IPSS-QOL Score Research Articles

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.

Transperineal Laser Ablation for Focal Therapy of Localized Prostate Cancer: 12-Month Follow-up Outcomes from a Single Prospective Cohort Study.

To evaluate the oncological and functional outcomes of transperineal laser ablation (TPLA) as the focal therapy for localized prostate cancer (PCa) after a 12-month follow-up. Patients with low- and intermediate-risk localized PCa were prospectively treated with focal TPLA between July 2021 and December 2022. The inclusion criteria were the following: clinical stage < T2b; PSA < 20 ng/mL; International Society of Urological Pathology (ISUP) grade ≤ 2; MRI-fusion biopsy-confirmed lesion classified as PI-RADS v2.1 ≥ 3. Intra-, peri-, and post-operative data were collected. Variables including age, PSA, prostate volume (PVol), Charlson's Comorbidity Index (CCI), International Prostate Symptom Score (IPSS) with QoL score, International Index of Erectile Function (IIEF-5), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD) were collected at baseline and at 3, 6 and 12 months after TPLA. Post-operative mpMRI was performed at 3 and 12 months. Finally, all patients underwent prostatic re-biopsy under fusion guidance at 12 months. The success of this technique was defined as no recurrence in the target treated lesion at the 12-month follow up. Twenty-four patients underwent focal TPLA. Baseline features were age [median 67 years (IQR 12)], PSA [5.7 ng/mL (3.9)], PVol [49 mL (27)], CCI [0 (0)], IPSS [11 (9)], IPSS-QoL [2 (2)], IIEF-5 [21 (6)], ICIQ-SF [0 (7)], MSHQ-EjD ejaculation domain [14 (4)] and bother score [0 (2)]. Median operative time was 34 min (IQR 12). Median visual analogue scale (VAS) 6 h after TPLA was 0 (IQR 1). The post-operative course was regular for all patients, who were discharged on the second post-operative day and underwent catheter removal on the seventh post-operative day. No patient had incontinence at catheter removal. A significant reduction in PSA (p = 0.01) and an improvement in IPSS (p = 0.009), IPSS-QoL (p = 0.02) and ICIQ-SF scores (p = 0.04) compared to baseline were observed at the 3-month follow-up. Erectile and ejaculatory functions did not show any significant variation during the follow-up. No intra- and peri-operative complications were recorded. Three Clavien-Dindo post-operative complications were recorded (12%): grade 1 (two cases of urinary retention) and grade 2 (one case of urinary tract infection). At the 12-month follow-up, eight patients showed mpMRI images referable to suspicious recurrent disease (PIRADS v2.1 ≥ 3). After re-biopsy, 7/24 patients' (29%) results were histologically confirmed as PCa, 3 of which were recurrences in the treated lesion (12.5%). The success rate was 87.5%. The focal TPLA oncological and functional results seemed to be encouraging. TPLA is a safe, painless, and effective technique with a good preservation of continence and sexual outcomes. Recurrence rate at 12 months was about 12.5%.

Peripheral zone thickness in preoperative MRI is predictive of Trifecta achievement after Holmium laser enucleation of the prostate (HoLEP).

