International Prostate Symptom Score Quality Of Life Score Research Articles

Predicting Urinary Function Outcomes Following Low-dose-rate Brachytherapy for Prostate Cancer

Background and objectiveOur aim was to develop a tool using readily available clinical parameters to predict the probability of poor urinary function following low-dose-rate brachytherapy (LDR-BT) for localized prostate cancer. MethodsData from the multicentre, prospective Swiss LDR-BT cohort were analyzed for men treated with LDR-BT. Inclusion criteria were minimum follow-up of 3 yr or postoperative treatment with transurethral resection of the prostate (TURP). A total of 914 men were analyzed, with complete data available for 607 men. Pre-interventional variables assessed were International Prostate Symptom Score (IPSS), prostate volume (PV), maximum urinary flow rate, prostate-specific antigen, postvoid residual urine volume, and age. The primary outcome was poor urinary function after LDR-BT, defined as an IPSS-Quality of Life score >3 (“mostly dissatisfied” or worse) at 3 yr or the occurrence of TURP during follow-up. Associations were evaluated using univariable and multivariable logistic regression. Receiver operating characteristic curve analysis was also performed. Key findings and limitationsPoor urinary function outcomes were observed in 46 patients (5.0%). Significant predictors included pre-interventional IPSS (adjusted odds ratio [aOR] per point 1.18; p < 0.001) and PV (aOR per ml, 1.04; p = 0.004). Limitations of the study include potential selection bias and the absence of external validation. Conclusions and clinical implicationsPre-interventional IPSS and PV were significant predictors of poor urinary function after LDR-BT for prostate cancer. A risk calculator based on these parameters was developed to assist individualized treatment planning. Further studies are needed to validate these findings before they can be applied in routine clinical practice. Patient summaryWe created a tool to predict the likelihood of urinary problems after a type of radiotherapy called brachytherapy for prostate cancer. The size of the prostate and urinary symptoms before treatment were associated with poor urinary function after treatment. This tool could help doctors and patients in making informed decisions about treatment for prostate cancer.

Observation on the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP) with preservation of the urethral mucosa from the bladder neck to the tip of the prostate for the treatment of benign prostatic hyperplasia.

This study investigates the efficacy and safety of transurethral prostate laser resection (HoLEP) with preservation of the urethral mucosa from the bladder neck to the tip of the prostate for the treatment of benign prostatic hyperplasia (BPH). A retrospective study was conducted on 208 patients with BPH treated at our hospital. In the control group, the urethral mucosa from the bladder neck to the tip of the prostate was not retained during surgery to ensure maximum removal of possible diseased tissue. The urethral mucosa was preserved in the observation group, which was finely separated to avoid injury, in order to protect urinary control function to the greatest extent and reduce postoperative complications. The surgical-related indicators, urinary function, sexual function, quality of life (QOL), and occurrence of postoperative complications were compared between the 2 groups of patients. After the procedure, both groups of patients experienced an increase in maximum flow rate and a decrease in residual urine volume (P < .05). The observation group showed a higher immediate postoperative urinary continence rate of 98.23% compared to 85.26% in the control group (P < .05). After the procedure, both groups of patients exhibited a significant increase in International index of erectile function-5 scores (P < .05). The retrograde ejaculation rates were compared between the 2 groups of patients before the procedure (P > .05). After the procedure, the occurrence rate of retrograde ejaculation decreased in both groups of patients, with the observation group being lower than the control group (P < .05). The International prostate symptom score (IPSS) scores and QOL scores were compared between the 2 groups of patients before and after the procedure (P > .05). After the procedure, both groups of patients showed a decrease in IPSS scores and QOL scores compared to before the procedure (P < .05). The occurrence of complications such as urethral injury, urinary incontinence, urinary retention, and postoperative bleeding was compared between the 2 groups of patients (P > .05). The efficacy and safety of performing HoLEP treatment for BPH patients with preservation of the urethral mucosa from the bladder neck to the tip of the prostate are comparable to those without preservation. However, it can improve immediate urinary continence rate and reduce retrograde ejaculation rate.

