Reduction In International Prostate Symptom Score Research Articles

“Laser vaporization of the prostate: A comparative study between ejaculatory preserving and non-ejaculatory preserving technique”

ABSTRACT Introduction and objectives Laser vaporization techniques have emerged as a prominent alternative to transurethral prostate resection in managing benign prostatic obstruction (BPO). This study focuses on assessing the effectiveness of the ejaculatory preserving laser vaporization of the prostate technique compared to the conventional non-ejaculatory approach in managing BPO. Patients and Methods Our study was performed between August 2022 and September 2023. The study included 120 patients with bladder outlet obstruction, due to benign prostatic hyperplasia (BPH). Patients were randomly assigned to two groups: the first underwent conventional non-ejaculatory preserving laser vaporization of the prostate (n = 80), while the second group underwent the innovative ejaculatory preserving laser vaporization technique using diode laser (n = 40). We assessed baseline International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), post voiding residual urine volume (PVRU), semen volume (semen analysis). Parameters were re-evaluated 3 months post-surgery and the change in sexual satisfaction was evaluated using a scale from 1 (much less satisfied) to 5 (much more satisfied) in response to a question. Results The mean age (±SD) of participants was 59.6 (±7.9) and 57.6 (±7.8) for the non-ejaculatory preserving and ejaculatory preserving groups, respectively, with no statistical difference between groups. Both groups showed significant reduction in IPSS (p < 0.001), improvement in Qmax (p < 0.001), and decline in PVRU (p < 0.001), postoperatively. However, the ejaculatory preserving technique led to a significant improvement in antegrade ejaculation, postoperative semen volume and sexual satisfaction compared to the non-ejaculatory preserving technique (p < 0.001). Conclusions The ejaculatory preserving technique effectively preserved antegrade ejaculation, semen volume and sexual satisfaction compared to the non-ejaculatory preserving technique. However, the later yielded better outcomes in terms of IPSS and urine flow. Both techniques demonstrated significant improvements across all parameters compared to baseline. Further research with extended follow-up periods is needed to fully understand the long-term postoperative effects with this technique.

Predicting surgical efficacy and diagnosing histological inflammation: the clinical significance of prostate exosome proteins in benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms (LUTS) among the aging male population. Recent studies have shown that histological inflammation (HI) plays a significant role in BPH, with prostatic exosomal protein (PSEP) identified as a potential biomarker for prostate diseases. Therefore, this study aimed to explore the effect of HI on LUTS in patients with BPH, and to further explore the clinical value of PSEP as a diagnostic biomarker of BPH complicated with HI and whether PSEP could be used as an index to predict the improvement of LUTS after operation. This study was an open-label, cohort study. The study enrolled all patients who were clinical diagnosed as BPH with LUTS and prepared to receive operation of the prostate at the Department of Urology of the Second Hospital of Hebei Medical University. International Prostate Symptom Score (IPSS) were used to evaluate the LUTS of the BPH. And the enrolled patients were divided into four groups, including none, mild HI, moderate HI, and severe HI, based on postoperative pathological results. Then the relationships between HI and IPSS, the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), as well as PSEP were analyzed. Simple and multiple linear regression analyses were performed on the preoperative IPSS and the difference of IPSS before and after surgery was examined. SPSS software version 26 was used for statistical analysis and Prism 9.0 was used to make violin plots. A total of 69 patients were enrolled in the study. The violin plot results indicated IPSS and NIH-CPSI scores exhibited significant increases in correlation with the severity levels of HI (P<0.001; P<0.001). Among BPH patients with total prostate-specific antigen (t-PSA) levels higher than 4.0 ng/mL, a significant correlation was observed between PSEP levels and HI (P=0.04). Besides, simple and multiple linear regression analysis showed that HI (P<0.001) or PSEP (P=0.03) was significantly associated with IPSS and improvement of LUTS, assessed by postoperative and preoperative IPSS differences. The study indicated that IPSS and PSEP (when t-PSA >4 ng/mL) were correlated with the severity of HI in patients with BPH. PSEP was linearly correlated with IPSS and the degree of reduction in IPSS after surgery. Consequently, PSEP may serve as a promising predictor for assessing surgical efficacy and diagnosing the severity of HI in patients with BPH.

Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis

Despite the availability of various drugs for benign prostatic hyperplasia (BPH), alpha(α)-blockers are the preferred first-line treatment. However, there remains a scarcity of direct comparisons among various α-blockers. Therefore, this network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of α-blockers in the management of BPH. A comprehensive electronic search covered PubMed, Embase, Ovid MEDLINE, and Cochrane Library until August 2023. The primary endpoints comprised international prostate symptom score (IPSS), maximum flow rate (Qmax), quality of life (QoL), and post-void residual volume (PVR), while treatment-emergent adverse events (TEAEs) were considered as secondary endpoints. This NMA synthesized evidence from 22 studies covering 3371 patients with six kinds of α-blockers with 12 dose categories. IPSS has been considerably improved by tamsulosin 0.4 mg, naftopidil 50 mg and silodosin 8 mg as compared to the placebo. Based on the p-score, tamsulosin 0.4 mg had the highest probability of ranking for IPSS, PVR, and Qmax, whereas doxazosin 8 mg had the highest probability of improving QoL. A total of 297 adverse events were reported among all the α-blockers, silodosin has reported a notable number of TEAEs. Current evidence supports α-blockers are effective in IPSS reduction and are considered safer. Larger sample size with long-term studies are needed to refine estimates of IPSS, QoL, PVR, and Qmax outcomes in α-blocker users.

