Changes In International Prostate Symptom Score Research Articles

Evaluation of early apical release with bipolar Collins knife versus Thulium-Yag laser enucleation of large-sized prostate. A randomized study

ABSTRACT Introduction and objectives Anatomical endoscopic enucleation of the prostate (AEEP) provides durable management for patients with lower urinary tract symptoms (LUTS) secondary to large-sized prostate over other surgical modalities. We aimed to assess the early outcomes of Collins knife-assisted bipolar enucleation (BipolEP) versus Thulium-Yag enucleation (ThuLEP) in a group of patients with LUTS secondary to a prostate larger than 80 grams. Methods We included patients with benign prostatic hyperplasia (BPH) having a prostate volume > 80 grams, international prostate symptom score (IPSS) >7, urine flow (Q-max) <15, and post-void residual (PVR)>150 ml. We excluded those with a history of previous prostatic surgery, stone, or neurogenic bladder. Bipolar enucleation with early apical release was performed using Collins knife at an 80/100-watt setting (Lamidey Noury), while ThuLEP was conducted using 550- micron fiber and 40/15-watt energy (Lisa Laser). Patients were evaluated before then 2 weeks and 3, 6,12 months postoperatively for changes in IPSS, Q- max, PVR, and the incidence of stress incontinence. Result One hundred and twenty patients were equally randomized with a mean prostate size of 104 ± 25 gram. The mean IPSS score was 25 ± 6, Qmax 7.6 ± 1.3 mL/S, and PVR 225 ± 39. There was no significant difference regarding enucleation time, morcellation time, and enucleated tissue volume. Irrigation volume and post-operative hemoglobin drop were significantly lower in the bipolar group (p = 0.008, p = 0.0002), respectively. At the third-month follow-up, IPSS, Q-max, and PVR were comparable across both groups, with stress incontinence at 3.3% in the bipolar group versus 1.6% in the thulium group, showing an insignificant difference (p = 0.5).” Conclusion Both BipolEP and ThuLEP, with early apical release, provide a safe and effective management of large-size prostate resulting in significant decrease in post-operative stress incontinence incidence during early follow-up. Intraoperative irrigation saline volume, and post-operative hemoglobin drop favored the bipolar group.

Clinical, Technical, and MRI Features Associated with Patients' Outcome at 3 Months and 2 Years following Prostate Artery Embolization: Is There an Added Value of Radiomics?

Our aim was to investigate which features were associated with clinical successes at short- and mid-terms following prostate artery embolization (PAE) for symptomatic benign prostate hypertrophy (BPH). All adults treated by PAE for BPH at our referral center between January 2017 and March 2021, with pre-treatment MRI, technical success, and follow-up at 3 months and 2 years were included in this single-center retrospective study. Radiologists reviewed the prostatic protrusion index (PPI), adenomatous dominant BPH (adBPH), and Wasserman classification on pre-treatment MRI. Radiomics analysis was achieved on the transitional zone on pre-treatment T2-weighted imaging (WI) and ADC, and comprised reproducibility assessment, unsupervised classifications, and supervised radiomics scores obtained with cross-validated Elasticnet regressions. Eighty-eight patients were included (median age: 65 years), with 81.8% clinical successes at 3 months and 60.2% at 2 years. No feature was associated with success at 3 months, except the radiomics score trained on T2-WI and ADC (AUROC = 0.694). Regarding success at 2 years, no radiomics approaches provided significant performances; however, Wasserman type-1 and change in international prostate symptom score (IPSS) at 3 months ≤ -35% were associated with success in multivariable analysis (OR = 5.82, p = 0.0296, and OR = 9.04, p = 0.0002). Thus, while radiomics provided limited interest, Wasserman classification and early IPSS changes appeared predictive of mid-term outcomes.

Optilume drug-coated balloon for anterior urethral stricture: 2-year results of the ROBUST III trial.

The aim of this study is to report the updated 2-year results of the intervention arm of the ROBUST III randomized trial evaluating the safety and efficacy of the Optilume drug-coated balloon (DCB) versus standard endoscopic management of recurrent male anterior urethral stricture. Eligible patients included men with recurrent anterior urethral stricture ≤3cm in length and ≤12Fr in diameter, International Prostate Symptom Score (IPSS) ≥11 and peak flow rate (Qmax) <15 mL/s. Patients were randomized to treatment with the Optilume DCB or standard-of-care endoscopic management. Primary efficacy endpoints measured at 2years included freedom from re-intervention and changes in IPSS, Qmax and post-void residual (PVR). Secondary endpoint was impact on sexual function using the International Index of Erectile Function (IIEF). Primary safety endpoint was freedom from serious procedure- or device-related adverse events (AEs). A total of 127 patients enrolled at 22 sites in the United States and Canada (48 randomized to standard-of-care dilation and 79 to DCB dilation). Seventy-five patients in the DCB arm entered the open-label phase after 6 months. Participants averaged 3.2 prior endoscopic interventions (range 2-10); most (89.9%) had bulbar strictures with an average stricture length of 1.63 cm (SD 0.76). Significant improvements in IPSS, average Qmax and PVR were maintained at 2years. Freedom from repeat intervention was significantly higher in the Optilume DCB arm at 2years versus the Control arm at 1year (77.8% vs. 23.6%, p < 0.001). During the follow-up period, there were 15 treatment failures and two non-study-related deaths. Treatment-related AEs were rare and generally self-limited (haematuria, dysuria and urinary tract infection). The Optilume DCB shows sustained improvement in both objective and subjective voiding parameters at 2-year follow-up. Optilume appears to provide a safe and effective endoscopic treatment alternative for short recurrent anterior urethral strictures among men who wish to avoid or delay formal urethroplasty.

Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy.

To evaluate longitudinal changes in lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation in patients undergoing radiation therapy (RT) in comparison to those in non-irradiated patients. This retrospective study included 20 and 51 patients with and without a history of pelvic RT (RT and non-RT group, respectively) who were treated with primary AUS implantation for post-radical prostatectomy incontinence between 2010 and 2020. Longitudinal changes in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the International Prostate Symptom Score (IPSS), and the Overactive Bladder Symptom Score (OABSS) were calculated with a linear mixed model. In the RT and non-RT group, 18 (90%) and 48 (94%) patients achieved social continence, defined as daily pad use ≤1 at 1 month after activation of AUS, respectively (p = .555). During the mean follow-up of 38 months, ICIQ-SF, IPSS, and OABSS significantly improved after AUS implantation in both the RT and non-RT groups. In the RT group, ICIQ-SF, IPSS, and OABSS subsequently deteriorated with a slope of 0.62/year (p = .010), 0.55/year (p = .025), and 0.30/year (p = .007), respectively. In the non-RT group, no significant longitudinal changes in subsequent IPSS and OABSS were observed, although ICIQ-SF significantly deteriorated (0.43/year, p = .006). Comparing between the groups, the slopes of IPSS and OABSS were significantly greater in the RT group than in the non-RT group (p < .001, and .015, respectively). Longitudinal deterioration in LUTS that improved immediately after AUS implantation was observed in patients with a history of pelvic RT, but not in patients without a history of pelvic RT.

Prophylactic Α-Blockers for Radiotherapy-Induced LUTS in Men with Prostate Cancer: A Phase III Randomized Trial Analysis.

Radiation therapy (RT) to the pelvis is one of the curative approaches for patients with localized prostate cancer. Most patients treated with prostate RT experience some degree of radiation-induced lower urinary tract symptoms (RI-LUTS). The present phase III randomized trial assessed the efficacy of prophylactic versus therapeutic α-blockers at improving RI-LUTS in prostate cancer patients receiving external beam radiotherapy (EBRT). A total of 148 prostate cancer patients were randomized 1:1 to receive either prophylactic Silodosin at day one of EBRT or at the time of RI-LUTS. LUTS were quantified using the International Prostate Symptom Score (IPSS) at regular intervals during the study. The primary endpoint was the change in the IPSS from baseline to the last day of radiotherapy (RT). Secondary endpoints included changes in IPSS from baseline to 4 weeks and 12 weeks after the start of RT. Patient demographics, baseline IPSS and prescribed radiation doses were balanced between arms. On the last day of RT, the mean IPSS was 14.8 (SD 7.6) in the experimental arm and 15.7 (SD 8.5) in the control arm (95% CI -4.5 to 1.8, p = .40). There were no significant differences in IPSS between the study arms in the intention-to-treat (ITT) analysis at baseline, last day of RT, 4 weeks and 12 weeks post-RT. The as-treated analysis however, identified statistically significant difference at 4 weeks post-RT (95% CI -6.4 to -0.4, p = .03) in favor of prophylactic α-blockers. In an exploratory analysis, patients with prostate volumes less than or equal to 50 cc benefited at 4 weeks post-RT from prophylactic α-blocker (95% CI -8.4 to -0.3, p = .04). Prophylactic α-blocker was not effective at significantly reducing RI-LUTS in prostate cancer patients treated with EBRT. Treating patients with α-blocker at the onset of RI-LUTS will avoid unnecessary drug exposure and toxicity. There may be a benefit for prophylactic α-blocker in patients with smaller prostate. This however, needs to be further studied in a larger study.

Chronological Changes of Lower Urinary Tract Symptoms in Elderly Patients with Prostate Cancer after Low-Dose-Rate Prostate Brachytherapy.

To compare chronological changes in lower urinary tract symptoms (LUTS) after low-dose-rate prostate extended-release therapy (LDR-BT) using the overactive bladder symptom score (OABSS) in patients aged ≥ 75 years (elderly group) versus those aged < 75 years (control group). Patients with prostate cancer who underwent LDR-BT at Gifu University Hospital were included in this study. The International Prostate Symptom Score (IPSS), OABSS, and quality of life-based on urinary symptoms (IPSS-QOL) were evaluated before and after LDR-BT. We compared chronological changes in IPSS, OABSS, and IPSS-QOL in the elderly group with those in the control group and assessed the association between the resolution of OABSS and clinicopathological covariates. A total of 484 patients were enrolled in this study. In the elderly group, the total IPSS, OABSS, and frequency scores increased at 1 month postoperatively, whereas the control group showed an increase at 3 months postoperatively. Multivariate analysis identified changes from baseline to the maximum OABSS and pre-treatment OABSS as significant predictors of delayed resolution of OABSS after LDR-BT. Changes in pre-treatment OABSS and pre- and post-LDR-BT OABSS values were independent predictors of delayed resolution of OABSS; however, no correlation was found with age.

