Mean American Urological Association Symptom Score Research Articles

PD19-02 LONGITUDINAL URINARY BOTHER AND SYMPTOMS FOLLOWING RADICAL PROSTATECTOMY WITH MEMBRANOUS URETHRAL LENGTH PRESERVATION

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD19)1 Sep 2021PD19-02 LONGITUDINAL URINARY BOTHER AND SYMPTOMS FOLLOWING RADICAL PROSTATECTOMY WITH MEMBRANOUS URETHRAL LENGTH PRESERVATION Raymond Carrillo Ceja, Linda Huynh, Huang Wei Su, Erica Huang, Douglas Skarecky, and Thomas Ahlering Raymond Carrillo CejaRaymond Carrillo Ceja More articles by this author , Linda HuynhLinda Huynh More articles by this author , Huang Wei SuHuang Wei Su More articles by this author , Erica HuangErica Huang More articles by this author , Douglas SkareckyDouglas Skarecky More articles by this author , and Thomas AhleringThomas Ahlering More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002008.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our group previously published that maximization of membranous urethral length (MUL) during radical prostatectomy (RP) yields a significant improvement in continence recovery rates following RP. The present study seeks to further investigate the role of MUL preservation in improving urinary bother (QoL), American Urological Association Symptom Score (AUASS), and continence status following RP. METHODS: A retrospective analysis was conducted on RP patients from November 2004 to November 2018. Inclusion criteria consisted of RP as primary intervention, pad-free status at time of surgery, minimum 2-year follow-up, and outcome data availability at pre-op, 3 months, and one other time point. Primary outcomes were urinary symptoms measured by AUASS and QoL. Secondary outcomes were continence rates through pad-free status. Age-stratification was conducted to investigate its confounding effect. While primary analysis used t-test and chi-squared, ad-hoc paired difference analysis was also performed. RESULTS: No differences in mean AUASS and QoL were observed for the overall sample. However, mean differences were greater for patients older than 65 years during paired difference analysis after the technique change (Figure 1A-B). Sample continence rates were reported as 34%, 72%, and 92% prior to the technique change and increased to 52% (p<0.001), 95% (p<0.001), and 96% (p=0.011) at 30-day, 9-month and greater than 15-month follow-up points, respectively (Table 1). CONCLUSIONS: This technique change significantly improved QoL and AUASS for those over the age of 65, those at highest risk for adverse symptoms as supported by their higher pre- and post-operative mean AUASS and QoL scores. Men under 65 did not show this substantial benefit. Time to continence improved for all patients. The results support the implementation of MUL maximization. However, further trials are encouraged. Source of Funding: This study is self-funded with no other funding to disclose © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e362-e362 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raymond Carrillo Ceja More articles by this author Linda Huynh More articles by this author Huang Wei Su More articles by this author Erica Huang More articles by this author Douglas Skarecky More articles by this author Thomas Ahlering More articles by this author Expand All Advertisement Loading ...

Same-Day Discharge Following Holmium Laser Enucleation in Patients Assessed to Have Large Gland Prostates (≥175 cc).