Transperineal Laser Ablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Long-Term Follow-Up in 40 Patients

PurposeTo evaluate the durability, effectiveness, and safety of transperineal laser ablation (TPLA) of the prostate. Materials and MethodsPatients with symptomatic benign prostatic hyperplasia (BPH) underwent TPLA with a 1,064-nm continuous-wave diode laser. International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual (PVR), and prostate volume were evaluated at baseline and successive timepoints. ResultsForty prospectively enrolled patients had follow-up of ≥36 months; median duration of follow-up was 57 months (range, 36–76 months). Compared with baseline, the median reduction in IPSS at 12-month follow-up was 74% (interquartile range [IQR], 60%–81%) (P < .001). Median QoL score at 12 months was improved from 5 (IQR, 4–5) at baseline to 1 (IQR, 0–1) (P < .001). Median PVR at 12 months decreased from 108 mL (IQR, 38–178 mL) to 13.5 mL (IQR, 0–40.5 mL) (P < .001), a median reduction of 88% (IQR, 61%–100%). At 12 months, median prostate volume was significantly reduced from 66 mL (IQR, 48.5–86.5 mL) to 46 mL (IQR, 36–65 mL) (P < .001), a median reduction of 32% (IQR, 21%–45%). For all of these parameters, the benefit of TPLA persisted at last follow-up, and all changes were statistically significant compared with baseline. There were no intraprocedural adverse events; periprocedural adverse events consisted of 1 case of prostatitis and 1 case of urinary tract infection (both Society of Interventional Radiology [SIR] Grade I). ConclusionsTPLA for symptomatic BPH produced durable benefits across a range of clinical outcomes and was well tolerated in follow-up at median duration of 57 months.

Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Obstruction: 5-year Outcomes of a Randomised, Open-label, Noninferiority Trial

Background and objectiveProstatic artery embolisation (PAE) and transurethral resection of the prostate (TURP) are two of the surgical options for treatment of lower urinary tract symptoms/benign prostatic obstruction (LUTS/BPO). Our aim was to compare the efficacy and safety of PAE and TURP for LUTS/BPO treatment at long-term follow-up. MethodsWe conducted a randomised, open-label, single-centre trial at a Swiss tertiary care centre. The main outcome was the change in International Prostate Symptom Score (IPSS) after PAE versus TURP. Secondary outcomes included patient-reported outcomes, functional measures, and adverse events assessed at baseline and at 3, 6, 12, 24, and 60 mo. Between-group differences in the change from baseline to 5 yr were tested using two-sided Mann-Whitney and t tests. Key findings and limitationsOf the 103 patients with refractory LUTS/BPO who were randomised between 2014 and 2017, 18/48 who underwent PAE and 38/51 who underwent TURP reached the 60-mo follow-up visit. The mean reduction in IPSS from baseline to 5 yr was −7.78 points after PAE and −11.57 points after TURP (difference 3.79 points, 95% confidence interval [CI] −0.66 to 8.24; p = 0.092). TURP was superior for most patient-reported secondary outcomes except for erectile function. At 5 yr, PAE was less effective than TURP regarding objective parameters, such as the improvement in maximum urinary flow rate (3.59 vs 9.30 ml/s, difference −5.71, 95% CI −10.72 to −0.70; p = 0. 027) and reduction in postvoid residual volume (27.81 vs 219.97 ml; difference 192.15, 95% CI 83.79–300.51; p = 0.001). Conclusions and clinical implicationsThe improvement in LUTS/BPO at 5 yr after PAE was inferior to that achieved with TURP. The limitations of PAE should be considered during patient selection and counselling. Patient summaryIn this study, we show the long-term results of prostate artery embolisation (PAE) in comparison to transurethral resection of the prostate (TURP) for the treatment of benign prostate enlargement causing urinary symptoms. PAE shows good long-term results in properly selected patients, although the improvements are less pronounced than with TURP.This trial is registered on ClinicalTrials.gov as NCT02054013.