Prophylactic A-Blockers for Radiotherapy-Induced Lower Urinary Tract Symptoms in Men with Prostate Cancer: A Phase III Randomized Trial.

The present phase III randomized trial assessed the efficacy of prophylactic versus therapeutic α-blockers at improving RI-LUTSs in prostate cancer patients receiving external beam radiotherapy (EBRT). A total of 148 prostate cancer patients were randomized 1:1 to receive either prophylactic silodosin on day one of EBRT or the occurrence of RI-LUTSs. LUTSs were quantified using the international prostate symptom score (IPSS) at regular intervals during the study. The primary endpoint was the change in the IPSS from baseline to the last day of radiotherapy (RT). Secondary endpoints included changes in IPSS from baseline to 4 weeks and 12 weeks after the start of RT. Patient demographics, baseline IPSS, and prescribed radiation doses were balanced between arms. On the last day of RT, the mean IPSS was 14.8 (SD 7.6) in the experimental arm and 15.7 (SD 8.5) in the control arm (p = 0.40). There were no significant differences in IPSSs between the study arms in the intention-to-treat (ITT) analysis at baseline, the last day of RT, and 4 and 12 weeks post-RT. Prophylactic α-blockers were not effective at significantly reducing RI-LUTSs in prostate cancer patients treated with EBRT. Treating patients with α-blockers at the onset of RI-LUTSs will avoid unnecessary drug exposure and toxicity.

MP51-13 FOUR-YEAR REZUM OUTCOMES IN RELATIONSHIP TO THE NUMBER OF INJECTIONS: IS THE “LESS IS MORE” TREATMENT APPROACH DURABLE?

You have accessJournal of UrologyCME1 Apr 2023MP51-13 FOUR-YEAR REZUM OUTCOMES IN RELATIONSHIP TO THE NUMBER OF INJECTIONS: IS THE “LESS IS MORE” TREATMENT APPROACH DURABLE? Mustufa Babar, Umair Azhar, Justin Loloi, Rahman Sayed, Kevin Labagnara, Michael Zhu, Kevin Tang, Azizou Salami, Sandeep Singh, Matthew Ines, Nazifa Iqbal, and Michael Ciatto Mustufa BabarMustufa Babar More articles by this author , Umair AzharUmair Azhar More articles by this author , Justin LoloiJustin Loloi More articles by this author , Rahman SayedRahman Sayed More articles by this author , Kevin LabagnaraKevin Labagnara More articles by this author , Michael ZhuMichael Zhu More articles by this author , Kevin TangKevin Tang More articles by this author , Azizou SalamiAzizou Salami More articles by this author , Sandeep SinghSandeep Singh More articles by this author , Matthew InesMatthew Ines More articles by this author , Nazifa IqbalNazifa Iqbal More articles by this author , and Michael CiattoMichael Ciatto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Traditional treatment approach for Rezum utilizes injections based on prostate volume. Recent literature with short-term follow-up has shown that improvements in lower urinary tract symptoms (LUTS) can be achieved with less injections. We assessed the long-term durability of Rezum outcomes in relationship to the number of injections utilized during treatment. METHODS: A single office, retrospective study was conducted on men with moderate to severe LUTS who were treated with Rezum. Men were stratified into four cohorts based on the number of injections received per lateral prostatic lobe: 1, 2, 3, or 4 injections. International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), and adverse events (AEs) were collected at baseline, 1-, 3-, 6-, 12- and/or 48-months postoperatively. The impact of the number of injections on urinary outcomes and AEs were assessed using multivariate linear regression and logistic regression models, respectively, after adjusting for confounders at baseline. RESULTS: A total of 179 men were included: 58, 91, 22, and 8 men in the 1, 2, 3, and 4 injections cohorts, respectively. Compared to baseline, at 3-months, all cohorts saw significant mean changes in IPSS (-9.7±7.9, p<0.001) and QoL (-1.9±1.9, p<0.001), and improvements remained durable to 48-months (IPSS -10.8±9.0, p<0.001; QoL -2.7±1.9, p<0.001). The 2 injections cohort saw a significantly greater mean change in Qmax at 6-months (10.2±10.1 ml/s) when compared to the 1 injection cohort (0.6±4.6 ml/s, p=0.02). There were no significant differences in mean changes in IPSS, QoL, and PVR between the cohorts at any follow-up (p>0.05). The most common AE was gross hematuria (69.8%), followed by penile burning (65.8%). By 48-months, reoperation rate was 9.2%, with no significant difference in reoperation rates between the cohorts (p>0.05). Multivariate logistic regression showed that for each additional injection, the odds of gross hematuria, penile burning, penile pain, and dysuria increased by 3.8 (95% CI 1.7, 9.1), 2.6 (95% CI 1.2, 5.9), 2.2 (95% CI 1.1, 4.9), and 3.0 (95% CI 1.3, 7.5), respectively. Multivariate linear regression showed that the number of injections was not significantly associated with changes in IPSS, QoL, and PVR at any follow-up (p>0.05) but significantly associated with change in Qmax at 3-months (β=5.7, p=0.02). CONCLUSIONS: Utilizing less lateral lobe injections during Rezum treatment is a safer treatment approach that can still achieve long-term durable relief in LUTS. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e698 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mustufa Babar More articles by this author Umair Azhar More articles by this author Justin Loloi More articles by this author Rahman Sayed More articles by this author Kevin Labagnara More articles by this author Michael Zhu More articles by this author Kevin Tang More articles by this author Azizou Salami More articles by this author Sandeep Singh More articles by this author Matthew Ines More articles by this author Nazifa Iqbal More articles by this author Michael Ciatto More articles by this author Expand All Advertisement PDF downloadLoading ...

