Including International Prostate Symptom Score Research Articles

The efficacy and safety of prostatic urethral lift as a minimally invasive therapeutic modality to treat lower urinary tract symptoms while maintaining sexual function in patients with benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials.

Benign prostatic hyperplasia (BPH) is prevalent among elderly men, necessitating focused attention. The Prostatic Urethral Lift (PUL) procedure, a minimally invasive intervention, has emerged as a promising option for BPH management. It has shown remarkable results in ameliorating lower urinary tract symptoms (LUTS), enhancing quality of life, and preserving sexual function. This study aims to evaluate the effectiveness and safety of PUL in BPH patients. Key databases (MEDLINE, Cochrane CENTRAL, ScienceDirect, EBSCO, Google Scholar) were systematically searched using pertinent terms related to PUL and BPH. Following the PRISMA checklist, we considered only randomized controlled trials (RCTs) from 2013 to 2023. The assessment focused on LUTS, quality of life, sexual function, and adverse events within three months. Follow-up post-treatment mean values compared with controls (Sham) and the improvement from baseline to post-treatment follow-up duration were considered. Statistical analysis and risk of bias evaluation were conducted using Review Manager 5.4.1, presenting results as difference of mean values (MD) and risk ratios (RR). A meta-analysis with a Random Effects Model of 7 RCTs involving 378 confirmed BPH patients demonstrated significant improvements in the PUL arm including International Prostate Symptom Score (IPSS) (MD 5.51, p<0.0001), maximum urinary flow rate (Qmax) (MD 2.13, p=0.0001), BPH Impact Index (BPHII) (MD 2.14, p=0.0001), and IPSS-QoL (MD 1.50, p<0.0001), without significant increase of adverse events (RR 1.51; p=0.50). Positive outcomes were observed in sexual function variables and post-void residual measurements when post-treatment values were compared to baseline. PUL holds advantages over control interventions, providing encouraging prospects for BPH management. This study underscores the need for further exploration of PUL's efficacy and safety in BPH patients.

Day case Rezum™ water vapour therapy for urinary retention secondary to benign prostatic hyperplasia

Objectives: Rezum (Boston Scientific) water vapour therapy is an effective day case minimally invasive surgical treatment (MIST) for men with troublesome lower urinary tract symptoms (LUTSs) due to benign prostatic obstruction. The potential place for MISTs in the treatment of patients with urinary retention or permanent catheter dependence is currently unclear. Patients and Methods: A total of 48 patients presenting with retention of urine (out of a total of 524 patients) over a 4-year period from 2017 underwent Rezum treatment. All patients were followed up at 3, 6 and 12 months after the procedure. At each visit, flow rate, post void residual urine, and patient reported outcome measures (PROMs) including International Prostate Symptom Score (IPSS) were recorded. Results: A total of 34 patients had an indwelling catheter prior to treatment and 14 were self-catheterising. The mean age was 67 years (standard deviation (SD) = 3) with a mean prostate volume of 56 mL (SD = 6). The average number of injections per case was 8 (SD1), which included median lobe (ML) treatment in one man. 75% of the patients passed their post treatment trial without catheter (TWOC). IPSS improved to 6 ( p = 0.001) in 12 months. Conclusion: The results from this cohort of patients are encouraging. Further evaluation with longer follow-up is required. The addition of MISTs to the portfolio of options for men with retention of urine may offer a streamlined and efficient alternative to the conventional treatments, and help therefore to reduce the national waiting list, and allow men a more rapid solution avoiding prolonged catheterisation. Level of evidence: Not applicable.

(210) Four-Year Surgical and Sexual Function Outcomes of Rezum Therapy Across a Broad Range of Prostate Volumes

