Median International Prostate Symptom Score Research Articles

Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty

Background and purpose — Postoperative urinary retention (POUR) is a clinical challenge, but there is no scientific evidence for treatment principles. We describe the incidence of and predictive factors for POUR in fast-track total hip (THA) and knee arthroplasty (TKA).Patients and methods — This was a prospective observational study involving 1,062 elective fast-track THAs or TKAs, which were performed in 4 orthopedics departments between April and November 2013. Primary outcome was the incidence of POUR, defined by postoperative catheterization. Age, sex, anesthetic technique, type of arthroplasty, and preoperative international prostate symptom score (IPSS) were compared between catheterized and non-catheterized patients.Results — The incidence of POUR was 40% (range between departments: 30–55%). Median bladder volume evacuated by catheterization was 0.6 (0.1–1.9) L. Spinal anesthesia increased the risk of POUR (OR = 1.5, 95% CI: 1.02–2.3; p = 0.04) whereas age, sex, and type of arthroplasty did not. Median IPSS was 6 in non-catheterized males and 8 in catheterized males (p = 0.02), but it was 6 in the females in both groups (p = 0.4).Interpretation — The incidence of POUR in fast-track THA and TKA was 40%, with spinal anesthesia and increased IPSS in males as predictive factors. The large variation in perioperative bladder management and in bladder volumes evacuated by catheterization calls for randomized studies to define evidence-based principles for treatment of POUR in the future.

Associations of carotid artery plaque with lower urinary tract symptoms and erectile dysfunction.

To evaluate the relationship of carotid artery plaque with international prostate symptom score (IPSS) and international index of erectile function-5 (IIEF). We enrolled 799 men who had participated in a health examination. They received an IPSS, IIEF, a carotid duplex ultrasound, and a full metabolic work-up. Data were analyzed using Spearman's correlation test, the Mantel-Haenszel Extension test, and logistic regression analyses. The median age of the study population was 57 years, and the median IPSS and IIEF were 11 and 15, respectively. The IPSS voiding sub-score was significantly correlated with maximum intima-media thickness (max IMT) (P = 0.002). We observed a significant increase in the severity of the voiding sub-score with increasing severity of plaque size (P = 0.003). Additionally, there was an increased likelihood of having a higher IPSS voiding sub-score as severity of plaque size increased after adjusting for age and components of metabolic syndrome. The IIEF showed a significant negative correlation with max IMT (P < 0.001). Additionally, there was a significant increase in the severity of erectile dysfunction (ED) with increased plaque size (P < 0.001). There was a greater likelihood of having moderate ED in the moderate and severe plaque size groups than in the group with an absence of plaque, after adjusting for age and components of metabolic syndrome (odds ratio = 1.672, P = 0.021). Our data suggest that atherosclerosis may play a role in the development of lower urinary tract symptoms (LUTS) and ED and indicate a potential role of ED and LUTS in the prediction of carotid artery plaque.

Prostate Stereotactic Body Radiotherapy — First UK Experience

AimsStereotactic body radiotherapy (SBRT) combines image-guided radiotherapy with hypofractionation, both of which will probably result in improvements in patient outcomes in prostate cancer. Most clinical experience with this technique resides in North America. Here we present the first UK cohort to receive SBRT for prostate cancer. Materials and methodsFifty-one prostate cancer patients (10 low risk, 35 intermediate risk and 6 high risk) were treated with 36.25 Gy in five fractions over 1–2 weeks and gold seed image guidance. All patients had toxicity International Prostate Symptom score (IPSS) and Radiation Therapy Oncology Group recorded prospectively and prostate-specific antigen was measured 3–6 monthly during follow-up. ResultsThe median IPSS was 6, 11, 8 and 5 at baseline, 1–3 weeks, 4–6 weeks and 7–12 weeks after treatment. Radiation Therapy Oncology Group genitourinary and gastrointestinal toxicity of grade 2 was seen in 22% and 14%, respectively, at 1–3 weeks after treatment; no patient had grade 3+ toxicity at this time point, although two patients had grade 3 urinary frequency recorded during treatment. The median follow-up for the 42 patients who did not receive androgen deprivation was 14.5 months. Prostate-specific antigen at 13–18 months after treatment was 1.3 ng/ml. ConclusionProstate SBRT is a promising treatment for organ-confined prostate cancer and is currently being investigated in a UK-led phase III trial.