To investigate various anatomical features of the prostate using preoperative MRI and patients' clinical factors to identify predictors of successful Holmium:YAG laser enucleation of the prostate (HoLEP). 71 patients who had received HoLEP and undergone a 3.0-T prostate MRI scan within 6 months before surgery were retrospectively enrolled. MRI features (e.g., total prostate and transitional zone volume, peripheral zone thickness [PZT], BPH patterns, prostatic urethral angle, intravesical prostatic protrusion, etc.) and clinical data (e.g., age, body mass index, surgical technique, etc.) were analyzed using univariable and multivariable logistic regression to identify predictors of successful HoLEP. Successful HoLEP was defined as achieving the Trifecta, characterized by the contemporary absence of postoperative complications within 3 months, a 3-month postoperative maximum flow rate (Qmax) > 15 mL/s, and no urinary incontinence at 3 months postoperatively. Trifecta achievement at 3 months post-surgery was observed in 37 (52%) patients. Patients with Trifecta achievement exhibited a lower preoperative IPSS-quality of life score (QoL) (4.1 vs. 4.5, P = 0.016) and a thinner preoperative peripheral zone thickness (PZT) on MRI (7.9 vs.10.3mm, P < 0.001). In the multivariable regression analysis, a preoperative IPSS-QoL score < 5 (OR 3.98; 95% CI, 1.21-13.07; P = 0.017) and PZT < 9mm (OR 11.51; 95% CI, 3.51-37.74; P < 0.001) were significant predictors of Trifecta achievement after HoLEP. Alongside the preoperative QoL score, PZT measurement in prostate MRI can serve as an objective predictor of successful HoLEP. Our results underscore an additional utility of prostate MRI beyond its role in excluding concurrent prostate cancer.

Effect of benign prostatic hyperplasia surgery on ejaculatory function

Introduction. There are a wide range of techniques available for the removal of hyperplastic prostate tissue. However, the choice of method rarely considers its effect on ejaculatory function.Objectives. To evaluate the effect of surgery for benign prostatic hyperplasia (BPH) by endovideosurgical posterior adenomectomy (EVS AE) and transurethral electroenucleation of the prostate (TUEB) on copulatory function and its ejaculatory component.Materials &amp; methods. Sixty sexually active patients aged 58 to 78 years with indications for surgical treatment of BPH were included in the study. The patients were randomized into two equal groups. The first group (30 patients) underwent EVS AE by standard technique without preservation of the prostatic urethra. The second group (30 patients) underwent TUEB. Before treatment, standard questionnaires used in urologic practice were completed: IIEF-5, IPSS-QOL, and the scale of quantitative assessment of male copulatory function (scale “MCF”). The block of questions specifically characterizing the ejaculatory component and the "Male Sexual Health Questionnaire", namely the section " Ejaculatory function domain", were analyzed separately. The assessment was conducted before treatment and at the 12th week following surgery. No significant differences were found between the groups on any of the questionnaires prior to surgery.Results. Three months following surgery, there was a significant improvement in the IPSS-QOL scores for the EVS AE group, by 24 points and 4.3, respectively, and for the TUEB group, 25.6 points and 4.3 (both p &lt; 0.0001). No change was observed in the IIEF-5 questionnaire (p &gt; 0.05). A slight reduction in scores was noted on the MCF scale for the TUEB group (by 2.9 points, p &lt; 0.05), indicating that the general state of erectile function remained unchanged. However, reductions were seen in the "MCF — Ejaculatory Component" and "Male Sexual Health Questionnaire — Ejaculatory function domain" scales for the TUEB group, with ballpark scores decreasing by 3.2 and 6.8 points, respectively (both p = 0.0326 and p = 0.0254), indicating a worsening in ejaculatory function following TUEB treatment.Conclusion. When selecting a specific surgical approach for BPH management, consideration should be given to the patient's tolerance for the degree of invasiveness of the procedure while preserving ejaculatory function, and adherence to a treatment strategy that aligns with the patient's individual preferences and expectations.

Real-world experience of water vapour therapy (Rezum) in patients with benign prostatic enlargement: a retrospective single-center study.