Impact of Preoperative Continence on HoLEP Symptom Recovery: A Close Investigation of Patient-Reported Outcomes.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is an increasingly utilized surgical intervention for benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). It is unclear how pre-HoLEP voiding performance (including pre-HoLEP incontinence) affects post-HoLEP urinary symptom performance and recovery which challenges effective patient counseling. Methods: This is a single-institution retrospective analysis of 266 patients who underwent HoLEP. Pre-HoLEP continence status was determined by patient report. Continence (severity and bother, severity broken into urge and stress) and LUTS (total IPSS score and QoL) were assessed preoperatively and 1 week (1wk), 1 month (1m), 3 months (3m), and 1-year (1y) post-HoLEP using the Michigan Incontinence Symptom Index (MISI) and International Prostate Symptom Score (IPSS), respectively. Primary outcome measures were MISI differences between groups at each time point. Results: Of the 376 patients who underwent HoLEP from two surgeons from 11/6/2020 to 12/18/2023, 266 were included in the study. Inclusion criteria were patients undergoing HoLEP during this period. There were no exclusion criteria. A total of 178 participants were continent and 88 were incontinent pre-HoLEP. Average age at time of HoLEP was 70.3 and 70.8 respectively, average preoperative prostate size measured by ultrasound or axial imaging was 109.0 g and 113.7 g, respectively. Based on MISI stress (#1-3) and urge (#4-6) items, pre-HoLEP Stress:Urge ratio in continent pre-HoLEP patients was 1.29:3.02. In the incontinent pre-HoLEP group, Stress:Urge was 2.45:6.18. MISI scores were statistically similar between cohorts at 1wk. Preop incontinent patients had a statistical and clinically significant improvement in MISI severity score at 1y post-HoLEP (5.62 n = 11 vs 10.170 n = 50, p = 0.013). IPSS total scores were statistically similar between cohorts at 1m and IPSS QoL scores were statistically similar at preop. At preop evaluation, urge symptoms were worse than stress symptoms in all cohorts. Conclusions: Preoperative incontinence should not be considered a predictor of poor intermediate or long-term post-HoLEP outcomes. Pre-HoLEP incontinence is likely largely urge-related.

Functional outcomes following external beam radiation therapy for patients with prior holmium laser enucleation of the prostate.

Holmium laser enucleation of the prostate (HoLEP) is an increasingly popular size-independent technique of treating male voiding dysfunction due to benign prostatic hypertrophy. Some patients after HoLEP may develop clinically significant prostate cancer and opt for definitive treatment with external beam radiation therapy (EBRT). Little is known about the safety of EBRT after HoLEP and how it may functionally impact voiding after HoLEP has altered the anatomy of the prostate. Our study aimed to assess patient-reported voiding outcomes following EBRT after HoLEP with a focus on incontinence related patient outcomes. This study was conducted with approval from our hospital's institutional review board. Patients that underwent HoLEP followed by EBRT were identified and data were collected in a retrospective nature from a single surgeon HoLEP cohort over the past 4years (2019-2023). Patient demographics, disease and radiation therapy characteristics, radiation therapy, and baseline voiding symptoms were recorded. Current functional voiding outcomes were also collected via phone-call or portal communication in a cross-sectional manner with questions pertaining to type of incontinence, IPSS quality of life score, and administration of the Michigan incontinence symptom index (M-ISI). Adverse events encountered during follow-up were recorded. 24 patients were identified who received RT for prostate cancer after HoLEP with an average age of 73.6 (± 5.3). One third of patients reported no incontinence whatsoever after radiation and of those who experienced incontinence, the majority felt that it was not worsened after radiation. Median IPSS QoL score following radiation was 1 (range 0-6), median M-ISI Severity Score was 4 out of a maximum of 32, and median M-ISI bother score was 0 out of a maximum of 8. One patient developed a bladder neck contracture (BNC) approximately 1year following his radiation therapy (approximately 18months after HoLEP) causing bothersome incontinence and LUTS. In our cohort most patients who received RT after HoLEP reported a high urinary-symptom related quality of life and a low rate of urinary incontinence. One patient who received SBRT suffered a BNC which is a known adverse event with RT but given our small sample size it remains unclear if the risk is higher in patients receiving RT after HoLEP. Larger studies should focus on examining the rate of bladder neck contracture in patients receiving RT after HoLEP, particularly focusing on whether the degree of dose fractionation may impact their development.

Laborie Optilume® Drug-coated balloon may lower the re-treatment rate post-intervention for challenging urethral stricture disease in long-term follow-up: A prospective cohort study.