Background: Holmium laser enucleation of the prostate (HoLEP) is a highly effective and durable minimally invasive surgery for benign prostatic hyperplasia. Historically, alternative treatments for large glands (≥175 cc) are associated with prolonged length of stay (LOS) and postoperative catheterization. However, advances in laser technology combined with surgical technique optimization have early evidence supporting same-day discharge. We look to examine contemporary same-day discharge outcomes for large glands. Materials and Methods: With Institutional Review Board (IRB) approval we queried our electronic medical record and retrospective clinical registry to examine perioperative outcomes of large gland (≥175 cc) prostates that underwent HoLEP with consideration for same-day discharge. Results: From December 10, 2019 to September 29, 2020 we identified 55 patients with a preoperative prostate size ≥175 cc (39 CT, 12 MRI, 4 transrectal ultrasound), of which 45 were scheduled for same-day discharge and 10 for admission. Mean preoperative prostate size was 229.9 cc (range 175-535 cc) and 36 (65.5%) were in urinary retention. Mean preoperative prostate-specific antigen (PSA) was 8.58 ng/mL, American Urological Association Symptom Score (AUASS) 22.3, and Qmax 8.8 mL/second. At 3 months postoperative follow-up mean AUASS was 6.7, PSA 0.87 ng/mL and Qmax 20.4 mL/second. All comer same-day discharge rate was 70% (38/55). Of patients planned for same-day discharge 38/45 (84%) were effective. Average LOS for all patients was 11.8 hours with catheterization of 21.2 hours. When compared with 2010 published large gland outcomes, our current LOS represents a 220% reduction. Looking specifically at patients planned for same-day discharge, average LOS and catheter duration was 8.8 and 17.0 hours, whereas LOS and catheter duration for patients planned for admission was 25.7 and 39.4 hours, respectively. Conclusions: We report the first outcomes of preoperatively planned same-day discharge for HoLEP in large glands (≥175 cc). A combination of technologic advances and optimization of technique have allowed for a safe adoption of same-day discharge, providing additional advantages over alternative large gland treatments.

The Spectrum of Clinical and Urodynamic Findings in Patients with Spinal Tuberculosis Exhibiting Lower Urinary Tract Symptoms, before and after Spinal Surgical Intervention with Antitubercular Treatment: A Prospective Study.

Study DesignObservational study.PurposeThis study aims to assess the clinical and urodynamic parameters in patients with spinal tuberculosis (TB) exhibiting lower urinary tract symptoms (LUTS) at the time of presentation and after spinal surgical intervention.Overview of LiteratureVariable urodynamic findings in patients with spinal TB.MethodsWe prospectively evaluated 10 patients with spinal TB exhibiting LUTS. Urinary symptoms were assessed by the American Urological Association (AUA) symptom score. We performed a urodynamic study (UDS), including electromyography, in all patients before and 3 months after spinal surgery.ResultsThe mean age of patients was 29.7 years (range, 15–52 years), and the mean AUA symptom score was 12.5 and 11.8 before and after spinal surgery, respectively. Overall, five patients exhibited improvement in the AUA symptom score, and three showed no change, while two patients’ condition worsened. We observed detrusor overactivity (DO) in two patients, and detrusor sphincter dyssynergia (DSD) in four patients. In addition, high-pressure voiding (HPV) was noted in two patients. On follow-up after spinal surgery, DO and DSD exhibited no improvement. Although HPV resolved, two patients developed new-onset poor compliance with worsening DO and DSD. Furthermore, two patients had bilateral hydronephrosis before surgery, which resolved on follow-up.ConclusionsPatients with spinal TB exhibiting LUTS can display a spectrum of clinical presentations and variable UDS findings. As two patients exhibited new onset poor compliance with bilateral hydronephrosis in one of them, this study concludes that a close follow-up for upper tracts in these patients is required despite successful spinal surgery.

Long-term Natural History of Lower Urinary Tract Symptoms Following Radical Retropubic Prostatectomy: A Prospective 15-Year Longitudinal Study

ObjectiveTo provide insights into the long-term impact of radical retro-pubic prostatectomy (ORRP) on lower urinary tract symptoms (LUTS) which are age and prostate dependent and adversely impact quality of life. Methods1995 men undergoing ORRP enrolled in a prospective longitudinal outcomes study. The American Urological Association Symptom Index was self-administered before ORRP and at predetermined time-points after surgery. A multivariate generalized linear model was used to evaluate the association of time since ORRP with American Urological Association symptom score (AUASS). McNemar's test and paired sample t-tests were used to assess whether the proportion of men with clinically significant LUTS (CSLUTS) defined by an AUASS >7 or mean AUASS differed significantly between the time-dependent assessments, respectively. ResultsThe 15-year mean adjusted AUASS was similar to baseline (7.00 vs 6.85, P = .66). Throughout the 15 years of follow-up, the proportion of men with CSLUTS was lower than baseline with the exception of the 3 month and 15 year assessments. Among men with baseline clinically insignificant LUTS (CILUTS), the mean adjusted AUASS at 15 years was significantly greater than baseline (6.09 vs 3.19, P < .001). Among men with baseline CSLUTS, ORRP led to a significant decrease in mean adjusted AUASS between baseline and 15 years (13.26 vs 8.67, P < .001). ConclusionORRP favorably affects the long-term natural history of LUTS. The long-term economic and quality of life benefits of ORRP on LUTS should inform the risks and benefits of RP for treatment of localized prostate cancer.

