Mean Prostate Volume Research Articles

MP59-05 PERI-OPERATIVE AND SHORT-TERM FUNCTIONAL OUTCOMES COMPARISON BETWEEN HOLEP AND ROBOTIC SIMPLE PROSTATECTOMY FOR LARGE PROSTATE

You have accessJournal of UrologyCME1 Apr 2023MP59-05 PERI-OPERATIVE AND SHORT-TERM FUNCTIONAL OUTCOMES COMPARISON BETWEEN HOLEP AND ROBOTIC SIMPLE PROSTATECTOMY FOR LARGE PROSTATE Giovanni Cochetti, Morgan Roupret, Alessio Paladini, Thomas Seisen, Christophe Vaessen, Ugo Pinar, Sara Ciarletti, Angelica Tancredi, Eleonora Saqer, Liliana Guadagni, Emmanuel Chartier-kastler, and Ettore Mearini Giovanni CochettiGiovanni Cochetti More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Alessio PaladiniAlessio Paladini More articles by this author , Thomas SeisenThomas Seisen More articles by this author , Christophe VaessenChristophe Vaessen More articles by this author , Ugo PinarUgo Pinar More articles by this author , Sara CiarlettiSara Ciarletti More articles by this author , Angelica TancrediAngelica Tancredi More articles by this author , Eleonora SaqerEleonora Saqer More articles by this author , Liliana GuadagniLiliana Guadagni More articles by this author , Emmanuel Chartier-kastlerEmmanuel Chartier-kastler More articles by this author , and Ettore MeariniEttore Mearini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium Laser enucleation of Prostate (HoLEP) and open simple prostatectomy (OSP) are recommended treatments for large benign prostate hyperplasia (BPH). Robot-assisted simple prostatectomy (RASP) seems comparable to open simple prostatectomy (OSP) in terms of efficacy and safety, providing similar improvements in Qmax and IPSS, but with advantages of minimally invasive technique. It remains unclear which is the best treatment between HoLEP and RASP. The aim of the study was to compare these techniques in terms of perioperative data, short-term functional outcomes in patients (pts) with prostate larger than 100 cc. METHODS: From January 2016 to January 2022, data from 94 pts with BPH >100 cc who underwent HoLEP or RASP were retrospectively analyzed. Overall, 47 pts underwent HoLEP and 47 underwent RASP. Operative time (OT), blood loss evaluated as ΔHb, length of catheterization (LOC), length of stay (LOS), IPSS, quality of life (QoL) index, urgency, maximum flow rate (Qmax), PSA, complications and urinary continence were analyzed at 30 and 90 days after surgery. Statistical analysis was made with T-test or Wilcoxon test for parametric and non-parametric continuous variables, respectively. Chi-square test was used for percentage variables. Statistical significance was set at p<0.05. RESULTS: The groups were comparable in terms of age, BMI, pre-operative IPSS and QoL index. The mean prostate volume was similar even if in HoLEP group was slightly lower (128.4±23.9 vs 144±34.1 cc, p>0.05). LOC (2.4±0.9 vs 4.5±1.5 days, p=0.003) and LOS (3.5±1.1 vs 5±1.8 days, p=0.002) were significantly shorter for HoLEP group. No differences were observed in post-operative ΔHb, QoL, IPSS, urgency and urinary continence at 30 and 90 days after surgery. Otherwise, OT of RASP was significantly lower than HoLEP (107,5±20,1 vs 178,9±62 min, p<0.05), while at 3 months Qmax and PSA value were higher and lower, respectively, in HoLEP group (33.2±12.4 vs 24.5±15.3 ml/sec, p=0.03 and 0.8± vs 1.6± ng/ml, p=0.003). No intraoperative complication according to EAUiaiC occurred and only minor postoperative complications according to Clavien Dindo classification were observed without significant differences (4,25% for HoLEP vs 10.6% for RASP, p=0.27). CONCLUSIONS: Compared to RASP, HoLEP shows advantages in reducing LOC and LOS, but needs of longer OT. Lower levels of PSA in HoLEP, that could be the result of more tissue removal, and the better Qmax do not affect IPSS and QoL in peri-operative and short-term outcomes. HoLEP and RASP are both safe and effective enucleative techniques. Probably, RASP could be more useful for pts with larger BPH and multiple vesical lithiasis or large diverticulum. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e807 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Cochetti More articles by this author Morgan Roupret More articles by this author Alessio Paladini More articles by this author Thomas Seisen More articles by this author Christophe Vaessen More articles by this author Ugo Pinar More articles by this author Sara Ciarletti More articles by this author Angelica Tancredi More articles by this author Eleonora Saqer More articles by this author Liliana Guadagni More articles by this author Emmanuel Chartier-kastler More articles by this author Ettore Mearini More articles by this author Expand All Advertisement PDF downloadLoading ...