Abstract Introduction Benign prostatic hyperplasia (BPH) often leads to the development of lower urinary tract symptoms (LUTS), which can result in significant deterioration in quality of life (QoL). Rezum therapy has demonstrated efficacy in alleviating LUTS secondary to BPH across a broad range of prostate volumes (PVs). However, there is a scarcity of long-term real-world data on Rezum outcomes across a wide range of PVs. Objective To evaluate surgical and sexual function Rezum outcomes over a 4-year period in patients with PVs &amp;lt;30cc, 30-80cc, or &amp;gt;80cc. Methods A retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were stratified into three cohorts based on PV: &amp;lt;30cc, 30-80cc, or &amp;gt;80cc. Outcome measures, including International Prostate Symptom Score (IPSS), QoL, International Index of Erectile Function (IIEF)-Erectile and Orgasmic function, maximum urinary flow rate (Qmax), BPH medication usage, adverse events (AEs), and decisional regret scores were collected and compared at baseline and 1-, 3-, 6-, 12-, and/or 48-months follow-up. Results A total of 252 patients were analyzed, with 35 (13.9%), 196 (77.8%), and 21 (8.3%) patients in the 30cc, 30-80cc, and &amp;gt;80cc cohorts, respectively. The &amp;gt;80cc cohort was significantly older (66.9 years [8.1]) than the &amp;lt;30cc cohort (63.4 years [8.5], p = 0.02). The &amp;lt;30cc cohort had a significantly higher baseline IPSS (21 [15-28]) and QoL (5 [4-6]) than the 30-80cc (IPSS 17 [10-23], p = 0.003; QoL 4 [3-5], p=0.02) and &amp;gt;80cc (IPSS 16 [6.5-22.5], p = 0.01; QoL 4 [3-5], p = 0.006) cohorts. The number of injections utilized per lateral prostatic lobe significantly increased with PV (&amp;lt;30cc: 1 injection [0-1] vs 30-80cc: 2 injections [1-2] vs &amp;gt;80cc: 3 injections [2-3.5], p &amp;lt; 0.001). When compared to baseline, the combined cohort saw significant percent changes at 48-months in IPSS (-70.6%, p &amp;lt; .001), QoL (-80%, p &amp;lt; .001), and Qmax (52%, p = 0.003). Within each PV cohort, significant improvements in IPSS and QoL were found at all follow-ups when compared to baseline. Qmax improvements were significant only in the 30-80cc cohort at all follow-ups. There were no significant differences in percent changes in IPSS, QoL, or Qmax between cohorts at 3-, 6-, 12-, or 48-months when compared to baseline. The &amp;lt;30cc and 30-80cc cohorts had significant decreases in BPH medication usage as early as 3-months that remained durable through 48-months (all p &amp;lt; 0.05). The &amp;gt;80cc cohort experienced a significant decrease in BPH medication usage at 3-months but it did not remain durable to 12- or 48-months. No significant differences in postoperative AEs or decision regret scores were observed between cohorts. There were no significant changes in erectile function and orgasmic function at 12-months within cohorts. No significant differences were found in 48-months reoperation rates between the &amp;lt;30cc, 30-80cc, and &amp;gt;80cc cohorts (0% vs 4.9% vs 5%, p = 0.49). Conclusions Rezum effectively improved LUTS secondary to BPH irrespective of PV, with improvements being durable over 4 years. However, patients with PVs &amp;gt;80cc should be counseled on the possibility of continuing their BPH medications following treatment. Disclosure No.

Comparison of the Efficacy of Low Dose Tadalafil with Tamsulosin against Lower Urinary Tract Symptoms and Sexual Dysfunction after Low Dose Rate Prostate Brachytherapy.

Patients with clinically localized prostate cancer (PCa) can be curatively treated with different modalities, including low dose rate (LDR) prostate brachytherapy (PB). LDR-PB allows the patient a relatively short recovery time compared with other treatment modalities such as prostatectomy. However, PB might exert distinct impact on quality of life, lower urinary tract symptoms (LUTS) and sexual dysfunction (SD) are two major concerns. The aim of present study was to assess prospectively the efficacy of low dose tadalafil treatment on both SD and LUTS compared with tamsulosin treatment in patients treated PB for localized PCa. Patients scheduled for PB with I-125 seeds for low or intermediate-risk localized PCa at our institution were eligible for this study. The prescribed dose was set at 160 gray. Participants were randomized into two groups; those started treating with a daily use of 0.2 mg of tamsulosin hydrochloride or 5 mg of tadalafil just after PB. The duration of the study was 12 months and the patients were assessed for urinary and sexual function status at baseline, and 1, 3, 6, and 12 months after PB. The primary study endpoints were both changes from baseline in urinary and sexual function status. Between July 2015 and August 2020, 120 participants were enrolled in this study. The median age was 68 years with the median PSA of 6.5 ng/ml. A total 15 patients were excluded within 6 months after randomization. All subjective LUTS findings, including International Prostate Symptom Score (IPSS), and Over Active Bladder Symptom Score (OABSS), were significantly deteriorated at 1, 3, and 6 months after PB compared with baseline in both groups, respectively (p<0.05). Among objective LUTS findings, a significant decrease in maximum urinary flow rate (Qmax) was found at 1, 3, 6, and 12 months after PB compared with baseline in both groups, respectively (p<0.05). A significant increase in post void residual urine (PVR) was found at 1, 3, and 6 months after PB compared to baseline in tadalafil group, whereas no significant increase was seen in tamsulosin group. There were no statistically significant differences between the 2 groups in scores of the total International Index of Erectile Function (IIEF)-15 and Erection Hardness Score (EHS) before and at 1 month post PB. The EHS was significantly higher in tadalafil group compared with tamsulosin group at 3, 6 and 12 months (p = 0.001, p = 0.004, and p = 0.019, respectively). The EHS after PB in tadalafil group was not significantly decreased from baseline. After LDR-PB, tamsulosin treatment significantly decreased PVR compared with tadalafil. On the other hand, tadalafil contributed to maintain erection hardness compared with tamsulosin.

