Mean Prostate Volume Research Articles

Prostatic Inflammation's Effects on Individuals with Benign Prostate Hyperplasia's Clinical Consequences

Objective: In order to ascertain the impact of silent inflammatory prostatitis on the clinical results of individuals receiving trans urethral prostate resection owing to benign prostatic hyperplasia. Study Design: Retrospective study Place and Duration: This retrospective study was conducted at Liaquat National Hospital Karachi in the period from April, 2022 to September, 2022. Methods: Total 330 patients were presented in this study. In this study, individuals over 45 years without a history of urologic surgery who presented to a urology clinic with lower urinary tract symptoms related to benign prostatic hyperplasia were included. Pathological outcomes and clinical indicators were evaluated before and one year after surgery. Mean Standard deviation was used to present data and categorical variables were assessed by frequencies and percentages. Results: Mean age of the patients was 61.3±10.42 years. Among 330 cases, 200 (60.6%) patients were had benign prostatic hyperplasia and 130 (39.4%) cases had both prostatic inflammation (category-IV) and benign prostatic hyperplasia. Before TURP, mean prostate volume in BP patients was 55.7±8.11 m3 and in BPH/PI patients was 55.3±10.6 m3 and after TURP mean prostate volume in BP patients was 23.2±1.20 m3 and in BPH/PI group 23.4±8.17 m3. We found that people with prostate inflammation had lower Qmax values and a higher preoperative prostate score compared to those who had no signs of inflammation before to prostate transurethral resection. Conclusion: In this study, we came to the conclusion that in individuals with benign prostatic hyperplasia, prostate inflammation without symptoms might worsen lower urinary tract symptoms and the rate of urine flow. Keywords: Benign Prostatic Hyperplasia (BPH), Prostate Pathology, Prostatic Inflammation

Rezūm™: yay or nay? From the patients’ perspective: a patient reported outcome measure (PROM) study from a single UK centre

Background: RezūmTM steam ablation therapy is an effective minimally invasive surgical therapy for the treatment of symptomatic benign prostatic hyperplasia. The aim of this study was to assess the perception of this treatment from the patients’ perspective at a single centre. Methods: A patient reported outcome measure (PROM) questionnaire was sent to 65 consecutive patients at least 6 months after undergoing RezūmTM therapy. We evaluated changes in their prostate symptoms, quality of life (QoL) as well as new onset sexual dysfunction. Results: A total of 44 questionnaires were analysed with a response rate of 67.7%. Mean prostate volume was 62 mL in a mean population age of 68 years. There was a significant improvement in mean International Prostate Symptom Score and QoL scores (P < 0.0001). There was a higher rate of de novo sexual dysfunction noted as compared to other studies. Retreatment procedures occurred in 4.3% of patients, whilst 88.9% reported being medication free. Thirty-five (79.5%) respondents will recommend the procedure. Conclusions: This study highlighted that the beneficial effects of RezūmTM observed clinically were also perceived positively by patients in a real-world setting, which is just as equally important.

Serum prostate specific antigen is a good indicator of prostatic volume in men with benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is the most common cause of bladder outlet obstruction in men over the age of 50 years. An association between the prostate specific antigen (PSA), International Prostate Symptoms Score (IPSS) and prostate volume (PV) may be instrumental in determining patients who may benefit from treatment. Targeted therapy will reduce the cost of care because it is unwise to treat all men with prostate enlargement to prevent complications when the risk of occurrence is negligible. To determine the correlation between the PSA, IPSS and PV in men of African descent. This was a cross sectional analysis involving 92 patients diagnosed as having symptomatic BPH at the Ho Teaching Hospital. The data were collected using standardised questionnaires. The IPSS determined urinary symptom severity. The PV was determined using a transabdominal ultrasound machine. Serum PSA was retrieved from the electronic medical records. The mean PV was 61.04 cm3 ± 21.95 cm3, the mean PSA was 4.21 ng/mL ± 3.85 ng/mL, and mean IPSS of 21.59 ± 3.78. The Pearson's correlation between PV and PSA was 0.283 (p = 0.01), between PV and IPSS was 0.108 (p = 0.30), and finally, between Serum PSA and IPSS Score was -0.086 (p = 0.42). This study showed that serum PSA has a positive correlation with PV. However, IPSS had no significant association with PSA or PV in patients with BPH.Contribution: This study provides insights into the implications of clinical parameters on the management of prostate enlargement.

The impact of robotic-assisted transperineal biopsy of the prostate on erectile function.