MP79-16 ANALYSIS OF THE EFFECT OF TESTOSTERONE REPLACEMENT ON BODY COMPOSITION, PHYSICAL FITNESS AND THE CORRELATION WITH HYPOGONADAL SYMPTOMS IN THE TESTOSTERONE DEFICIENCY

You have accessJournal of UrologyCME1 Apr 2023MP79-16 ANALYSIS OF THE EFFECT OF TESTOSTERONE REPLACEMENT ON BODY COMPOSITION, PHYSICAL FITNESS AND THE CORRELATION WITH HYPOGONADAL SYMPTOMS IN THE TESTOSTERONE DEFICIENCY Tae Yong Park, Dong Su Kim, Jeong Kyun Yeo, and Min Gu Park Tae Yong ParkTae Yong Park More articles by this author , Dong Su KimDong Su Kim More articles by this author , Jeong Kyun YeoJeong Kyun Yeo More articles by this author , and Min Gu ParkMin Gu Park More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study aimed to investigate how testosterone replacement therapy (TRT) change body composition and physical fitness, and which those changes correlate with serum testosterone level and hypogonadal symptoms. METHODS: Seventy patients with testosterone deficiency (TD) were divided into group I (n: 23) and group II (n :47). Only group II was given testosterone enanthate intramuscularly for 6 months. Both groups were investigated following items at the beginning and end of the study: Baseline demographics and serologic test; questionnaires of aging male symptom (AMS) scale and international prostate symptom score (IPSS); BMI, waist circumference, body composition; and physical fitness. Body composition was assessed by bioelectrical impedance analysis. Seven types of basic exercise tests were used to measure physical fitness. RESULTS: No significant difference was observed in baseline measurements between the two groups before treatment. After 6 months, group I showed no significant change in all measurements. Group II showed significant improvement in IPSS and AMS scales. Hematocrit, and prostate specific antigen slightly increased, while total cholesterol significantly decreased after treatment. As to body composition parameters, TRT significantly decreased body fat mass, visceral fat mass and waist circumference. Skeletal muscle mass was significantly increased by TRT although upper body muscle appeared to be more responsive. Most parameters of physical fitness resulted in improvement except for flexibility and endurance. The decrease of waist circumference was significantly correlated with serum testosterone level changes. AMS scale improvement was correlated with the changes of IPSS, cardiorespiratory fitness and agility. CONCLUSIONS: TRT improved hypogonadal and lower urinary tract symptoms. TRT also resulted in overall improvement in metabolic syndrome components, body composition and physical fitness. Testosterone increment and hypogonadal symptom improvement are correlated with waist circumference, cardiorespiratory fitness, and agility, respectively. Combined adjunctive exercise program that improve those parameters, might maximize the effect of TRT. Source of Funding: No conflict of interests © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1147 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tae Yong Park More articles by this author Dong Su Kim More articles by this author Jeong Kyun Yeo More articles by this author Min Gu Park More articles by this author Expand All Advertisement PDF downloadLoading ...

