Mean Prostate Volume Research Articles

Prostatic stents: a systematic review and analysis of functional outcomes and complication rate.

This review aims to identify and summarize the current literature on the use of prostatic stents or nitinol devices as minimally invasive techniques for the management of lower urinary tract symptoms (LUTS) resulting from benign prostatic hyperplasia (BPH). A comprehensive search of the literature was conducted until October 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023474884). Thirty-eight articles were included (2618 patients). Generally, the risk of bias was deemed as high or very high. The most frequently investigated stents were the UroLume, followed by the Memokath/Memotherm. The mean age was 72.01 ± 5.6 years, with a mean prostate volume of 48.27 ± 12.8 cc and a mean urethral length of 40.53 ± 9.16 mm. Surgeries were usually performed under local anesthesia. The rates of catheter-free status and complications were 85.2% and 30.83%, respectively. The primary complications included urinary tract infections (17.2%), followed by calcifications (12.6%), irritative symptoms (12.2%), and acute urinary retention (10.4%). During a follow-up period of 12 months, the failure rate intended as stent removal or repositioning was 14.8%. The International Prostate Symptom Score (IPSS) showed an overall improvement of 9.85 points. The mean improvement in maximum flow rate and post-void residual volume were 6.62 ml/sec and 147 ml, respectively. Prostatic stents remain an efficient choice for addressing obstructive symptoms from BPH, offering the advantage of being performed under local anaesthesia, relieving symptoms with good functional outcomes and a low incidence of major complications. Prospective studies are needed to corroborate these results.

Efficacy and safety of prostatic urethral lift according to preoperative urinary retention and prostate volume: A Japanese real-world multicenter data.

Prostatic urethral lift (PUL) for benign prostatic hyperplasia has recently been initiated in Asia; therefore, few studies with real-world data have been reported. This study evaluated the efficacy and safety of PUL using Japanese real-world multicenter data. Indications for PUL were based on relevant guidelines in Japan. The preoperative patient status, postoperative progress at 1 and 3 months, and perioperative complications were evaluated. Also, we compared preoperative urinary retention and nonurinary retention patients, and prostate volumes <30, 30 to <50, and ≥50 mL. A total of 160 patients were included in the study. The mean age was 75 years and the mean prostate volume was 44 mL. The International Prostate Symptom Score, quality of life score, maximum flow rate, and postvoid residual volume significantly improved 1 and 3 months postoperatively compared to preoperatively. The catheter-free rates in the preoperative urinary retention group were 58.1%, 72.1%, 83.7%, and 88.4% on postoperative days 1, 7, 30, and 90, respectively. The catheter-free rates in the nonurinary retention group were 94.9%, 98.3%, and 100% on postoperative days 1, 7, and 14, respectively. The group with a prostate volume ≥50 mL had a longer operation time and used significantly more implants; however, no difference was observed in the postoperative urinary status among the three groups. PUL can be considered a safe and effective procedure for both preoperative urinary retention and nonurinary retention patients with prostate volumes <100 mL in older patients with comorbidities.

Modified robotic simple prostatectomy technique: a retrospective analysis of a series of 162 surgeries performed by a high-volume surgeon.

Benign prostatic hyperplasia (BPH) affects up to 80% of men by age 80, with large-gland BPH often treated by simple prostatectomy (SP). This technique significantly improves symptoms but is associated with high rates of complications such as transfusions and infections. Minimally invasive techniques, including robotic-assisted laparoscopic simple suprapubic prostatectomy (RALSP), have emerged as alternatives. This study reports on 162 patients who underwent RALSP from May 2018 to June 2023. The mean age of the patients was 69years, mean prostate volume 144.8cm3, mean robot time 78.7min, and mean blood loss 183.1mL. Results demonstrated significant improvements in the results: prostate volume (mean decrease from 144.8 to 26.6cm3), mean PSA level decreased from 7.8 to 0.8 (p < 0.0001), mean IPSS decreased from 23.0 to 4.4 (p < 0.0001), and mean uroflowmetry increased from 6.3 to 22.6ml/s (p < 0.0001). No patient experienced worsening erectile function after surgery. All patients showed absence of stress urinary incontinence within 3months. Catheterization time decreased from 4.2 to 2.6days over the study period. The postoperative complication rate was 2.29%, with no need for surgical reintervention for complications. While RALSP showed promising results, further prospective studies are needed to compare it with other techniques. This study highlights RALSP as a viable minimally invasive option for treating large-volume BPH, offering reduced recovery times and fewer complications.