Prostate biopsy represents one of the most frequently performed urologic procedures worldwide and therefore presupposes knowledge on potential effects like on the erectile function, especially in extensive or repeated biopsies. The robotic-assisted biopsy system (Mona Lisa) offers a minimal invasive approach via only two incision points ensuring maximal accuracy combined with protection of the neurovascular bundle of the prostate. Our purpose was to analyse the impact of robotic-assisted transperineal biopsy of the prostate on the erectile function. Our prospective study analyses the outcomes of 210 patients, who had undergone minimal-invasive, transperineal robotic-assisted biopsy of the prostate at the University Hospital Basel from January 2020 to March 2022 and provided sufficient data. Of these, 157 (74.8%) were included in final analysis. Mean (range) age, prostate volume, PSA and IIEF-5 score at baseline were 63.8 years (46.1-83.6), 46.4 ml (9-310), 13.2 ng/ml (0.2-561), and 18.8 points (6-25), respectively. EF before and 1 month after intervention was assessed with the IIEF-5 questionnaire for the whole cohort. No significant change of IIEF-5 was observed for the whole cohort with a mean (± SD) decrease of 0.4 (± 3.1) points. Except for patients > 69 years, subgroup analysis revealed no change of IIEF-5 in statistically significant manner for all subgroups. Number of biopsy cores (< 20 and ≥ 20), previous biopsies and active surveillance showed no significant influence. Our results suggest that the minimally invasive and highly precise robotic technique can spare the erectile function without limiting the extent of biopsy and without compromising diagnostic accuracy.

Correlation between Prostate Volume Estimated by Digital Rectal Examination and Trans-Rectal Ultrasound Measurements in Patients Diagnosed with Benign Prostatic Hyperplasia

Background: Measurement of Prostate Volume (PV) is fundamental in the proper management of patients with benign prostatic hyperplasia (BPH). Although a crude way of assessing PV, digital rectal examination (DRE) has been used in various centres and then objectified by the use of Transrectal Ultrasound Scan (TRUS) measurement for reasons of accuracy. Prostate volume measurement together with the use of international prostate symptom score (IPSS) is central in choosing treatment modalities whether medical or surgical. In this study, we aimed at correlating PV measured by DRE and TRUS. Patients and Methods: This is a prospective study of seventy four (74) patients being managed for BPH in our facility between September 2019 and December 2020 who met inclusion criteria. Full clinical history was obtained together with physical examination and well-focused DRE of the prostate to estimate PV based on Romero et al., technique combined with the sliding scale technique. Subsequently patients were sent for TRUS measurements of the prostate which is also a routine procedure in BPH managements. Data were collated and analysed using statistical package for social sciences (SPSS) version 20.0 Results: A total of 74 patients were studied with a mean age of 63.05±9.89 years ranging from 43 to 90 years. Mean PV estimated by DRE was 47.91±14.16 mls and that by TRUS was 53.42±25.33 mls. There was a statistically significant correlation in PV measurements between the two modalities (P v=.750, PV &lt; .05). Conclusion: PV measured by DRE closely approximates TRUS measurements.

Prostatic Inflammation's Effects on Individuals with Benign Prostate Hyperplasia's Clinical Consequences

Objective: In order to ascertain the impact of silent inflammatory prostatitis on the clinical results of individuals receiving trans urethral prostate resection owing to benign prostatic hyperplasia. Study Design: Retrospective study Place and Duration: This retrospective study was conducted at Liaquat National Hospital Karachi in the period from April, 2022 to September, 2022. Methods: Total 330 patients were presented in this study. In this study, individuals over 45 years without a history of urologic surgery who presented to a urology clinic with lower urinary tract symptoms related to benign prostatic hyperplasia were included. Pathological outcomes and clinical indicators were evaluated before and one year after surgery. Mean Standard deviation was used to present data and categorical variables were assessed by frequencies and percentages. Results: Mean age of the patients was 61.3±10.42 years. Among 330 cases, 200 (60.6%) patients were had benign prostatic hyperplasia and 130 (39.4%) cases had both prostatic inflammation (category-IV) and benign prostatic hyperplasia. Before TURP, mean prostate volume in BP patients was 55.7±8.11 m3 and in BPH/PI patients was 55.3±10.6 m3 and after TURP mean prostate volume in BP patients was 23.2±1.20 m3 and in BPH/PI group 23.4±8.17 m3. We found that people with prostate inflammation had lower Qmax values and a higher preoperative prostate score compared to those who had no signs of inflammation before to prostate transurethral resection. Conclusion: In this study, we came to the conclusion that in individuals with benign prostatic hyperplasia, prostate inflammation without symptoms might worsen lower urinary tract symptoms and the rate of urine flow. Keywords: Benign Prostatic Hyperplasia (BPH), Prostate Pathology, Prostatic Inflammation