MP24-04 RANDOMIZED PLACEBO-CONTROLLED N-OF-1 TRIALS OF TAMSULOSIN FOR LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyCME1 Apr 2023MP24-04 RANDOMIZED PLACEBO-CONTROLLED N-OF-1 TRIALS OF TAMSULOSIN FOR LOWER URINARY TRACT SYMPTOMS Kevin Li, Scott Bauer, Stacey Kenfield, Kaiwei Lu, Charles McCulloch, Michael Steinman, Akinyemi Oni-Orisan, Natalie Rios, Anthony Enriquez, and Benjamin Breyer Kevin LiKevin Li More articles by this author , Scott BauerScott Bauer More articles by this author , Stacey KenfieldStacey Kenfield More articles by this author , Kaiwei LuKaiwei Lu More articles by this author , Charles McCullochCharles McCulloch More articles by this author , Michael SteinmanMichael Steinman More articles by this author , Akinyemi Oni-OrisanAkinyemi Oni-Orisan More articles by this author , Natalie RiosNatalie Rios More articles by this author , Anthony EnriquezAnthony Enriquez More articles by this author , and Benjamin BreyerBenjamin Breyer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Alpha blockers such as tamsulosin are considered 1st line for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Despite widespread use, their efficacy versus placebo is modest/highly variable and adverse effects including orthostatic hypotension/falls in older men are costly. A personalized approach can identify patients in whom benefits outweigh harms and those who can be deprescribed without worsening LUTS or causing complications. METHODS: We conducted placebo-controlled N-of-1 trials in men ≥55 on tamsulosin ≥12 months for BPH. To ensure tolerance of tamsulosin discontinuation, all men completed a one week run-in without taking tamsulosin or study pills. Participants then completed 2 block-randomized cycles, each comprised of two 2-week treatment periods of tamsulosin/placebo separated by 1 week of washout on placebo, and completed daily symptom assessment on REDCap (International Prostate Symptom Score (IPSS) modified for 24 h recall). Linear mixed models adjusted for treatment period were used to calculate predicted random effects, representing the mean effect of tamsulosin for each participant. RESULTS: 30/71 eligible patients contacted were enrolled. 4 failed run-in and were excluded. The remaining 26 were grouped by mean change in daily IPSS on tamsulosin vs. placebo and categorized as minimal (11/26, 42%), moderate (11/26, 42%), or strong responders (4/26, 15%) based on preset cutoffs (Figure 1). Demographics, social/health-related behaviors, and medical history except coronary artery disease (p = 0.005) were similar across groups (Table 1). Responder groups significantly differed in perceived fatigue from LUTS (p=0.024) at baseline. CONCLUSIONS: It is feasible to conduct placebo-controlled N-of-1 trials in older men receiving tamsulosin using daily symptom reporting. Patients identified as minimal responders are candidates for deprescribing and alternative interventions. Source of Funding: UCSF-RAP © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e318 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Li More articles by this author Scott Bauer More articles by this author Stacey Kenfield More articles by this author Kaiwei Lu More articles by this author Charles McCulloch More articles by this author Michael Steinman More articles by this author Akinyemi Oni-Orisan More articles by this author Natalie Rios More articles by this author Anthony Enriquez More articles by this author Benjamin Breyer More articles by this author Expand All Advertisement PDF downloadLoading ...

Better timing for HoLEP: a retrospective analysis of patients treated with HoLEP over a 10-year period with a 1-year follow-up.

The aim of this study was to explore the optimal timing of holmium laser enucleation of the prostate (HoLEP) in patients presenting benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). A retrospective analysis was conducted based on the perioperative and postoperative outcome data of 1212 patients who underwent HoLEP in Shanghai Ninth People's Hospital (Shanghai, China) between January 2009 and December 2018. According to the preoperative International Prostate Symptom Score (IPSS), all patients whom we analyzed were divided into Group A (IPSS of 8-18) and Group B (IPSS of 19-35). Peri- and postoperative outcome data were obtained during the 1-year follow-up. IPSS changes were the main postoperative outcomes. The postoperative IPSS, quality of life, peak urinary flow rate, postvoid residual, and overactive bladder symptom score (OABSS) improved significantly. The IPSS improved further in the group with severe LUTS symptoms, but the postoperative IPSS was still higher than that in the moderate LUTS group. OABSSs showing moderate and severe cases after follow-up were more frequent in Group B (9.1%) than in Group A (5.2%) (P < 0.05). There were no significant intergroup differences in the intraoperative American Society of Anesthesiologists or hospitalization expense scores, and the medication costs, as well as the total costs, were significantly higher in Group B. In this retrospective study, HoLEP was an effective treatment for symptomatic BPH. For patients with LUTS, earlier surgery in patients with moderate severity may result in a marginally better 12-month IPSS than that in men with severe symptoms.

Evaluation of intermittent tamsulosin in treating symptomatic patients with benign prostatic hyperplasia

The purpose of this study is to evaluate and assess the effect of intermittent tamsulosin treatment as a trial to increase the drug safety (in terms of reducing the drug side effects, particularly retrograde ejaculation) while maintaining the effect in reducing the symptoms and assess its impact on the patients' quality of life. Patients who enrolled in this study were suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and were using 0.4 mg tamsulosin daily to relieve their symptoms but complained of ejaculatory problems. A baseline assessment involves medical history and evaluation of ejaculatory function abdominopelvic ultrasound, postvoid residual volume (PVR) estimation, the International Prostate Symptom Score (IPSS), quality of life assessed using global satisfaction, vital signs, physical examination including digital rectal examination, and renal function. During the study, patients consented to take 0.4 mg tamsulosin intermittently every other day and to proceed with their sexual activities on the days they did not take the drug in. Baseline assessment was repeated and recorded after 3 months from starting the treatment. The adverse effects and compliance were analyzed in all patients. Twenty-five patients had a mean baseline IPSS of 6.6 ± 1 and baseline PVR of 87.6 ± 15.1 ml. At the 3rd month, the mean PVR was 100.4 ± 15.1 ml and the mean IPSS was 7.3 ± 1.1. Moreover, 20 out of the total number of 25 patients (80%) reported improvement in their ejaculation. All our 20 patients who showed improvement in their ejaculatory function are either satisfied or very satisfied (4 or 5), in regard to the global satisfaction rate. Intermittent tamsulosin therapy (0.4 mg/every other day) is well-tolerated and shows a potential advantage in recovery in patients who suffer from LUTS/BPH and complaining from abnormal ejaculation, especially absent ejaculate. Although there was a significant change in PVR and IPSS after using intermittent tamsulosin therapy. Most patients show a higher overall satisfaction with the treatment compared to the standard dose (0.4 mg/daily). A study on a larger scale is still needed to confirm our results.