Urethral stricture disease is a common and at times unsatisfying condition that can lead to complications severely impacting a patient's quality of life. Open urethroplasty remains the gold standard treatment; however, it is an invasive and highly specialized procedure. Strictures between 2 to 4 cm in length have been shown to recur at a rate of 50% within 12 months, a rate that typically decreases with each subsequent treatment. The Laborie Optilume drug-coated balloon (DCB) is the first of its kind developed for adjunct treatment of urethral strictures in men. The DCB initially treats the stricture through balloon dilatation and subsequently aims to prevent recurrence via the localized application of Paclitaxel. Our study assesses the safety and efficacy of the DCB in an Australian population with strictures exceeding 2 cm who have undergone at least two prior procedures for urethral stricture disease. Patients were prospectively recruited from November 2019 to September 2021. International prostate symptom score (IPSS), IPSS quality of life (QOL) and voiding parameters were collected at baseline, and again at 1, 6, 12 and 18 months. The drug coated balloon was applied by a single consultant urologist under rigid cystoscope with shallow direct vision internal urethrotomy with a cold knife prior to application of the DCB. 17 patients were recruited with an average of 7.7 prior urethral procedures for recurrent stricture disease. 76% were stricture free at 30 months follow-up. There were improvements in almost all parameters including max flow, average flow, IPSS and IPSS QOL scores at 12 and 24 months. There were no complications. The DCB is a safe and effective method at reducing the rates of recurrence for high-risk stricture disease and can delay or prevent the need for urethroplasty in what remains a very challenging cohort of patients.

Clinical characteristics and predictors of long-term postoperative urinary incontinence in patients treated with robot-assisted radical prostatectomy: A propensity-matched analysis.

This study aimed to elucidate the clinical characteristics and predictors of long-term postoperative urinary incontinence (PUI) after robot-assisted radical prostatectomy (RARP). This study included patients who underwent RARP at our institution and were stratified into PUI (≥1 pad/day) and continence (0 pad/day) groups at 60 months after RARP. A propensity score-matched analysis with multiple preoperative urinary status (Expanded Prostate Cancer Index Composite urinary subdomains, total International Prostate Symptom Score (IPSS), and IPSS-quality of life scores) was performed to match preoperative urinary status in these groups. Serial changes in urinary status and treatment satisfaction preoperatively and until 60 months after RARP were compared, and predictors of long-term PUI were assessed using multivariate logistic regression analysis. A total of 228 patients were included in the PUI and continence groups (114 patients each). Although no significant difference in preoperative urinary status was observed between the two groups, the postoperative urinary status significantly worsened overall in the PUI group than in the continence group. Treatment satisfaction was also significantly lower in the PUI group than in the continence group from 12 to 60 months postoperatively. Multivariate logistic regression analysis revealed that age (≥70 years) and biochemical recurrence (BCR) were significant predictors of the long-term PUI group (p < 0.05). Patients with long-term PUI had poor overall postoperative urinary status and lower treatment satisfaction than the continence group. Considering the age and risk of BCR is important for predicting long-term PUI when performing RARP.

Mid-term results of ReMEEX sling system in female stress urinary incontinence with various indications and feasibility of readjustment.

To examine efficacy and safety of ReMEEX implantation in patients with female stress urinary incontinence (SUI) associated with detrusor underactivity (DU), recurrence, or intrinsic sphincter deficiency (ISD). Retrospective cohort study included 303 females who underwent ReMEEX system (March 2008 to May 2021). Patients were stratified into three groups by purpose of surgery (SUI with DU, reoperation, and SUI with ISD) and evaluated with following criteria: cure (absence of subjective complaint of leakage and objective leakage in the stress test), improvement (rare leakage subjectively, but satisfaction regardless of stress test), and failure. Primary outcome was success rate of surgery assessed through patient interviews and a stress test. Surgical outcomes and complications were evaluated. Mean follow-up was 34.4 months (range, 6.0-145.0 months). At the final follow-up visit, 42.9% and 49.2% of patients were cured and improved. Twenty-one point five percent required tension readjustment (mean number, 1.2). The total complication rate was 19.5% (none for grade ≥4). Preoperative Qmax was significantly higher in the ISD group (p<0.001) and preoperative total International Prostate Symptom Score (IPSS) score was significantly higher in the DU group (p=0.044). Moreover, at postoperative 1 year, both total IPSS score and IPSS quality of life score were significantly higher in the DU group (both p=0.001). The success rate of ReMEEX system was 92.1% at mean follow-up of 34.4 months in female SUI with DU, reoperation, or ISD. It also enabled postoperative readjustment of sling tension, as needed, up to 130 months after surgery.

The learning curve for transurethral enucleation with bipolar energy for benign prostate hyperplasia: a single-surgeon experience of 494 patients.