Evaluating the demographic profile and mapping the prevalence of overactive bladder in benign prostrate hypertrophy patients: a retrospective, observational study

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objectives of the study was to evaluate the demographic profile of benign prostatic hyperplasia (BPH) patients and prevalence of overactive bladder (OAB) among these patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A real-world, retrospective, observational study (DEMO-2) on BPH patients was conducted across India from April-2021 to March-2022. Demographics, BPH characteristics, status of OAB, and their management were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 5881 BPH patients were included with a mean age of 65.3 years and mean BPH duration of 3.2 years. Majority (80.98%) of the patients had associated comorbidity; hypertension (50.2%), diabetes (26.9%) and dyslipidemia (13%) were the most common. Majority (63%) of the patients complained of incomplete bladder emptying. In BPH patients, 29.9% had OAB. These patients had a higher mean prostate volume (44.96 vs. 42.17 cc) and prostate specific antigen (PSA) levels (4.11 vs. 3.79 ng/ml) versus BPH patients without OAB. For BPH, tamsulosin was the most prescribed drug (85.90%) followed by dutasteride (66.90%); tamsulosin + dutasteride was most common combination therapy (32.6%). In BPH patients with OAB, 82% received OAB medications and solifenacin (63.9%) was the most common medication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: Majority of the BPH patients were between the ages of 50-75 years. Tamsulosin was the most commonly prescribed medication in BPH patients. Combination of tamsulosin and dutasteride was the mainstay of treatment. OAB was seen in 29.9% of the BPH patients, and solifenacin was the most commonly utilized (63.1%) medication in BPH patients with OAB. About 18% of these patients did not receive any specific medication for OAB. Adequate treatment strategies need to be adopted for BPH patients with OAB.&lt;/p&gt;

Correlation of Uroflowmetry with Prostate Volume and International Prostatic Symptom Score (IPSS)

Objective: To correlate Uroflowmetry with Prostate volume and International Prostatic Symptom Score in BPH patients and healthy adults in a subset of Karachi Population. Study Design and Setting: This is a crossectional study carried out at Ziauddin Hospital, Karachi over a period of 6 months. Methodology: In this study 100 Samples were taken through non probability convenience sampling. Inclusion criteria includes 40years and above. Sample initially was taken on the basis of International Prostatic Symptom Score i.e., less than 8 and greater than 8 score. Ultrasonography was performed. 65 Individuals with International Prostatic Symptom Score &gt; 8 and Prostate volume &lt;25 and individuals having symptom index &lt; 8 and Prostate volume &gt; 25ml went for Uroflowmetry. Mean and standard deviation was taken out for quantitative variables. Univariate analysis and Multiple Linear Regression applied to assess relationship between Uroflowmetry with Prostate volume and International Prostatic Symptom Score. Result: Mean age of patients was found to be 58±6 years. Mean International Prostatic Symptom Score was 11±4. Mean Prostate Volume was 28ml±5, mean Qmax was 14ml/s ±4. The correlation between Qmax and International Prostatic symptom score was found to be negative (-0.78) and statistically significant. No correlation was found between Prostate volume and Qmax. Conclusion: Qmax and International Prostatic Symptom Score are reliable tool for assessing Benign Prostatic Hyperplasia patients concluding that as Symptom Score increases Qmax decreases. Qmax showed no correlation with Prostate volume. Prostate volume assessed on Ultrasonography is not an authentic parameter for diagnosing BPH patients

Quality of life and outcome after holmium laser enucleation of the prostate (HoLEP)