Chronological changes of lower urinary tract symptoms after low-dose-rate brachytherapy for prostate cancer using SpaceOAR® system.

The aim of this study is to investigate chronological changes of lower urinary tract symptoms (LUTS) in patients with prostate cancer who underwent low-dose-rate brachytherapy (LDR-BT) followed by the insertion of SpaceOAR® system (SpaceOAR). In this retrospective study, 483 patients with localized prostate cancer underwent LDR-BT at the Gifu University Hospital between August 2004 and December 2020. SpaceOAR was inserted in 30 patients after LDR-BT (SpaceOAR group), and 453 patients received LDR-BT alone (non-SpaceOAR group). The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), quality of life due to urinary symptoms (IPSS-QOL), and uroflowmetry (UFM), including maximum flow rate (Qmax), voided volume, and post-voided residual urine (PVR), were evaluated before LDR-BT, and at 1, 3, 6, 9, and 12months after LDR-BT. The outcomes were chronological changes in IPSS, OABSS, and IPSS-QOL compared to pretreatment values and those of covariates in relation to UFM. The IPSS, OABSS, IPSS-QOL, Qmax, and voided volume were not significantly associated with either group. According to the PVR interaction effect, the insertion of SpaceOAR was significantly affected by chronological changes in PVR (P=0.001). Three months after LDR-BT, PVR in the SpaceOAR group was significantly higher than that in the non-SpaceOAR group (49.8mL vs. 30.5mL; P=0.002). SpaceOAR use may temporally increase PVR; however, IPSS, OABSS, IPSS-QOL, Qmax, and voided volume were not significantly associated with LUTS before and after LDR-BT. The combination of LDR-BT and SpaceOAR may be acceptable for treating patients with prostate cancer regarding the chronological changes in LUTS after brachytherapy.

Clinical significance of prostate volume and testosterone reduction on lower urinary tract symptoms in patients with prostate cancer undergoing androgen deprivation therapy

To investigate the effect of both prostate volume and serum testosterone changes on lower urinary tract symptoms in patients with prostate cancer undergoing androgen deprivation therapy. A total of 167 patients who received androgen deprivation therapy for prostate cancer treatment from January 2010 to August 2020 were enrolled in this retrospective study. Changes in the International Prostate Symptom Score (IPSS) in the patient groups stratified by prostate volume and the amount of testosterone reduction were assessed every 4 weeks until 12 weeks after androgen deprivation therapy initiation. Longitudinal mixed models were used to assess the adjusted effects of prostate volume and testosterone reduction on IPSS change. All mean values of IPSS-total score (IPSS-total), voiding subscore (IPSS-vs), and storage subscore (IPSS-ss) significantly decreased from baseline to week 12 in both patients with small (< 33 mL) and large (≥ 33 mL) prostates. The mean values of IPSS-total, IPSS-vs, and IPSS-ss similarly decreased in patients with large prostate with a baseline IPSS-total of ≥ 13. However, in those with small prostate, IPSS-ss specifically remained unchanged, while IPSS-total and IPSS-vs significantly decreased. In addition, only in patients with small prostate (< 33 mL), patients with lesser testosterone reduction (< Δ400 ng/dL) showed greater improvement in IPSS-ss by 7.5% compared with those with greater testosterone reduction (≥ Δ400 ng/dL). In conclusion, although androgen deprivation therapy generally improves lower urinary tract symptoms, it may worsen specifically storage symptoms in patients with relatively small prostate and greater testosterone reduction. Our finding suggests that testosterone may influence lower urinary tract symptoms in these patients.

Rezum Outcomes in Relationship to Number of Injections: Is Less More?

Objectives: To assess efficacy and safety outcomes in relationship to the number of injections given during Rezum treatment. Methods: A retrospective study was conducted on patients with moderate to severe lower urinary tract symptoms (LUTS) treated with Rezum. Patients were stratified into cohorts based on the number of injections received per lateral prostatic lobe: 1, 2, 3, or 4 injections. International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), International Index of Erectile Function (IIEF)-Erectile Function, IIEF-Orgasmic Function, and adverse events were collected at baseline, 1, 3, 6, and/or 12 months postoperatively. Results: A total of 179 patients were included: 58, 91, 22, and 8 patients in the 1, 2, 3, and 4 injections cohorts, respectively. Baseline demographics significantly different across cohorts were age, history of urinary retention, prostate-specific antigen, prostate volume, prostatic urethral length, and presence of median lobe. At 3 months, all cohorts reported significant improvements in IPSS and QoL, which remained durable to 12 months. There were no significant differences in changes in IPSS, QoL, PVR, and IIEF-Erectile and Orgasmic Function between the cohorts at any follow-up. Multiple linear regression showed that the number of injections did not predict changes in IPSS, QoL, PVR, and IIEF-Erectile and Orgasmic Function at any follow-up (p > 0.05) but predicted change in Qmax at 3 months (β = 5.7, p = 0.019). Multiple logistic regression showed that for each additional injection, the odds of gross hematuria, penile burning, penile pain, and dysuria increased by 3.8, 2.6, 2.2, and 3.0, respectively. Conclusions: Utilizing less injections represents a safe treatment strategy without compromising Rezum's efficacy in providing durable relief in LUTS.