VE17: Robot-assisted laparoscopic YV-plasty in patients with refractory bladder neck contracture

We present preliminary results of a case series on refractory bladder neck contracture (BNC) treated with robot-assisted laparoscopic Y-V plasty (RAYV). Between 01/2013 and 02/2016, 12 consecutive adult male patients underwent RAYV in our hospital. BNC developed after transurethral procedures (n = 9), simple prostatectomy (n = 2) and HIFU therapy of the prostate (n = 1). Each patient had had multiple unsuccessful previous endoscopic treatments. All RAYV procedures were performed using a transperitoneal six-port approach (four-arm robotic setting). There were no intraoperative or major postoperative complications. During a median follow-up of 23.2 months two cases of refractory BNC were observed. In both cases a postoperative International Prostate Symptom Score (IPSS) of 20 and 25 was reported, respectively. In contrast, amongst the patients without evidence of refractory BNC the median IPSS was 6.5 reflecting an only mildly impaired voiding function in most cases, thus, suggesting a treatment success in 83.3% of patients. To the best of our knowledge, this is the first report on RAYV for refractory BNC. In our series RAYV was feasible in all patients, and only two cases of refractory BNC were reported during a median follow-up of almost 2 years. At the same time, no intraoperative or major postoperative complications were observed. More clinical data with a longer follow-up are needed in this promising field to reveal the actual efficacy and relevance of RAYV.

Robot-Assisted Bladder Diverticulectomy

To describe our technique for robot-assisted bladder diverticulectomy (RABD). Ten patients underwent RABD using an extra- or transvesical approach. Three (30%) patients underwent concomitant procedures: Robot-assisted radical prostatectomy, robot-assisted simple prostatectomy, and transurethral resection of the prostate. All RABDs were performed successfully. Median estimated blood loss, operative time, and diverticulectomy time were 75 mL, 210 minutes, and 80 minutes, respectively. Median follow-up time was 18 months. Median International Prostate Symptom Score decreased by 57%, P=0.001. RABD is feasible and safe. It can be performed via a trans- or extravesical approach, as a stand-alone, or concomitant procedure.

MP32-05 ASSOCIATIONS BETWEEN PREMATURE EJACULATION, LOWER URINARY TRACT SYMPTOMS AND ERECTILE DYSFUNCTION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation1 Apr 2014MP32-05 ASSOCIATIONS BETWEEN PREMATURE EJACULATION, LOWER URINARY TRACT SYMPTOMS AND ERECTILE DYSFUNCTION Jun Ho Lee and Dong-Gi Lee Jun Ho LeeJun Ho Lee More articles by this author and Dong-Gi LeeDong-Gi Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.935AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is controversy concerning the relationship between premature ejaculation (PE) and erectile dysfunction (ED), as well as the scan data regarding the association between PE and lower urinary tract symptoms (LUTS). We performed this study to evaluate the association between PE and ED or LUTS. METHODS A total of 2591 policemen aged 40-59 years who had participated in a health examination were included in this study. PE, LUTS and ED were evaluated using the premature ejaculatory diagnostic tool (PEDT), the international prostate symptoms score (IPSS) and the international index of erectile function questionnaire-5 (IIEF), respectively. Males with PEDT scores>10 were classified as having PE. Spearman¡¯s correlation test, the multiple linear regression test and logistic regression analyses were used to evaluate the relationship between PE and ED or LUTS. RESULTS The median age of the study group was 49.0 years and the median PEDT, IIEF and IPSS was 4, 18 and 9, respectively. In total, 1279 men had moderate LUTS (49.4%) and 319 (12.3%) men had severe LUTS. The number of men with mild ED, mild to moderate ED, moderate ED, and and severe ED was 785 (30.3%), 530 (20.5%), 242 (9.3%), and and 260 (10.0%), respectively. Additionally, 660 (25.5%) men had PE. By univariate analysis, PEDT showed a significant correlation with IPSS (r=.310, P=<.001) and IIEF (r=-.413, P<.001). After adjusting for age, components of metabolic syndrome, testosterone and IIEF, PEDT was significantly correlated with IPSS (Beta=.166, P<.001). PEDT was also significantly correlated with IIEF after adjusting for age, components of metabolic syndrome, testosterone and IPSS (Beta=-.274, P<.001). Additionally, the severity of LUTS or ED was associated with the PE positive ratio (P trend=.001) (PE; positive ratio (%) according to LUTS severity: mild, 15.6; moderate, 27.5; severe 48.9) (PE; positive ratio (%) according to ED severity: normal, 11.1; mild, 23.1; mild to moderate: 28.5; moderate, 45.6; severe, 51.5). The odds ratio (OR) for PE also significantly increased with the severity of LUTS or ED after adjusting for potential confounding factors(PE; OR, 95% CI vs. severity of LUTS: mild LUTS, 1.000, reference; moderate LUTS, 1.681, 1.335-2.115; severe LUTS, 3.736, 2.754-5.070; P=.001) (PE; OR, 95% CI vs. severity of LUTS: normal, 1.000, reference; mild ED, 2.242, 1.678-2.997; mild to moderate ED, 2.806, 2.049-3.844; moderate ED, 5.821, 4.036-8.395; severe ED, 7.782, 5.422-11.171; P=.001). CONCLUSIONS In our study, ED and LUTS were significantly and independently correlated with PE. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e332 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jun Ho Lee More articles by this author Dong-Gi Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-term Follow-up After Transurethral Treatment of Infravesical Obstruction in Boys