Holmium Laser Enucleation of the Prostate (HoLEP) was established 20 years ago as an alternative to Transurethral Resection of the Prostate (TUR-P) based on improved morbidity in patients with benign prostate syndrome (BPS). HoLEP can be applied independently to almost all sizes of prostate glands and is recommended in national and international guidelines. Although the HoLEP procedure has a good reputation, many patients still prefer conservative treatment due to fears of side-effects such as pain and urinary incontinence. The aim of this study was to identify patients' feelings, fears and perception of their HoLEP treatment based on Patient-reported Outcome Measures (PROMs) via questionnaires. During the time period from June to December 2020, 152 consecutive patients were treated by HoLEP due to BPS and were interviewed based on questionnaires right after their surgical treatment and 3 months later concerning their satisfaction as well as micturition and continence. Based on a written informed consent, 112 patients were included in the study, and a complete 3-month follow-up was available for 88 patients. The mean volume of enucleated prostate tissue was 62.1 [g] and the mean prostate volume estimated pre-operatively (trans-rectal ultrasound) was 83.1 [cm3]. Overall patient-reported satisfaction with the hospital stay including surgical treatment was 94.6%; after 3 months it was 91.8%. Concerning micturition, 76.5% of the patients reported satisfaction after surgery and 80.4% were satisfied after 3 months. Urinary incontinence was reported in 8.3% initially and in 9.1% after 3 months. Positive answers to questions concerning the quality of life index [L] were obtained in 62.1% initially and their number increased to 85.7% after 3 months. The share of negative answers decreased from 11.7% after surgery to 3.4% within the 3-month follow-up. HoLEP is a well-established treatment of BPS with lower side-effects compared with TUR-P according to the literature. To address doubts and misgivings, it is important to perform surveys on subjective patient satisfaction after the surgical procedure and over time. The high patient satisfaction could help future patients and the urologists treating them to establish the indication for HoLEP treatment earlier in order to avoid severe LUTS or catheterization.

A Comparison of Safety and Efficacy between Silodosin Monotherapy Versus Silodosin with Tadalafil add on Therapy in Patients with Benign Prostatic Hyperplasia

Background: For relieving symptoms of LUTS due to BPH treatment modalities are watchful waiting, medical treatment and surgery. Among medical treatment, options are alpha 1 adrenoreceptor blockers, 5 alpha reductase inhibitors and recently introduced phospodiesterase 5 inhibitors or combination therapy. Objective: To compare the safety and efficacy of silodosin versus silodosin and tadalafil for treating patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Materials and Methods: This prospective observational study was conducted in the Department of Urology, BSMMU, Dhaka from April 2020 to March 2021. A total of 66 patients with LUTS due to BPH were selected by purposive sampling on the basis of selection criteria from OPD of Urology, BSMMU. They were randomly divided into two groups: according to odd or even hospital number and label as A group (odd no) and B group (even no). Group-A were provided with silodosin 8.0 mg daily and group-B were provided with silodosin 8.0 mg and tadalafil 5.0 mg daily (B group). Two patients from each group were excluded due to adverse effect and one patients from each group was lost to follow-up. Final analysis was done on sixty patients (30 from each group). The patients were assessed by IPSS, Qmax and PVR. The results were expressed as frequency &amp; percentage (categorical data) and mean ± SD (numerical data). Unpaired t-tests and paired t tests were performed as applicable using SPSS 22.0 and p &lt;0.05 was considered as the level of significance. Results: Out of sixty six patients, sixty patients completed the study. Two patients from group A was suffering from hypotension and headache and two patients from group B was suffering from ejaculatory dysfunction and dizziness, one patient from each group was lost after 1st follow up, so they were excluded from study. Maximum study subjects were within 51 to 70 years of age in both groups. Mean age of the study subjects was 57.13 ± 9.36 years in Group-A and 59.33 ± 7.09 years in Group-B. Mean prostate volume of the study subjects was 37.93 ± 13.19 ml in Group-A and 35.50 ± 10.57 ml in Group-B. IPSS was reduced to 21.90±3.68 after 6 weeks and 18.90 ± 3.79 after 12 weeks from 25.10 ± 3.96 prior to treatment in Group-A. Similarly, in Group-B, IPSS was reduced from 19.67 ± 3.45 after 6 weeks and 16.37 ± 2.03 after 12 weeks from 23.03 ± 4.16 prior to treatment. PVR decreased to 58.00 ± 20.41 after 6 weeks and 42.10 ± 17.40 after 12 weeks from 74.15 ± 26.40 prior to treatment in Group-A. Similarly, PVR in Group-B reduced to 52.70 ± 12.51 after 6 weeks and 33.57 ± 8.97 after 12 weeks from 66.17 ± 15.50 before treatment. After 6 weeks, Qmax increased to 15.67 ± 2.11 and at 12 weeks17.73 ± 2.66 from 13.39 ± 1.83 before treatment in Group-A. Similarly, after 6 weeks, Qmax in Group- B increased to 16.74 ± 1.14 and at 12 weeks18.94±1.31 from 14.17±1.28 before treatment. Conclusion: Improvements in both silodosin (alpha blocker) group and silodosin in combination with tadalafil (PDE 5 inhibitor) group were found to be effective, safe and satisfactory in treating patients with symptomatic BPH. Even though combination group showed better efficacy than silodosin monotherapy group but as per improvement rate it was not statistically significant. Bangladesh J. Urol. 2021; 24(2): 205-213

Correlation between prostate volume and prostate-specific antigen in Nigerian men with symptomatic histologically-diagnosed benign prostatic hyperplasia.