MP24-02 CLUSTER ANALYSIS IDENTIFIES BENIGN PROSTATIC HYPERTROPHY CLINICAL PHENOTYPES

You have accessJournal of UrologyCME1 Apr 2023MP24-02 CLUSTER ANALYSIS IDENTIFIES BENIGN PROSTATIC HYPERTROPHY CLINICAL PHENOTYPES Matthew Simmons, Nathaniel Taylor, W Carter Reed, Pablo Santamaria, Zachary Klaassen, Sherita King, and Martha Terris Matthew SimmonsMatthew Simmons More articles by this author , Nathaniel TaylorNathaniel Taylor More articles by this author , W Carter ReedW Carter Reed More articles by this author , Pablo SantamariaPablo Santamaria More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Sherita KingSherita King More articles by this author , and Martha TerrisMartha Terris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hypertrophy (BPH) is a heterogeneous disease that is affected by multiple variables including infection, genetics and inflammation. This study assessed whether hierarchical cluster analysis could better characterize BPH patients. METHODS: Patients who underwent TURP or simple prostatectomy between January 2017 to August 2022 were reviewed. 92 patients who had CT imaging within 18m of surgery were selected. CT-based prostate volumes (PV) were calculated using the ellipsoid volume formula (L*W*H*(π/6)). Metabolic syndrome score (MetX) was calculated by adding normalized BMI score to the number of metabolic syndrome-related diseases present (i.e., hypertension, hyperlipidemia, type II diabetes mellitus each disease given a score of 1). Data were scaled using Z transformation. Hierarchical clustering was conducted with Heatmapper software using average linkage and Pearson distance measurement methodology. RESULTS: Mean age of the cohort was 68 (SD=8.5), and 40% were African American. Hypertension, hyperlipidemia and type II diabetes mellitus were present in 73%, 58% and 32% of patients, respectively. Mean prostate volume was 84 ml (SD=56). Median lobes (ML) were present in 26%. Intraprostatic calcifications (IPCs) were present in 37%. Clustering revealed three clear groupings. Group 1 cnsisted of men with IPCs. These men had lower than average age, PV, and MetX scores. Group 2 consisted of men with either MLs or high PV without concomitant high MetX score. Two categories of men were included in Group 2 - younger than average men with MLs; and older than average men men with high PVs. Group 3 consisted of men with high MetX score. Age and PV was lower than average in this group. CONCLUSIONS: Cluster analysis identified three distinct clinical phenotypes of BPH. Classification of BPH subtypes may allow for improved diagnosis and therapy. Future studies will correlate molecular subtyping data and clinical outcomes data to further validate findings. Source of Funding: Medical College of Georgia © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e317 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Simmons More articles by this author Nathaniel Taylor More articles by this author W Carter Reed More articles by this author Pablo Santamaria More articles by this author Zachary Klaassen More articles by this author Sherita King More articles by this author Martha Terris More articles by this author Expand All Advertisement PDF downloadLoading ...

MP76-13 PROSTATE ARTERY EMBOLIZATION - MULTICENTER RETROSPECTIVE EXPERIENCE OF 1000 PATIENTS WITH SHORT, MID, AND LONG TERM FOLLOW UP

You have accessJournal of UrologyCME1 Apr 2023MP76-13 PROSTATE ARTERY EMBOLIZATION - MULTICENTER RETROSPECTIVE EXPERIENCE OF 1000 PATIENTS WITH SHORT, MID, AND LONG TERM FOLLOW UP Shivank Bhatia, Andrew Richardson, Aneesha Maini, Hamed Jalaeian, Rohit Reddy, Kenneth Richardson, Ansh Bhatia, Hemendra Shah, and Bruce Kava Shivank BhatiaShivank Bhatia More articles by this author , Andrew RichardsonAndrew Richardson More articles by this author , Aneesha MainiAneesha Maini More articles by this author , Hamed JalaeianHamed Jalaeian More articles by this author , Rohit ReddyRohit Reddy More articles by this author , Kenneth RichardsonKenneth Richardson More articles by this author , Ansh BhatiaAnsh Bhatia More articles by this author , Hemendra ShahHemendra Shah More articles by this author , and Bruce KavaBruce Kava More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate and expand upon the effectiveness and safety profile of PAE in treating BPH with LUTS or urinary retention. METHODS: 1000 patients underwent PAE for either BPH with LUTS or urinary retention from January 2014 to September 2022. Mean patient age was 70.2±9.5 years, mean prostate volume was 107.2±65.1 g, median pre-procedure IPSS, SHIM and QoL scores were 23 (IQR 18-28), 17 (IQR 10-21) and 5 (IQR 4-6), respectively. Mean PVR was 195.6±232 cc, mean PSA was 6.6±6.9 ng/dl, and mean Qmax 8.0±4.2 cc/s. 100 individuals were indwelling catheter dependent at time of PAE with an average of 127.6 days of catheter dependence prior to PAE. 781 individuals reported BPH medication usage. Patient evaluation occurred at 3-6, 12, 24, 60 and 72-month (mo) intervals post PAE. Adverse events were recorded using the Clavien-Dindo (CD) classification. Two-tailed p<0.05 was considered significant. RESULTS: Median follow up was 1027 days. 63.4% of patients had 3 months or greater follow up. Median IPSS of baseline catheter independent individuals decreased to 5, 6, 7, 3, and 6 at 3-6, 12-, 24-, 60- and 72-months post PAE, respectively (all p<0.01). Percent of non-responders (IPSS>13) are included in the Table 1. Median SHIM, mean prostate size, mean PVR, mean PSA and mean Qmax data is displayed in the Table 1. Average time to indwelling catheter independence was 25.9 days following PAE. At 3 months post PAE 29% (21/73) of individuals were catheter dependent who ultimately achieved catheter independence. 67 patients (6.7%) have required a second procedure for recurrent LUTS; 10 underwent a second PAE. BPH medication cessation, decreased medication burden, and # of individuals on α-blockers of 5α reductase inhibitors is reported in the Table 1. Self-limited frequency, urgency, and dysuria (CD grade I) postoperative symptoms occurred in 33.5% of patients. Complications of non-target embolization, urosepsis, and TIAs were seen in 3 patients each. CONCLUSIONS: PAE is a clinically effective procedure for patients LUTS and urinary retention secondary to BPH with great short-term to midterm results. Long-term outcomes including maintained LUTS relief and significant improvement in QoL continue to be promising. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1096 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shivank Bhatia More articles by this author Andrew Richardson More articles by this author Aneesha Maini More articles by this author Hamed Jalaeian More articles by this author Rohit Reddy More articles by this author Kenneth Richardson More articles by this author Ansh Bhatia More articles by this author Hemendra Shah More articles by this author Bruce Kava More articles by this author Expand All Advertisement PDF downloadLoading ...