Does Post-Void Residual Volume Predict Worsening Urological Symptoms in Patients with Multiple Sclerosis?

Our goal was to examine how post-void residual urine volume relates to urinary symptoms in patients with multiple sclerosis. We retrospectively reviewed the records of patients with multiple sclerosis who had lower urinary tract symptoms and presented to a tertiary neurourology clinic. Patients for whom post-void residual volume was recorded at the initial urological assessment were included in our analysis. Results of the AUA (American Urological Association) SI (Symptom Index) and the M-ISI (Michigan Incontinence Symptom Index) completed at this visit were analyzed to assess the severity of lower urinary tract symptoms and incontinence. A chart review was performed to obtain information on demographics and documented urinary tract infections. Between 2014 and 2017, 110 patients diagnosed with multiple sclerosis underwent post-void residual volume measurement at our clinic. Average post-void residual volume was 123.4 cc (range 0 to 650 cc). The mean AUA symptom score was 19.1 with an average bother score of 4.1. Analysis of post-void residual volume as a continuous variable did not show an association between increasing post-void residual volume and an increasing AUA SI or bother score (p= 0.53 and 0.44, respectively). When evaluated by post-void residual volume tertile, no relationship was found between post-void residual volume, and the AUA SI and the M-ISI (p = 0.54 and 0.57, respectively). No correlation was also found between increasing post-void residual volume and a recent history of recurrent urinary tract infections (p = 0.27). Post-void residual volume was not associated with worsening obstructive lower urinary tract symptoms as assessed by the AUA SI, worsening incontinence as measured by the M-ISI score or an increased risk of recurrent urinary tract infections in select patients with multiple sclerosis and lower urinary tract symptoms.

A Prospective Study to Evaluate the Efficacy of Botulinum Toxin-A in the Management of Dysfunctional Voiding in Women.

Objectives:To assess the outcomes of Botulinum Toxin-A (BoNT-A) to the external urethral sphincter (EUS) in dysfunctional voiding (DV) refractory to standard urotherapy and bowel management.Methods:Our criteria to diagnose DV in women included neurologically normal individuals with lower urinary tract symptoms, dilated proximal urethra on voiding cystourethrogram, and high detrusor pressure (PdetQmax > 20 cm H2O) associated with increased electromyography activity during voiding in urodynamic study (UDS). A total of 16 female patients with a median age of 36 years (5-60 years) received BoNT-A from June 2014 to December 2015. Patients below and above 10 years of age received 100 units and 200 units of BoNT-A to EUS, respectively. Patients were followed up till 6 months.Results:Mean AUA (American Urological Association) symptom score decreased significantly from 11.75 ± 6.14 to 5.06 ± 5.1 and 4.25 ± 3.4 at day 14 and day 45 after BoNT-A, respectively (P < .0001). There were no significant improvements in maximal flow (Qmax) on uroflowmetry (UFM) and detrusor pressure at maximal flow (PdetQmax) in UDS. Significant reduction in post-void residual (PVR) from 69.31 ± 77.3 to 17.50 ± 22.3 mL at day 14 (P = .007) was observed, although the reduction was not significant at day 45. Although minor adverse effects were reported, none were serious or life-threatening.Conclusions:Our study showed that BoNT-A plays a role in improvement of urinary symptoms and reduces PVR at D14 in DV, but showed no improvement in UFM and urodynamic parameters, albeit with limited numbers and limited follow-up.