Water vapor thermal therapy (Rezum) is a minimally invasive treatment for benign prostatic enlargement (BPE). Studies reporting urodynamic results regarding the procedure are rare. Our study aimed to assess the effectiveness of Rezum on urinary outcome parameters in a consecutive series of patients and compare urodynamic data before and after treatment. We retrospectively evaluated all the patients treated with Rezum between 07/2017 and 12/2023 at our institution. Patients who had more than one Rezum intervention, those who were unable to void (i.e., catheter-dependent patients), and those with insufficient data were excluded from the data analysis. Descriptive outcomes, such as symptom scores (IPSS, IPSS-QoL), peak flow in uroflowmetry (Qmax), post-micturition residual urine volume (PVR), and prostate volume (PVol), were analyzed. If available, preoperative and postoperative urodynamic results were evaluated. In total, 250 Rezum procedures were performed during the observational period. After applying the exclusion criteria, the data from 193 patients were included in the analysis. Patients achieved significant symptom relief as measured using the IPSS (46% reduction) and IPSS-QoL scores (41% reduction). Qmax improved by 4.8 ml/s, as the mean PVR significantly decreased by 50%. PVol and PSA values decreased by 30% and 27.5%, respectively. In 19/193 patients with a urodynamic evaluation, pre- and postoperative data analysis showed a significant reduction in the bladder outlet obstruction index (BOOI) by approximately 70%. Rezum is effective and can improve urinary symptoms. In appropriate patients, Rezum can significantly reduce the bladder outlet obstruction (BOO).

Variation of inflammatory indexes in patients with chronic abacterial prostatitis treated with an herbal compound/extract.

Inflammation is a highly prevalent finding in the prostate. Men with inflammation have higher IPSS score and increased prostate size. For men with prostatic inflammation, there is a significantly increased risk of developing acute urinary retention and the need of a surgical approach to the disease. Some laboratory tests (i.e. fibrinogen, C-reactive protein), can play a role in identifying patients at greatest risk of complications and adverse outcomes after surgery. There have been several experiences exploring the role of nutraceutical approach to the prostate inflammation. Aim of our study were to describe the variation in symptoms and inflammatory indexes in men affected by chronic abacterial prostatitis, treated with an herbal extract containing Curcuma Longa 500 mg, Boswellia 300 mg, Urtica dioica 240 mg, Pinus pinaster 200 mg and glycine max 70 mg. A prospective multicenter study was conducted from February 2021 and March 2022. One hundred patients, with a diagnosis of Chronic Prostatitis were enrolled in a multicentric phase III observational study. They were treated with the herbal extract, one capsule per day, for 60 days. No placebo arm was included. In each patient, inflammatory indexes, PSA, prostate volume, IIEF-5, PUF, uroflowmetry (Qmax), IPSS-QoL, NIH-CPPS were registered and statistically compared at baseline and at the follow up visit. The variation obtained on the inflammation indexes showed a global improvement after treatment, including the PSA reduction. We also recorded a significant improvement on IPSS-QoL, NIH-CPPS, PUF and Qmax scores. The herbal extract considered in our study may represent a promising and safe therapeutic agent leading to a reduction of inflammation markers, and could be used in the treatment of prostatitis and benign prostatic hyperplasia.

Rezum water vapor thermal therapy for treatment of lower urinary tract symptoms: A retrospective single-centre analysis from a German high-volume centre.

Rezum is a minimal invasive surgical treatment for patients with lower urinary tract symptoms (LUTS) related to benign prostatic enlargement (BPE). The aim of our study was to assess safety and efficacy of the Rezum procedure in a consecutive series of patients. A retrospective study was performed in a single tertiary care hospital in patients undergoing Rezum procedure between 2018 and 2020. All patients that underwent intervention because of drug-refractory moderate to severe LUTS were assessed. Descriptive outcomes such as symptoms scores (IPSS, IPSS-QoL), peak flow in uroflowmetry (Qmax), post-micturition residual urine volume (PVR) and prostate volume (PVol) were analysed. In total, 92 Rezum procedures were performed in the observational period. All interventions were competed without device- or procedure relates adverse events. Patients achieved a significant symptom relief as measured in IPSS (50% reduction, p<0.001, n = 35) and IPSS-QoL score (53% reduction, p<0.001, n = 35). Qmax improved by 7.3 ml/s from 10.6 ± 4.2 ml/s to 17.9 ± 9.3 ml/s (p = 0.003, n = 20) were as mean PVR significantly decreased by 136 ml from 175 ± 194.1 to 39 ± 62 ml (p = 0.007, n = 20). PVol significantly decreased by 40.3% from 73.9 ± 41.2 to 44.9 ± 29 ccm (p = 0.024, n = 17). All pre-interventional catheter-depending patients (28.3% of all patient) were catheter independent after six weeks. Rezum therapy is safe and effective and can be considered a viable treatment option for BPH related LUTS.