Assessing the Safety and Effectiveness of Bipolar Technology in Transurethral Prostate Resection: A study in a Tertiary Care Private Hospital

Background: Benign enlargement of prostate (BEP) is a common affliction among aging males, predominantly emanating from the transition zone of the prostate, resulting in lower urinary tract symptoms. Despite the availability of diverse treatment modalities, transurethral resection of prostate (TURP) has conventionally served as a benchmark intervention. Recently, there has been a growing interest in bipolar energy techniques, spurred by their potential advantages in mitigating complications such as TUR syndrome and surgical bleeding. Objectives: The main aim of the study to evaluate the safety profile (including serum sodium and hemoglobin reductions, clot retention, TUR syndrome, catheterization duration, and hospital stay) and efficacy (resection rate, maximum flow rate increase, and International Prostate Symptom Score reduction) within the bipolar technique for the TURP. Methods &amp; Materials: A prospective observational study was conducted at the Department of Urology, Square Hospitals Ltd, Dhaka, Bangladesh, spanning December 2020 to November 2021. The study employed comprehensive preoperative assessments, including bipolar transurethral resection of the prostate (B-TURP) using Olympus ESG-400 energy platform. Surgical parameters, postoperative monitoring, and statistical analysis were meticulously executed to evaluate outcomes and complications for symptomatic benign enlargement of prostate. Results: In a sample of 50 individuals undergoing bipolar transurethral resection of the prostate (B-TURP), the distribution of ages revealed 66.97±7.95 years as the bipolar system's average age, ranging from 53-82 years. The majority resided in urban areas (62%), with family income predominantly in the 25000-50000 bracket (42%). Preoperative baseline variables, including IPSS, Qmax, serum hemoglobin, and sodium levels, exhibited similar values between groups. Intraoperatively, the mean resection rate was 0.56±0.16 gm/min. Postoperatively, B-TURP resulted in a slight ......

Safety and efficacy of tamsulosin 0.4 mg as an initial dose in 1,219 Korean patients with moderate to severe lower urinary tract symptoms: data from a phase IV study

BackgroundAn initial dose of tamsulosin 0.2 mg is frequently prescribed for Asian men. We investigated the safety and efficacy of tamsulosin 0.4 mg as the initial dose in Korean men with moderate to severe lower urinary tract symptoms (LUTSs) in everyday clinical practice. Materials and methodsA phase IV study was conducted in South Korea. Eligible patients were prescribed tamsulosin 0.4 mg for 6 months. We excluded patients with previous exposure to LUTS drugs and patients with an international prostate symptom score (IPSS) < 8. ResultsThe mean total IPSS, storage subscore, voiding symptoms subscore, and quality of life significantly decreased from 18.0, 10.8, 7.2, and 3.8 to 12.8, 7.5, 5.3, and 2.6, respectively, after 6 months of treatment. The number of nocturia episodes significantly decreased from 3.0 to 2.2 in patients who reported at least 2 nocturia events at baseline. A mean reduction in the IPSS was quantitatively equivalent in all age groups. The mean reduction in the IPSS was greater in the IPSS ≥ 20 group than in the IPSS < 20 group (mean reduction in the total IPSS: −2.6 in the IPSS < 20 group; −9.4 in the IPSS ≥ 20 group). All treatment-emergent adverse events were mild. The most frequently recorded treatment-emergent adverse event was dizziness, which was reported in 22 patients (1.8%). ConclusionTreatment of LUTS with tamsulosin 0.4 mg as the initial dose for 6 months in Korean men was effective in improving LUTS and showed a favorable safety profile in a real-life setting.

PD41-02 12-MONTH OUTCOMES FROM THE FIRST NORTH AMERICAN STUDY OF THE ZENFLOW SPRING SYSTEM FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH)

You have accessJournal of UrologyCME1 Apr 2023PD41-02 12-MONTH OUTCOMES FROM THE FIRST NORTH AMERICAN STUDY OF THE ZENFLOW SPRING SYSTEM FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) Dean Elterman, Edward D. Matsumoto, and Kevin C. Zorn Dean EltermanDean Elterman More articles by this author , Edward D. MatsumotoEdward D. Matsumoto More articles by this author , and Kevin C. ZornKevin C. Zorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The ZEST-CAN study is a prospective single-arm study evaluating the Zenflow Spring System for BPH. The Zenflow Spring System is a novel minimally invasive surgical therapy (MIST) that delivers an appropriately sized nitinol stent-like device into the prostatic urethra displacing the lateral lobes for improved urinary flow. METHODS: Ten (10) subjects received the device at 3 centers in Canada. Symptom improvement was measured utilizing the International Prostate Symptom Score (IPSS) and IPSS-QOL, and functional improvement was measured by peak urinary flow rate (Qmax). Erectile and ejaculatory function were evaluated utilizing validated questionnaires. The clinical events committee independently adjudicated any adverse event. RESULTS: Subjects treated with the Zenflow Spring showed a significant reduction in IPSS from baseline to 12 months (21.2 vs 11.4, p<0.01), representing a 47% reduction in IPSS. IPSS QOL significantly improved from baseline to 12 months (5.4 vs 2.4, p<0.010, representing a 56% improvement. Qmax improved from 9.7 mL/sec at baseline to 14.0 mL/sec after treatment (p<0.05) representing a 45% improvement. There were no changes in sexual or ejaculatory function as assessed by the validated questionnaires. The responder rate at 12 months calculated as those with 30% improvement in IPSS was 70%. (7/10 subjects). Adverse events post procedure were typically mild and transient and common to events reported in similar procedures. CONCLUSIONS: The Zenflow Spring System resulted in immediate and significant symptomatic improvements from 3 through 12 months. Subjects experienced improvements in symptoms, quality of life, maximum flow rate without any sexual dysfunction through 12 months of follow up. These results are currently being validated through a large, multiple centers, prospective randomized study in the United States and Canada. Source of Funding: Zenflow Inc © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1058 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean Elterman More articles by this author Edward D. Matsumoto More articles by this author Kevin C. Zorn More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-03 12-MONTH OUTCOMES FROM A RANDOMIZED, SHAM CONTROLLED STUDY EVALUATING A NOVEL DRUG COATED BALLOON FOR THE TREATMENT OF BPH