MP76-01 MID-TERM EVALUATION OF IMPACT ON STORAGE AND OBSTRUCTIVE SYMPTOMS WITH REZŪM: OUTCOMES OF A LARGE, MULTI-CENTER, PROSPECTIVE REGISTRY OF REZŪM WATER VAPOR THERAPY BENIGN PROSTATIC ENLARGEMENT

You have accessJournal of UrologyCME1 Apr 2023MP76-01 MID-TERM EVALUATION OF IMPACT ON STORAGE AND OBSTRUCTIVE SYMPTOMS WITH REZŪM: OUTCOMES OF A LARGE, MULTI-CENTER, PROSPECTIVE REGISTRY OF REZŪM WATER VAPOR THERAPY BENIGN PROSTATIC ENLARGEMENT Kevin C. Zorn, Naeem Bhojani, Bilal Chughtai, and Dean Elterman Kevin C. ZornKevin C. Zorn More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , and Dean EltermanDean Elterman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rezūm convective water vapor ablation is a minimally invasive procedure to treat benign prostatic tissue. Herein, we report a prospective, multi-center results of the largest cohort of prostates treated with Rezum in Canada to address mid-term outcomes on IPSS storage and obstructive voiding symptoms. 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). Sub-category IPSS-V and IPSS-S were evaluated for the entire cohort, men in retention and those with prostate volume >80 cc vs <80 cc and median lobe vs non-median lobe. IPSS-S was calculated by summing question 1 (incomplete emptying), question 3 (intermittency), question 5 (weak stream), and question 6 (straining to void). IPSS-V was calculated by summing question 2 (frequency), question 4 (urgency), and question 7 (nocturia). RESULTS: 345 men (mean age of 67.4, were treated with Rezūm from April 2019 to October 2022. The mean prostate volume was 72.3 cc (range 17-271) and 64% had a median lobe. 85 patients had prior episode of urinary. Mean number of injections was 10.1(range 2-28). Mean duration of procedure was 3.7 minutes (range 1-13). Mean duration of post-procedure catheterization was 9.8 days. IPSS-S reduced from a baseline score of 9.4 to 8.4 (10%), 6.1 (35%), 4.9 (48%), 4.8 (49%), 4.6 (51%), 4.3 (54%) at 1, 3, 6, 12, 24 and 36 months respectively. Comparatively, IPSS-V reduced from a baseline of 12.7 to 7.7 (39%), 4.1 (67%), 4.3 (66%), 4.3 (66%), 4.6 (64%), 3.7 (70%) at 1, 3, 6, 12, 24 and 35 months respectively. Outcomes were similar among subgroup analysis of men with baseline retention, men with prostate volume >80 cc or those with median lobe (all p>0.05). CONCLUSIONS: Rezum therapy is safe, effective, quick, out-patient, office-based procedure for prostate glands over a wide range of volumes with equally significant improvements in storage and voiding symptoms regardless of prostate volume, median lobe status and baseline urinary retention. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1090 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin C. Zorn More articles by this author Naeem Bhojani More articles by this author Bilal Chughtai More articles by this author Dean Elterman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-16 EXPERIENCE WITH 3,000 CASES OF HOLMIUM LASER ENUCLEATION OF PROSTATE IN A SINGLE INSTITUTION