Aquablation Outcomes in Men With LUTS Due to BPH Following Single Versus Multi-pass Treatments

OBJECTIVETo determine whether existing data support the use of multiple passes in Aquablation for LUTS due to BPH. METHODSData were obtained from 2sources. The WATER trial (NCT02505919) is a prospective, multicenter, double-blind, randomized controlled trial of Aquablation vs TURP in prostate volumes of 30 - 80 ml. The WATER II trial (NCT03123250) is a prospective single-arm multicenter trial of Aquablation in prostate volumes of 80-150ml. The number of passes was determined by the procedural data collected and the video recordings of all study cases. RESULTSIn total, 127 Aquablation subjects underwent a single pass, 90 underwent multiple passes (80 had 2passes and 10 underwent 3passes), and 65 underwent TURP (in WATER only). Men undergoing 2or more passes with Aquablation had larger prostates but few differences in other baseline parameters, including prostate size range. Compared to a single pass, the use of 2or more passes during Aquablation resulted in lower IPSS scores (by ∼4 points, P = .0002) and lower IPSS QoL scores (by ∼0.7 points, P = .0096) at the later timepoints of 24 and 36 months. Similarly, 36-month Qmax values were higher (by ∼5 ml/sec, P = .0220) in those with 2or more passes than in those with 1pass. There was no statistically significant difference in ejaculatory dysfunction between groups. CONCLUSIONIndependent of prostate volume, a multiple treatment pass protocol led to improved voiding outcomes and IPSS improvement.

Outcomes of Initial Transcorporal Versus Standard Placement of Artificial Urinary Sphincter in Patients With Prior Radiation.

Objective: This study aimed to evaluate both device and functional outcomes of men who underwent initial artificial urinary sphincter (AUS) placement after pelvic radiation using the transcorporal versus the standard approach.Methods: A retrospective review of patients who underwent first-time AUS placement after pelvic irradiation for prostate cancer was conducted between January 2008 and June 2020. Patients were grouped by transcorporal versus standard device placement. The primary outcomes of interest included major complications (revision or explant surgery) and functional outcomes (pads per day, International Prostate Symptom Score {IPSS}, quality of life {QOL} score).Results: We identified 45 patients who underwent first-time AUS with a history of prior pelvic irradiation for prostate cancer, 27 underwent transcorporal placement and 18 underwent standard placement. Transcorporal AUS placement resulted in a significantly lower number of major complications (p=0.01), explants (p=0.02), and revisions (p=0.04) The transcorporal artificial urinary sphincter group had better postoperative pads per day (p=0.04), IPSS (p<0.01), and IPSS QOL score (p<0.01).Conclusions: Initial transcorporal artificial urinary sphincter placement is a promising technique with lower rates of major complications in patients with a history of prior pelvic radiation and had better functional urinary outcomes.

