erectile function with return to baseline function occurring from 3 mo and continuing up to 18 mo after focal cryotherapy. Patient summaryIn men who underwent focal cryotherapy for prostate cancer, approximately nine in 10 returned to their baseline urinary and sexual function. Keeping in mind that level 1 evidence and long-term data are still needed, in men who wish to preserve urinary and sexual function, focal cryotherapy may be considered an alternative treatment option to radical therapy.

Evaluation of different MRI parameters in benign prostatic hyperplasia-induced bladder outlet obstruction

BackgroundBenign prostatic hyperplasia (BPH) is a common health problem faced by aging men and can be associated with bladder outlet obstruction (BOO). BPH patients usually suffer from lower urinary tract symptoms (LUTS) including obstructive and irritative urinary symptoms. The purpose of the current study was to clarify the correlation between MRI-derived prostate measurements and BPH-induced symptoms and findings including International Prostate Symptom Score (IPSS), uroflowmetry, and Postvoid residual urine (PVR).MethodsIn all, 34 patients (mean age was 58 ± 8 years, range 43 to 73 years) were examined by prostate MRI, uroflowmetry, postvoid residual urine, and fulfilled International Prostate Symptom Score questionnaire in this prospective study. The MRI-derived measurements including total prostate volume, transition zone volume, transition zone index, prostatic urethral angle, intravesical prostatic protrusion, and anterior fibromuscular stroma distance were correlated with International Prostate Symptom Score, uroflowmetry including maximum flow rate (Qmax) and Qmax grades, and postvoid residual urine using Pearson correlation coefficients (r) and multiple linear regression. Relationship between BPH types was correlated with the same parameters using one-way analysis of variance.ResultsWe found a strong significant correlation between total prostate volume, transition zone volume, and transition zone index with International Prostate Symptom Score, Qmax, Qmax grades, and postvoid residual urine; however, in multiple linear regression analysis, all of them were found to be significant parameters for International Prostate Symptom Score. Also, our study showed a strong significant correlation between anterior fibromuscular stroma distance and intravesical prostatic protrusion with International Prostate Symptom Score and postvoid residual urine; however, in multiple linear regression analysis, only intravesical prostatic protrusion was found to be a significant parameter for postvoid residual urine. Our results also revealed a significant correlation between BPH types with Qmax, Qmax grades, International Prostate Symptom Score, and postvoid residual urine.ConclusionSeveral MRI-derived prostate parameters (total prostatic volume, transition zone volume, transition zone index, prostatic urethral angle, intravesical prostatic protrusion, anterior fibromuscular stroma distance, and BPH types) correlating significantly with the International Prostate Symptom Score, uroflowmetry parameters (Qmax and Qmax grades), and postvoid residual urine.

Epidemic investigation of benign prostatic obstruction with coexisting overactive bladder in Shanghai Pudong New Area and its impact on the health-related quality of life

BackgroundWe aimed to investigate the prevalence, relative risk factors, and the impact on the health-related quality of life (HRQoL) of benign prostatic obstruction (BPO) with coexisting overactive bladder (OAB) in men aged over 50 and living in Shanghai Pudong New Area.MethodsUsing a multi-stage sampling and descriptive epidemiological method, 1632 men were selected from among the general population. Participants completed an evaluation of lower urinary tracts symptoms (LUTS), including international prostate symptom score (IPSS) and quality of life (QoL) questionnaires. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire. In addition, the Overactive Bladder Symptom Score (OABSS) and King’s health questionnaire (KHQ) were used to assess the impact of BPO with coexisting OAB on the HRQoL. Maximum flow rate (Qmax), postvoid residual urine volume (PVR) and prostate-specific antigen (PSA) were also recorded.ResultsA total of 1476 men with complete data were analyzed. The overall prevalence of BPO with coexisting OAB was 39.6%. Age and prostate volume were associated risk factors for BPO with coexisting OAB. In addition, BPO with coexisting OAB negatively impacted the HRQoL, with increased IPSS, QoL, OABSS, and KHQ scores and decreased IIEF-5 scores compared to that in patients with BPO without OAB.ConclusionsQmax, PVR and serum PSA did not predict whether the patients had a combined BPO + OAB or not. The prostate volume and age were associated risk factors for BPO with coexisting OAB. BPO is a progressive disease and may be one of the risk factors for OAB.