Erectile Function in Men Presenting with Lower Urinary Tract Symptoms from Benign Prostate Enlargement: Association with Quality of Life Scores in the Context of Interviewer-Assisted Questionnaire Administration

Abstract Background: Interviewer-assisted administration of International Prostate Symptoms Score (IPSS) and Internal Index of Erectile Function-5 (IIEF-5) questionnaires in men with lower urinary tract symptoms (LUTS) due to benign prostate enlargement (BPE) may generate inconsistent outcomes. Objectives: To assess the correlation between the scores from interviewer-assisted administration of the IPSS questionnaire and the IIEF-5 questionnaire in men with uncomplicated LUTS due to BPE. Materials and Methods: The IPPS and the IIEF-5 questionnaires were administered with interviewer assistance to a cross-section of men presenting to the hospital with symptoms of LUTS due to uncomplicated BPE. The demographics were ascertained, and the association between IPPS and IIEF-5 scores was determined using linear correlation. Results: There were 211 participants in 18 months with a mean age of 66.5 ± 9.5years. The mean prostate volume, prostate-specific antigen, peak flow rate, and post-void residual volume were 55.2 ± 10.1 mL, 3.1 ± 0.7 ng/mL, 20.8 ± 8.2 mL/s, and 38.1 ± 21.5 mL, respectively. One hundred and eighty-six participants (88.2%) attained post-primary level of formal education. Moderate LUTS was reported in 51.7% (n = 109), while severe LUTS was reported in 10.4% (n = 22) participants. The mean storage LUTS (sLUTS) score was 6.25 ± 2.84, the mean voiding LUTS (vLUTS) score was 4.27 ± 4.56, and the mean IPSS was 10.38 ± 6.44. The mean IIEF-5 score was 15.17 ± 6.09. There was a poor correlation between IIEF-5 and sLUTS (Spearman rho –0.02; P = 0.77), vLUTS (Spearman rho –0.058; P = 0.403), IPSS scores (Spearman rho –0.048; P = 0.49), as well as with quality of life (QoL) preferences (F 1.722; P = 0.117). Conclusions: Interviewer-assisted IIEF-5 scores do not relate with sLUTS, vLUTS IPSS, and QoL due to LUTS, as is the case with reports on self-administered IIEF-5 scores.

MRI-guided transrectal prostate laser ablation for benign prostatic hypertrophy: a retrospective cohort study.

To investigate whether MRI-guided transrectal laser ablation is safe and effective for the treatment of lower urinary tract symptoms caused by BPH. This single-center retrospective cohort study evaluated men who underwent MRI-guided transrectal laser ablation for BPH between February 2017 and July 2021. Age, prostate-specific antigen, prostate volume, prior surgical BPH treatments if any, International Prostate Symptom Score (IPSS) and Sexual Health Inventory of Men (SHIM) were collected. The primary outcome measures assessed were change in IPSS and SHIM 6, 12 and 24 months after laser ablation and adverse events. Fifty-two patients were included, having completed at least one follow-up survey. The mean patient age was 62.9 ± 5.7 years, and mean prostate volume was 80.2 ± 39.2 cc. Eighteen patients (34.6%) had received a prior BPH treatment. The IPSS scores dropped an average of 16.7 ± 7.0 (p < 0.001), 16.9 ± 7.5 (p < 0.001) and 17.1 ± 7.2 (p < 0.001) points from baseline at 6, 12 and 24 months, respectively. There was no statistically significant difference in IPSS score drop between patients who had received a prior BPH procedure and those who had not (p = 0.628). The SHIM scores showed a statistically insignificant increase at all time points. Nineteen patients (36.5%) reported a complication. There were 12 grade II complications (23%) and seven grade I complications (13.5%). There were no grade III or higher complications. Transrectal MRI-guided focal laser ablation is safe and effective for the treatment of lower urinary tract symptoms caused by BPH, with a significant improvement in symptom severity after 2 years.

Efficacy of Rezūm water vapor therapy for the treatment of catheter-dependent urinary retention: A single-center, Canadian experience.