This study was performed to investigate the learning curve of transurethral enucleation with bipolar energy (TUEB) for benign prostatic hyperplasia. The study involved 494 consecutive patients who underwent TUEB for benign prostatic hyperplasia from August 2018 to March 2022 by one surgeon (SJJ, Seoul National University Bundang Hospital, Seongnam, Korea). The patients were followed up at 1 week, 1 month, 3 months, and 6 months postoperatively. To evaluate the learning curve of TUEB, perioperative parameters including the enucleation ratio (enucleated tissue weight/transitional zone volume), TUEB efficiency (enucleated tissue weight/operation time), and enucleation efficiency (enucleated tissue weight/enucleation time) were analyzed. Functional outcomes and postoperative complications were also assessed, including the International Prostate Symptom Score (IPSS), IPSS quality-of-life (QoL) score, and uroflowmetry outcomes. The patients' median age was 72 (interquartile range [IQR]: 66-78) years, and the estimated prostate volume and transitional zone volume were 63.0 (IQR: 46.0-90.6) ml and 37.1 (IQR: 24.0-60.0) ml, respectively. The enucleation ratio, TUEB efficiency, and enucleation efficiency were 0.60 (IQR: 0.46-0.54) g ml -1 , 0.33 (IQR: 0.22-0.46) g min -1 , and 0.50 (IQR: 0.35-0.72) g min -1 , respectively, plateauing after 70 cases. The functional outcomes, including total IPSS, IPSS QoL score, and uroflowmetry outcomes, significantly improved at 6 months after TUEB (all P < 0.05), but without significant differences over the learning curve. Sixty-five (13.2%) patients developed complications after TUEB, 21.5% of whom experienced major complications (Clavien-Dindo grade ≥3). The rate of major complications declined as the number of TUEB cases increased ( P = 0.013). Our results suggest that the efficiency of TUEB stabilized within 70 procedures.

Outcome of transurethral resection of the prostate (TURP) using 5% dextrose water as irrigant.

TURP remains the gold standard for simple prostatectomy presently. Different fluids have been used for irrigation while performing monopolar TURP. The choice of irrigation fluid depends on a lot of factors. We sought to find out if the outcome of monopolar TURP using 5% dextrose water in our setting compares with findings in other studies using different fluids as irrigation fluid in monopolar TURP. This was a prospective study of 220 patients who had monopolar TURP using 5% dextrose water as irrigation fluid from 2015 to 2020. The study was completed by 220 patients. The mean age was 66.25 yrs. The mean weight of prostate was 53.2 g, and mean resected weight was 30.10 g using a mean irrigation volume of 45.35 liters, 5% dextrose water over a mean resection time of 66.08 mins. The mean changes in International Prostate Symptom Score/quality of life score (IPSS/QOLS) were statistically significant. Early complications recorded were postoperative hematuria with clot retention (1.4%), urinary tract infection (UTI) (13.2%), and secondary hemorrhage (10%). TURP syndrome was not recorded. Late complications seen within 2 years follow-up were transient urinary incontinence (6.4%), urethral stricture (4.1%), and bladder neck contracture (2.3%). There was no repeat TURP for residual adenoma within this period. TURP using 5% dextrose water has comparable outcomes to other irrigation fluids for monopolar TURP. It is a good alternative to any other irrigation fluid.

MP74-07 THE EFFECT OF TESTOSTERONE REPLACEMENT THERAPY ON LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyCME1 Apr 2023MP74-07 THE EFFECT OF TESTOSTERONE REPLACEMENT THERAPY ON LOWER URINARY TRACT SYMPTOMS Norichika Ueda, Go Tsujimura, Takahiro Imanaka, Sohei Kuribayashi, Koichi Okada, Kentaro Takezawa, Shinichiro Fukuhara, and Norio Nonomura Norichika UedaNorichika Ueda More articles by this author , Go TsujimuraGo Tsujimura More articles by this author , Takahiro ImanakaTakahiro Imanaka More articles by this author , Sohei KuribayashiSohei Kuribayashi More articles by this author , Koichi OkadaKoichi Okada More articles by this author , Kentaro TakezawaKentaro Takezawa More articles by this author , Shinichiro FukuharaShinichiro Fukuhara More articles by this author , and Norio NonomuraNorio Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both late-onset hypogonadism (LOH) syndrome and lower urinary tract symptoms (LUTS) increase with age and decrease quality of life (QOL). The standard treatment for LOH syndrome is testosterone replacement therapy (TRT). Since the prostate is an androgen-dependent organ, TRT may have some effect on LUTS. However, the effect of TRT on LUTS is not fully understood. The number of patients with both LUTS and LOH syndrome is increasing, therefore it is important to understand the relationship between TRT and LUTS. In this study, we retrospectively examined the effect of TRT on LUTS. METHODS: Ninety-four patients who received TRT for LOH syndrome from May 2017 to August 2022 were evaluated. Three months after the first testosterone administration, Aging males Symptoms rating scale (AMS), Sexual Health Inventory for Men (SHIM), Erection Hardness Score (EHS), International Prostate Symptom Score (IPSS), and IPSS QOL score were assessed. IPSS was also evaluated for the voiding and storage subscores, respectively. RESULTS: TRT improved AMS, SHIM and EHS significantly (all p<0.01). In the evaluation of urinary symptoms, TRT did not improve any of the IPSS total scores, IPSS voiding subscores, IPSS storage subscores, or IPSS QOL scores in the LUTS mild group (IPSS: 8 or less), but in the LUTS moderate-severe group (IPSS: 8-35), TRT significantly improved them all (IPSS total scores: 14.2±0.9 vs 9.8±1.1: p<0.001, IPSS voiding subscores: 8. 0±0.6 vs 5.3±0.8: p<0.001, IPSS storage subscores: 6.3±0.6 vs 4.5±0.5: p=0.003, IPSS QOL scores: 3.9±0.2 vs 3.0±0.3: p=0.002, respectively) (Figure 1). CONCLUSIONS: TRT for LOH patients does not exacerbate LUTS but improves LUTS, especially for moderate or severe LUTS patients. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1071 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Norichika Ueda More articles by this author Go Tsujimura More articles by this author Takahiro Imanaka More articles by this author Sohei Kuribayashi More articles by this author Koichi Okada More articles by this author Kentaro Takezawa More articles by this author Shinichiro Fukuhara More articles by this author Norio Nonomura More articles by this author Expand All Advertisement PDF downloadLoading ...