Efficacy and Safety of Transurethral Enucleation with Bipolar Energy for Treatment of Benign Prostatic Hyperplasia: Does Prostate Volume Matter?

We evaluated the association of prostate volume (PV) with the efficacy and safety of transurethral enucleation with bipolar energy (TUEB) for treatment of benign prostatic hyperplasia (BPH). We retrospectively evaluated data from 180 patients with symptomatic BPH who underwent TUEB between 2008 and 2015. Efficacy was assessed by perioperative changes in international prostate symptom score (IPSS), Quality of Life Score (QOLS), maximum flow rate on uroflowmetry (Qmax), and serum prostate-specific antigen level (PSA), which were recorded at 3 months postoperatively. Safety was assessed by perioperative incidence of adverse events (AEs). AEs were recorded up to 2 years after surgery. Patients were divided into two groups based on PV as the standard group (SG; PV < 80 mL) and large group (LG; PV ≥ 80 mL). A total of 132 (73%) patients were grouped as the SG, and 48 (27%) were grouped as the LG. No significant differences between the groups were observed in the preoperative variables age, IPSS, and QOLS. However, the LG had a significantly larger PV and higher serum PSA levels. Analysis of surgical outcomes revealed that postoperative changes in IPSS, QOLS, Qmax, serum PSA, serum sodium, and hemoglobin levels did not differ significantly between groups. However, LG had a significantly longer operative time and heavier specimen weight. The rates of early complications, including hyponatremia and blood transfusion, and late complications after surgery did not differ between the groups. The present findings suggest that TUEB is safe and effective for treatment of BPH, regardless of PV.

Extract from Cucurbita pepo improves BPH symptoms without affecting sexual function: a 24-month noninterventional study

PurposeTo assess the symptoms, quality of life and sexual well-being in patients with lower urinary tract symptoms due to benign prostatic hyperplasia LUTS/BPH treated with pumpkin seed soft extract (PSE) in routine practice.MethodsThis noninterventional study included 130 men treated for up to 24 months. The International Prostate Symptom Score (IPSS) and related quality of life, Aging Males’ Symptoms Scale (AMS), and International Index of Erectile Function (IIEF-5) were recorded. Descriptive statistical methods were applied. The mean with 95% confidence interval (CI) was calculated for the primary end point (change in IPSS after 12-month treatment).ResultsAnalysis at 12 months included 83 patients [mean (SD) age 65.2 (8.7) years and IPSS (15.6 (3.4), IPSS-QoL 3.4 (0.9)]. AMS and IIEF-5 indicated mild or mild to moderate disorder regarding sexual well-being and erectile dysfunction, respectively. After 12 months, the mean IPSS change from baseline was − 4.7 (95% CI − 5.4 to − 3.9), with 83% (95% CI 65.3 to 84.1) and 53% (95% CI 42.3 to 63.7) of the patients achieving reductions by at least 3 and 5 points, respectively. The proportion of patients with IPSS-QoL below 3 points (mostly satisfied) was 11% (9/83) at baseline and rose to 62% (51/83) and 73% (40/55) at 12 and 24 months, respectively. AMS and IIEF-5 scores did not indicate a negative impact on sexual function during treatment.ConclusionIn men with a moderate LUTS suggestive of BPH, a low progression risk and an active sex life, treatment with pumpkin seed soft extract provided symptomatic relief, improved IPSS-QoL, and maintained sexual well-being.Trial registrationDRKS00010729, June 22, 2016.

Beneficial effects of pumpkin seed soft extract on lower urinary tract symptoms and quality of life in men with benign prostatic hyperplasia: a meta-analysis of two randomized, placebo-controlled trials over 12\u2009months