You have accessJournal of UrologyCME1 Apr 2023PD41-03 12-MONTH OUTCOMES FROM A RANDOMIZED, SHAM CONTROLLED STUDY EVALUATING A NOVEL DRUG COATED BALLOON FOR THE TREATMENT OF BPH Steven A. Kaplan, Jared Moss, Sheldon Freedman, Karl Coutinho, Ning Wu, Mitchell Efros, Dean Elterman, Richard D'Anna, Osvaldo Padron, Kaiser J. Robertson, Samuel Lawindy, Sandeep Mistry, Neal Shore, Jeffrey Spier, Jed Kaminestky, Brian Mazzarella, David Cahn, Mark Jalkut, and Alexis Te Steven A. KaplanSteven A. Kaplan More articles by this author , Jared MossJared Moss More articles by this author , Sheldon FreedmanSheldon Freedman More articles by this author , Karl CoutinhoKarl Coutinho More articles by this author , Ning WuNing Wu More articles by this author , Mitchell EfrosMitchell Efros More articles by this author , Dean EltermanDean Elterman More articles by this author , Richard D'AnnaRichard D'Anna More articles by this author , Osvaldo PadronOsvaldo Padron More articles by this author , Kaiser J. RobertsonKaiser J. Robertson More articles by this author , Samuel LawindySamuel Lawindy More articles by this author , Sandeep MistrySandeep Mistry More articles by this author , Neal ShoreNeal Shore More articles by this author , Jeffrey SpierJeffrey Spier More articles by this author , Jed KaminestkyJed Kaminestky More articles by this author , Brian MazzarellaBrian Mazzarella More articles by this author , David CahnDavid Cahn More articles by this author , Mark JalkutMark Jalkut More articles by this author , and Alexis TeAlexis Te More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The PINNACLE study is a prospective, randomized, double-blind, sham controlled study evaluating the Optilume BPH System. Optilume BPH is a novel minimally invasive surgical therapy (MIST) that combines mechanical dilation with the delivery of paclitaxel for the treatment of lower urinary tract symptoms (LUTS) secondary to BPH. Mechanical dilation with Optilume BPH achieves an anterior commissurotomy, while delivery of paclitaxel is intended to maintain luminal patency during healing. METHODS: 148 subjects were randomized in a 2:1 fashion at 18 centers in the US and Canada. Subjects and evaluating personnel were blinded to treatment through 12-months. 12-month follow-up is complete. Symptom improvement was measured utilizing the International Prostate Symptom Score (IPSS) and BPH Impact Index (BPH-II), functional improvement measured by peak urinary flow rate (Qmax) and post-void residual volume (PVR). Erectile and ejaculatory function were evaluated utilizing validated questionnaires. Adverse events were prospectively collected and relatedness to treatment was adjudicated by an independent, blinded clinical events committee. RESULTS: Subjects treated with Optilume BPH showed a significant reduction in IPSS through 12 months (23.4 vs 10.9, p<0.001). Improvement in IPSS at 12 months was significantly greater for Optilume BPH compared to Sham in the intent-to-treat population (11.5 vs 4.8, p<0.001). Qmax more than doubled from 8.9 mL/sec at baseline to 19.0 mL/sec after treatment with Optilume BPH, while average PVR decreased from 84 mL to 58 mL (p=0.004). There were no changes in perceived sexual or ejaculatory function. The most reported treatment related adverse events after treatment with Optilume BPH included hematuria (39/98 [39.8%]), urinary tract infection (11/98 [11.2%]), and dysuria (8/98 [8.2%]). CONCLUSIONS: Treatment with Optilume BPH resulted in significant, immediate symptomatic and functional improvements and to date the highest Qmax reported in BPH MIST trials. Durability of these outcomes was shown through 12 months follow-up, demonstrating the intended effect of an immediate mechanical benefit that is sustained long-term by the delivery of paclitaxel. Long-term outcomes will be verified with 5 year follow-up for Optilume BPH. Source of Funding: Urotronic, Inc © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1059 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven A. Kaplan More articles by this author Jared Moss More articles by this author Sheldon Freedman More articles by this author Karl Coutinho More articles by this author Ning Wu More articles by this author Mitchell Efros More articles by this author Dean Elterman More articles by this author Richard D'Anna More articles by this author Osvaldo Padron More articles by this author Kaiser J. Robertson More articles by this author Samuel Lawindy More articles by this author Sandeep Mistry More articles by this author Neal Shore More articles by this author Jeffrey Spier More articles by this author Jed Kaminestky More articles by this author Brian Mazzarella More articles by this author David Cahn More articles by this author Mark Jalkut More articles by this author Alexis Te More articles by this author Expand All Advertisement PDF downloadLoading ...