B-TURP versus HoLEP: Peri-Operative Outcomes and Complications in Frail Elderly (>75 y.o.) Patients: A Prospective Randomized Study

Background: The aim of this study was to compare the peri-operative and functional results between trans-urethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) in middle-old patients. Materials and Methods: This prospective single-center study included patients over 75 years old treated with B-TURP or HoLEP for BPH associated with LUTS with prostate volume (PV) <100 mL. Primary endpoints were the intra-operative blood loss, percentage of loss of hemoglobin, blood transfusion, complications, and the comparison of functional outcomes. All patients were evaluated at 1, 3, 6, and 12 months of follow-up. Results: Overall, 96 patients undergoing HoLEP and 104 B-TURP were eligible and enrolled for the study. Post-operative results showed statistically significant differences between the two groups, all in favor of HoLEP group, specifically in terms of removed prostate tissue, PV reduction rate, hemoglobin values at 24 h, hemoglobin loss, operative time, length of hospitalization, days of catheterization, and urinary flow rates. There was no significant difference in terms of postvoid residual urine volume, perioperative complication, blood transfusion, International Prostate Symptom Score (IPSS), and IPSS quality of life scores. Conclusions: In middle-old patients, the HoLEP technique represents a prostate size-independent treatment option with a more favorable safety profile defined by less bleeding, lower blood transfusions, and a significantly lower hemoglobin drop than B-TURP.

Role of Antimuscarinics Combined With Alpha-blockers in the Management of Urinary Storage Symptoms in Patients With Benign Prostatic Hyperplasia: An Updated Systematic Review and Meta-analysis.

We evaluate the efficacy and safety of combining antimuscarinics with alpha-blockers to treat storage symptoms in men with benign prostatic hyperplasia. Searches were carried out on PubMed, MEDLINE, EMBASE, and Cochrane databases to identify randomized, placebo-controlled trials published before February 15, 2022, assessing the efficacy or safety of antimuscarinics in men with benign prostatic hyperplasia treated with alpha-blockers. Further meta-analyses were performed using standardized mean difference and risk ratio. A total of 12 randomized trials were included in the systematic review. The meta-analysis showed no impact of antimuscarinics on the number of urgencies per day (SMD -0.23 [95%CI: -0.64; -0.17]; P = .21). However, the use of antimuscarinics was associated with a small reduction of micturition episodes per day (SMD -0.19 [95%CI: -0.37; -0.01]; P = .045). With regard to side effects, post-void residual increased slightly in patients treated with antimuscarinics (SMD 0.26 [95%CI: 0.15; 0.37]; P < .01). In addition, there was a higher risk of acute urinary retention (RR 3.26 [95%CI: 1.35; 7.86]; P = .02), dry mouth (RR 3.43 [95%CI: 1.86; 6.32]; P < .001), and constipation (RR 2.92 [95%CI: 1.48; 5.73]; P < .001) with the use of antimuscarinics. Finally, the risk of treatment interruption due to adverse events was higher for the patients treated with antimuscarinics (RR 1.74 [95%CI: 1.27; 2.38]; P < .01). The addition of antimuscarinics to alpha-blockers was not associated with a substantial reduction in urgencies and micturition episodes in benign prostatic hyperplasia patients with storage symptoms. In addition, the toxicity profile was not in favor of antimuscarinic use in these patients.