Straining to void is associated with dyspareunia in Japanese women

ABSTRACT Introduction Female lower urinary tract symptoms (LUTS) affect quality of life and sexual activity. Objectives This study aimed to evaluate the influences of LUTS on female dyspareunia (pain during vaginal penetration), as little is known on this topic. Methods The study population comprised 369 women who participated in 2-day health examinations at a single institution in Japan, from April 2010 to March 2011. All participants were asked to complete a standardized self-reported questionnaire. Using the International Prostate Symptom Score (IPSS), IPSS-QOL score, and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), we evaluated urinary symptoms, including urinary incontinence, urgency, daytime frequency, straining, and nocturia. To assess dyspareunia, we asked the question "Over the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration?", with answer choices of "Did not attempt intercourse", "Almost always or always", "Most times", "Sometimes", “A few times”, and "Almost never or never", from part of a questionnaire from the Japanese translation of the Female Sexual Function Index (Question 17 of FSFI-J) [Rosen. J Sex Marital Ther, 2000]. We analyzed relationships between dyspareunia and LUTS. The Mann-Whitney U test and logistic regression models were used for statistical analyses. Values of P&amp;lt;0.05 were considered statistically significant. Results A total of 315 individuals completed the questionnaire (response rate, 84%). The mean age of respondents was 47.2 years (range, 31-69 years). Our analysis included 125 women (40%), and excluded 190 women (60%) who reported that they had not attempted intercourse over the past 4 weeks. Among sexually active women, 44% had experienced dyspareunia. Straining to void and IPSS-QOL score were significantly higher in women reporting dyspareunia. In multivariate analysis, significant correlations were found between dyspareunia and both straining to void and IPSS-QOL score (Odds ratio, 16.9 (1.38-205)). Conclusion Straining to void and IPSS-QOL score correlated significantly with dyspareunia among Japanese women in this study. The underlying mechanism remains unclear, and little data have been accumulated on the association between straining to void and dyspareunia, although a previous study reported LUTS as a predictor of sexual pain for women in the United States (odds ratio = 7.61) [Laumann. JAMA, 1999]. Our study confirmed straining to void and IPSS-QOL score as factors independently associated with dyspareunia. These results suggest that straining to void can offer a predictor of female dyspareunia. Disclosure Work supported by industry: no.

Evaluation of sexual function after dutasteride treatment in patients with once negative prostate biopsy and benign prostate hyperplasia.

ABSTRACT Introduction 5α-reduced inhibitors (5ARIs) are usually administered to patients with benign prostatic hyperplasia, however, whether 5ARIs affect sexual function remains a controversial issue for both patients and urologists. Objective In this study, we evaluated the impact of dutasteride treatment for erectile function in patients with once-negative prostate biopsy and benign prostate hyperplasia. Methods 81 patients with benign prostate hyperplasia were enrolled in a one-arm prospective study. They were administrated 0.5 mg/day of dutasteride for 12 months. Patient characteristics, change of IPSS and IIEF-15 scores at baseline and 12 months after dutasteride administration were examined. Results The mean ± SD age of the patients was 69.4 ± 4.9 years and the prostate volume was 56.6 ± 21.3 mL, respectively. The mean ± SD prostate volume and PSA levels were decreased 25.0% and 50.9%, respectively, after 12 months of dutasteride administration. IPSS total, voiding subscore, storage subscore, and QOL score significantly improved after 12 months of dutasteride administration. No significant change was observed in any of the IIEF scores after 12 months. There was no decrease in EF severity. Conclusion Twelve months administration of dutasteride for patients with BPH improved urinary function and did not increase the risk of sexual dysfunction. Disclosure Work supported by industry: no.

Prevalence of moderate to severe lower urinary tract symptoms in systemic sclerosis.

Lower urinary tract symptoms (LUTS) are common in SSc. The severity of symptoms can affect the quality of life (QOL); however, LUTS is often neglected during routine assessments. We determined the prevalence of moderate to severe LUTS in SSc and its associated factors. A cross-sectional study was conducted between March 2020 and June 2020. Adult SSc patients were enrolled from the Scleroderma Clinic, Khon Kaen University, Thailand. All completed a self-administered questionnaire on LUTS using the International Prostate Symptom Score (IPSS), categorized into absent, mild, moderate or severe LUTS. In addition, we investigated the factors associated with moderate to severe LUTS, and the correlation between IPSS-QOL score and IPSS severity. A total of 135 patients were enrolled. Most cases were female (87 cases; 64.4%) and had dcSSc (88 cases; 65.2%). Twenty-six were defined as having moderate to severe LUTS, for a prevalence of 19.3% (95% CI 13.0, 26.9%). In addition, most had storage symptoms (63.0%), followed by voiding symptoms (19.3%) and post-voiding symptoms (12.6%). The factors associated with moderate to severe LUTS per the multivariable logistic regression included a modified Rodnan skin score ≥20 points and gastrointestinal symptoms with adjusted odds ratios 7.64 and 5.78, respectively. In addition, the IPSS-QOL score had a moderate positive correlation with IPSS severity (rho = 0.560, P < 0.001). Moderate to severe LUTS occurred in about one-fifth of SSc patients, particularly those with extensive skin tightness and gastrointestinal involvement. The more severe the LUTS, the poorer the QOL.