Urinary retention secondary to benign prostatic hyperplasia (BPH) requiring catheterization is a prevalent and morbid condition. The objective of this study was to evaluate the real-world efficacy and safety of Rezūm as the primary treatment of catheter-dependent urinary retention. A single-center, retrospective study analyzed patients with catheter-dependent urinary retention secondary to BPH who were treated with Rezūm between April 2022 and April 2024. Standardized postoperative followup was required for inclusion. Patient demographics, medication use, volume drained at time of urinary retention, catheter-free status, complications, and postoperative International Prostate Symptom Score (IPSS) was collected. A total of 53 patients were included. Mean age was 73.4 years (standard deviation 9.4), and the mean Charlson comorbidity index score was 3.7. The baseline mean prostate volume was 81.7 (range 33-179) mL. Patients were catheter-dependent for an average of 225 (range 30- 1821) days prior to surgical intervention. Average followup time was 10.2 months. Of the 53 patients treated, 42 (79%) patients were able to become catheter-free after treatment. Twenty-six (49%) patients failed their initial trial of void at 14 days postoperatively; 11% (n=6) of patients experienced hematuria with one admitted to hospital due to hematuria/clot retention. There were no Clavien Dindo ≥3 complications. Only retention volume ≥1 L was a significant independent predictor of treatment failure on univariate and multivariate logistic regression analysis. Rezūm effectively treated catheter-dependent urinary retention. Given the simplicity of treatment, accessibility, and minimal anesthetic requirements, providers should consider Rezūm to minimize indwelling catheter-related morbidity for catheter-dependant patients.

Ultrasonographic Evaluation of the Association between the Prostate Volume and Anthropometric Measurements in a Subset of Adult Nigerian Men with Benign Prostatic Hypertrophy

Background: Benign prostatic hypertrophy (BPH), a major cause of men`s morbidity, is positively related to obesity, which is assessed using anthropometric measurements. Despite the scarcity of local literature on this relationship, varying associations between prostate volume (PV), age, and anthropometric parameters have been reported. Objectives: To ascertain the average BPH volume, the predominant age at risk for BPH, and any correlations between PV and anthropometric measurements in our community. Methods: A prospective cross-sectional study conducted on 125 men aged 40–80years, with normal prostatic-specific antigen (PSA) levels, at the Radiology department, Benue State University Teaching Hospital, Makurdi, from May 2023 to May, 2024. PV was calculated by transabdominal ultrasonography. Anthropometric measurements were made using set procedures, from which the body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) were computed. The data was analyzed using SPSS and Microsoft Excel with P value &lt; 0.05. Results: The mean age and PV of participants was 61.6±9.5years and 74.2±52.5ml, respectively with majority, 41 (32.8%) of men in their seventh decade of life. Age and PV did not statistically significantly correlate (P = 0.159); however, BMI, HC, WC and WHTR did (P = 0.000, 0.002, 0.006, and 0.014). Conclusion: The mean sonographic PV was 74.2±52.5ml, with men in their seventh decade being the most at risk for BPH. PV exhibited a statistically significant correlation with some anthropometric parameters but not with respondents' age. The equations and models generated from this study will benefit future research on prostatic growth and early detection of BPH.

The early learning curve of the bipolar enucleation of the prostate: a multicenter cohort study

ObjectivesTo evaluate the early learning curve of BipolEP (Bipolar Enucleation of the Prostate).Subjects/patients and methodsWe conducted a retrospective, multicenter analysis of surgical and functional outcomes of patients treated with BipolEp for BPO (benign prostatic obstruction). We evaluated the first 20 cases of BipolEp performed by four different surgeons in three different countries. The following baseline parameters were obtained: age, IPSS, indwelling catheter, transrectal measured prostate volume, post void residual volume (PVR) and uroflowmetry. The learning curve was analysed based on perioperative parameters and the influence of perioperative parameters was correlated with the sequence of BipolEp cases.Results84 BipolEp operations performed by 4 different surgeons in their early learning curve were studied. Mean prostate volume was 75 ml, 39% of cases had an indwelling catheter and the average operating time was 101 min. Three out of four surgeons performed at least 50% of successful operations according to Trifecta (complete enucleation and morcellation < 90 min., no conversion to TUR-P). Conversion rate to TURP was 11.9% in total which however was driven by a single surgeon with an almost 50% conversion rate. Mean enucleated prostate was 33.3 gr (18-54.5). Intraoperative complications and reported stress incontinence ranged from 0 to 38.1%. At six-weeks review, the IPPS improved by 12.5 (8–16) points and Qmax by 208% (109.8-266.7). Uroflowmetry outcomes correlated with the sequence of cases with a linear improvement during 20 consecutive cases (p = 0.018) in all centres. Major complications (Clavien Dindo ≥ 3) were rare (4.8%) and comparable between the groups.ConclusionSurgeons starting to learn BipolEp can expect to be able to achieve a linear improvement in Uroflow at the six-week postoperative evaluation after 20 consecutive cases. BipolEp can be successfully performed during the early learning curve with an acceptable rate of conversion to standard TUR-P.