The pressure flow study investigation of pathophysiology of post-micturition dribble in male patients.

In this study, we aimed to elucidate the pathophysiology of post-micturition dribble (PMD) through analyzing several variables including pressure flow study (PFS) findings and symptoms questionnaire. We retrospectively analyzed male patients who visited our department between 2010 and 2020. We used modified international prostate symptom score (m-IPSS), which consists of eight sub-score related to lower urinary tract symptoms (Incomplete Emptying, Frequency, Intermittency, Urgency, Weak Stream, Straining, Nocturia, and PMD) and one question related to quality of life (QOL). Multivariate regression analysis was conducted to evaluate the relationship between PMD and the variables, including age, prostate volume (PV), body mass index, bladder outlet obstruction index (BOOI), bladder contractility index, and bladder voiding efficiency, which were obtained by PFS. A total of 143 male patients were analyzed. The patients with PMD showed significantly larger PV and higher BOOI, and worse IPSS total and QOL score than those without PMD. Multivariate regression analysis showed that large PV and BOOI were significantly associated with PMD. In Spearman's correlation analysis, PMD and each m-IPSS sub-score except nocturia had significant positive correlation. Furthermore, Spearman's correlation analysis showed that PMD and QOL had significant strong positive correlation. PMD was significantly associated with large PV and BOO evaluated by PFS. Furthermore, PMD significantly exacerbated QOL. The severity of PMD and the other m-IPSS sub-score except nocturia could have intercorrelation with each other.

Comparison of PKRP and TUVP in the treatment of high-risk BPH and analysis of postoperative influencing factors.

ObjectiveThis study aims to compare the efficacy of plasma kinetic loop resection of the prostate (PKRP) and transurethral vaporization of the prostate (TUVP) for the treatment of high-risk benign prostatic hyperplasia (BPH), and analyze the influence of the related factors on the operation of BPH.MethodsA total of 108 high-risk BPH patients diagnosed in our hospital from March 2018 to September 2021 were selected and randomly divided into an observation group and a control group, with 54 cases in each group. The control group was treated with TUVP, and the observation group was treated with PKRP. The international prostate symptom score (IPSS), quality of life (QOL) index, maximum urine flow rate (Qmax), and residual urine volume (RU) were observed before and after treatment. The general information such as age, educational level, residence, and residence status of the patient, as well as clinical information such as surgical method, nocturia frequency, preoperative IPSS score, RU, medical history, and prostate texture, were also recorded. All patients were followed up for 1 month, and complications were recorded.ResultsThe IPSS score, QOL score, and RU of patients in the two groups were lower after treatment than those before treatment, and the Qmax was higher than that before treatment (P < 0.05). The IPSS score, QOL score, and RU of the observation group were lower than those of the control group, and the Qmax was higher than that of the control group (P < 0.05). The incidence of postoperative complications in the observation group was lower than in the control group (P < 0.05). Univariate analysis showed that the patient's age, surgical method, nocturia frequency, preoperative IPSS score, RU, medical history, and prostatic texture all could affect the postoperative condition of patients with BPH (P < 0.05). Multivariate logistic analysis showed that the patient's age, surgical method, nocturia frequency, preoperative IPSS score, RU, and medical history were the independent influencing factors of the postoperative condition of patients with BPH (P < 0.05).ConclusionPKRP in the treatment of high-risk BPH patients can effectively reduce the IPSS score, QOL score, and RU and significantly increase Qmax, with fewer complications and a good prognosis. Patients’ postoperative recovery was related to their age, surgical method, nocturia frequency, preoperative IPSS score, RU, and medical history. Therefore, choosing PKRP to treat high-risk BPH patients can effectively improve the postoperative urethral functional recovery of patients and reduce the occurrence of complications.

Feasibility and safety of definite volumetric modulated arc therapy with simultaneous integrated boost to the dominant intraprostatic lesion in patients with unfavorable intermediate to high-risk prostate cancer.