Ventral Inlay Labia Minora Graft Urethroplasty for the Management of Female Urethral Strictures

To evaluate the functional outcomes of ventral inlay labia minora graft urethroplasty (VILGU) for the management of female urethral strictures. Data of 7 consecutive women treated with VILGU between 2011 and 2013 were reviewed. Two patients had cystostomy tubes at repair, and 5 had undergone previous urethral dilations and urethrotomies. Clinical evaluation included assessment of the effect of voiding symptoms with American Urological Association (AUA) symptom score, uroflowmetry, voiding cystourethrography, and intraoperative urethrocystoscopy using a 6.5F pediatric ureterorenoscope. Preoperative AUA symptom score and peak urinary flow rate were compared with postoperative values. Cure was defined as the absence of any restenosis requiring additional intervention with subjective patient satisfaction at the last follow-up. Mean stricture length was 1.5 cm (range, 1-2.5), and mean operative time was 95 minutes (range, 70-110). With a mean follow-up of 18.2 months (range, 3-30), cure was achieved in 6 (86%) women. At the last follow-up, mean maximum urine flow (mL/s) increased from 3.9 ± 3.1 preoperatively to 22.7 ± 8.3 postoperatively (P <.001), and mean AUA symptom score decreased from 25.3 ± 5.2 preoperatively to 6.9 ± 3.7 postoperatively (P = .001). No fistulae developed after surgery. "De-novo" stress urinary incontinence was not evident in any case. VILGU effectively provides better urinary flow and significantly improves patient satisfaction in patients with female urethral stricture disease.

Radical Prostatectomy Improves and Prevents Age Dependent Progression of Lower Urinary Tract Symptoms

The prevalence of lower urinary tract symptoms increases with age and impairs quality of life. Radical prostatectomy has been shown to relieve lower urinary tract symptoms at short-term followup but the long-term effect of radical prostatectomy on lower urinary tract symptoms is unclear. We performed a prospective cohort study of 1,788 men undergoing radical prostatectomy. The progression of scores from the self-administered AUASS (American Urological Association symptom score) preoperatively, and at 3, 6, 12, 24, 48, 60, 84, 96 and 120 months was analyzed using models controlling for preoperative AUASS, age, prostate specific antigen, pathological Gleason score and stage, nerve sparing, race and marital status. This model was also applied to patients stratified by baseline clinically significant (AUASS greater than 7) and insignificant (AUASS 7 or less) lower urinary tract symptoms. Men exhibited an immediate worsening of lower urinary tract symptoms that improved between 3 months and 2 years after radical prostatectomy. Overall the difference between mean AUASS at baseline and at 10 years was not statistically or clinically significant. Men with baseline clinically significant lower urinary tract symptoms experienced immediate improvements in lower urinary tract symptoms that lasted until 10 years after radical prostatectomy (13.5 vs 8.81, p <0.001). Men with baseline clinically insignificant lower urinary tract symptoms experienced a statistically significant but clinically insignificant increase in mean AUASS after 10 years (3.09 to 4.94, p <0.001). The percentage of men with clinically significant lower urinary tract symptoms decreased from baseline to 10 years after radical prostatectomy (p = 0.02). Radical prostatectomy is the only treatment for prostate cancer shown to improve and prevent the development of lower urinary tract symptoms at long-term followup. This previously unrecognized long-term benefit argues in favor of the prostate as the primary contributor to male lower urinary tract symptoms.