Prostate-specific antigen (PSA) is elevated in the serum of most men with prostatic diseases. Benign prostatic hyperplasia (BPH) is the commonest of these diseases. The degree of enlargement of the prostate may determine the amount of PSA elaborated. Several reports in some parts of the world have shown a significant correlation between prostate volume (PV) and PSA. However, only a few reports have been documented in Nigeria, especially in the South-South region. This research aimed to ascertain if there is any correlation between prostate volume (PV), total PSA (tPSA), and free PSA (fPSA) in men with histologically diagnosed BPH. This knowledge may help in the estimation of PV from a given PSA. This prospective hospital-based study was carried out in a southern Nigerian tertiary hospital between November 2017 and October 2018. Eighty (80) eligible and consenting patients participated in the study and were enrolled at first contact in the urology clinic. Each patient's blood was taken for PSA estimation. The prostate volume was estimated by transrectal ultrasound scan (TRUS). Those who had tPSA values greater than 4 ng/mL whose biopsy report showed prostate malignancy were excluded from the study. A proforma was used to collect patients' sociodemographic and clinical information. Data were entered and analyzed with Statistical Package for Social Sciences version 22 (SPSS Inc., Chicago, IL, United States). For all statistical tests, P < 0.05 was regarded as significant. The mean age of the patients for this study was 68.03 years. The mean prostate volume was 87.9 mL with a range of 34 to 234 mL. The mean tPSA was 5.5 ng/mL with ranges of 1.1 to 21.1 ng/mL. There was a significant correlation between PV and tPSA with a P value of 0.0001. This correlation was also shown between PV and fPSA with a P value of 0.0001. There is a statistically significant correlation between PV and PSA (both free and total) in men with symptomatic histologically diagnosed BPH. This finding showed that larger benign prostate glands elaborated greater amounts of PSA. It may, therefore, be appropriate to say that it is not in all cases of elevated serum tPSA that the possibilities of malignancy or inflammation should be entertained.

Thulium Fiber Laser Enucleation of the Prostate: Prospective Study of Mid- and Long-Term Outcomes in 1328 Patients.

Objective: The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). Materials and Methods: We analyzed patients who underwent ThuFLEP due to lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, postvoid residual (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen level, and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization, and data on hospital stays were also collected. A subgroup analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. Results: A total of 1328 patients were included in the analysis. The mean age was 66.9 ± 7.5 years. Mean prostate volume was 86.9 ± 41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p < 0.05) and showed durable improvement up to 3 years of follow-up. The frequency of late complications was as follows: stress urinary incontinence-1.2%; urethral stricture-1.1%; and bladder neck contracture-0.9%. Subgroup analyses revealed increased urinary tract infection frequency in older patients (3.5% vs 0.8%, p = 0.003) as well as higher rate of stress urinary incontinence (0.4% vs 1.8%, p = 0.002) and higher rate of clot retention (11.3% vs 4.4%, p < 0.001) in those with larger glands. Conclusions: Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be a promising alternative to holmium laser enucleation of the prostate for treatment of LUTS associated with BPO.

Correlation between prostate volume measured by ultrasound and symptoms severity score in patients with benign prostatic hypertrophy in Southeastern Nigeria.