BackgroundThe most common site of recurrence of prostate cancer after definite radiation therapy is the dominant intraprostatic lesion (DIL). This study aimed to investigate the feasibility and safety of definite volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) to the DIL in patients with unfavorable intermediate to high-risk prostate cancer.Materials and methodsIn this prospective uncontrolled clinical trial, patients were delivered VMAT at a dose of 87.75 Gy in 39 fractions or 70 Gy in 20 fractions to the DIL in combination with androgen deprivation therapy. Genitourinary (GU) and rectal toxicity, International Prostate Symptom Score (IPSS) and IPSS quality of life (IPSS-QOL) score were collected.ResultsForty-five patients with a median follow-up of 20 months were analyzed. The cumulative incidence of acute grade ≥ 2 GU and rectal toxicity was 33.1% and 9.5%, respectively. Regarding late toxicity, the cumulative incidence of grade ≥ 2 GU and rectal toxicity was 12.6% and 2.8%, respectively. During treatment, the mean increase of IPSS was +7.4 ± 4.2 and the mean increase of IPSS-QOL was +1.7 ± 1.3. However, both IPSS and IPSS-QOL scores returned to their baseline levels by 3-months post-treatment. No significant correlation between baseline characteristics and grade ≥ 2 GU or rectal toxicity was found.ConclusionFocal SIB to the DIL of ≥ 90 Gy EQD2 in unfavorable intermediate to high-risk prostate cancer patients resulted in tolerable toxicity profiles. The mean IPSS and IPSS-QOL scores both worsened during treatment; however, both scores returned to baseline level by 3 months after treatment.

MP01-03 TRANSURETHRAL ULTRASOUND ABLATION FOR BENIGN PROSTATIC HYPERPLASIA: THREE-MONTH CLINICAL OUTCOMES OF A PHASE 1-2 STUDY

You have accessJournal of UrologyCME1 May 2022MP01-03 TRANSURETHRAL ULTRASOUND ABLATION FOR BENIGN PROSTATIC HYPERPLASIA: THREE-MONTH CLINICAL OUTCOMES OF A PHASE 1-2 STUDY Mikael Anttinen, Antti Viitala, Pouya Doerwald, Pietari Mäkelä, Pekka Taimen, Roberto Blanco Sequeiros, and Peter Boström Mikael AnttinenMikael Anttinen More articles by this author , Antti ViitalaAntti Viitala More articles by this author , Pouya DoerwaldPouya Doerwald More articles by this author , Pietari MäkeläPietari Mäkelä More articles by this author , Pekka TaimenPekka Taimen More articles by this author , Roberto Blanco SequeirosRoberto Blanco Sequeiros More articles by this author , and Peter BoströmPeter Boström More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI-guided transurethral ultrasound ablation (TULSA) is a novel therapy option for treating lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). We have previously reported 12-mo clinical outcomes from the first 10 patients treated at our institution. Since then, we have acquired more clinical data by treating an additional 10 patients. Combined data set of all 20 patients is reported here for the first time. METHODS: Men with LUTS due to BPH in need of surgical interventions were enrolled in this prospective, investigator-initiated, single-center, phase 1-2 study (NCT03350529). Efficacy of the procedure is assessed by uroflowmetry, PSA, and functional status and quality of life (QoL) questionnaires including EPIC-26, IPSS, and IIEF-5 at baseline and 3, 6, 9 and 12 mo post-TULSA. MRI is obtained at baseline, 3 and 12 mo. Medication use before and after TULSA and adverse events (AEs) in Clavien-Dindo classification are recorded. RESULTS: 20 patients have undergone TULSA, with a median follow-up of 12 mo. At baseline, median [IQR] age was 67 yr [64–72], PSA 3 ng/ml [2–6], prostate volume 51 ml [48–65], average flow rate 4 ml/s [3–7], maximum flow rate 11 ml/s [8–16], voided volume 210 ml [144–378], and post-void residual volume 71 ml [40–304]. Median sonication, hospitalization, and catheterization times were 43 min, 24 h, and 16 d, respectively. AEs included six grade 2 and one grade 3 events, including urinary tract infection, urinary retention, and epididymitis (grade 3), all resolving within 3 mo. 17 patients have completed their 3-mo follow-up. Between baseline and 3 mo, median values for measured parameters changed as follows: prostate volume reduced from 51 to 38 ml, PSA reduced from 3 to 1 ng/ml, post-void residual volume decreased from 71 to 54 ml, average flow rate increased from 4 to 8 ml/s, Qmax increased from 11 to 23 ml/s, voided volume decreased from 210 to 171 ml, IPSS score improved from 16 to 6, IPSS QoL score improved from 4 to 1, IIEF-5 improved from 17 to 21, EPIC-26 urinary incontinence domain improved from 86 to 97, EPIC-26 irritative/obstructive domain improved from 69 to 91, EPIC-26 bowel domain improved from 88 to 96 and EPIC-26 sexual domain improved from 63 to 95. The results of uroflowmetry, functional status, and QoL questionnaires all improved already at 3 mo despite discontinuation of LUTS medication in all 17 patients receiving LUTS medication before TULSA. CONCLUSIONS: These short-term outcomes strengthen our previously reported results on the safety and efficacy of TULSA as a promising treatment option for BPH. Source of Funding: Urology and radiology departments at Turku University Hospital have received an unrestricted educational grant from Profound Medical Inc., which enabled us to conduct this trial in accordance with our own predefined protocol. Our study was planned and implemented solely by the clinical authors © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mikael Anttinen More articles by this author Antti Viitala More articles by this author Pouya Doerwald More articles by this author Pietari Mäkelä More articles by this author Pekka Taimen More articles by this author Roberto Blanco Sequeiros More articles by this author Peter Boström More articles by this author Expand All Advertisement PDF DownloadLoading ...