1511 OUTCOMES OF SACRAL NERVE STIMULATION IN PATIENTS WITH OR WITHOUT INTERSTITIAL CYSTITIS/CHRONIC PELVIC PAIN SYNDROME

INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) is approved for urinary urgency/frequency, urge urinary incontinence and non-obstructive idiopathic urinary retention. Many of these patients also have conditions such as interstitial cystitis (IC) or chronic pelvic pain syndrome (CPPS). Although IC/CPPS is not a primary indication for SNS, anecdotal reports suggest some patients have symptomatic improvements. This study examined clinical outcomes of SNS using a validated instrument, and compared results in those with and without IC/CPPS. METHODS: Prospective data were collected in patients undergoing SNS by a single surgeon. Subjects completed the American Urological Association (AUA) Symptom Index at each preand postoperative visit. Patients were divided into two groups based on whether or not they also had an established diagnosis of IC/CPPS. Total AUA Symptom Score (AUA-SS), quality of life (AUA-QoL) and filling and voiding subscores (AUA-F; AUA-V) were analyzed. Within group analyses were performed using paired t-tests and repeated measures ANOVA. Between group analyses used two-sample t-tests for means, and one-way and factorial ANOVA. Results were considered significant at p 0.05. RESULTS: Sixty-eight subjects (19 men, 49 women), median age 58 (range 21– 86), underwent SNS for clinically indicated symptoms and met inclusion criteria. Group 1 (n 26) also had IC/CPPS, and Group 2 (n 42) did not. Median followup was 4.4 years. Mean AUA-SS improved from 27.3 to 14.9 in Group 1 and 21.7 to 12.1 in Group 2 (both, p 0.0001). Overall, 20 (29%) patients experienced 15 points improvement in total AUA-SS. Mean preoperative AUA-F subscores were worse in Group 1 (13.6) versus Group 2 (10.7) (p 0.0001). Other preoperative parameters were equivalent between groups. Within-group analyses showed improvements in all postoperative variables (AUA-SS, AUA-QoL, AUA-F, AUA-V) for both groups (p 0.0001). Despite statistically significant improvement within groups, mean postoperative AUA-F subscores remained higher in Group 1 versus Group 2 (p 0.038). CONCLUSIONS: To our knowledge, this is the largest study to prospectively compare voiding outcomes after SNS in patients with or without IC/CPPS with a validated instrument. These data demonstrated both groups experienced significant improvement in almost all voiding parameters measured by AUA-SS and its component subscores. Patients should be counseled regarding realistic goals that can be potentially achieved using SNS for voiding symptoms based on presence or absence of IC/CPPS.

High-Power Potassium-Titanyl-Phosphate Laser Photoselective Vaporization Prostatectomy for Symptomatic Benign Prostatic Hyperplasia

Potassium-titanyl-phosphate (KTP) laser photoselective vaporization prostatectomy (PVP) is a relatively new technology for the management of lower urinary-tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We review our initial experience. We prospectively evaluated our initial 12-month experience with 80 W KTP laser PVP. All had American Urological Association symptom score (AUASS), American Society of Anesthesiologists (ASA) risk score, serum prostate-specific antigen (PSA), maximum flow rate (Qmax), and postvoid residual (PVR) determinations and transrectal ultrasonography. There were 160 consecutive patients identified, with a mean age of 69.7 years (range 34-88 yrs) and a mean ASA score of 2.4 (range 1-4). The mean prostate volume was 72.3 cm(3) (range 20.3-261 cm(3)), with a mean PSA level of 2.2 ng/mL (range 0.1-17.9 ng/mL). Mean laser time and energy usage were 33.4 minutes (range 4-165 min) and 99.0 kJ (range 11.3-524 kJ), respectively. All were outpatient procedures with 96 (60%) patients catheter-free at discharge. Twenty-eight patients need catheter drainage for 1 week. Urinary-tract infections developed in 13 patients. Fourteen patients had clinically insignificant hematuria for more than 1 week. Bladder neck contractures that necessitated intervention developed in three patients. Three patients had persistent urinary retention. No urethral strictures or urinary incontinence were noted. Mean AUASS decreased significantly from 23 to 13, 9, 8, 7, and 6 (P < 0.05) at 1, 4, 12, 24, and 52 weeks, respectively. Qmax and PVR values also showed statistically significant improvement. Our initial results demonstrate that KTP laser PVP is safe and effective for the management of LUTS secondary to BPH.