You have accessJournal of UrologyCME1 Apr 2023MP13-16 EXPERIENCE WITH 3,000 CASES OF HOLMIUM LASER ENUCLEATION OF PROSTATE IN A SINGLE INSTITUTION Hyo Myoung Lee, Min Chul Cho, Sung Yong Cho, Jae-Seung Paick, and Seung-June Oh Hyo Myoung LeeHyo Myoung Lee More articles by this author , Min Chul ChoMin Chul Cho More articles by this author , Sung Yong ChoSung Yong Cho More articles by this author , Jae-Seung PaickJae-Seung Paick More articles by this author , and Seung-June OhSeung-June Oh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of HoLEP in patients with benign prostatic hyperplasia (BPH) at a single institution. METHODS: From August 2008 to June 2022, the baseline demographics, and post-operative follow-up results were retrospectively analyzed through EMR review. Patients were followed up at 2 weeks (n=2,997), 3 months (n=2,199), and 6 months (n=1,853) postoperatively under a critical pathway. Then, they were on open follow-up. RESULTS: A total of 3,000 patients (mean age 69.6±7.7 years) underwent HoLEP. Mean total prostate volume was 67.9 (±34.2) ml and the baseline total IPSS score and the quality of life score were 19.3 (±7.7) and 3.9 (±1.1), respectively. The preoperative maximum flow rate (Qmax) was 9.4 (±4.8) ml/s, and the postvoid residual urine (PVR) volume was 77.8 (±97.6) ml. The total operation time was 60.7 (±31.6) minutes, and the catheter time was 1.3 (±1.2) day. Complications within 2 weeks postoperatively included re-catheterization in 110 patients (3.7%), blood transfusion in 19 patients (0.6%), transurethral coagulation (TUC) in 16 patients (0.5%), stress urinary incontinence (SUI) in 215 (mild 204; severe 11) patients (7.2%), urgency urinary incontinence (UUI) in 174 (mild 129; severe 45) patients (5.8%). Complications at 3 months postoperatively were SUI in 128 (mild 109; severe 19) patients (5.8%), UUI in 113 (mild 74; severe 39) patients (5.1%). Complications at 6 months postoperatively included SUI in 36 (mild 34; severe 2) patients (1.9%), UUI in 25 (mild 17; severe 8) patients (1.3%), bladder neck contracture in 15 patients (0.8%), de novo prostatic fossa stone in 11 patients (0.6%), and urethral stricture in 29 patients (1.5%). A total of 61 patients (2.0%) required secondary surgery (TUC 16, 0.5%; TUI for BNC 16, 0.5%; removal of prostatic fossa stones 11, 0.4%; EIU for urethral stricture 18, 0.6%). At 3 months postoperatively, the total IPSS score was 7.9 (±5.9), Qmax was 21.8 (±11.6) ml/s, and the PVR volume was 21.0 (±38.1) ml. At 6 months postoperatively, the total IPSS score was 6.6 (±5.8), Qmax was 22.2 (±11.3) ml/s, and the PVR volume was 19.7 (±36.8) ml. CONCLUSIONS: Our mid-term follow-up results after HoLEP in BPH patients showed excellent efficacy and low complications. Unlike other previous reports, the incidence of SUI and UUI after HoLEP was low, but the occurrence of de novo stone formation in the prostatic fossa was notable. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e179 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyo Myoung Lee More articles by this author Min Chul Cho More articles by this author Sung Yong Cho More articles by this author Jae-Seung Paick More articles by this author Seung-June Oh More articles by this author Expand All Advertisement PDF downloadLoading ...

MP24-13 PROSTATE SHAPE AND INTRAVESICAL PROSTATIC PROTRUSION ASSESSED BY MAGNETIC RESONANCE IMAGING ARE RELATED TO URINARY SYMPTOMS

MP24-13 PROSTATE SHAPE AND INTRAVESICAL PROSTATIC PROTRUSION ASSESSED BY MAGNETIC RESONANCE IMAGING ARE RELATED TO URINARY SYMPTOMS

PD41-05 SECOND GENERATION TEMPORARY IMPLANTABLE NITINOL DEVICE (iTIND) IMPACT ON SERUM PSA LEVEL: RESULTS FROM a MULTICENTER PROSPECTIVE STUDY (MT-06-STUDY)

PD41-05 SECOND GENERATION TEMPORARY IMPLANTABLE NITINOL DEVICE (iTIND) IMPACT ON SERUM PSA LEVEL: RESULTS FROM a MULTICENTER PROSPECTIVE STUDY (MT-06-STUDY)

MP80-16 BLACK PATIENTS HAVE WORSE CONTINENCE OUTCOMES AT 12 MONTHS FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP80-16 BLACK PATIENTS HAVE WORSE CONTINENCE OUTCOMES AT 12 MONTHS FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY Findlay MacAskill, Majed Shabbir, Arun Sahai, Cathcart Paul, and Noel Jonathan Findlay MacAskillFindlay MacAskill More articles by this author , Majed ShabbirMajed Shabbir More articles by this author , Arun SahaiArun Sahai More articles by this author , Cathcart PaulCathcart Paul More articles by this author , and Noel JonathanNoel Jonathan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is known that racial disparities exist for oncological outcomes following prostate cancer, with black patients having a higher mortality. There remains a paucity of specific data regarding functional outcomes and ethnicity in robotic-assisted radical prostatectomy (RARP). The aim of this study was to investigate if racial disparity exists in outcomes following RARP at our institution, which covers a diverse population. METHODS: This single site study utilised an institution approved (10128) prospective database of patients that underwent primary RARP from 2020-2021 with a minimum follow up of 12 months. All 5 surgeons perform a retropubic approach. Logistic regression was performed to investigate the continence rate at 3, 6 and 12 months for significance (p<0.05). Continence is defined as 0 pads/24 hours. Further analysis was performed using propensity score matching for 12-month continence rate only. RESULTS: In this study, 232 men were included of which 37% (86) were black. On average black men underwent surgery at a younger age (59 versus 63 year). However, no difference was observed between black and white men for mean prostate volume, ISUP grade or T stage. While difference in urinary continence recovery was not significant at 3 months (36% versus 52%) and 6 months (49% versus 63%), recovery of urinary continence recovery was inferior for black men at 12 months after surgery (57% versus 75%, p=0.01). After propensity score matching, 95 white and 95 black patients were evaluated. Mean age was 61 (44-67) and 59 (43-73) years, ISUP grade 2.55 and 2.6, MRI 39 (16-112) and 28 (12-112) cc for white and black patients, respectively. Continence rate at 12 months was 76% and 60% (p=0.02), for respectively. CONCLUSIONS: The study demonstrates a racial disparity for return of urinary continence following robotic-assisted laparoscopic prostatectomy with black men having inferior recovery of urinary continence. Further work is required to investigate the reasons for the different outcome. Source of Funding: FM, MS and AS have received an unrestricted educational grant from Boston Scientific © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1159 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Findlay MacAskill More articles by this author Majed Shabbir More articles by this author Arun Sahai More articles by this author Cathcart Paul More articles by this author Noel Jonathan More articles by this author Expand All Advertisement PDF downloadLoading ...