A clinical trial comparing BiVap (Richard Wolf®) saline vaporization of the prostate vs. TwisterTM Diode Laser System in the treatment of benign prostatic obstruction between prostate volume 90 to 150 ml.

To evaluate the efficacy, safety and postoperative outcomes of the BiVap and Twister systems with benign prostatic obstruction (BPO) in prostate volüm between 90-150 ml. In total, we included 131 patients treated with BiVap system (n = 68) and Twister system (n = 63). Postoperative complications including urinary tract infection, transient hematuria, severe dysuria and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. Preoperative demographic characteristics were similar in the 2 groups. There was observed significant improvement for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. Maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 12, 3 and 12th months respectively in group 1. In group 2 maximum improvement in the same parameters were achieved at postoperative 6, 3, 6, 6 and 12th months, respectively. BiVap and Twister systems are safe, effective, and useful technique, which can be used in the surgical treatment of BPO between 90-150 ml.

Short-term efficacy and safety of second generation bipolar transurethral vaporization of the prostate (B-TUVP) for large benign prostate enlargement: Results from a retrospective feasibility study.

BackgroundTo investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml.Materials and methods100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients’ characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml.Results17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients’ QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed.ConclusionsThis is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE.

Tadalafil 5 mg Once Daily Improved Each IPSS Subscore, QOL, and Nocturia in Elderly BPH Patients over 70 Years Old in a Real-World Clinical Setting

Objective: No reports have evaluated the treatment effects of tadalafil by age group in a positive, noninterventional observational study of Japanese men. The present study aimed to evaluate the treatment effects of tadalafil by age group in a positive, noninterventional observational study of Japanese men. We therefore divided patients into 2 groups about the age of 70 years and investigated the treatment effects of tadalafil regarding voiding and storage functions by age group. Methods: Changes from baseline in each parameter (International Prostate Symptom Score [IPSS], quality of life [QOL] score, Overactive Bladder Symptom Score [OABSS], and residual urine volume) at 4, 12, and 24 weeks after initiating tadalafil for benign prostatic hyperplasia (BPH) patients were compared between groups (50–69 years vs. ≥70 years). In addition, side effects of tadalafil were investigated by age group. Results: In the 50–69 years group, significant improvements from baseline were seen in IPSS total and QOL score for all time points. In addition, significant improvements in IPSS storage subscore from baseline were observed at the 4- and 24-week time points. In the ≥70 years group, significant improvements from baseline were seen in IPSS total, IPSS voiding and storage subscores, and QOL score at each time point. Conclusions: Tadalafil 5 mg once daily appeared effective in clinical settings for elderly BPH patients even over 70 years old.