BackgroundIn clinical practice, plant extracts are an option to treat mild-to-moderate lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH). However, only a few herbal extracts have been investigated in long-term placebo-controlled studies. The safety and efficacy of a well-tolerated proprietary pumpkin seed soft extract (PSE) were investigated in two randomized placebo-controlled 12-month studies (Bach and GRANU study). Both trials studied LUTS/BPH patients with an International Prostate Symptom Score (IPSS) ≥13 points at baseline. The Bach study demonstrated positive effects of PSE compared to placebo, but no difference between treatments was observed in the GRANU study. We aimed to assess the efficacy of PSE in a meta-analysis using the patient-level data of these two studies.MethodsPooled analysis was performed in the intention-to-treat set using last-observation-carried-forward (ITT-LOCF). An IPSS improvement of ≥5 points after 12 months of therapy was the predefined response criterion. Logistic regression and ANCOVA models included the covariables treatment group, study, center size, and baseline IPSS. Each analysis was repeated for the per-protocol (PP) set.ResultsThe ITT/PP analysis sets consisted of 687/485 and 702/488 patients in the PSE and placebo groups, respectively. At the 12-month follow-up, the response rates in the PSE group were 3% (ITT) and 5% (PP) higher than those in the placebo group. The odds ratio of response obtained by logistic regression analysis for comparing PSE versus placebo was 1.2 (95% CI 0.9, 1.5), favoring PSE (ITT- LOCF). For the IPSS change from baseline to 12 months, the ANCOVA estimated difference between the treatment groups was 0.7 points (95% CI 0.1, 1.2) in favor of PSE. The variables study, baseline IPSS, and center size had a relevant influence on treatment response.ConclusionAlthough the Bach and the GRANU study showed contradictory results, the analysis in a pooled form still pointed towards an advantage of PSE; namely, more patients in the PSE group showed an IPSS improvement of at least 5 points after 12 months. Therefore, the results of this meta-analysis suggest that patients with moderate LUTS/BPH may benefit from PSE treatment in terms of symptomatic relief.

Epirubicin-loaded beads transarterial prostatic arterial chemoembolization is a promising treatment for advanced prostate cancer with lower urinary tract obstruction or hematuria-a case series report.

BackgroundProstatic arterial embolization (PAE) is an effective minimally invasive treatment for lower urinary tract obstruction and hematuria in patients with benign prostatic hyperplasia (BPH). This study was aim to evaluate the safety and short-term efficacy of drug epirubicin-loaded beads transarterial prostatic arterial chemoembolization (DEB-PACE) for the treatment of advanced prostate cancer (PC) with lower urinary tract obstruction or hematuria.MethodsA total of 8 patients with advanced PC undergoing DEB-PACE from August 2020 to February 2022 were retrospectively enrolled. The patients were followed up at 1 week, 1, 3, 6 and 12 months after DEB-PACE. The origin of prostatic arteries, technical success, clinical success rate, duration of the indwelling urinary catheter, International Prostate Symptom Score (IPSS), QoL score (quality of life), prostate volume (PV), prostate-specific antigen (PSA) level and complications were recorded. The short-term efficacy (changes in IPSS, PV and QoL value from baseline to 3 months) were analysed.ResultsThere were 17 prostatic arteries in 8 patients, which mainly originated from internal pudendal artery (11/17, 64.7%), the technical success rate is 100%. After treatment, the symptoms of lower urethral obstruction in 8 patients were significantly improved that PSA, PV, IPSS and QoL level were significantly reduced. The catheter was successfully removed within 1 week on average, and 2 patients with hematuria disappeared within 5 days. The clinical success rate is 100%. At 1 month postoperatively, mean PV reduction was 30.28±6.963 cm3 (P=0.0457), mean IPSS reduction was 21.13±2.887 points (P=0.0042), mean QoL reduction was 3.75±0.366 points (P=0.006). At 3 months postoperatively, mean PV reduction was 46.14±8.906 cm3 (P=0.0112), mean IPSS reduction was 24.5±2.398 points (P=0.0003), mean QoL reduction was 4.25±0.25 points (P=0.0003). There were no serious complications occurred in all patients.ConclusionsDEB-PACE is a promising treatment for advanced PC with lower urinary tract obstruction or hematuria. However, the efficacy and safety of DEB-PACE for advanced PC is needed to validated by prospective large sample randomized controlled study.

The cutoff value of transitional zone index predicting the efficacy of dutasteride on subjective symptoms in patients with benign prostate hyperplasia.

We investigated the efficacy of dutasteride add-on therapy to α-1 adrenoceptor antagonists in patients with benign prostate hyperplasia (BPH) in relation to the transitional zone index (TZI) and evaluated the cutoff value of TZI that predicted improvements of subjective symptoms at 6 months. Male BPH patients with prostate volume (PV) ≥ 30 mL receiving dutasteride 0.5 mg/d for 6 months as add-on therapy along with α-1 adrenoceptor antagonists were enrolled. PV, transitional zone volume (TZV), TZI, International Prostate Symptom Score (IPSS), and uroflowmetry parameters before and at 6 months with dutasteride add-on treatment were evaluated. Eighty-three patients were included. The changes of total IPSS, IPSS voiding subscore, IPSS quality of life score, and voided volume were significantly correlated with TZI. Among baseline parameters, TZV and TZI were significantly associated with the changes of total IPSS in univariate analysis, and only TZI remained as an independent predictive factor for improving total IPSS in multivariate analysis (odds ratio -8.3, P=.048). The cutoff point of TZI for predicting an improvement of the total IPSS by 6 points or more was 0.67 (area under the curve 0.71, sensitivity 0.62, specificity 0.79). A higher TZI was significantly associated with improvement of subjective symptoms but not uroflowmetric findings for BPH patients with 6 months of dutasteride add-on therapy along with α-1 adrenoceptor antagonists, and the predictive value of TZI for effective dutasteride add-on therapy was higher than 0.67. BPH patients using α-1 adrenoceptor antagonists with a TZI higher than 0.67 can be good candidates for add-on dutasteride therapy.