(288) Risk Factors and Real-World Short-Term Outcomes of a Failed Trial of Void After Rezum in a Multiethnic Population

Abstract Introduction A failed trial of void (TOV) following surgery for benign prostatic hyperplasia (BPH) predisposes patients to have trouble voiding, increases hospital stays and office visits, and increases detrusor muscle injury due to bladder over-distention. Rezum is a minimally invasive surgical therapy that utilizes convective radiofrequency water vapor thermal energy to ablate obstructive lobes of the prostate, resulting in improvement in lower urinary tract symptoms (LUTS) secondary to BPH. Identifying risk factors for a failed Rezum TOV can help identify a group of BPH patients who may need to be counseled preoperatively for an increased risk of postoperative urinary retention and therefore have their period of postoperative catheterization extended. Objective The purpose of the study was to identify risk factors for a TOV following Rezum and assess the impact of a failed TOV on real-world short-term outcomes. Methods A single office, retrospective study was conducted on patients treated with Rezum between December 2017 and October 2019. Patients were included if they had a follow-up for catheter removal after Rezum. Patients were excluded if they were in urinary retention requiring catheterization on the day of the procedure. A urinary catheter was placed in all patients following treatment. Demographic data and outcome measures, including International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF)-Erectile and -Orgasmic function, maximum urinary flow rate (Qmax), postvoid residual (PVR), and adverse events were analyzed at baseline, 1-, 3-, and/or 6-months postoperatively. Risk factors were identified through multivariate logistic regression analyses. Results A total of 289 patients were included, with the majority being Asian (36.0%), followed by non-Hispanic Black (28.7%), Hispanic (22.5%), and non-Hispanic White (12.8%). Thirty-five patients (12.1%) failed their TOV while 254 (87.9%) had a successful TOV. All patients were given a TOV after a median of 5 days (4-5). Those who failed their TOV spent a mean of 13.7 days (SD: 13.3) with a catheter. Patients who failed their TOV were more likely to get a urinary tract infection (20.0% vs. 4.7%, p 200 ml failed their TOV (40.0%) when compared to patients with a baseline PVR &amp;lt;200 ml (10.9%, p=0.008). Conclusions Following Rezum, approximately 1 in 8 patients were not able to pass their initial TOV. Baseline PVR was the only independent risk factor for a failed TOV. Nevertheless, all patients experienced significant relief in LUTS with preservation of sexual function. Patients with large baseline PVR, particularly &amp;gt;200 ml, should be counseled on possibly failing their TOV and requiring a catheter for an extended period. These patients should also be counseled on alternative BPH treatment options for which they may be a better candidate for. Disclosure No

PD35-08 4 YEARS OF THE OPTILUME® DRUG COATED BALLOON FOR RECURRENT ANTERIOR URETHRAL STRICTURES: A SUMMARY OF ROBUST I, II AND III

You have accessJournal of UrologyCME1 Apr 2023PD35-08 4 YEARS OF THE OPTILUME® DRUG COATED BALLOON FOR RECURRENT ANTERIOR URETHRAL STRICTURES: A SUMMARY OF ROBUST I, II AND III Rachel Mann, Jessica Delong, Ramon Virasoro, and Sean Elliott Rachel MannRachel Mann More articles by this author , Jessica DelongJessica Delong More articles by this author , Ramon VirasoroRamon Virasoro More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Optilume Drug Coated Balloon has been studied in three clinical investigations (ROBUST I, II and III). ROBUST I was the first in man trial conducted as a single arm, prospective multicenter study in Latin America (4 sites, 53 subjects) followed by ROBUST II assessing early feasibility (5 sites, 15 subjects), and ROBUST III, the randomized pivotal trial (79 Optilume). Optilume data combined from all three studies are presented here. METHODS: A total of 148 subjects were treated with Optilume in ROBUST I, II and III in Latin America, Canada, and the United States. Men with strictures ≤ 3cm and 1-4 prior endoscopic interventions were treated with Optilume. Follow-up was completed at 3 months, 6 months and annually thereafter. All studies were designed to follow subjects through 5 years with Robust I at 4-year follow-up, Robust II at 3-year follow-up and Robust III at 2-year follow-up, currently. Outcomes included International Prostate Symptom Score (IPSS), quality of life, freedom from reintervention, erectile function, flow rate, and post-void residual volume. Subjects receiving secondary treatment were considered failures. The safety endpoint assessed serious urinary events. RESULTS: At the time of this abstract submission, IPSS improved in all patients treated with Optilume from 22.5 at baseline to 7.8 at 4 years. Peak urinary flow rate (Qmax) had a sharp improvement and was sustained through follow-up in all trials (7.1 to 14). Freedom from repeat intervention is approximately 73% at 4 year follow-up (Figure 1). Results will be updated at the time of the presentation. CONCLUSIONS: Subjects with recurrent bulbar strictures treated with Optilume® paclitaxel-coated balloon exhibited significant improvement in symptomatic and functional outcomes through 4 years post treatment with demonstrably improved recurrence rates. There was no impact on erectile function and there were no serious adverse events. Source of Funding: Urotronic © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e977 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Mann More articles by this author Jessica Delong More articles by this author Ramon Virasoro More articles by this author Sean Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Emergency holmium laser enucleation of the prostate (HoLEP): a novel approach in the management of refractory hematuria for patients with benign prostatic hyperplasia (BPH): a single-institution experience.