GreenLight Laser Enucleation of the Prostate (GreenLEP): Initial Experience with a Simplified Technique

ObjectiveTo present outcomes of a simplified GreenLight laser enucleation of the prostate (GreenLEP) technique and to inform urologists considering incorporation of enucleation into their practice. MethodsWe reviewed all consecutive GreenLEPs by a single surgeon from 2015 to 2018. Baseline patient characteristics, pre-enucleation prostate volume, enucleated adenoma weight, blood loss, lasering time, and energy utilized were recorded. Primary outcomes were urinary flow rate (uroflow) and postvoid residual. Secondary outcomes included International Prostate Symptom Score (IPSS) and prostate-specific antigen change. Primary and secondary outcomes were measured up to 3 years and compared using Student's t test. Adverse event and complication rates were recorded. ResultsOne hundred and eight patients underwent GreenLEP with mean follow up of 10.2 months. Statistically significant improvements were noted at 3 months in Qmax (237%, P <.01) and Qavg (227%, P <.01), with changes remaining durable through 2 years. Statistically significant improvements were noted at 3 months in International Prostate Symptom Score (−64%, P <.01), postvoid residual (−83%, P <.01), and prostate-specific antigen change (−77%, P <.01). Adverse event and complication rates were comparable to other published enucleation studies. Sexual activity was reported in 36% of patients, all of whom reported retrograde ejaculation. Patients experienced dysuria (6%), stress urinary incontinence (6%), urge urinary incontinence (16%), urethral stricture (6%), bladder perforation (n = 2), prostatic capsular perforation (n = 1), and ureteral injury (n = 1). ConclusionSimplified GreenLEP shows effective and durable results with an acceptable adverse event and complication profile. This technique is optimal for novice enucleators familiar with photoselective vaporization.

Prostate Artery Embolization for Lower Urinary Tract Symptoms in Men Unfit for Surgery.

Nearly one in three men develop lower urinary tract symptoms (LUTS) and 10% clinically progress despite medication. Transurethral resection of the prostate (TURP) is the reference standard for symptoms refractory to medical treatment. However, some patients cannot tolerate TURP for medical (e.g., comorbidity) or technical (e.g., large prostate) reasons. This study estimated the safety and effect of prostate artery embolization (PAE) in men unfit for surgery. A prospective, single-centre trial including men with LUTS or urinary retention secondary to benign prostatic hyperplasia (BPH) who were unfit for surgery. The primary objective was to treat urinary retention and LUTS. Outcome measures included International Prostate Symptom Score (IPSS), quality of life (IPSS-QoL), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate-specific antigen (PSA), peak void flow (Qmax), post-void residual (PVR), and complications. A p-value < 0.05 was considered statistically significant. Eleven consecutive patients with a mean age of 75.2 (SD ± 8.2) underwent PAE. Catheter removal was successful in 60%. IPSS-QoL improved 4.5 points (95% CI: −5.6; −3.4), and PV was reduced by 26.2 cm3 (95% CI: −50.9; −2.3). None of the remaining outcomes changed. No major complications occurred. PAE was effective and safe for LUTS and urinary retention associated with BPH in men unfit for surgery.

04:21 PM Abstract No. 130 The utility of CO2 angiography in identifying the origin of the prostatic artery during prostate artery embolization