Correlation of blood glucose and prostatic-related parameters in patients with prostate enlargement

Enlarged prostate, either in benign prostatic hyperplasia or prostate cancer is the predominant urological disease affecting older men. Metabolic syndrome including high blood glucose was considered to take part in the development of prostate enlargement, although their association is still unclear. This study aims to investigate the correlation between blood glucose with prostatic-related parameters. A cross-sectional study was conducted involving 91 men with prostate enlargement from Urology Polyclinic, Tabanan Hospital, Bali Province, Indonesia. Prostatic-related parameters collected include patient’s international prostate symptoms score using the questionnaire, prostate-specific antigen and random blood glucose analysis from serum blood sample, and prostate volume determined with transabdominal ultrasonography. Patient’s mean age was 65.4 ± 10 years, mean prostate volume 52.7 ± 26 ml, mean prostate-specific antigen (PSA) 9.2 ± 17 ng/ml, mean international prostatic symptoms score (IPSS) 14.31 ± 7.1, mean random blood glucose 121.1 ± 40.5 mg/dl. This study found weak positive correlation between random blood glucose and prostate volume (r=0.269; p=0.01). PSA and prostate volume showed moderate positive correlation (r=0.365; p&lt;0.001). No correlation between random blood glucose with PSA or IPSS was found in this study. This study found random blood glucose has positive correlation with prostate volume. We recommend enhancing blood glucose control to prevent the progress of prostate enlargement.

Survey on clinical and subclinical characteristics of first diagnosed prostate cancer at 108 Military Central Hospital

Objective: To describe several clinical and subclinical characteristics of patients with first diagnosed prostate cancer at 108 Military Central Hospital. Subject and method: A retrospective study was performed on 312 patients with first diagnosed prostate cancer in Department of Urology, 108 Military Central Hospital, from January 1st, 2016, to December 31st, 2020. Main research criteria: age, symptoms of urinary disorders, total PSA, signs of bone metastases, and Gleason score. Result: Mean age was 73.9-year-old, frequent clinical symptoms were urinary hesitancy 51% and acute urinary retention 32.4%; mean prostate volume was 61.1ml; the rate of carcinoma was 99.6%; most of cases had high PSA (³ 20ng/ml) and very high (³ 100ng/ml); 63.7% of cases had signs of bone metastases at the time of diagnosis. Conclusion: Prostate cancer is mainly late diagnosed; the rate of adenocarcinoma accounted for 99.6%.

Analysing the learning curve of prostate enucleation with the Holmium laser: A retrospective, single-center experience.

Holmium laser enucleation of the prostate (HoLEP) is a proven surgical technique for the treatment of benign prostatic hyperplasia (BPH). However, its challenging learning curve prevents its widespread adoption by urologists. The aim of this study was to analyse the learning curve of HoLEP and to determine the factors accelerating it. This was a retrospective, monocentric cohort study of the first 60 cases of HoLEP performed by three operators. The primary outcome measure was operative efficiency, defined as the ratio of preoperative prostate volume estimated by trans-abdominal ultrasound (TAUS)to total surgical time in minutes. The studied learning curve parameters included the number of previously performed cases (NPPCs) and monthly case density (CD) (number of monthly performed cases before the studied one). Overall, 180 patients with a mean age of 71 (±9) years and a mean prostate volume (g) of 80.4 (±41) were included. The mean operative efficiency in the population was 0.74 (±0.37) g/min. Operative efficiency was increased in patients who had been operated on by surgeons with a CD ≥3 (CD ≤2: 0.66 (±0.27) g/min vs. CD ≥3: 0.79 (±0.43) g/min; P=0.012). At 3months, 46 patients (29%) developed stress urinary incontinence (SUI). Early SUI was significantly decreased in patients who had been operated on by surgeons with a CD ≥3 (CD ≤2: 37%, (n=26) vs CD ≥3: 22%, (n=20); P=0.045). A high frequency HoLEP procedures, set as one case per week, appeared to accelerate learning curves by improving operative efficiency. A high CD was also associated with reduced rates of early SUI. 5.