Prior Negative Biopsy, PSA Density, and Anatomic Location Impact Cancer Detection Rate of MRI-Targeted PI-RADS Index Lesions.

MRI fusion prostate biopsy has improved the detection of clinically significant prostate cancer (CSC). Continued refinements in predicting the pre-biopsy probability of CSC are essential for optimal patient counseling. We investigated potential factors related to improved cancer detection rates (CDR) of CSC in patients with PI-RADS ≥ 3 lesions. The pathology of 980 index lesions in 980 patients sampled by transrectal mpMRI-targeted prostate biopsy across four medical centers between 2017-2020 was reviewed. PI-RADS lesion distribution included 291 PI-RADS-5, 374 PI-RADS-4, and 315 PI-RADS-3. We compared CDR of index PI-RADS ≥ 3 lesions based on location (TZ) vs. (PZ), PSA density (PSAD), and history of prior negative conventional transrectal ultrasound-guided biopsy (TRUS). Mean age, PSA, prostate volume, and level of prior negative TRUS biopsy were 66 years (43-90), 7.82 ng/dL (5.6-11.2), 54 cm3 (12-173), and 456/980 (46.5%), respectively. Higher PSAD, no prior history of negative TRUS biopsy, and PZ lesions were associated with higher CDR. Stratified CDR highlighted significant variance across subgroups. CDR for a PI-RADS-5 score, PZ lesion with PSAD ≥ 0.15, and prior negative biopsy was 77%. Conversely, the CDR rate for a PI-RADS-4 score, TZ lesion with PSAD < 0.15, and prior negative biopsy was significantly lower at 14%. For index PI-RADS ≥ 3 lesions, CDR varied significantly based on location, prior history of negative TRUS biopsy, and PSAD. Such considerations are critical when counseling on the merits and potential yield of prostate needle biopsy.

Evaluation of the learning curve for Thulium fiber laser enucleation of prostate (ThuFLEP): retrospective study of a single-surgeon experience in real-world settings.

To assess the learning curve of Thulium Fiber Laser Enucleation of prostate (ThuFLEP) of a single surgeon inexperienced in laser endoscopic enucleation of prostate (EEP). We retrospectively analyzed all patients with benign prostate hyperplasia undergoing ThuFLEP at our center between January 2022 and August 2023 by one surgeon. Inclusion criteria were International Prostate Symptom Score > 7, prostate volume < 200g, and maximal urinary flow rate < 15 mL/s. The surgeon was inexperienced in laser EEP and trained by watching educational videos of ThuFLEP before starting to perform the procedure under mentoring during the first 4 cases. Procedural data (enucleation and morcellation efficiency, complications) and functional results up to 3 months were evaluated. Patients were divided into 4 cohorts of 20 consecutive cases to evaluate outcomes evolution throughout time. The mean age of the patients was 69.9 years (SD 7.8) and mean prostate volume was 89.9g (SD 25.8). Preoperative functional parameters were comparable between the groups. Mean enucleation efficiency (EE) ratio and morcellation efficiency (ME) ratio reached respectively 0.78g/min (SD 0.55) and 2.49g/min (SD 1.03) and both variables significantly increased from group 1 to group 3 (p < 0,001). Perioperative complications remained low throughout the caseload with similar significant 3-month functional improvements between all groups. This is the first study to evaluate ThuFLEP learning curve for a single surgeon inexperienced in laser EEP with limited mentoring. Under these real-world conditions, nearly 60 cases were needed to complete the learning curve with a complications rate remaining low throughout the training process.