Refractory hematuria secondary to prostatic disease typically resolves with conservative management; however, this condition may require hospitalization with extensive measures to control life-threatening bleeding. The aim of this study was to report our experience using holmium laser enucleation of the prostate (HoLEP) as an emergency treatment in this clinical setting. We conducted a retrospective review of all patients that presented to the emergency department with refractory hematuria of prostatic origin from October 2017 to September 2021, for whom hospitalization and conservative management failed to control bleeding. All emergency HoLEP procedures were performed by a single surgeon. Preoperative and intraoperative parameters, as well as perioperative outcomes, were collected and analyzed. Postoperative outcomes included duration of foley catheterization, length of postoperative hospital stay, and hospital readmissions. A total of 40 emergency HoLEP procedures were performed. Our cohort had a median prostate volume of 110.5cc and a median resected weight of 81g. Twenty-seven patients (67.5%) were on anticoagulant or antiplatelet medications on admission. The urethral catheter was removed within 1day in 95% of patients with a successful trial of void (TOV). Moreover, 92.5% of patients were discharged home within 24h of their procedure. Two patients (5%) experienced clot retention within one-week post-discharge with a 2.5% overall readmission rate. All postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and post-void residual volume (PVR), showed significant improvement at 1year follow up. Our experience demonstrates that emergency HoLEP is an effective treatment option for patients with refractory hematuria of prostatic origin. Further studies are warranted to consolidate our results.

Association between interleukin-6 and lower urinary tract symptoms of benign prostatic hyperplasia

ObjectiveTo evaluate the association between IL-6 in prostatic tissue/blood sample and BPH-LUTS, so as to preliminarily discover an indicator of inflammation that could show the severity of LUTS. Patients and methodsThe prostatic tissues and blood samples were collected from 56 patients who underwent transurethral plasmakinetic resection of the prostate (TUPKRP). The association between IL-6 detected on prostatic tissues/blood sample and LUTS parameters, including international prostate symptom score (IPSS), peak flow rate (Qmax) and urodynamic parameters were analyzed with SPSS version 18.0, and p-value <0.05 was chosen as the criterion for statistical significance. ResultsThe TPSA and prostate volume (PV) were found to be higher in the inflammation group (p=0.021, 0.036). There was a positive association between prostate tissue inflammation and LUTS ([IPSS, storage symptoms score (SSS), voiding symptoms score (VSS), p<0.05], [Qmax, p=0.025], [obstruction, p=0.027] and [AUR, p=0.018]). The level of serum IL-6 was significantly higher in inflammatory group (p=0.008). However, no differences were observed in different degrees of inflammation (p=0.393). The level of IL-6 in prostatic tissue significantly increased with the degree of inflammation (p<0.001), and the intensity of IL-6 expression was statistically correlative with the degree of inflammation (p<0.001). The IL-6 expression in prostatic tissue was statistically relevant with IPSS (p=0.018) and SSS (p=0.012). ConclusionIL-6 expression in prostatic tissue is associated with storage IPSS, suggesting chronic inflammation might contribute to storage LUTS.

806 The Efficacy of Prostatic Arterial Embolisation as Indicated by Clinical Outcomes

Abstract Aim PAE (prostatic arterial embolisation) is a non-surgical, minimally invasive procedure used to treat symptoms of benign prostatic hyperplasia (BPH). It is used to treat patients with moderate to severe lower urinary tract symptoms including those requiring long term urinary catheter placement and intermittent self-catheterisation. The incidence of urinary tract infection is greater in this group at baseline and the risk of infection as a complication of PAE is recognised in the literature. This study aimed to compare the clinical outcomes of PAE to those of TURP (transurethral resection of the prostate), the reference standard for BPH treatment. Method All patients who underwent PAE between 2019 to 2021 at a single centre were included in this retrospective study. Clinical outcomes of patients were also recorded including international prostate symptom score (IPSS) and urodynamic results. These were compared to TURP results provided in the UK ROPE study. Results 82% of patients experienced an improved IPSS after PAE, with a median reduction of 15 points, compared with a median reduction of 17 points with TURP. PAE caused a greater reduction in median prostate volume but proved to be less effective in improving urodynamic test results when compared to TURP. Conclusion While still clinically effective, PAE is less effective for treatment of lower urinary tract symptoms from BPH when compared to TURP.