Influence of benign prostatic hyperplasia patterns detected with MRI on the clinical outcome after prostatic artery embolization

BackgroundTo investigate the influence of benign prostatic hyperplasia (BPH) patterns detected with MRI on clinical outcomes after prostatic artery embolization (PAE).Materials & methodsThis retrospective study included 71 consecutive patients with lower urinary tract symptoms (LUTS), who underwent magnetic resonance imaging (MRI) of the prostate followed by PAE at a single centre. MRI scans were evaluated and BPH patterns were determined according to Wasserman type and a modified BPH classification. Additionally, scans were evaluated regarding the presence of adenomatous-dominant benign prostatic hyperplasia (AdBPH). LUTS were assessed using the International Prostate Symptom Score (IPSS) and urinary flow rate (Qmax). Follow-up examination included MRI and clinical outcome.ResultsFor clinical outcome at follow-up, IPSS showed median reduction of 54% (IQR 41—75%) and Qmax improved by 4.1 ml/s. We noted significant reduction in volume, intraprostatic protrusion, and prostatic urethral angle in our collective (p < 0.01). Median volume reduction was 25% (IQR 15%—34%). Bilateral embolization was a significant predictor for volume reduction at follow-up. Multiple linear regression analysis showed significant effect of high initial volume on reduction in IPSS after treatment (p < 0.01). Presence of AdBPH was significantly associated with both, volume loss and clinical improvement in terms of IPSS reduction (p < 0.01). Neither BPH pattern based on the Wassermann type nor modified BPH classification were significantly related with postinterventional IPSS and volume loss.ConclusionsMen benefit from PAE regardless the macroscopic BPH MRI pattern. Preinterventional prostate volume and presence of AdBPH on MRI should be considered for outcome prognosis after PAE.

Correlation of Postoperative Outcomes According to the Amount of Prostatic Tissue Removed in Patients Undergoing Transurethral Resection of the Prostate.

The present study assesses the effect of the proportion of tissue resected during transurethral resections of the prostate (TUR-P) on lower urinary tract symptoms (LUTS) and other parameters in patients with a benign prostatic obstruction (BPO). Forty-three patients who underwent TUR-P between 2018 and 2021 were assessed prospectively. The patients were divided into two groups according to the percentage of tissue removed (group 1 <30%, group 2 >30% resection). Age, prostate volume, amount of resected tissue, operative time, length of hospital stay, duration of catheterization, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), and serum prostate-specific antigen (PSA) (ng/dl) at preoperative and postoperative three months were recorded. The percentage of tissue removed was 22.2% vs. 48.4% (p = 0.001), IPSS reduction was 77.7% vs. 83.3% (p = 0.048), QoL improvement was 77.2% vs. 84.8% (p = 0.133), Qmax increase was 171.3% vs. 193.5% (p = 0.032), and serum PSA decrease was 56.4% vs. 69.2% (p = 0.049) in groups 1 and 2, respectively. In addition, the operative time was 38.5 vs. 53.6 min (p = 0.001), the length of hospital stay was 2.0 vs. 2.4 days (p = 0.001), and the duration of catheterization average was 4.1 vs. 4.9 days (p = 0.002). Resections of at least 30% of prostatic tissue can provide a significant improvement in the symptoms and parameters related to benign prostatic obstruction, while resections of less than 30% of prostatic tissue can effectively reduce urinary symptoms and improve the quality of life in older adult patients with comorbidities who require shorter operating times.

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.

Potential of pre-interventional magnetic resonance angiography for optimization of workflow and clinical outcome of prostatic arterial embolization

PurposeImpact of pre-interventional magnetic resonance angiography (MRA) on prostatic artery embolization (PAE) regarding workflow, radiation dose, and clinical outcome. MethodRetrospective evaluation of 259 patients (mean age 68 ± 9, range 41–92) with benign prostatic hypertrophy (BPH) undergoing PAE between January 2017 and December 2020. MRA was performed in 137 cases. In 122 patients, no pre-interventional MRA was performed. Origin of the PA, volumetry of the prostatic gland and ADC values were evaluated. International Prostate Symptom Score (IPSS), Quality of Life (QoL) and International Index of Erectile Function (IIEF) were evaluated before and after PAE. ResultsOrigin of the PA was identified in all cases. Significant differences regarding volume reduction (−20 ± 13 ml with MRA vs −17 ± 9 ml without MRA) and ADC value reduction were found (−78 ± 111 10−6 mm2/s with MRA vs −45 ± 99 10−6 mm2/s without MRA). PAE workflow was modified in 16 patients due to MRA findings. Radiation dose (5518.54 ± 6677.97 µGym2 with MRA vs 23963.50 ± 19792.25 µGym2 without MRA) and fluoroscopy times (19.35 ± 9.01 min. with MRA vs 27.45 ± 12.54 min. without MRA) significantly differed. IPSS reduction improved (−11 ± 8 points with MRA vs −7 ± 9 points without MRA, p < 0.001), while QOL (−2 ± 1 points with MRA and −2 ± 2 points without MRA) and IIEF (+2 ± 10 points with MRA and +1 ± 11 points without MRA) showed no significant differences (p > 0.05). ConclusionsPre-interventional MRA facilitates improved workflow and patient safety of PAE while reducing radiation dose and intervention time.