To study whether boys who underwent transurethral treatment of (mild) infravesical obstruction during childhood have lower urinary tract symptoms and complications at young adult age. Young adult men who underwent transurethral treatment for infravesical obstruction as a child were contacted. The following measurements were done: International Prostate Symptom Score (IPSS), International Consultation on Incontinence Modular Questionnaire on Urinary Incontinence, frequency volume chart uroflowmetry, and postvoid residual. A group of 151 male students who completed IPSS and underwent uroflowmetry was used as reference group to compare with patients. Of 135 traceable patients, 87 men (median age 21.9 years; interquartile range [IQR] 19.6-25.6) returned the questionnaires, and 71 underwent uroflowmetry. Median age at initial treatment was 7.9 years (IQR 1.0-10.8). Compared with men in the reference group, patients had similar IPSS and quality of life scores; median IPSS was 3, and IPSS-quality of life 1 (IQR 0.0-1.0). Urgency incontinence and postmicturition incontinence were reported in 2.4% and 8.5%, respectively. Frequency volume charts (n = 29) showed normal frequency and voided volumes. Uroflowmetry results were comparable with the reference group, although 16 (22.5%) patients voided volumes >600 mL. One patient had urethral stricturing, and one a significant postvoid residual. Young adult men treated for (mild) urethral obstruction in childhood have few micturition symptoms and good uroflowmetry results, not different from a reference group. Some patients, however, report incontinence, and this group deserves close attention. Late complications were rare.

Outcome of nephrostomy balloon dilation for vesicourethral anastomotic strictures following radical prostatectomy: a retrospective study

To evaluate the efficacy of nephrostomy balloon dilation (NBD) for patients who developed vesicourethral anastomotic stricture (VAS) following radical prostatectomy. NBD was performed in patients who developed VAS following radical prostatectomy. Quality of life (QoL), International Prostate Symptom Score (IPSS) and maximal urinary flow rate (Qmax) were evaluated. Four hundred and sixty-three prostate cancer patients underwent radical retropubic prostatectomy (RRP), and 86 underwent laparoscopic radical prostatectomy (LRP). Most patients (90.3%) had T2 or T3 prostate cancer and a pathological Gleason score of ≤ 7. Forty-five (8.2%) and four (4.7%) patients developed VAS due to radical or LRP, respectively. Forty (89%) patients underwent NBD, including three cases of repeat dilation. The median Qmax was 4 ml s−1 (interquartile range (IQR), 2.3-5.6) before dilation and improved to 16 ml s−1 (IQR, 15–19) and 19 ml s−1 (IQR, 18-21) at the 1- and 12-month follow-up, respectively (P < 0.01). Fifteen (37.5%) patients had urinary incontinence prior to dilation, whereas only three (7.5%) patients had incontinence 12 months following dilation (P < 0.01). The median IPSS score improved from 19 (IQR, 17–24) before dilation to 7 (IQR, 6–8) at 12 months following dilation, and the QoL score improved from 5 (IQR, 4–6) before dilation to 2 (IQR, 2–3) at 12 months following dilation (P < 0.01 in both). VAS occurs in a small but significant proportion of patients following radical prostatectomy. NBD offers an effective remedy for VAS.