DIODE LASER ABLATION OF PROSTATE VERSUS MONOPOLAR TRANSURETHRAL ELECTRO-RESECTION OF PROSTATE FOR TREATING SYMPTOMATIC BPH: A PROSPECTIVE STUDY

Background: Benign prostate hyperplasia (BPH) can be treated with endoscopic urological procedures, which includes both laser ablation of prostate and transurethral resection of the prostate (TURP). Objective: To determine the advantages and disadvantages of using diode laser procedure in treating patients with BPH in contrast to TURP treatment. Methods: In a prospective non-randomized study at a single center, 40 patients presenting with symptoms of lower urinary tract symptoms attributable to BPH between the ages of 50 to 90 years were enrolled from November 2014 to June 2015. TURP was used in Group A, and transurethral laser ablation of prostate (TULAP) was used in Group B. Outcomes, including International Prostate Symptom Score (IPSS) and higher maximum flow rate (Qmax) were compared at 3 months. Results: At 3 months, patients treated with TULAP had a significantly Qmax than those treated with TURP (p&lt;0.001). There was a significantly lower hospital stay for BPH patients treated with the TULAP technique (p&lt;0.001). Patients treated with the TULAP procedure had a significantly shorter catheter time (p=0.001). There was a non-significant difference in procedure time between the two methods (p=0.2). There was a significant increase in prostate-specific antigen (PSA) among those treated with the TURP technique (p=0.01). Conclusion: Lower urinary tract problems induced by BPH can be successfully treated by diode laser ablation of prostate. Our findings suggest that diode laser is reliable and efficient when patients are carefully chosen for surgery. Keywords: BPH, Ablation of Prostate, TULAP, TURP Citation: Sami AKM, Bajalan DH. Diode laser ablation of prostate versus monopolar transurethral electro-resection of prostate for treating symptomatic BPH: A prospective study. Iraqi JMS. 2022; 20(1): 26-34. doi: 10.22578/IJMS.20.1.4

MP29-07 FIVE-YEAR OUTCOMES AFTER AQUABLATION COMPARED TO TURP: THE FINAL WATER STUDY RESULTS

You have accessJournal of UrologyCME1 May 2022MP29-07 FIVE-YEAR OUTCOMES AFTER AQUABLATION COMPARED TO TURP: THE FINAL WATER STUDY RESULTS Peter Gilling Peter GillingPeter Gilling More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare five-year 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 (Qmax). RESULTS: The primary safety endpoint was successfully achieved at 3 months where the Aquablation group had a lower event rate compared to TURP (26% vs. 42%, p=.0149 for superiority). The rate of persistent grade 1 events (all of which were retrograde ejaculation) at month 3 was lower (7% vs. 25%, p=.0004) after Aquablation and the rate of grade 2 and above events was similar across groups (20% for Aquablation vs. 23% for TURP, p=.3038). The primary efficacy endpoint was successfully achieved at 6 months where the mean IPSS decreased from baseline by 16.9 points for Aquablation and 15.1 points for TURP; the mean difference in change score at 6 months was 1.8 points larger for Aquablation (p<.0001 for non-inferiority, p=.1346 for superiority).At five years, IPSS scores improved by 15.5 points in the Aquablation group and 13.5 points in TURP (p=.3768, 95% CI for difference -6.4 to 2.5 points). Improvements in maximum flow rate (Qmax) were large in both groups at 10.4 and 9.0 cc/sec for Aquablation and TURP, respectively (p=.9078, 95% CI for difference -4.3 to 7.0). PSA was reduced in both groups; the change in PSA at month 60 did not differ across groups (p=.9460). CONCLUSIONS: Aquablation data at five years has been shown to be durable and consistent across all years of follow-up and comparable to TURP. Retrograde ejaculation rates were less for Aquablation. *On behalf of WATER study investigators. Source of Funding: PROCEPT BioRobotics © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e471 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Gilling More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP29-10 AQUABLATION IN VERY LARGE PROSTATES (&gt;150ML): TECHNIQUE AND MULTICENTER CASE SERIES