Learning curve in aquablation: an international multicenter study.

To describe and analyze the learning curve (LC) of aquablation for the treatment of benign prostatic obstruction and determine the number of cases needed to achieve acceptable surgical safety, efficiency, and efficacy. A retrospective analysis of prospectively maintained aquablation databases from France, Lebanon, and Spain was conducted. The combined LC of three surgeons was defined by trifecta and pentafecta outcomes. Trifecta reflected efficiency and safety: operative time < 60min, hemoglobin reduction ≤ 2mg/dL, and no 90day Clavien-Dindo grade ≥ 2 complications. Pentafecta reflected effectiveness: percent reduction in International Prostate Symptom Score (IPSS) and ejaculation preservation. The combined LC was plotted using a moving average with polynomial fitting. The cohort included 175 consecutive patients. Median (IQR) prostate volume was 70 (50-91) cc, and baseline IPSS was 23 (18-27). The achievement of trifecta exceeded 50% after 4 cases, and 70% after 50 cases. Pentafecta achievement exceeded 50% after 38 cases. Logistic regression showed significant improvement in hemoglobin reduction and ejaculation preservation. Grade ≥ 2 complication was not affected by experience, and neither was 3month %IPSS reduction as 94% of patients showed ≥ 50% symptoms' improvement. Aquablation is associated with a quick learning curve for the defined trifecta and pentafecta outcomes. It provided effective LUTS relief and low complication rates independent of surgeon experience. Hemoglobin drop and ejaculatory function preservation were the two factors influenced by the surgeons' LC. Training to reduce operative time, standardization of hemostasis techniques, and early assistance to improve veru-protection zone planning are keys to quicker learning.

Abstract No. 40 Does the use of a hybrid 4D angio-CT system significantly impact procedure time for prostate artery embolization?

To evaluate whether the use of a hybrid angio-CT (4DCT) imaging impacts procedure time during prostate artery embolization (PAE) This is an institutional review board approved, single-center, retrospective study. Medical charts of 10 consecutive patients who underwent technically successful bilateral PAE in a hybrid angio-CT suite between September 2017 and February 2020 were reviewed. Every patient had intraprocedural selective CT angiography (CTA) of each prostatic artery (PA), resulting in 2 CTA/patient. Procedure time (PT) was measured from the start of the procedural conscious sedation until the patient left the angiography suit. Timestamps of the CTA and DSA/fluoroscopy (DSAFCs) were extracted from the imaging DICOM data. The time required to obtain an intraprocedural CTA of a PA (CTT) was defined as the time elapsed between the last DSAFC before and the first DSAFC after the CTA acquisition. CTT also included “on-the-go” evaluation of the images by the operators. Short-term clinical success was evaluated by comparing International Prostate Symptom Score (IPSS) and Quality of Life (QOL) scores before treatment and at 6-week follow-up. Mean PT was 147.9 minutes (range 94-225 mins). Mean CTT was 17.1 minutes per procedure (range 7.9-34.3 mins; n = 10) including 2 CTAs/procedure for every patient. CTT was 12.3 ± 5.4% of PT. Three of the 20 PA angiograms revealed intra-prostatic collateral flow, confirmed with CTA, which were treated with preventative coiling. No serious adverse event was reported. In 2 of 10 patients, minor side effects (rectal discomfort, fever, and flank pain) occurred. Clinical improvement was significant, with mean IPSS reduction from 21.1 ± 6.06 to 7.2 ± 4.38 (P< .001; n = 8) and mean QOL improvement from 3.6 ± 1.14 to 1.6 ± 0.52 (P = .004; n = 5). Intraprocedural CTA of bilateral PAs is valuable for confirming PA origin as well as the presence of intra- and extra-prostatic collaterals in order to optimize treatment success and avoid non-target embolization. Acquisition of intraprocedural CTA of bilateral PAs consumed only 12% (17 min) of total procedure time.