Benign prostatic hypertrophy (BPH) is a common urological condition in men older than 50 years. It is important in the aetiologies of life-threatening obstructive uropathies. Ultrasound measurement of prostate volume is non-invasive, easily available, and a cost-effective method, useful in assessing bladder outlet obstruction (BOO). The International Prostate Symptoms Score (IPSS) on the other hand objectively assesses symptoms severity in BOO patients. This study was aimed at determining the correlation between ultrasound-measured prostate volume and IPSS in men with BPH. Following ethical approval from the Nnamdi Azikiwe University Teaching Hospital Ethical Committee, 100 patients who met the inclusion criteria and were diagnosed with clinical BPH were enrolled into the study. They had no other identifiable cause of BOO except BPH after clinical evaluation. The IPSS, Quality of life score (QOL), and prostate volumes were measured. Correlation between prostate volume, IPSS, and QOL were done using SPSS version 20. P value <0.05 was considered significant. The mean age of patients was 69.3 ± 10.6 years with a range of 48-100 years. The mean prostate volume, IPSS, and QOL were 96.0 ± 70.5 cm3, 15.63 ± 8.6, and 4.8 ± 1.3, respectively. The highest recorded IPSS was 35 and the lowest was 4, whereas the smallest and largest recorded prostate volumes were 19 cm3 and 350 cm3, respectively. Nocturia was the major IPSS subscore. There was a weak positive correlation between prostate volume and IPSS in men with BPH (r = +0.109; P = 0.28) and between prostate volume and QOL (r = +0.072; P = 0.45). There was also a weak positive correlation between patients with only severe symptoms and corresponding prostate volumes (r = +0.122; P = 0.125). The correlation between patients with severe symptoms and their corresponding QOL was strong (r = +0.537; P = 0.135, respectively). These findings were, however, not statistically significant. There is a weak positive correlation between prostate volume measured by ultrasound and symptoms severity scores in patients with BPH, although not statistically significant. This may be as a result of the small sample size. A larger sample size may be able to achieve statistical significance.

Digital rectal examination impact on PSA derivatives and prostate biopsy triggers: a contemporary study.

To evaluate the impact of the digital rectal exam (DRE) on PSA measurements and clinical decision-making. Healthy male volunteers between 50 and 70years old were recruited during a 30-day public screening program. PSA levels were measured using two different methods (standard enhanced chemiluminescence immunoassay-ECLIA, and novel immunochromatography assay-ICA/rapid PSA) in the same blood sample. Two blood samples were drawn; first before DRE and the second 30-40min after DRE. The effect of DRE on PSA levels and its impact on clinical decision-making for individual patients were evaluated based on different biopsy trigger cutoffs. ECLIA-PSA was measured in 74 participants both pre- and 37 ± 5min post-DRE, mean age 57.2 ± 8.3years, and mean prostate volume 33.6 (20-80) cm3. Both total and free ECLIA-PSA increased significantly after DRE (mean increase of 0.47 and 0.26ng/ml, respectively, both p < 0.001). Different internationally accepted biopsy triggers were reached after DRE only: 5 total PSA > 3ng/ml, 13 increase > 0.75ng/ml, 3 PSA density > 0.15, and 1 free/total PSA < 0.18. On two occasions, patients were pushed away from biopsy trigger after DRE due to free/total PSA > 0.18. ICA-PSA was detectable (> 2.0ng/ml) in 5 of 45 measured samples (11%) before DRE and 13/45 (29%) after DRE, p = 0.0316. Four among five detectable ICA-PSA tests increased after DRE. Performing DRE immediately before PSA measurement might change the clinical decision-making on a significant number of occasions (roughly 1 in 3); even though the mean increase (0.47ng/ml) looks deceivingly small. Further studies are required that include gold standard tests (biopsy, or imaging).

Long-Term Outcome of Prostatic Artery Embolization for Patients with Benign Prostatic Hyperplasia: Single-Centre Retrospective Study in 1072 Patients Over a 10-Year Period.

Assess long-term outcomes of prostatic artery embolization (PAE) for patients with benign prostatic hyperplasia (BPH). Single centre retrospective study from 2009-2019 including 1072 patients who received PAE and had available follow-up. Patients were evaluated yearly at 1-10years post PAE using the International Prostate Symptom Score (IPSS) and quality of life (QoL), prostate volume (PV), prostate-specific antigen (PSA), peak urinary flow rate (Qmax) and postvoid residual (PVR) volume. The need for prostatic medication, re-intervention rates, repeat PAE and prostatectomy rates were assessed with Kaplan-Meier survival analysis and compared between different embolic agents using Cox regression analysis. Mean follow-up time was 4.39 ± 2.37years. At last follow-up visit, mean IPSS and QoL improvements were -10.14 ± 8.34 (p < .0001) and -1.87 ± 1.48 (p < .0001) points, mean PV reduction was -6.82 ± 41.11 cm3 (p = 0.7779), mean PSA reduction was -1.12 ± 4.60ng/mL (p = 0.9713), mean Qmax increase was 2.72 ± 6.38mL/s (p = 0.0005), mean PVR reduction was -8.35 ± 135.75mL (p = 0.6786). There were 335 patients (31.3%) needing prostatic medication after PAE. Re-intervention rates were 3.4%at 1year, 21.1%at 5years and 58.1%at 10years. Repeat-PAE rates were 2.3%at 1year, 9.5%at 5years and 23.1%at 10years. Prostatectomy rates were 1.1%at 1year, 11.6%at 5years and 35.0%at 10years. No significant differences were found between polyvinyl alcohol particles, Bead Block, Embospheres and Embozenes. PAE induces durable long-term LUTS relief, with re-intervention rates of 20% in the first 5years and 30%-60% > 5years post-PAE.