You have accessJournal of UrologyCME1 May 2022MP29-10 AQUABLATION IN VERY LARGE PROSTATES (>150ML): TECHNIQUE AND MULTICENTER CASE SERIES Alexander Glaser, Brian Helfand, Ali Kasraeian, Steve Sterious, Pooja Talaty, Miguel Alcantara, Kaitlyn Alcantara, Andrew Higgins, Eric Ghiraldi, and Dean Elterman Alexander GlaserAlexander Glaser More articles by this author , Brian HelfandBrian Helfand More articles by this author , Ali KasraeianAli Kasraeian More articles by this author , Steve SteriousSteve Sterious More articles by this author , Pooja TalatyPooja Talaty More articles by this author , Miguel AlcantaraMiguel Alcantara More articles by this author , Kaitlyn AlcantaraKaitlyn Alcantara More articles by this author , Andrew HigginsAndrew Higgins More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , and Dean EltermanDean Elterman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aquablation has been well-studied in men with prostate volume (PV) <150ml. AUA guidelines distinguish surgical interventions for men with large prostates (80-150ml) and very large prostates (>150ml). In this study, we describe the technique for Aquablation in men with PV>150mL and outcomes in a multicenter case series. METHODS: Additional procedural steps for men with PV>150mL are often needed based on the maximum ablation length (7cm) and depth (2.4cm) (Figure 1). After the first pass, the handpiece position should be adjusted by tipping the handpiece down to maximize depth (Figure 2). For long prostates (>7cm), the handpiece should then be leveled and re-positioned at the external sphincter, then a third pass completed (Figure 3). Focal bladder neck hemostasis is then performed as previously described. Data from was collected retrospectively for men with PV>150mL including international prostate symptom score (IPSS), peak urinary flow rate (Qmax), length of stay, and blood transfusion. RESULTS: Thirty-four men (age 69 ± 8) were treated at four institutions. The average PV was 209mL ± 56 (range 151-362mL). Symptoms improved from a baseline IPSS 19 ± 6 to 7 ± 5 after mean follow-up of 7 ± 9 months. Qmax also improved from 7 ± 4 mL/s to 19 ± 5 mL/s. There were no reports of transfusion, urinary incontinence, erectile dysfunction, or ejaculatory dysfunction, and most patients were discharged POD1. CONCLUSIONS: Most prostates greater than 150mL typically require repositioning of the handpiece for either depth or length. Preliminary data suggests Aquablation is effective and safe in prostates greater than 150mL. Source of Funding: Drs. Helfand, Kasraeian, Sterious, and Elterman have had or currently have a consulting agreement with PROCEPT BioRobotics. No funding was received this manuscript © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e472 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Glaser More articles by this author Brian Helfand More articles by this author Ali Kasraeian More articles by this author Steve Sterious More articles by this author Pooja Talaty More articles by this author Miguel Alcantara More articles by this author Kaitlyn Alcantara More articles by this author Andrew Higgins More articles by this author Eric Ghiraldi More articles by this author Dean Elterman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Evaluating outcomes of combined bladder neck and supramontanal sparing ejaculatory preserving transurethral resection of the prostate: Results from a prospective, randomised study.

Although conventional transurethral resection of the prostate (TURP) is highly successful in improving urinary symptoms and flow rates, a higher incidence of loss of antegrade ejaculation has been reported. Therefore, we aimed at prospectively comparing the efficacy and outcomes of a novel dual bladder neck and supramontanal sparing TURP to conventional TURP to improve voiding and ejaculation. Between January 2019 and November 2020, all patients with benign prostatic hyperplasia (BPH) satisfying the eligibility criteria underwent either conventional TURP (Group 1) or combined bladder neck and supramontanal sparing TURP (Group 2) after randomisation. The groups were compared for functional outcomes including International Prostate Symptom Score (IPSS), peak flow rates, post-void residual urine, perioperative variables and postoperative complications. Ejaculation was assessed with International Index of Erectile Function-Question 9 (IIEF-9) and Ejaculation Projection score (EPS). A total of 90 patients were randomised, 45 each to Group 1 and 2 respectively. The demographic profiles across both groups were comparable. Retrograde ejaculation and bladder neck contracture were significantly higher in Group 1. Both groups demonstrated significant improvement in the IPSS (26.12 ±2.88 to 4.69 ±0.87 (Group 1) vs 26.60 ±3.45 to 4.36 ±1.74 in Group 2) and Qmax (7.03 ±2.71 to 24.36 ±3.82 mL/s in Group 1 vs 6.29 ±2.64 to 25.28 ±4.33 mL/s in Group 2) at 3 months. However, a significant difference in IPSS and Qmax were recorded at 6 months. IIEF-9 score in Group 2 remained similar to preoperative profile (4.18 ±0.75) vs 2.58 ±0.86 (Group 1). EPS significantly decreased in Group 1 but remained similar to preoperative EPS in Group 2. Antegrade ejaculation was preserved in 88.89% in Group 2 as compared to 22.22% in Group 1. Dual bladder neck and supramontanal ejaculation preserving TURP is superior to conventional TURP in preventing retrograde ejaculation and bladder neck contractures in prostates <50 cc with comparable functional results, perioperative and postoperative morbidity.