Prostatic artery embolization performed in anteroposterior projections versus steep oblique projections: single centre retrospective comparative analysis

BackgroundTo present and evaluate an approach for reduction of utilization of steep oblique angiographic projections during prostatic artery embolization (PAE).MethodsSingle-center, retrospective study of patients who underwent bilateral PAE (from October 2018 to November 2019) and in whom it was possible to embolize PA of at least one pelvic side utilizing anteroposterior projections only (AP-PAE group), with the following techniques: Identification of the origin of PA on anteroposterior angiographic views. Utilization of anatomic landmarks from the planning computed tomographic angiography. Distal advancement of the angiographic catheter or microcatheter in the anterior division of internal iliac artery. Gentle probing with microguidewire at the expected site of origin of the PA. The AP-PAE approach was initially applied to all PAE patients during the study period and when this approach failed, additional steep oblique projections were acquired; patients who underwent bilateral PAE, with both anteroposterior and oblique projections for both pelvic sides, formed the standard PAE (S-PAE) group. The AP-PAE group was compared with S-PAE group in terms of baseline clinical and anatomic features, technical/procedural aspects and outcomes.ResultsForty-six patients (92 pelvic sides) were studied. AP-PAE was feasible in 12/46 patients (26.0%): unilateral AP-PAE in 9/46 patients (19.5%); bilateral AP-PAE in 3/46 patients (6.5%). AP-PAE group had larger prostates (p = 0.047) and larger PAs (p < 0.001). Body mass index (BMI) and other baseline features were comparable between the two groups (mean BMI, AP-PAE group: 27.9 ± 3.6, S-PAE group: 27.0 ± 3.5, p = 0.451). Mean fluoroscopy time and dose area product were lower in AP-PAE group (46.3 vs 57.9 min, p = 0.084 and 22,924.9 vs 35,800.4 μGy.m2, p = 0.018, respectively). Three months post PAE, comparable clinical success rates (11/12 vs 31/34, p = 0.959) and mean International Prostate Symptom Score reduction (60.2% vs 58.1%, p = 0.740) were observed for AP-PAE and for S-PAE group, respectively. No major complications were encountered.ConclusionAP-PAE is associated with significant reduction in radiation exposure and appears to be feasible, safe and effective, but it can be applied in a relatively small percentage of patients.

Association between intravesical prostatic protrusion and clinical outcomes in prostatic artery embolization

PurposeTo evaluate the influence of intravesical prostatic protrusion (IPP) on clinical outcomes after prostatic artery embolization (PAE) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Materials and methodsAll consecutive patients who underwent PAE for lower urinary tract symptoms between January 2017 and January 2019 were retrospectively included. IPP was evaluated on pre-treatment magnetic resonance imaging examination and symptoms were assessed at follow-up consultations using the international prostate symptom score (IPSS) and quality of life (QOL) questionnaire. IPPs were classified as grade 1 (<5mm), grade 2 (5–10mm), or grade 3 (>10mm). ResultsA total of 160 consecutive men (mean age 65±7.8 [SD] years; range: 45–89 years), underwent PAE. The mean IPSS was 21±7.3 (SD) (range: 5–35) and prostate volume 87±38 (SD) mL (range: 30–200mL). The IPP grade was 1 for 28 (28/160; 18%), 2 for 52 (52/160; 33%), and 3 for 80 (80/160; 50%) patients. There were no significant differences in IPSS at baseline between the three IPP grades. Patients with severe (grade 3) IPP had a significantly higher reduction in IPSS than those with non-severe IPP (grade 1 or 2), with estimated mean reductions of 12±2.5 (SD) (range: −4–28) and 8.3±1.9 (SD) (range: −8–21) (P=0.02), respectively. The mean reduction in the QOL score was 3.0 for grade 3 and 2.0 for grade 1 or 2 IPP (P=0.02). ConclusionsThe degree of IPP does not limit the efficacy of PAE in patients with lower urinary tract symptoms due to benign prostatic hyperplasia.

Preserving ejaculatory function in young patients with lower urinary tract symptoms: medium- to long-term follow-up of prostatic urethral lift at a single center.

Background and aims:Prostatic urethral lift (Urolift™) is a minimally invasive technique to treat male lower urinary tract symptoms (LUTSs) due to benign prostatic hyperplasia (BPH). The aim of the present study was to assess safety and medium- to long-term outcomes in the relief of urinary symptoms.Methods:We included 35 men, affected by severe symptomatic BPH evaluated by International Prostate Symptom Score (IPSS), with normal erectile function (EF) and ejaculatory function (EjF) evaluated by the International Index of Erectile Dysfunction (IIEF-5) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD-SF). Exclusion criteria were prostate larger than 70 cm3, bladder neck sclerosis, concomitant third prostatic lobe, and/or other cervical urethral obstruction or cancer. All patients, preoperatively, performed uroflowmetry (UFM) with peak flow (Q-max) and post void residual volume (PVR), digital rectal exam, transrectal prostate ultrasound to measure prostate volume, PSA, and cystoscopy. Follow-up was scheduled at 1–3–6 months, then yearly, evaluating UFM, IPSS, IIEF-5, and MSHQ-EjD-SF.Results:All procedures were performed by a single senior surgeon and follow-up was 33.8 ± 12 months. Preoperative PSA was 0.82 ± 0.4 ng/ml and mean operative time was 19.6 ± 10 min and 3 (2–4) implants per patient were used. Parameters reported at last follow-up schedule were: Q-max increase of 68% (p = 0.001), PVR reduction 68% (p = 0.005), and IPSS reduction 55% (p < 0.0001). EF and EjF were similarly preserved, and no patients presented retrograde ejaculation. A total of 88.6% of patients were satisfied with LUTSs improvement and 100% satisfied with EjF.Conclusion:Urolift can improve urinary disorders secondary to BPH, preserving EjF and EF. It is a safe and easy method, reproducible, and with low incidence of complications. Careful selection of patients is mandatory. The main reason for dissatisfaction is the higher expectation of better BPH symptoms relief although patients with high bladder neck and/or prostate volume >45 cm3 were aware of the possible failure.