Holmium Laser Enucleation of the Prostate versus Open Prostatectomy for Prostates Greater than 100 Grams: 5-Year Follow-Up Results of a Randomised Clinical Trial

ObjectivesTo report 5-year follow-up results of a randomised clinical trial comparing holmium laser enucleation of the prostate (HoLEP) with open prostatectomy (OP). MethodsOne hundred twenty patients with prostates greater than 100g in weight according to transrectal ultrasound were randomised to either the HoLEP or the OP group (ie, 60 patients to each group). Preoperative and postoperative assessments included American Urological Association Symptom Score (AUA-SS), maximum urinary flow rates (Qmax), and postvoid residual urine (PVRU) volumes. Measurements were performed at 1, 3, 6, 12, 18, 24, 36, 48, and 60 mo. Postoperative outcome data were compared. All complications were recorded. ResultsFive years postoperatively, a total of 46 patients (38.3%) were lost to follow-up or had to be excluded from the study. All the remaining 74 patients (42 HoLEP vs. 32 OP patients, p=0.11) had undergone the 5-yr follow-up assessments. Mean AUA-SS was 3.0 in both groups (p=0.98), mean Qmax was 24.4ml/s in both groups (p=0.97) and PVRU volume was 11ml in the HoLEP and 5ml in the OP group (p=0.25). Late complications consisted of urethral strictures and bladder-neck contractures; reoperation rates were 5% in the HoLEP and 6.7% in the OP group (p=1.0). No patient developed benign prostatic hyperplasia recurrence. ConclusionsFive years after the operation, the improvements in micturition obtained with HoLEP and OP were equally good, and reoperation rates similarly low. HoLEP seems to be a true endourological alternative to OP.

Correlation between risk factors for vascular disease and the American Urological Association Symptom Score

To evaluate the correlation between risk factors for vascular disease and the American Urological Association Symptom Score (AUA-SS), by comparing the presence of these risk factors with the degree of lower urinary tract symptoms (LUTS). We retrospectively reviewed the medical history, AUA-SS, and prostate volume of men who had a radical prostatectomy. The degree of LUTS in men with and without risk factors for cardiovascular disease was compared. The mean AUA-SS was 7.2 for the entire cohort, 5.6 in men with no risk factors, and 7.9 in men with at least one risk factor (P < 0.05). In men with one to four risk factors, the mean AUA-SS was 6.9, 7.9, 10.7, and 19.5, respectively. There was no correlation between the AUA-SS and prostate size in the entire cohort or among any groups. Men with risk factors for vascular disease are more likely to have a higher AUA-SS than men without these risk factors. These findings suggest the possibility of an association between vascular disease and the development and severity of LUTS in men.

Low AUA symptom score independently predicts positive prostate needle biopsy: results from a racially diverse series of 411 patients

Objectives To evaluate the prebiopsy parameters, including the American Urological Association symptom score (AUASS), that may be predictive of positive biopsy. Transrectal ultrasound (TRUS) biopsy of the prostate represents the reference standard in the diagnosis of prostate cancer. Methods A total of 411 consecutive men undergoing TRUS biopsy were prospectively evaluated. The indications for biopsy were abnormal digital rectal examination (DRE) findings and/or an elevated prostate-specific antigen (PSA) level. A single surgeon (C.R.P.) examined all the men. DRE and TRUS were each given a level of suspicion between 1 (low suspicion—smooth DRE, homogeneous TRUS) and 5 (high suspicion—hard DRE, hypoechoic lesion). A level of suspicion of 3 or greater was considered abnormal. The prebiopsy parameters examined included PSA level, age, race, biopsy history, prostate volume, TRUS-detected lesion, and AUASS. Results Of 411 men, 62% were African American and 38% were white. The mean PSA level was 11.6 ng/mL. The mean patient age was 65.3 years. Overall, 39% of men had abnormal DRE and 32% abnormal TRUS findings. The mean AUASS was 9.3. The positive biopsy rate was 40.8%. Univariate analysis demonstrated that age, PSA level, prostate volume, abnormal DRE findings, TRUS-detected lesion, and AUASS (less than 7, low) were all predictive of a positive biopsy ( P <0.05). Race was not statistically significant ( P = 0.38). Detailed analysis of the AUASS in the 411 men indicated that 41% had low symptom scores (less than 7), 32% had moderate scores (8 to 19), and 27% had severe scores (20 to 35). In the group of men with low symptom scores (n = 169), univariate analysis demonstrated that age, PSA level, prostate volume, and abnormal TRUS findings were all statistically significant predictors of positive biopsy ( P <0.05). Multivariate analysis of the data from the 411 men demonstrated that age, PSA level, prostate volume, abnormal DRE findings, and low AUASS were all independent predictors of positive biopsy ( P <0.05). Conclusions In this prospective study, the independent predictors of positive TRUS biopsy included age, PSA level, prostate volume, abnormal DRE findings, and low AUASS. A low AUASS may be an important variable to consider when counseling patients before biopsy and when designing patient algorithms for prostate biopsy.