363 Patient-Reported Outcomes Measures From 153 Men Treated with Water Vapour Thermal Therapy (Rezūmtm) For Symptomatic Benign Prostate Hyperplasia

Abstract Background Transurethral water vapour treatment (RezumTM) is a novel minimally invasive technique (MIST) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The aim of this study was to report patient-reported outcome measures (PROMS) and adverse events from patients treated with RezumTM. Method Consecutive patients were retrospectively identified at a single tertiary centre. Exclusion criteria included a history of acute urinary retention, previous BPH surgery, prostate cancer or prostatitis. PROMS including International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QoL) and the International Index of Erectile Function (IIEF-5) were compared between baseline and at a single discrete follow-up period (Initial [4-6 months]; Early [7-12 months]; Medium [13-18 months]; or Late [&amp;gt; 18 months]) using student’s t-test (SPSS v26.0; p &amp;lt; 0.05). Results 153 patients were included. IPSS, IPSS-QoL and IIEF-5 at baseline were 23.4 (SD 6.8), 4.8 (SD 3.7) and 14.9 points (SD 7.1), respectively. Paired PROMS were available at: Initial 20.2% (31/153), Early 43.7% (67/153), Medium 24.8% (38/153) and Late 11.1% (17/153) follow-up. Compared to baseline, all mean IPSS and IPSS-QoL reductions were significant (p &amp;lt; 0.05). At medium follow-up, paired IPSS and IPSS-QoL reductions were significant at -14.2 points and -3.2 points (p &amp;lt; 0.0001), respectively. There was no reported de novo erectile dysfunction. One patient required re-operation due to persistent symptoms, and one patient experienced postoperative urosepsis (Clavien-Dindo II). Conclusions Our findings demonstrate real-world data that water vapour therapy for BPH confers durable patient-reported improvements in most men, with preservation of patient-reported erectile function.

MP01-09 REZŪM FOR RETENTION - A RETROSPECTIVE ANALYSIS OF REZŪM FOR BENIGN PROSTATIC HYPERPLASIA IN MEN WHO PRESENT WITH CATHETER-DEPENDENT URINARY RETENTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-09 REZŪM FOR RETENTION - A RETROSPECTIVE ANALYSIS OF REZŪM FOR BENIGN PROSTATIC HYPERPLASIA IN MEN WHO PRESENT WITH CATHETER-DEPENDENT URINARY RETENTION Daniel Bassily, Vincent Wong, John Phillips, Mitchell Fraiman, Ross Bauer, Christopher Dixon, and Nathan Wong Daniel BassilyDaniel Bassily More articles by this author , Vincent WongVincent Wong More articles by this author , John PhillipsJohn Phillips More articles by this author , Mitchell FraimanMitchell Fraiman More articles by this author , Ross BauerRoss Bauer More articles by this author , Christopher DixonChristopher Dixon More articles by this author , and Nathan WongNathan Wong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rezūm is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30mL and ≤80mL, it is unclear how effective Rezūm is for men in acute or chronic urinary retention. Our objective is to determine whether Rezūm vapor ablation is effective in the treatment of acute/chronic catheter-dependent urinary retention. METHODS: A retrospective chart review was conducted on 49 consecutive patients who presented for acute/chronic urinary retention and were treated with Rezūm. We evaluated procedural details including type of anesthesia, operating room time, treatment time, number of steam treatments, length of hospital stay and catheter duration. We examined details pre- and post-Rezūm including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Q max), post void residual volume (PVR), PSA, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI). RESULTS: The median age of treated patients was 73 years with a median prostate volume of 73cc (Interquartile range (IQR) 50, 103). All patients were in urinary retention prior to treatment with a median PVR of 900mL (IQR 566, 1146). Following treatment, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved (p <0.01). Qmax increased from 3mL/s to 6mL/s (p=0.03) and PVR decreased from 900mL to 78mL (p <0.01). Only 17/38 patients taking alpha-blockers required continued alpha blocker therapy and 7/15 patients on 5ARIs required continued 5ARI therapy (p <0.01). Of the 49 patients treated, 10 remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months even after further, more invasive surgical therapies for BPH (p <0.01). CONCLUSIONS: Rezūm is an effective therapy for treating acute/chronic urinary retention in patients with BPH. As a minimally invasive therapy, it can be used in patient who cannot tolerate general anesthesia. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e3-e4 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Bassily More articles by this author Vincent Wong More articles by this author John Phillips More articles by this author Mitchell Fraiman More articles by this author Ross Bauer More articles by this author Christopher Dixon More articles by this author Nathan Wong More articles by this author Expand All Advertisement Loading ...

Rezūm for retention-retrospective review of water vaporization therapy in the management of urinary retention in men with benign prostatic hyperplasia.