Relationship of prostate volume and prostate-specific antigen levels in Sri Lankan men with Benign Prostatic Hyperplasia

Purpose: Benign Prostatic Hyperplasia (BPH) is an important cause of morbidity for ageing men worldwide. However, the available study is limited on the natural history of BPH and dynamics of Prostate-Specific Antigen (PSA) in Sri Lankan population. This study aimed to assess the relationship between serums Prostate Specific Antigen (PSA), prostate volume (PV), and PSA density (PSAD) and to evaluate variations of above parameters with aging and to assess the mean prostate volume of Sri Lankan men with Benign Prostatic Hyperplasia (BPH). Material and methods: This was a retrospective study, men diagnosed with Benign Prostatic Hyperplasia from January 2009 was evaluated. This study was approved by the Ethics Review Committee of Colombo South Teaching Hospital and the patient informed written consent was received. Those with UTI, PSA &gt;10ng/dl and suspicious prostate in digital rectal examination (DRE) were excluded from the study. Data were statistically analyzed to determine the relationship of PSA, PV, PSAD and variations with age groups. Results: This study recruited a total number of 562 men, clustered into 5 age groups and their mean Prostate Volume (PV) was 42.9 (12.56SD). The median PSA was 2.5ng/dl with an inter quartile range of 0.37. The mean PSA density (PSA/PV) was 0.11 (0.023SD). The tendency towards increase in PSA and prostate volume with increasing age showed statistical significance (P&lt;0.05). PSA density was not changed much between different age group except 51-60 age group. It is noted PSAD was fluctuating around mean PSAD of 0.11 in majority of the age groups. Conclusion: PV and PSA increase with age. Mean PV is relatively small compare to blacks and Caucasians. .PSA density in Sri Lankan men is comparable to published data in other countries and could be used as a surrogate marker to evaluate the prostate and for therapeutic decision making.

Prostate Artery Embolization in Patients above Eighty Years Old: Clinical Efficacy and Safety

Abstract Objectives Prostate artery embolization (PAE) has been established as an effective treatment option for benign prostate hyperplasia or hematuria of prostatic origin. We aim to confirm the effectiveness and safety of PAE in elderly patients aged ≥ 80 years old. Materials and Methods Between January 2014 and August 2020, PAE was attempted on 54 elderly patients with lower urinary tract symptoms (LUTS) or prostatic hematuria who were unfit for surgical treatment or opted for PAE. Outcome parameters (International Prostate Symptom Score [IPSS], quality of life [QoL] score, International Index of Erectile Function score (IIEF), maximal urinary flow rate, postvoid residual, and prostate volume) were collected and analyzed at baseline, 6 months, 1, 2, and 3 years. Results The mean patient age was 85.29 years (range: 80–98). Technical success was achieved in 50 patients (92.6%). Mean IPSS improved from 18 at baseline to 7.7, 8.5, 8.6, and 9.1 at 6 months, 1, 2, and 3 years. Mean QoL improved from 4.9 at baseline to 2.8, 1.7, and 1.5 at 6 months, 1, and 2 years. Mean prostate volume reduced from a baseline of 152.7 to 123.5 mL within 6 months and 120.5 mL after 7 months of PAE. Urinary catheter removal was successful in 13 out of 19 patients with urinary retention. PAE succeeded in stopping bleeding in 16 out of 17 patients with prostate-induced hematuria. Conclusion PAE is a feasible low-risk treatment for LUTS with or without urinary retention or prostatic hematuria in elderly patients.

Change in Postoperative Storage Symptoms and De Novo Urge Incontinence After Thulium:YAG Laser Enucleation of the Prostate: Results from a Prospective Multicenter Study.