Patients with BPH-induced obstructive uropathy often present with renal failure, thus precluding them from undergoing PAE due to the risk of iodinated contrast-induced nephropathy. The purpose of this study was to assess the utility of CO2 angiography in identifying the origin of the prostatic artery during PAE. From November 2015 to September 2018, 50 patients (mean age 69.6±9.2), who presented with BPH (n=42), prostate or bladder cancer (n=7), or urothelial trauma (n=1), underwent PAE with analysis of 74 total hemi-pelvises. Indications for PAE included LUTS (n=19), urinary retention (n=17), and hematuria (n=14). After obtaining femoral or radial access, 20cc of CO2 was first selectively injected to visualize the hemi-pelvic vasculature either unilaterally or bilaterally, followed by iodinated-contrast angiography to verify the prostatic artery origin prior to embolization. PAE was then performed by selective embolization of the prostatic artery. The primary endpoint was successful identification of the origin of the prostatic artery with CO2, verified by iodinated contrast. Secondary endpoints included International prostate symptom score (IPSS), Sexual health inventory for men (SHIM) score, and prostate size before and after PAE. CO2 angiography identified the origin of the prostatic artery in 54/74 hemi-pelvises (73.0%). Successful PAE was demonstrated by an average decrease in prostate volume from 187.4cc to 96.9cc (p<.05), a decrease in IPSS from 22.5 to 6.9 (p<.05), and an increase in SHIM score from 13.0 to 16.5 (p<.05), with a mean follow up of 3.4 months. CO2 angiography was able to successfully identify the prostatic artery in the majority of patients undergoing PAE. Therefore, CO2 may be a particularly beneficial contrast medium for PAE in patients where standard agents are contraindicated or ill-advised, such as those with BPH-induced obstructive uropathy. The goal of this study is to ultimately broaden the patient population for which PAE is a viable treatment option and suggest improvement of the technique.

Lower Urinary Tract Symptoms Following Transurethral Resection of Prostate.

Transurethral resection of the prostate (TURP) is the standard surgical therapy for lower urinary tract symptoms (LUTS) due to prostatic enlargement. Following TURP, LUTS may persist in a proportion of patients. Persistent LUTS necessitates proper evaluation and management. In this review, we sought to describe the prevalence, pathophysiology, and predictors of LUTS following TURP, as well as the recommended evaluation and management. Among the different techniques utilized for TURP, the prevalence of postoperative LUTS is similar. The chronically obstructed bladder has been shown to vary in its expression of collagen, tissue factors, and receptors when compared to the normal bladder which could contribute to the pathophysiology of LUTS after TURP. Although androgen receptors exist in the urinary epithelium, the role of sex hormones in LUTS remains obscure. GreenLight laser can lead to postoperative irritative voiding symptoms as a result of tissue necrosis. A large proportion of patients have persistent LUTS following TURP, with similar incidences between different techniques that can be used to perform TURP. LUTS after TURP should be evaluated with a thorough history and physical, including International Prostate Symptom Score, and urine culture to rule out infection. Noninvasive uroflow, post-void residuals, and subsequent urodynamic study or cystoscopy can be utilized as needed. Further research is necessary to be able to more precisely predict the patients who will experience no improvement in or worsening of LUTS following TURP.

Safety and efficacy of Transurethral Bipolar Enucleation of prostate (TUBE) in BPH

Objectives: To evaluate the safety and efficacy of transurethral bipolar enucleation of the prostate due to benign prostatic hyperplasia. Methods: This is a prospective study and 37 patients undergoing Transurethral bipolar enucleation of the prostate (TUBE) for BPH will be taken for the study. Preoperative factors evaluated included International Prostate Symptom Score (IPSS), postvoid residual volume (PVR), estimated blood loss, operative time, pathologic weight, and complications. Postoperative evaluation was performed at 1month, 6 months and 12months. Results: Preoperative, 1 month, 6 months, and 12 months mean postvoid residual volumes were 235 mL, 33.6 mL, 20 mL and 20 mL; mean IPSS were 31.6, 2.97, 2.97 and 2.97; mean Q max was 5.8ml/sec, 20.23ml/sec,25.5ml/sec, and 25.5ml/sec; preoperative and post operative mean quality of life scores were 5.4 and 2.2; mean operative time was 87.5 minutes. Hemoglobin drop was 0.6g/dl, and pathologic weight was 45.45 g. 10 patients underwent partial enucleation. Early stress incontinence occurred in 9 patients (24.3%).Urinary tract infection occurred in 1 patient, and Superficial mucosal bladder injury in 1 patient. Conclusions: International Prostate Symptom Score, quality of life, Qmax, and postvoid residual volume (PVR) showed statistically significant improvements from baseline. TUBE is a safe, effective, and reproducible procedure for BPH.