MP01-08 REZŪM WATER VAPOR THERAPY FOR LARGE VOLUME (≥80 ML) BENIGN PROSTATIC ENLARGEMENT: LARGE, MULTI-CENTER COHORT

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-08 REZŪM WATER VAPOR THERAPY FOR LARGE VOLUME (≥80 ML) BENIGN PROSTATIC ENLARGEMENT: LARGE, MULTI-CENTER COHORT Dean Elterman, Naeem Bhojani, Bilal Chughtai, and Kevin C. Zorn Dean EltermanDean Elterman More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Bilal ChughtaiBilal Chughtai 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.0000000000001962.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Open or laser prostatectomy are the standard treatments for benign prostatic hyperplasia (BPH) of large volume prostates ≥80 mL. Rezūm is a minimally invasive procedure to ablate benign prostatic tissue. Herein, we report the prospective, multi-center results of the largest cohort of prostates ≥80 mL treated with Rezum. METHODS: A prospective registry was established for Rezūm therapy in Canada (2019) at two high-volume centers. All patients had baseline medical and BPH history documented along with uroflowmetry (Qmax and PVR), and validated questionnaires (IPSS, IPSS QoL, BPHII, IIEF-15, MSHQ-EjD function and bother). RESULTS: 83 patients (mean age 68.7 years) with prostate size ≥80 ml were treated with Rezūm from April 2019 to Dec 2020. The average prostate volume was 104.6 ml (range 80-160 ml) and 65% had a median lobe. 21 patients had prior episode of urinary retention. Mean number of injections was 13.6 (range 8-28). Mean duration of procedure was 5.9 minutes (range 2.5-14). Mean duration of post-procedure catheterization was 11.8 days. IPSS reduced from a baseline score of 20.9 by 24.3% (15.8), 56.7% (9), 59.1% (8.4) at 1, 3, 12 months respectively. IPSS QoL score improved from a baseline of 4.2 to 1.8 (-56%) at 3 months and 1.4 (-70%) at 12 months. Qmax improves from a baseline of 9.2 ml/s up to 14.3 ml/s (55%) at 3 months. BPHII improved from a baseline of 6.4 to 2.8 (-57%) at 3 months and 1.8 (-71%) at 12 months. IIEF showed no significant change from 52 at baseline to 57 at 12 months. Similarly, no changes in MSHQ function (10.3 to 10.1 at 12 months) or bother (1.4 to 1.3 at 12 months). No Clavien-Dindo events ≥ grade III occurred. CONCLUSIONS: Rezum therapy is safe, effective, quick, out-patient procedure in prostate glands ≥80 ml with similar outcomes to prostates <80 mL. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e3-e3 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean Elterman More articles by this author Naeem Bhojani More articles by this author Bilal Chughtai More articles by this author Kevin C. Zorn More articles by this author Expand All Advertisement Loading ...

Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis.

Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis.

Long-term efficacy and safety of artificial urinary sphincter AMS 800&lt;sup&gt;ТМ&lt;/sup&gt; implantations

Introduction. Stress urinary incontinence in men in most cases occurs after radical prostatectomy or surgery of benign prostate hyperplasia. In addition to a significant reduction in the quality of life, the treatment and care of such patients require significant financial costs. Purpose of the study . To study the long-term efficacy and safety of artificial urinary sphincter (AUS) implantation. Materials and methods . AUS was implanted in 52 patients with severe stress urinary incontinence (UI) from 2004 to 2020. Urine loss was estimated by the urinary diary. A cure was considered as the use of ≤ 1 pad per day («social continence»). The quality of life was assessed using a numeric scale (from 0 to 100), IPSS-QoL, and the ICIQ-UI SF questionnaire. Complications were described according to the Clavien-Dindo classification. Results. The median age was 67.5 years (IQR 63 - 72 years). The causes of severe stress UI were the following: radical prostatectomy - 29 (55.8%) patients, transurethral resection of the prostate — 12 (23.1%), transvesical simple prostatectomy — 5 (9.6%), others — 6 (11.5%) patients. Median time after the intervention that caused UI was 24 months (IQR 13-36 months). Both perineal (67%) and penoscrotal (33%) approaches were used. The results of implantation efficiency were evaluated in 43 patients. A significant decrease in the median urine loss from 800 ml (IQR 700 - 1100 ml) to 0 ml (IQR 0-30 ml) was registered at a median follow-up of 100.4 months (IQR 70.5 - 136.9 months). There was also a statistically significant reduction in daily pad use from 7 (IQR 6-8) to 1 (IQR 0 - 1). 36 (84%) patients met the cure criteria. Improvement was noted in 6 (14%) patients, failure - in 1 (2%) patient. Median IPSS-QoL scores decreased from 4 (IQR 4-5) to 2 (IQR 1 - 2), p < 0.05, numeric analog scale scores improved from 25 (IQR 20 - 35) to 80 (IQR 60 - 90), p < 0.05., The ICIQ-UI SF score was 7 (IQR 1-9) after treatment. Complications more than grade II according to the Clavien-Dindo classification were registered in 15 (28.8%) patients. Conclusion. AUS implantation provides satisfactory results in reducing urine loss and improving quality of life but it's accompanied by a high rate of complications and revisions in long-term follow-up.