A randomized prospective study of laser ablation of the prostate versus transurethral resection of the prostate in men with benign prostatic hyperplasia

Objectives. To compare the safety and efficacy of laser ablation of the prostate, one of the minimally invasive treatments available for men with benign prostatic hyperplasia, to transurethral resection of the prostate (TURP). Methods. A prospective randomized study of 100 men with benign prostatic hyperplasia, with 50 patients in each treatment arm, was conducted. All patients met the entry criteria: age older than 45 years, no history of carcinoma of the prostate, a peak flow rate less than 15 mL/s, medical therapy failure, and the ability to undergo regional or general anesthesia. All patients underwent a preoperative evaluation consisting of the American Urological Association (AUA) symptom score, uroflowmetry, pressure-flow study, transrectal ultrasound for prostate volume, and serum prostate-specific antigen determination. Patients underwent either TURP or laser ablation of the prostate using the potassium titanyl phosphate (KTP)/neodymium:yttrium-aluminum-garnet laser. Patients were seen for follow-up at 1, 3, 6, and 12 months. Results. The mean age was 68.2 years (range 45 to 90) for the laser group and 67.4 years (range 54 to 82) for the TURP group. The mean AUA symptom score was 22 for the laser group and 21 for the TURP group. The mean peak uroflow rate was 7.6 ± 3.4 mL/s for the laser group and 6.5 ± 4.0 mL/s for the TURP group. At 12 months of follow-up, the mean AUA symptom score had decreased to 7 (−69.5%) for the laser group and to 3 (−80.9%) for the TURP group. The mean peak uroflow rate increased to 15.4 mL/s (+107.8%) for the laser group and to 16.7 mL/s (+150.7%) for the TURP cohort. Seventy-five percent of the laser group had a 50% or greater decrease in their individual AUA symptom score compared with 93% of the TURP group. Sixty-five percent of the laser cohort had a 50% or greater increase in their peak uroflow rate compared with 75% of the TURP cohort. Conclusions. Laser prostatectomy produced improvements in the peak flow rate and symptom score similar to those produced by TURP. The patients who underwent laser treatment required a longer period to reach maximum improvement, which probably reflects the lack of tissue debulking at the time of surgery. Further improvement in laser technology will be required to produce more immediate results.

RADICAL RETROPUBIC PROSTATECTOMY REDUCES SYMPTOM SCORES AND IMPROVES QUALITY OF LIFE IN MEN WITH MODERATE AND SEVERE LOWER URINARY TRACT SYMPTOMS