Aquablation at 4-years: Real World Data From the Largest Single-center Study With Associated Outcomes Follow-up

ObjectivesTo report real-world experience of 4-year safety and efficacy outcomes of Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH). MethodsThis is a prospective single-center, observational study evaluating the outcomes of robotic-assisted Aquablation therapy for moderate-to-severe BPH between December 2019 and December 2023. Patient-level data included age, prostate volume, IPSS score, peak urinary flow rate (Qmax), post-void residual (PVR) were evaluated at 3M, 6M, and Years 1 - 4. Primary outcomes included change in IPSS score, change in Qmax, change in PVR, preservation of antegrade ejaculation, and complications. ResultsIn this cohort of 330 men, mean prostatic volume was 110.3 mL (range 38-330 mL) at baseline. International Prostate Symptom Score (IPSS) improved from a baseline of 23.8 (SD 8.4) to 6.9 (SD 2.9) at 4 years. Mean peak urinary flow rate (Qmax) also demonstrated improvement and increased from 6.4 ml/sec (SD 4.2) to 17.4 ml/sec (SD 5.5) at 4 years. At one year, mean prostate volume reduction was 45.5 mL (-41.3%). Postoperative antegrade ejaculation was preserved in 249/250 men (99.6)% of men. Complications included urinary tract infection within first month after procedure in 37 (11.2%) and bleeding requiring blood transfusion in 11 (3.3%). 13 patients (3.9%) required a second procedure including 2 for post operative bleeding, 1 for a bladder neck disruption and 10 (3.0%) for transurethral resection of residual anterior tissue. ConclusionsWe demonstrate Aquablation to not only be safe but also providing durable outcomes at 4-years for men with BPH.

Holmium laser enucleation of the prostate (HoLEP) in short-circuit outpatient care: Is prostatic volume a limiting factor?

Our goals were to study prostatic volume as a limiting factor after HoLEP surgery with short-circuit outpatient care (4 h) and to define other factors that affect the success of the proposed circuit. An observational analysis and review was performed using a prospective database. Preoperative, intraoperative, and postoperative variables were included for patients who were scheduled for short-circuit outpatient care (SCOC) and who underwent HoLEP between 2020 and 2023. We defined SCOC as a postoperative hospital stay of 4 h. Subjects who required more than 4 h in hospital were categorized as conventional hospital admission (CHA). A descriptive populational study was conducted, expressing the mean using a 95% confidence interval and percentages for the continuous variables. In order to analyze them, we used the Student's t-test for the continuous variables and the chi-squared test for the categorical variables. Sixty-eight patients were included, 54 of which completed SCOC, which represented a success ratio of 79.5%. The mean age and prostatic volume of the whole cohort were 68.9 (±6.8) years and 79.5 (±29.1) mL, respectively. We found no significant differences in age, prostatic volume, antiplatelet drug use, indwelling bladder catheter, or applied energy among the subjects who completed SCOC and those who required CHA. No patient was presented with a complication of Grade 3 (or higher) in the modified Clavien-Dindo classification. At the six-month follow-up, no differences were observed in the uroflowmetry or International Prostate Symptoms Score variables. Prostatic volume does not seem to be a limiting factor after undergoing HoLEP with short-circuit outpatient care.

Feasibility assessment of catheter-free water vapor thermal therapy for treatment of benign prostatic hyperplasia

PurposeTo investigate safety and feasibility of performing water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA) without postoperative catheterization among men with benign prostatic hyperplasia.MethodsThis is a prospective, single arm, unblinded pilot study of 20 consecutive male patients ages 40–80 who underwent WVTT at a single academic institution. All patients underwent 1 injection per lobe at the point of maximal obstruction based on visualization. Primary outcome was evaluation of voiding parameters, symptom scores, and need for catheterization at 3 day, 1, 3, and 6 month follow up compared to baseline visit 30 days prior to surgery.ResultsMean age was 65 years (range 55–75). Mean prostate volume and PVR were 43 cc (range 30–68) and 89 cc, with 30% (n = 6) having median lobes. Patients received 2–3 treatments based on presence of bilobar versus trilobar hyperplasia. One patient (55 cc prostate, no median lobe) required catheterization for acute urinary retention on postoperative day 2. No patients required antibiotics for urinary tract infection or inpatient readmission within 30 days. Qmax significantly increased from 6 mL/s to 8, 13, 12, and 14 at 3 days, 1, 3, and 6 months (p < 0.05). IPSS decreased from 17 preoperatively to 10, 6, 7, and 8 (p < 0.05). No significant differences were noted in PVR, IIEF, MSHQ-EjD, or SF-12.ConclusionsIn well-selected men, catheter-free WVTT is feasible and improved voiding parameters and symptom scores. No changes in sexual function, infectious complications, or readmission were noted. Only 1 patient (5%) required postoperative catheterization within 30 days.

INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS) CORRELATION WITH SONOGRAPHIC PROSTATE SIZE

The International Prostate Symptom Score (IPSS) is a broadly used questionnaire designed to assess the severity of lower urinary tract symptoms (LUTS) in men, particularly those related to harmless prostatic hyperplasia (BPH). Objectives: The primary aim of this study is to find the International Prostate Symptom Score (IPSS) and its correlation with sonography and prostate size. Methods: This cross-sectional study was conducted at CMH Lahore February 17, 2024, to May 16, 2024. Data were collected from 250 patients. Male patients aged&gt;40 years who presented with LUTS were included in the study. Patients with a history of prostate cancer, bladder dysfunction and prostate surgery were excluded from the study. Data were collected through a systematically designed questionnaire. All the study participants completed the IPSS questionnaire to find the severity and urinary symptoms. Results: Data were collected from 250 patients according to the study's inclusion criteria. The mean age of the patients was 62.4 ± 8.6 years, and the mean BMI was 27.1 ± 3.2 kg/m2. The mean PSA was 6.8 ± 2.5 ng/mL, and the mean IPSS score was 19.5 ± 6.8. there, 140 (56%) patients were smokers, and 125 (50%) also suffering from hypertension. Patients with IPSS scores ranging from 0-7 exhibited a mean PV of 32.5 ± 5.6 mL, with a Pearson correlation coefficient (r) of 0.25 (p = 0.038). As IPSS scores increased to the 22-35 range, the mean PV rose to 54.3 ± 9.2 mL, with a more robust correlation coefficient of 0.75 (p &lt; 0.001). Conclusion: It is concluded that there is a significant positive correlation between the International Prostate Symptom Score (IPSS) and prostate volume (PV) in patients with benign prostatic hyperplasia (BPH).

Tamsulosin 0.8 mg daily dose in management of BPH patients with failed tamsulosin 0.4 mg monotherapy and unfit for surgical intervention

AimThis study aims to evaluate the effectiveness and safety of administering double-dose tamsulosin (0.8 mg) for treating patients with benign prostatic hyperplasia (BPH) who have not responded to the standard single dose of tamsulosin (0.4 mg) and are deemed unsuitable for transurethral resection (TUR) intervention.Materials and methodsBetween November 2022 and July 2023, we prospectively analyzed 111 patients who were experiencing severe BPH symptoms. These patients received a double dose of tamsulosin for one month. We collected baseline characteristics such as age, body mass index, and underlying medical conditions. Various parameters including the International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) levels, prostate volume, peak urinary flow rate (Qmax), voided volume, and post-void residual volume were evaluated before and after treatment.ResultsAll 111 patients completed the study. The mean age, PSA level, and prostate volume were 63.12 ± 4.83 years, 3.42 ± 0.93 ng/ml, and 50.37 ± 19.23 ml, respectively. Of these patients, 93 showed improvement in Qmax, post-void residual volume, and IPSS score (p-value = 0.001). The total IPSS score and total Qmax improved from 24.03 ± 2.49 and 7.72 ± 1.64 ml/sec to 16.41 ± 3.84 and 12.08 ± 2.37 ml/sec, respectively.ConclusionDouble-dose 0.8mg tamsulosin as an alpha-blocker therapy appears to be a viable temporary management option for BPH patients who have not responded to the standard single dose 0.4mg tamsulosin and are not suitable candidates for TUR intervention.

Is the Serum Prostate-Specific Antigen Level Affected by Urethral Catheterization in Patients with Acute Urinary Retention?