A Proof-of-Concept Study on the Use of Prostate Artery Embolization Before Definitive Radiation Therapy in Prostate Cancer

PurposeProstatic artery embolization (PAE) is an effective therapy for alleviating lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia; however, is not well studied in patients with concurrent prostate cancer (PCa). We demonstrate a proof of concept for PAE before definitive radiation therapy (RT) in patients with PCa. Methods and MaterialsFrom December 2017 to July 2019, 9 patients with PCa underwent PAE for the indication of LUTS from benign prostatic hyperplasia with concurrent PCa. Five received radiation and all follow-ups at our institution and were therefore included in the analysis. Median follow-up was 18 months from the time of PAE. Side effects during radiation were quantified using the Common Terminology Criteria for Adverse Events scoring system. Pre- and post-PAE plans were compared in the 5 patients by performing an isovolumetric expansion of the post-PAE plan (treated plan) equivalent to the measured volume reduction after PAE. Patient 1 (PT-01) and PT-02 had prostate RT alone whereas PT-03, PT-04, and PT-05 had prostate with elective nodal coverage RT. Mean doses to organs at risk were compared between the 2 plans. ResultsThe mean International Prostate Symptom Score reduction after PAE was 13.8 (5.0-30.0; P = .02). The mean prostatic volume reduction after PAE was 23.1% (7.2%-47.7%). There were no Common Terminology Criteria for Adverse Events grade 3 (severe) or higher during radiation. Post-PAE plans in PT-01 and PT-02 had on average 23.2%, 39.8%, and 22.9% decrease in mean dose across the bladder, rectum, and penile bulb, respectively, compared with the pre-PAE plans. There were no appreciable differences in dosimetry in PT03, PT-04, and PT-05 who had nodal coverage. There was no biochemical failure in any of the patients. ConclusionsWe demonstrate a proof of concept that PAE is a clinically significant adjunctive therapy for alleviating LUTS and achieving significant volume reduction before RT, resulting in decreased radiation-related toxicity from RT for PCa.

Abstract No. 689 Prostate artery embolization in patients with prior transurethral resection of the prostate: a feasibility study

This study examines the feasibility of prostate artery embolization (PAE) as a treatment for benign prostatic hyperplasia (BPH) with refractory lower urinary tract symptoms (LUTS) after transurethral resection of the prostate (TURP). The feasibility of PAE to treat refractory BPH-associated LUTS in patients with prior TURP has not been established. PAE cases from April 2015 through June 2019 at two hospitals in a tertiary academic health system were queried (n = 159). Patients were included if they underwent elective PAE and had at least one prior TURP (n = 10). Patients undergoing emergent PAE for hematuria were excluded. Demographic, baseline, procedural, and follow-up data were collected where available for consecutive patients meeting the inclusion criteria. Technical success was defined as bilateral stasis. Patients studied had a mean age of 72.5 years (SD = 5.7) and ellipsoid prostate volumes of 131.1 cm3 (range, 54-196 cm3). The median time between most recent TURP and PAE was 7 years (range, 1-15 years). 7 patients had 1 prior TURP, 2 had 2, and 1 had 3. Mean baseline International Prostate Symptom Score (IPSS) was 20.2 (SD = 9.6) and mean Quality of Life score (QOL) was 4.4 (SD = 1.6). Procedures had a mean fluoroscopy time of 37.5 minutes, radiation dose of 647583.2 mGycm2, and contrast volume of 142 mL. Technical success was achieved in 8 of 10 patients. In the other 2 patients, unilateral stasis was achieved. One failure was unilateral due to excessive fluoroscopy time and one was due to inability to visualize the left prostatic artery. After an average of 70.8 days (SD = 88) post-PAE, mean IPSS reduction was 4.9 (n = 7, SD = 5.0, P = 0.03) and mean QOL reduction was 0.5 (n = 6, SD = 0.5, P = 0.04). Post-PAE adverse events included urethral irritation (n = 1), pain (n = 1), and incomplete emptying with a need for self-catheterization (n = 1). While more research is required to fully assess efficacy and safety, preliminary results in a group of 10 patients indicate feasibility of PAE as a promising treatment option in patients with BPH-associated refractory LUTS post-TURP.