Thulium (Tm:YAG) laser vaporesection of prostate and bipolar transurethral resection of prostate in patients with benign prostate hyperplasia: a systematic review and meta-analysis.

Thulium laser vaporesection (ThuVARP) and bipolar transurethral resection of the prostate (B-TURP) are novel surgeries for benign prostate hyperplasia (BPH). This paper is a systematic review and analysis of literatures comparing efficacy indicators, operative parameters, as well as safety indicators between ThuVARP and B-TURP for the treatment of BPH. A systematic search of electronic databases, including PubMed, the Cochrane Library, Web of Science, Embase, and China National Knowledge Internet (CNKI), was carried out up to December 1, 2015 (updated on March 1, 2016). The captivating outcomes included basic clinical characteristics, perioperative parameters, local complications, and efficacy indicators which included International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR). After assessing the quality of methodology and extracting data, a meta-analysis was carried out by using STATA 12.0 software. Five studies involving 500 patients met the standard. The outcomes of this analysis were as follows: (a) efficacy indicators: there were no significant differences in IPSS, QoL, PVR, and Qmax between the two groups (all P > 0.05); (b) perioperative indicators: ThuVARP had longer operative time [standardized mean difference (SMD) = 0.843; 95% confidence interval (CI) - 0.391, 1.296; P < 0.001] but less serum hemoglobin decreased (SMD = - 0.561; 95% CI - 0.796, - 0.327; P < 0.001), shorter hospital stay (SMD = - 1.558; 95% CI - 2.709, - 0.407; P < 0.01), and catheterization time (SMD = - 1.274; 95% CI - 2.158, - 0.390; P < 0.01). Additionally, no significant difference was found in estimated resected weight (P > 0.05); (c) safety indicators: no significant difference was found in local complication rates (all P > 0.05) between ThuVARP and B-TURP. In our analysis, there exists no statistical difference between ThuVARP and B-TURP group in efficacy. However, in spite of requiring longer surgical time, ThuVARP was better in terms of less blood loss as well as shorter hospitalization and catheterization time.

Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis.

To compare the efficacy and safety of thulium laser VapoResection of the prostate (ThuVaRP) versus standard traditional transurethral resection of the prostate (TURP) or plasmakinetic resection of prostate (PKRP) for benign prostatic obstruction. Systematic searches were performed in the Medline, EMBASE, the Cochrane Library, Web of Science, and CNKI in December 2017. The outcomes of demographic and clinical characteristics, perioperative variables, complications, and postoperative efficacy including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR) were assessed. 16 studies were selected in the meta-analysis including nine randomized controlled trials (RCTs) and seven non-RCTs. Among of them, nine studies compared ThuVaRP with PKRP, while seven studies compared ThuVaRP with TURP. It seemed that ThuVaRP needed longer operation time than TURP (WMD = 6.41, 95% CI 1.38-11.44, p = 0.01) and PKRP (WMD = 10.15, 95% CI 5.20-15.10, p < 0.0001). ThuVaRP was associated with less serum hemoglobin decreased, catheterization time, and the length of hospital stay compared with TURP (WMD = - 0.58, 95% CI - 0.77 to 0.38, p < 0.00001; WMD = - 1.89, 95% CI - 2.67 to 1.11, p < 0.00001; WMD = - 2.25, 95% CI - 2.91 to 1.60, p < 0.00001) and PKRP (WMD = - 0.28, 95% CI - 0.46 to 0.10, p = 0.002; WMD = - 1.88, 95% CI - 2.87 to 0.89, p = 0.0002; WMD = - 2.08, 95% CI - 2.63 to 1.54, p<0.00001). According to our assessment, there was no significantly difference in postoperative efficacy. The pooled data indicated that ThuVaRP had a nearly efficacy to TURP and PKRP based on IPSS, QoL, Qmax, and PVR. Although ThuVaRP was associated with longer operation time, it got distinct superiority on serum hemoglobin decreased, catheterization time, and hospital stay.

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.