Prostate cancer risk assessment by the primary care physician and urologist: transabdominal- versus transrectal ultrasound prostate volume-based use of the Rotterdam Prostate Cancer Risk Calculator.

Our objective was to assess the accuracy of transabdominal ultrasound (TAUS) measured prostate volume in the primary care setting with transrectal ultrasound (TRUS) measured prostate volume by the urologist as the reference test. Furthermore, our objective was to assess whether risk-stratification using TAUS prostate volume by the primary care physician could reduce unnecessary referrals to the urologist. Men in two Dutch primary care offices with a prostate cancer (PCa) screening request received a digital rectal examination (DRE), prostate specific-antigen (PSA), and TAUS prostate volume measurement by the general practitioner, followed by Rotterdam Prostate Cancer Risk Calculator (RPCRC) risk assessment. The examination was repeated by a urologist using TRUS. A prostate biopsy was performed in case of a RPCRC positive biopsy advice. A non-inferiority analysis was performed comparing TAUS and TRUS prostate volume differences. A risk-based referral strategy using TAUS and the RPCRC in the primary care setting was compared with the standard referral strategy based on PSA (≥3 ng/mL) and DRE. A total of 105 men were included with a median PSA of 1.9 ng/mL. The mean prostate volumes measured by TAUS and TRUS were 55 and 45 mL, respectively. The mean overestimation of the prostate volume by TAUS as compared to the reference test was 9.9 mL (95% CI: 5.9-13.8). According to Dutch standard practice, 41 out of 105 (39%) men would have been referred to the urologist. Stratification in primary care based on the RPCRC using TAUS prostate volume would have avoided 29 out of the 41 (71%) referrals, at the expense of non-referral of 5 out of 11 (45%) men with a biopsy indication, according to the urologist. RPCRC-based risk stratification in primary care using TAUS prostate volume measurement is feasible and may prevent unnecessary referrals to the urologist and reduce costs. The accuracy of the risk assessment with TAUS might be improved by sufficient training and centralization to achieve a higher volume of consultations in primary care facilities.

Comparison of Single Versus Multiple Doses of Fluoroquinolone (Levofloxacin) for Prophylaxis in Prostate Biopsy

Objective: To assess the efficacy of Levofloxacin 500 mg orally for prophylaxis in transrectal prostate biopsy guided by ultrasonography compared to three dosages. Study design: A comparative study Place and Duration: this study was done in Murshid Hospital and Health Care Centre Karachi from September 2021 to September 2022 Methodology: A total of 615 patients having the typical indications for prostate biopsy performed under transrectal ultrasonography guidance (increased PSA, abnormal digital rectal examination) were included in this study. Overall 425 patients were considered qualified for participation; using Graph Pad Prism 6.0, patients were assigned to one of two groups using random assignment, 205 individuals in Group A were given one oral dosage of 500 mg of levofloxacin 60 to 120 minutes before the procedure, Likewise, 220 patients in Group B received Levofloxacin (500 mg) once per 24 hours for two days before to the procedure as well as the day of it. Results: Patients in Group A were given orally a single dose of levofloxacin 500 mg there were 205 patients in this group. These individuals were diagnosed with diabetes mellitus (DM) at a rate of 43.9%, febrile urinary tract infections at a rate of 4.3%, and sepsis at a rate of 0.97%.In this group, 65.80cc,was the average prostate volume, and 90.17% were overweight.A total of 220 patients in groupB who received orally three doses of levofloxacin 500 mg, with an average age of 67.45 years and a PSA mean of 21.26 ng/mL; 31.8% of patients had diabetes mellitus, &amp; 4.45% had a febrile urinary tract infection (FUTI). In this group, no patients had sepsis, 75.61 cc was the mean prostate volume, and 72.74% of the patients were overweight, as in Group A. Conclusion: Because of how effective it is, a single dose of levofloxacin containing 500 milligrams is an excellent option for prophylaxis in patients who are going to have a transrectal prostate biopsy. Keywords: transrectal biopsy, flroquinolone, prophylaxis

Implementing HoLEP in an Academic Department With Multiple Surgeons in Training: Mentoring Is the Key for Success

ObjectiveHolmium laser enucleation of the prostate (HoLEP) has been recommended for the surgical management of benign prostatic hyperplasia (BPH) in most of the international guidelines, regardless of prostatic volume. The main advantages reported by randomized clinical studies are reduced perioperative bleeding, catheterization time, and length of hospital stay, but this technique is also described as difficult to master with a steep learning curve. The objective of this study was to describe the clinical outcomes of HoLEP in the real-life setting of an academic department with multiple operators with no previous experience.MethodsA retrospective observational study was conducted including all consecutive cases performed in our department from April 2012 to October 2020. Over the study period, 31 different operators were involved. In April 2012, 2 surgeons were trained by an experienced urologist. The 29 others learned the technique progressively with the help of the first 2 surgeons (surgical mentoring).ResultsA total of 1259 patients were included. Preoperatively, the mean prostate volume and Qmax were 82.3 g and 9.4 mL/s, respectively. The mean operative time was 79.7 min. The intraoperative complication rate was 5.6% (n = 71), with the need for conversion being 0.6%. Postoperatively, the complication rate was 18.6% (n = 234). Surgeon’s experience reduced the perioperative complication rates (P = 0.01), operative time (P &lt; 0.001), and length of hospital stay (P &lt; 0.001), but the difference in blood transfusion rate was statistically non-significant (P = 0.3).ConclusionsMost of the 31 urologists in training were able to master HoLEP progressively, with good functional outcomes and acceptable complication rates. Supervision by trained urologists was critical for the safe dissemination of the technique in our department.