Introduction of Rezum system technology to Ireland for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a pilot study on early outcomes and procedure cost analysis.

Rezum technology uses heat from radiofrequency-generated water vapour to ablate prostate tissue. We evaluate the introduction of this thermal therapy to an Irish teaching hospital for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. A pilot study of men with moderate to severe lower urinary tract symptoms who underwent Rezum treatment to the prostate was performed. Perioperative efficacy was evaluated using international prostate symptom score (IPSS), quality of life score (IPSS-QOL), uroflowmetry and post-void residual (PVR) volumes. Costs were evaluated and compared against matched patients undergoing the standard of care, transurethral resection of the prostate (TURP). Ten patients with a mean age of 70 ± 9years who met the inclusion criteria underwent Rezum treatment. Mean PSA was 4.73 ± 4ng/mL and mean prostate volume 72 ± 30cc. Rezum therapy significantly improved both IPSS by 74% from mean baseline score of 20.8 ± 4 to 5.3 ± 1.49 (p < 0.001) and IPSS-QOL score by 84% from mean baseline score of 4.4 ± 0.7 to 0.6 ± 0.7 (p < 0.001) at 3months. Maximum flow rate increase by 44% from 9.26 ± 2.5 to 13.34 ± 2.3mL/s (p < 0.001). When compared to ten matched patients undergoing TURP in the same period, there was a significant cost saving of €1986.52 per patient for Rezum, overall up-front cost saving of €22,819 with an additional 19 bed days and 5 theatre hours spared. Rezum, a minimally invasive thermal therapy, provides significantly improved symptom relief and quality of life with a significant cost saving to the institution.

Chronoradiation Therapy for Prostate Cancer: Morning Proton Beam Therapy Ameliorates Worsening Lower Urinary Tract Symptoms.

Background and Purpose: Worsening lower urinary tract symptoms (LUTS) are a frequent adverse event following proton beam therapy (PBT) for localized prostate cancer. We investigated the differences in worsening LUTS among patients who received PBT at different times of day. Participants and Methods: Among 173 patients who underwent PBT for prostate cancer, 168 patients (median age 68.5 years) completed international prostate symptom score (IPSS) questionnaires and were included. Changes in the IPSS from baseline to the end of PBT were assessed by multiple linear regression analysis for age, National Comprehensive Cancer Network risk classification, androgen deprivation therapy, fractional PBT dose, clinical target volume, severity of IPSS, diabetes, LUTS medication use before PBT, anti-coagulant therapy and radiation time of day (morning (08:30–10:30), around noon (10:31–14:30), and late afternoon (14:31–16:30)). Results: IPSS total score and IPSS-Quality of Life (QoL) score (12 patients were excluded due to missing IPSS-QoL score) increased from eight to 14.9 (p < 0.0001) and from two to four (p < 0.0001), respectively. Time of day (morning) was the only determinant for worsening LUTS (β = −0.24, p < 0.01), voiding subscore (β = −0.22, p < 0.05) and IPSS-QoL (β = −0.27, p < 0.005), and was a determinant in item four (urgency) (β = −0.28, p < 0.005) with age (β = 0.19, p < 0.05). Conclusions: Morning PBT for localized prostate cancer significantly ameliorated worsening LUTS and improved QoL compared with treatment around noon or late afternoon. Chronoradiation therapy for localized prostate cancer may be effective and further research to elucidate the underlying mechanism is warranted.