Rezūm vapor ablation is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for tissue ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30 and ≤80 ml, it is unclear how effective Rezūm is for men in urinary retention. We sought to determine whether Rezūm is effective in the treatment of catheter-dependent urinary retention secondary to BPH. A retrospective chart review was conducted on consecutive patients who presented for urinary retention and subsequently treated with Rezūm. We evaluated procedural details and examined variables pre- and post-Rezūm (at 6 months) including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Qmax ), post void residual volume (PVR), prostate specific antigen, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI). Of the 49 patients included in this study, median age of was 73 years, median prostate volume was 73cc (Interquartile range [IQR]: 50, 103) and a median lobe was present in 80% of patients. All patients were in urinary retention before treatment with a median PVR of 900 ml (IQR: 566, 1146). Following Rezum, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved at 6 months (p < 0.01). Qmax increased from 3 to 6 ml/s (p = 0.03) and PVR decreased from 900 to 78 ml (p < 0.01). Only 17/38 patients taking alpha-blockers and 7/15 patients on 5ARIs continued therapy at 6 months following Rezūm (p < 0.01). Of the 49 patients treated, 10 (20.4%) remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months (12.2%) even after further surgical therapies for BPH (p < 0.01). Rezūm is a safe and effective therapy for treating catheter dependent urinary retention in patients with BPH, including those with median lobes. As a minimally invasive therapy, it is a promising option in patient, particularly those who are not suitable for prolonged anesthesia.

Efficacy and safety of prostatic artery embolization for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials.

To investigate the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of the prostate (TURP) in patients affected by benign prostatic hyperplasia (BPH). We also reviewed mean changes from baseline in PAE at selected follow-up points. PubMed, Web of Science, and Embase were searched up to May 1, 2020. Randomized controlled trials on PAE were collected according to specific inclusion and exclusion criteria. Meta-analyses were performed using RevMan 5.3, STATA 14, and GraphPad Prism 8. Pooled patient-reported scores and functional outcomes were calculated by using a fixed or random-effect model. Eleven articles met our selection criteria and ten independent patient series were included in the final analysis. Pooled estimates suggested no significant difference between TURP and PAE for patient-reported outcomes including International Prostate Symptom Score (2.32 (- 0.44 to 5.09)) and quality of life (0.18 (- 0.41 to 0.77)) at 12months. PAE was less effective regarding improvements in most functional outcomes such as maximum flow rate, prostate volume, and prostate-specific antigen. Moreover, PAE may be associated with relatively fewer complications, lower cost, and shorter hospitalization. After the PAE procedure, the overall weighted mean differences for all outcomes except sexual health scores were significantly improved from baseline during follow-up to 24months. PAE is non-inferior to TURP with regard to improving patient-reported outcomes, though most functional parameters undergo more changes after TURP than after PAE. Moreover, PAE can significantly continue to relieve symptoms for 24months without causing serious complications. • PAE is as effective as TURP in improving subjective symptom scores, with fewer complications and shorter hospitalization times. • PAE is inferior to TURP in the improvement of most functional outcomes. • Improvements due to PAE are durable during follow-up to 24months.

The Clinical Course of α1 Blocker Discontinuation in Patients with LUTS/BPH Receiving Combination Therapy of Dutasteride and α1 Blocker

We retrospectively investigated the clinical course of α1 blocker discontinuation in patients who had lower urinary tract symptoms with benign prostate hypertrophy (LUTS/BPH) and received combination therapy ofdutasteride and α1 blocker. Among the patients with LUTS/BPH who had been receiving combination therapy, those who wished to reduce the number ofprescribed drugs and discontinue the use of α1 blocker because ofsymptom improvement were recruited in this study. Symptom scores including International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS), parameters ofuroflowmetry and prostate volume (PV) were evaluated at the time of α 1 blocker discontinuation. Twenty-two patients discontinued the use of α 1 blocker. The mean PV at the time of α 1 blocker discontinuation was 43.2 ml, and the mean duration ofcombination therapy was 39.4 months. In 11 (50%) patients, dutasteride monotherapy without α1 blocker was maintained for a mean follow-up of 10.5 months (9-12 months) after α1 blocker discontinuation (Non-resumption group). In the other 11 patients (50%), α1 blocker was resumed because ofthe patient's request to resume the use of α1 blocker (Resumption group). The mean length ofdutasteride monotherapy was 4. 5 months (1-8 months) in the resumption group. Compared with the non-resumption group, IPSS total score and storage sub-score ofIPSS at the time of α1 blocker discontinuation were significantly higher in the resumption group. Based on the ROC curve, IPSS total score <16, IPSS voiding/storage symptom score <7, OABSS <7 and PV 54 ml or more at the time of α1 blocker discontinuation were predictors ofnon-resumption of α1 blocker. These results suggest that if LUTS is controlled by a long-term combination therapy ofdutasteride and α1 blocker and still PV is large enough, α1 blocker can be discontinued.

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.