A Comparative Study of the Efficacy of Thulium Fiber Laser Enucleation and Transurethral Resection for Medium- to Large-Size Prostate

Abstract Purpose: The objective of this study was to evaluate the efficacy and safety of the newer, thulium fiber laser enucleation of the prostate (ThuFLEP) versus the transurethral resection of the prostate (TURP) for medium- to large-volume benign prostatic hyperplasia (BPH). Materials and Methods: We performed a single-center retrospective study between May 2020 and June 2021. Among these, we included patients &gt;50 years of age, with prostate size &gt;80 cc, International Prostate Symptom Score (IPSS) &gt;19, and maximum urine flow rate (Qmax) &lt;15 mL/s. All patients underwent either TURP or ThuFLEP. Preoperative parameters such as IPSS score, quality of life (QoL) score, Qmax, and residual urine were assessed. Results: Of the total of 101 patients, 29 underwent ThuFLEP and 72 TURP. The mean prostate volume was significantly higher in the ThuFLEP group compared to the TURP (P = 0.01). The mean operative time was longer for ThuFLEP compared to TURP (P &lt; 0.0001). No significant difference was noted in the postoperative hematuria (P = 0.29) and mean postoperative hemoglobin (P = 0.37). The QoL scores were significantly improved with ThuFLEP than TURP (P = 0.0006). Compared to a day after catheter removal, the proportion of patients with stress, urge, and total incontinence was significantly reduced at the end of 1 month in the ThuFLEP group (P &lt; 0.00001); however, it was significantly greater than with TURP (P &lt; 0.05). At 3 months, no significant difference was found between IPSS (P = 0.37) and Qmax (P = 0.98) scores between the groups; however, the decrease from baseline was significant for IPSS (P &lt; 0.0001). The Clavien–Dindo Grade I and II complications were 31% and 13.8%, respectively, for ThuFLEP and 8.3% and 1.4% for TURP. There was no significant difference of patients with late complications. Conclusion: ThuFLEP demonstrated efficacy similar to TURP in medium- to larger-size BPH in terms of IPSS and Qmax but had significant improvement in QoL scores. The overall complications with ThuFLEP were higher as compared to TURP.

Changes of lower urinary tract function after robot-assisted radical prostatectomy: An urodynamic follow-up within 1 year.

This study investigated the changes of lower urinary tract function after robot-assisted radical prostatectomy (RaRP) with 1-year urodynamic follow-up. Clinically localized prostate cancer patients receiving RaRP were prospectively enrolled. We analyzed their clinical symptoms, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) status, and videourodynamic studies (VUDSs) during the postoperative 1st year. In total, 74 patients were enrolled with a mean age of 69.4 ± 8.1 years, a mean total prostate volume of 34.7 ± 15.9 mL, a ≥pT3 stage proportion of 37.8%, and a positive surgical margin rate of 18.9%. The International Prostate Symptom Score significantly reduced from 7.3 ± 6.0 before surgery to 4.1 ± 4.1 at postoperative 1 year. Significantly increased full sensation, reduced detrusor voiding pressure, increased maximal urinary flow rate, and decreased bladder outlet obstruction index were noted at 1-year VUDS follow-up. The changes of VUDS parameters were significantly different between the patients with and without preoperative bladder outlet obstruction. At postoperative 1 year, 8.1% and 6.8% of patients experienced SUI and UUI, respectively. In multivariate analysis, the factors of T stage ≥3, preoperative detrusor overactivity (DO), and positive surgical margin were the independent predictors of immediate SUI and SUI at 3 and 12 months, respectively. During the 1st year after RaRP, patients experienced significant changes of lower urinary tract function demonstrated in VUDS with the improvement in clinical symptoms. Factors of T stage ≥3, preoperative DO, and positive surgical margin were the predictors of postoperative SUI.

Urethral-Sparing Robot-Assisted Simple Prostatectomy: Case Series of the Initial Experience of a Brazilian Surgical Center

Benign prostatic hyperplasia (BPH) is a common condition among older men that causes lower urinary tract symptoms. Although pharmacological treatments are available, surgery is often required. The development of surgical techniques has progressed, with robotic simple prostatectomy (RASP) being one of the minimally invasive techniques for larger prostates. However, ejaculatory dysfunction remains a common postoperative problem of BPH surgery, significantly impacting patients' quality of life. In 1990, Dixon et al. were the first to describe the urethral-sparing approach, which maintained anterograde ejaculation. Recently, Wang et al. performed the first urethral-sparing RASP (USRASP). We present a case series from the initial experience of US-RASP in a high-volume Brazilian surgical center with an experienced robotic surgeon. Three patients underwent US-RASP at our center in 2022 were included. The mean age and prostate volume were, respectively, 67.7 years (42-89) and 88.9ml (85.6-92). None of the patients had a median lobe. Total preservation of the urethra was achieved in all patients, with no US-RASP failures and conversion to standard RASP. The average operative time of US-RASP was 98min (86-118). There were no intraoperative complications. Two of the three patients maintained anterograde ejaculation (66.7%), but with reduced volume. There were no postoperative complications and the patients are still being followed up to assess the long-term results. Therefore, our results suggest that USRASP can be implemented with good rates of preservation of the urethra and anterograde ejaculation, since performed by an experienced robotic surgeon.