Background: The reason for elevated serum prostate-specific antigen (PSA) levels in patients undergoing urethral catheterization due to acute urinary retention (AUR) remains a significant and controversial issue. Objectives: To assess the serum PSA level in men with AUR and its changes after catheterization. Methods: This prospective quasi-experimental study was conducted on 43 patients who underwent transurethral catheterization following AUR caused by benign prostatic hyperplasia (BPH). Total PSA levels and free/total PSA ratios were measured before catheterization and one and three days after catheter insertion. Additionally, prostate volume and urine output after catheterization (UOAC) were recorded. Results: The mean age, prostate volume, and UOAC of the patients were 69.05 ± 9.45 years, 60.51 ± 26.35 g, and 844.04 ± 341.66 mL, respectively. The mean and median baseline total PSA levels were 12.59 ± 17.71 ng/mL and 6.30 ng/mL, respectively. These values changed to 13.73 ± 19.83 ng/mL (median = 4.80 ng/mL) and 11.57 ± 17.70 ng/mL (median = 4.40 ng/mL) after 1 and 3 days of catheterization, respectively. The changes in total PSA and free/total PSA levels during the study period were not statistically significant (P &gt; 0.05). Moreover, the PSA levels showed no statistically significant difference before, 1 day, and 3 days after catheterization in groups with total PSA ≤ 4 and total PSA &gt; 4 (P = 0.37; 0.22, respectively). Conclusions: Our results suggest an initial elevation in PSA levels in patients with AUR before urethral catheterization. Both PSA and free/total PSA ratios showed no statistically significant differences before and after urethral catheter insertion, and initial PSA did not affect its changes after catheterization.

Correlation Between Prostate Volume and Lower Urinary Tract Symptoms: A Hospital-Based Study

Background:&amp;nbsp;Lower urinary tract symptoms (LUTS) are manifestations of storage and voiding disorders involving the urinary bladder, urethra and the prostate gland. This study aimed to correlate prostate volume and lower urinary tract symptoms.&amp;nbsp; Materials and methods:&amp;nbsp;This study was a prospective cross-sectional study carried out among 120 males aged 40 years and above who presented with LUTS for prostate ultrasonography at the Radiology department within a period of six months. Informed consent and ethical approval were obtained from participants before commencement of the study. Severity of LUTS was evaluated using the International Prostate Symptom Score (IPSS). Each question was scored between 0 to 5 and the sum recorded as total IPSS score. The total score was graded as mild (0-7), moderate (8-19) or severe (20-35). Quality of life due to urinary symptoms was also evaluated and scored between 0 (delighted) and 6 (terrible). Prostate volume estimation was done by transabdominal ultrasonography using an ultrasound scanner fitted with a 3.5-MHz curvilinear transducer (Logic F6, General Electric, USA, 2017). Measurements were taken and the average values computed; volume calculation was obtained by default using the inbuilt computer algorithm in the ultrasound machine. The data obtained were statistically analyzed using the Statistical Package for Social Sciences (SPSS) software version 24 (International Business Machines, USA, 2016), and the results presented in tables, charts, and percentages. Pearson&amp;rsquo;s correlation coefficient was used to correlate between variables with P-values &amp;lt; 0.05 considered significant.&amp;nbsp; Results:&amp;nbsp;Results showed that the cumulative mean age of the participants was 65.1&amp;thinsp;&amp;plusmn;&amp;thinsp;9.6 years with majority of the participant&amp;rsquo;s between 60 and 69 years. The most common presenting LUTS was nocturia (98.0%), followed by frequency (92.7%). Overall, the mean IPSS score was 13.2 &amp;plusmn; 4.6 while quality of life (QoL) was 4.1 &amp;plusmn; 1.2. The mean prostate volume was 69.8 &amp;plusmn; 63.5cm3, with 79.2% of the subjects having a prostate volume &amp;ge; 30cm3. Pearson correlation between prostate volume and IPSS was significant (r = 0.304, p = 0.001). Conclusion:&amp;nbsp;The study established a positive significant correlation between prostate volume and International Prostate Symptoms Score (IPSS). This implies that sonographic PV assessment could be useful in objective assessment of LUTS severity and should be considered in management decisions and follow-up of patients with lower urinary tracts symptoms.&amp;nbsp;

A prospective analysis of thulium laser enucleation in benign prostatic hyperplasia comparing low- and high-power approaches for prostates exceeding 80 g