Purpose We determine the impact of radical retropubic prostatectomy on lower urinary tract symptoms and quality of life due to urinary problems in men with clinically localized prostate cancer. Materials and Methods The American Urological Association (AUA) symptom index, a symptom problem index and a quality of life due to urinary problems question were administered to 104 men before and 12 months after radical prostatectomy. Urinary continence and satisfaction with the decision to undergo radical prostatectomy were also examined. Results In men with moderate or severe baseline urinary symptoms (AUA score 8 or greater) the total AUA symptom, symptom problem and quality of life question scores decreased by 51 (-6.39), 57 (-4.22) and 25% (-0.65), respectively, after radical prostatectomy. Except for nocturia statistically significant improvements were observed for all questions captured by the AUA symptom index. Radical prostatectomy did not significantly change mean AUA symptom score or symptom problem index in men with mild urinary symptoms (AUA score less than 8). In men with moderate or severe urinary symptoms radical prostatectomy significantly improved quality of life due to urinary problems. Although 10% of men exhibited some degree of clinically relevant stress incontinence, 98% were very satisfied or satisfied with the decision to undergo radical prostatectomy. Conclusions In men with moderate or severe urinary symptoms radical prostatectomy improves lower urinary tract symptoms and quality of life due to urinary problems. The overall beneficial impact on voiding makes radical prostatectomy an attractive treatment option for clinically localized prostate cancer.

Laser Prostatectomy

Objective: This retrospective study was undertaken to evaluate results and complications in 303 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH) who underwent laser prostatectomy focusing on the long-term follow-up, 57 patients had a follow-up of more than 3 years. Materials and Methods: A total of 303 patients were treated with the neodymium:YAG laser system for 1993 to 1997, of whom 57 patients were followed up for at least 3 years. All of the patients have been evaluated after 3 months, 6 months and 2 years. 57 patients were evaluated after 3 years. Pre- and postoperative American Urological Association (AUA) symptom score, uroflowmetry (UF), and immediate and long-term complications were assessed. Results: The mean AUA symptom scores of 303 patients decreased over the 24 months follow-up from 16.9 to 7.6. In 57 patients after 36 months the mean AUA symptom score was 7.1. The mean maximal UF increased over the 24 months from 9 to 14.1 cm³/s in 303 patients. In 57 patients at 3 years the mean UF was 13.9 cm³/s. The overal complications of 303 patients included two perforations of the bladder wall and two perforations of the prostatic capsule. Six (1.9%) patients had postoperative febrile UTI and 28 (9.2%) patients had acute urinary retention after catheter removal. Early bleeding occurred in 3 (0.9%) patients, late bleeding in 8 (2.4%), 4 (1.2%) had urethral stricture, and 1 had stricture of the bladder neck. The overall reoperation rate for symptomatic residual tissue was 1.9% (6 patients). Conclusion: Neodymium:YAG laser ablation of prostate represents an efficacious surgical intervention for symptomatic bladder outlet obstruction due to BPH with minimal associated morbidity.

Similarity of the American Urological Association Symptom Index among men with benign prostate hyperplasia (BPH), urethral obstruction not due to BPH and detrusor hyperreflexia without outlet obstruction

To compare the specificity of the American Urological Association (AUA) Symptom Index for benign prostatic hyperplasia (BPH) versus other urodynamically verified micturitional dysfunction in men. Fifty-seven consecutive men who had been referred for video-urodynamic evaluation of voiding symptoms were evaluated. The patients were divided into three groups: (i) BPH group (n = 24); (ii) non-BPH obstructed group (n = 20; nine bladder neck obstruction, 11 bulbous urethral stricture); and (iii) detrusor hyper-reflexia group: detrusor hyper-reflexia without outlet obstruction (n = 13). The mean AUA symptom score for the BPH group was 18.9 (range 7-28). The mean score for the 20 non-BPH obstructed group was 17.6 (range 4-28) and the mean score for the 13 men with detrusor hyper-reflexia was 20.5 (range 12-27). There was no statistical difference in the AUA symptom score among the three groups. The AUA Symptom Index does not specifically identify BPH or bladder outlet obstruction. The index cannot differentiate the site of obstruction as noted by the similar scores among men with BPH from those with bladder neck obstruction and urethral strictures. Moreover, The AUA Symptom Index scores are similar between men with voiding symptoms secondary to bladder dysfunction and bladder outlet obstruction.