Correlation of Doppler ultrasound resistive index in the prostatic gland with severity of male lower urinary tract symptoms, prostate volume, and concomitant diabetes mellitus.

Benign prostatic enlargement (BPE) and type 2 diabetes mellitus (T2DM) are common in elderly men. This study aimed to correlate the Doppler resistive indices of prostatic arteries with the severity of lower urinary tract symptoms (LUTS) and prostate volume in men with concomitant BPE and T2DM. Fifty men with T2DM and BPE (BPE-DM) as cases and 50 age-matched men with BPE but no T2DM (BPE-ND) as controls were enrolled. B-mode and power Doppler ultrasonography of the prostate gland were done for both groups. The mean total prostatic volume of the BPE-DM was 79.18 ±8.9 ml, while that of BPE-ND was 60.73 ±10.6 ml (p <0.0001). The mean prostatic resistive index (PRI) was significantly higher among BPE-DM than BPE-ND (0.74 ±0.02 vs 0.68 ±0.09 for right capsular artery; 0.77 ±0.04 vs 0.71 ±0.02 for left capsular artery; and 0.76 ±0.04 vs 0.70 ±0.02 for the urethral artery). BPE-DM with higher glycated haemoglobin, fasting plasma glucose, and longer duration of T2DM experienced more severe lower urinary tract symptoms and had higher PRI. In conclusion, the BPE-DM group presented larger prostate glands and more bothersome LUTS, which correlated with higher PRI. Strict glycaemic control is necessary in men with co-existing BPE and T2DM.

Surgical outcomes of low-power thulium laser enucleation of prostates >80 g. One-year of follow-up.

The aim of this study was to assess the effectiveness of low-power thulium (30 W) and the duration necessary to eliminate adenomas at the level of the surgical capsule, as well as its impact on postoperative urinary and sexual function. Patients with symptomatic benign prostatic hyperplasia (BPH), who had ThuLEP between December 2019 and March 2022 and had a prostate size >80 mL and had not responded to the medication therapy, were included. The prostate size, prostate-specific antigen (PSA), enucleation and morcellation times, postoperative International Prostate Symptom Score (IPSS), and International Index of Erectile Function-5 (IEFF-5) records at 1, 3, 6, and 12 months were among the information gathered. The average age of the 80 patients who received ThuLEP was 66.7 ±6.4 years, with a mean prostate volume of 112.65 ±19.3 mL. The mean duration for enucleation was 71 ±11 min. At the initial follow-up after one month, the mean IPSS was 8.012 ±1.78 mL and the mean Qmax enhancement was 30.16 ±4 mL s-1. In contrast to baseline, our findings demonstrated a substantial improvement in postoperative urgency and urgency urinary incontinence (UUI) (p = 0.005) but no meaningful variation in IIEF-5 score at the 12-month follow-up. Low-power ThuLEP is worthwhile for therapeutic use because it effectively treats patients with large prostates with satisfactory urinary and sexual effects.Clinical trials .gov ID: NCT05494944.

Inter-observer Reliability in Reporting Complications of Transurethral Resection of the Prostate with Clavien-Dindo Classification: A Retrospective Observational Study

Introduction: Transurethral Resection of the Prostate (TURP) is a gold standard treatment for Benign Prostatic Hyperplasia (BPH). The Clavien classification system was proposed in 1992 to grade complications of general surgery, which was then modified in 2004 by Dindo. In 2017, the European Association of Urology (EAU) endorsed its use for reporting complications in urological procedures. However, the system relies on observers to grade complications, and different observers may assign different grades to the same negative outcome, highlighting the need for uniformity. Aim: To assess the inter-observer reliability and uniformity among urologists in reporting complications of TURP using the modified Clavien-Dindo classification system. Materials and Methods: A retrospective observational study was conducted at Department of Urology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India, from January 2018 to May 2023. The study included symptomatic patients with BPH and prostate gland sizes greater than 40 cc. Negative outcomes were evaluated and complications were rated by nine different raters. Inter-observer reliability was tested using weighted kappa with Statistical Package for Social Sciences (SPSS) version 21.0 (Fleiss’s kappa test). Results: A total of 523 men with BPH who underwent TURP were evaluated, with a mean age of 66.7±5.2 years and a mean prostate volume of 62 cc. Adverse events occurred in 96 patients (18.36%), and these complications were classified according to the Clavien-Dindo System (CDS) by nine different blinded observers. The rating of these complications was then assessed for concordance. A concordance rate using weighted kappa of 0.847 was observed, indicating high inter-observer reliability for TURP. Conclusion: Clavien-Dindo’s system demonstrated good interobserver concordance and reliability. Some modifications to the grading system are needed, taking into account the impact of pre-existing co-morbidities and auxiliary procedures. Largescale prospective studies are recommended to further validate these findings.