Introduction and objectivesTo compare the perioperative and functional outcomes of low-power and high-power thulium:YAG VapoEnucleation (ThuVEP) of the prostate for the treatment of large-volume benign prostatic hyperplasia (BPH) (> 80 ml).Patients and methodsA prospective analysis of 80 patients with symptomatic BPO and prostatic enlargement (more than 80 ml) was conducted. They were divided randomly into two groups (40 patients in each group). One group was treated with low-power ThuVEP, and the other group was treated with high-power ThuVEP.All patients were assessed preoperatively and early postoperatively, and 12-month follow-up data were analyzed. The complications were noted and classified according to the modified Clavien classification system.ResultsThe mean age at surgery was 68 (± 6.1) years, and the mean prostate volume was 112 (± 20.1) cc, and there were no differences between the groups (p = 0.457). The mean operative time was 88.4 ± 11.79 min for group A and 93.4 ± 16.34 min for group B, while the mean enucleation time was 59.68 ± 7.24 min for group A and 63.13 ± 10.75 min for group B. There were no significant differences between the groups regarding catheterization time and postoperative stay. The quality of life (QoL), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoiding residual urine (PVR), and prostate volume improved significantly after treatment and were not significantly different between those treated with the different energies. The incidence of complications was low and did not differ between both the groups.ConclusionLow-power ThuVEP is feasible, safe, and effective with comparable results with high-power ThuVEP in the treatment of BPO.

The Association between Estrogen Levels and Prostate Volume in Obese and NonObese Benign Prostatic Hyperplasia (BPH) Patients

Objective: To investigate the association between prostate volume and estrogen levels in obese and non-obese individuals suffering from Benign Prostatic Hyperplasia (BPH). Study Design and Setting: Cross-sectional, analytical study Methodology: The International Prostatic Symptom Score (IPSS) was used in the study to recognize sixty participants with BPH. The study examined patients' height, weight, waist circumference (WC), and body mass index (BMI). An IPSS score of less than 7 was seen as healthy. Using standardized BMI (25) and waist circumference (90cm), patients were split into two groups, with obese patients being placed in group A and non-obese patients being placed in group B. Using trans-rectal ultrasonography(TRUS), prostate gland's dimensions were measured, and blood samples were taken to determine serum estrogen levels. Results: In comparison to the non-obesity group, which had a mean prostate volume (PV) of 31.21±6.771 ml, the obese group's PV was 36.13±3.673ml. It was statistically significant that there was a difference between the two groups (p=0.001). In the non-obese group, average level of estrogen was 309.72±73.62pmol/l, compared to 328.21±115.05pmol/l in the obese group (p=0.462). Correlation study (r=0.279,p=0.031) revealed a significantly ideal relationship between participants' blood estrogen levels and PV. Among patients who were obese, there was a significant positive correlation among blood estrogen levels and prostate size(r=0.638, p=0.0001). Conclusion: When compared to the non-obese group, obesity significantly raises prostate volume in study participants, leading to benign prostatic hypertrophy. In addition, prostate volume and blood estrogen levels in obese males showed a significant positive association.

Evaluation of the learning curve for Thulium laser enucleation of the prostate in a contemporary cohort.

To assess the learning curve of Thulium laser enucleation of the prostate (ThuLEP) of a single surgeon. Hundred patients suffering from benign prostatic hyperplasia were treated by the same surgeon. In all cases, a well-trained urologist was present in the operating room. Patients urinary function was assessed preoperatively using the International Prostate Symptoms Score (IPSS), maximum flow rate and Post-Void Residual volume. Preoperative prostate volume was recorded. Enucleation and morcellation efficiency and complication rate were evaluated. Patients were divided into 5 cohorts of 20 consecutive cases to assess changes in outcomes through time. Mean age of patients was 73.1years (SD 17.5) and mean prostate volume was 89.7ml (SD 55.1). Overall, mean enucleation and morcellation efficiency were 1.7 (SD 2.9) and 5.1 (SD 2.7) g/min. A statistically significant increase in enucleation efficiency was observed when comparing cohort 1 vs 2 (0.9 vs 1.3g/min, p = 0.03) and cohort 2 vs 3 (1.3 vs 1.7g/min, p = 0.02). A statistically significant increase in morcellation efficiency was observed when comparing cohort 1 vs 2 (2.8 vs 3.7g/min, p = 0.02) and cohort 2 vs 3 (3.7 vs 4.9g/min, p = 0.03). In both cases, no significant differences were observed when comparing the following cohorts. Complication rate showed no significant differences throughout the caseload. In our single-surgeon experience, we observed a learning curve of nearly 60 cases for the ThuLEP procedure in presence of a well-trained surgeon. Complication rate was low from the beginning of surgical experience.