Objectives: To assess the change of storage symptoms (SS) and their impact on quality of life in men undergoing thulium:YAG laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH). Materials and Methods: BPH patients requiring surgery were prospectively evaluated (April 2019-October 2020). Inclusion criteria: International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate ≤15 mL/s, and urinary retention. Exclusion criteria: previous urethral/prostatic surgery, pelvic irradiation, bladder/prostate cancer, neurogenic bladder, concomitant transurethral surgery, and active urinary tract infection. IPSS, International Continence Society-Overactive Bladder (ICIQ-OAB) and International Continence Society-Overactive Bladder Quality of Life (ICIQ-OABq) scores were gathered before surgery and 1, 3, 6, and 12 months after surgery. Results: In total, 117 men were included. Mean age was 68.0 ± 7.7 years. Mean prostate volume was 86.6 ± 34 cc. Mean IPSS subscore was 8.7 ± 3.1 and 11.7 ± 4.7 for storage and voiding symptoms, respectively. Mean ICIQ-OAB was 29.1 ± 16.8. Mean ICIQ-OABq was 80.3 ± 30.6. Voiding IPSS decreased 72.8% at 1 month, whereas the reduction of storage IPSS was 38.0%. ICIQ-OAB decreased 49.6% at 1 month. ICIQ-OABq showed a 30.0% reduction. One year after surgery, the reduction of voiding IPSS was 94.8%, ICIQ-OAB 85.5%, storage IPSS 76.7%, and ICIQ-OABq 60.5%. Urge incontinence was present in 26.5% of men at 1 month, 15.4% at 3 months, and 4.3% at 6 months. Four (3.4%) patients complained of urge incontinence 12 months after surgery. Conclusion: Both storage and voiding lower urinary tract symptoms significantly decreased after ThuLEP, but storage symptoms showed less reduction with a significant impact on patients' quality of life, particularly during the first 3 months.

Clinical Outcomes of Prostatic Artery Embolization in Patients with Benign Prostatic Hyperplasia: A Prospective Clinical Study.

To determine the clinical outcomes of prostatic artery embolization applied to patients with Material and methods: The study includes 30 patients diagnosed with benign prostatic hyperplasia in the urology clinic between 2012 and 2016, for whom anesthesia was contraindicated due to advanced age and comorbidities and who underwent prostatic artery embolization. These patients were evaluated before the procedure and in the 1st, 3rd, 6th, and 12th months after the procedure. The mean prostate volume of the patients was 68 cm3 before the procedure and 45 cm3 12 monthsafter the procedure. A statistically significant decrease was observed (P = .001). The mean prostate-specific antigen value was 4.9 ng/dL before the procedure and 2.8 ng/dL 12 months after the procedure (P = .008). The mean Qmax value was 0 mL/s before the procedure and 12 mL/s 12 months after the procedure (P = .001). The mean international prostatic symptom scores value was 35 before and 16 twelve months after the proce-dure (P = .001). While the international index of erectile function value was 8.25 before the procedure, it was8.46 12 months after the procedure (P = .32). The quality of life index value was measured as 3.02 before theprocedure and 3.09 twelve months after the procedure; a statistically significant difference was determined (P = .027). Prostatic artery embolization, which is a minimally invasive procedure, can be applied as a safe and effective method to patients with benign prostatic hyperplasia who cannot tolerate anesthesia due to advanced age and comorbidities.

Initial Experience Performing "Cautery-Free Waterjet Ablation of the Prostate".

Introduction: Herein, we describe our initial experience performing waterjet ablation of the prostate without electrocautery. Materials and Methods: A retrospective review of patients undergoing Aquablation for benign prostatic hyperplasia between February and September 2019 was performed. A standardized perioperative protocol for optimizing hemostasis was implemented. The primary endpoint was to define bleeding complications perioperatively and up to 30 days postoperatively after Aquablation. Bleeding complications included hematuria requiring prolonged continuous bladder irrigation, drop in hemoglobin requiring transfusion, or take back to operating room for evacuation of bladder clots and bladder fulguration. Bivariable analysis using Fisher's exact test and unpaired t-tests were used to identify factors associated with bleeding complications. Results: Thirty-two patients underwent Aquablation over the study period. Average preoperative international prostate symptom score was 20 (range: 13-34) and Qmax was 7 mL/s (range: 0-11). Mean prostate volume was 65 cc (range: 30-200 cc). Average perioperative change in hemoglobin was 1.3 g/dL (range: -0.3 to 4.2 g/dL). Eight patients (25%) experienced bleeding complications. Three (9.4%) required blood transfusions. On Fisher's exact test, prostate volume (91 cc vs 55 cc; p = 0.0361) and preoperative prostate-specific antigen (6.6 vs 2.9; p = 0.0218) were associated with postoperative bleeding. Conclusions: Performing waterjet ablation of the prostate without the use of electrocautery after waterjet treatment to control bleeding resulted in significant bleeding complications (25% of our cohort) during our initial experience. A combination of traction and focal bladder neck electrocautery is the best strategy to minimize bleeding complications after Aquablation.