Endoscopic vaporization of benign prostatic hyperplasia using a contact 980 nm diode laser under antithrombotic therapy: A prospective survey.

To prospectively clarify whether endoscopic contact laser vaporization of the prostate (CVP) can be safely performed even in patients undergoing antithrombotic therapy. Fifty-five patients treated with CVP were enrolled. Patients were assigned to: (i) the antithrombotic therapy group (n=21, 38%); or (ii) control group without antithrombotic therapy (n=34, 62%). All patients in the antithrombotic therapy group continued all antithrombotic agents during the perioperative period and thereafter. No difference was noted in patient background between the two groups. In primary endpoints, decreases in the postoperative hemoglobin level were remarkable in the antithrombotic therapy group, while no serious effects were noted in either group. The control and antithrombotic therapy groups did not show a significant difference in the occurrence of catheter obstruction due to blood clots or serious hematuria following catheter removal. During follow-up, transurethral coagulation for hemostasis was needed only in the antithrombotic therapy group, with a frequency of transurethral coagulation of up to 14%. In secondary endpoints, no difference in the occurrence of perioperative or late-onset complications after surgery was noted between the two groups. Finally, no difference was noted in improvements in the International Prostate Symptom Score (IPSS), IPSS quality of life score, overactive bladder symptom score, maximum flow rate, or post-voiding residual urine volume between the two groups throughout the follow-up period. CVP can be performed safely and effectively in patients undergoing continuous antithrombotic therapy. However, the possibility of secondary bleeding after discharge in a subset of patients, such as those undergoing antithrombotic therapy, may be noted.

Effects of TORS-OSA Surgery on Lower Urinary Tract Symptoms, Overactive Bladder Symptoms, and Nocturia in Male Patients with Obstructive Sleep Apnea/Hypopnea Syndrome

ObjectiveTo determine the presence of lower urinary tract symptoms (LUTS), and overactive bladder (OAB) symptoms in men with obstructive sleep apnea/hypopnea syndrome (OSA) and the effects of transoral robotic surgery (TORS) for the treatment of OSA on these conditions.Materials and MethodsOne hundred twenty-three patients with a diagnosis of OSA were prospectively enrolled. The evaluations of LUTS and OAB symptoms were based on self-administered questionnaires containing international prostate symptom score (IPSS) and OAB symptom score (OABSS), respectively. Men with an OABSS urgency score of ≥2 and sum score of ≥3 were considered to have OAB. The therapeutic outcomes were assessed at baseline, and 12 weeks after TORS-OSA Surgery.ResultsThere were significant differences in IPSS, and OABSS according to OSA severity. After TORS-OSA surgery, significant improvements on OSA severity, daytime quality of life (QoL) and nighttime sleep quality were observed. TORS-OSA surgery was also associated with a statistically significant improvement of LUTS, LUTS QoL score, and OAB symptoms (IPSS 22.1% decrease; IPSS QoL score 21.1% decrease; OABSS17.4% decrease) at post-operative 3 months’ follow-up. The presence of OAB, and severe nocturia was significantly reduced from 22.8% to 11.4% (p=0.001), 5.7% to 0.8% (p=0.031) after TORS-OSA surgery. There were no patients who had acute airway compromise or massive bleeding peri- or post-operatively.ConclusionTORS upper airway surgery could improve LUTS and OAB symptoms on male patients with OSA in addition to improvement of major parameters of sleep study and sleep-related QoL.

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.

Prostatic artery embolization for giant prostatic hyperplasia: a single-center experience.

ObjectiveTo describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate.Materials and MethodsThis was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms.ResultsThe PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment.ConclusionIn patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.