Association of Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia Measures With International Index of Erectile Function 5 in Middle-aged Policemen of Korea and the Role of Metabolic Syndrome and Testosterone in Their Relationship

To evaluate which among the lower urinary tract symptom (LUTS)/benign prostatic hyperplasia (BPH) measures is the most relevant to erectile dysfunction (ED) and elucidate the role of metabolic syndrome (MetS) and testosterone in their relationship. A total of 2564 policemen aged 40-59 years who had participated in a health examination were included. LUTS/BPH and ED were evaluated by the international prostate symptoms score (IPSS), transrectal ultrasonography, uroflowmetry, postvoid residual urine volume (PVR), and international index of erectile function questionnaire 5 (IIEF-5). Spearman correlation tests, multiple linear regression tests, and logistic regression analyses were used. The median age was 49.0 years; the median total IPSS and IIEF scores were 9 and 19, respectively. Among the LUTS/BPH measures, IPSS (r = -0.311, P <.001) showed the highest correlation coefficient with IIEF, followed by total prostate volume (r = -0.082, P <.001), PVR (r = -0.080, P <.001), and maximal flow rate (r = 0.049, P = .014). In addition, only IPSS was significantly correlated with the IIEF score after adjusting for age, testosterone, and MetS. The severity of LUTS, as assessed by IPSS, was also significantly correlated with moderate to severe ED (IIEF ≤ 11), after adjusting for age, testosterone, MetS, and other LUTS/BPH measures. On multiple linear regression test, adjustment of Mets changed the P value and beta value of LUTS/BPH measures. However, there were no changes after adjusting testosterone. IPSS is the most powerful predictor of ED among the LUTS/BPH measures in middle-aged policemen. In addition, MetS might be a plausible explanation for the relationship between LUTS/BPH and ED.

Stereotactic body radiotherapy with a focal boost to the MRI-visible tumor as monotherapy for low- and intermediate-risk prostate cancer: early results

BackgroundThere is growing evidence that prostate cancer (PC) cells are more sensitive to high fraction dose in hypofractionation schemes. High-dose-rate (HDR) brachytherapy as monotherapy is established to be a good treatment option for PC using extremely hypofractionated schemes. This hypofractionation can also be achieved with stereotactic body radiotherapy (SBRT). We report results on toxicity, PSA response, and quality of life (QOL) in patients treated with SBRT for favorable-risk PC.MethodsOver the last 4 years, 50 hormone-naïve patients with low- and intermediate-risk PC were treated with SBRT to a total dose of 38 Gy delivered in four daily fractions of 9.5 Gy. An integrated boost to 11 Gy per fraction was applied to the dominant lesion if visible on MRI. Toxicity and QoL was assessed prospectively using validated questionnaires.ResultsMedian follow-up was 23 months. The 2-year actuarial biochemical control rate was 100%. Median PSA nadir was 0.6 ng/ml. Median International Prostate Symptoms Score (IPSS) was 9/35 before treatment, with a median increase of 4 at 3 months and remaining stable at 13/35 thereafter. The EORTC/RTOG toxicity scales showed grade 2 and 3 gastrointestinal (GI) acute toxicity in 12% and 2%, respectively. The late grade 2 GI toxicity was 3% during 24 months FU. Genitourinary (GU) grade 2, 3 toxicity was seen in 15%, 8%, in the acute phase and 10%, 6% at 24 months, respectively. The urinary, bowel and sexual domains of the EORTC-PR25 scales recovered over time, showing no significant changes at 24 months post-treatment.ConclusionsSBRT to 38 Gy in 4 daily fractions for low- and intermediate-risk PC patients is feasible with low acute and late genitourinary and gastrointestinal toxicity. Longer follow-up preferably within randomized studies, is required to compare these results with standard fractionation schemes.

Urinary functional outcomes and toxicity five years after proton therapy for low- and intermediate-risk prostate cancer: Results of two prospective trials

Background. To assess genitourinary (GU) function and toxicity in patients treated with image-guided proton therapy (PT) for early- and intermediate-risk prostate cancer and to analyze the impact of pretreatment urinary obstructive symptoms on urinary function after PT. Material and methods. Two prospective trials accrued 171 prostate cancer patients from August 2006 to September 2007. Low-risk patients received 78 cobalt gray equivalent (CGE) in 39 fractions and intermediate-risk patients received 78–82 CGE. Median follow-up was five years. The International Prostate Symptom Score (IPSS) and GU toxicities (per CTCAE v3.0 and v4.0) were documented prospectively. Results. Five transient GU events were scored Gr 3 per CTCAE v4.0, for a cumulative late GU toxicity rate of 2.9% at five years. There were no Gr 4 or 5 events. On multivariate analysis (MVA), the only factor predictive of Gr 2 + GU toxicity was pretreatment GU symptom management (p = 0.0058). Patients with pretreatment IPSS of 15–25 had a decline (clinical improvement) in median IPSS from 18 before treatment to 10 at their 60-month follow-up. At last follow-up, 18 (54.5%) patients had a > 5-point decline, 14 (42.5%) remained stable, and two patients (3%) had a > 5-point rise (deterioration) in IPSS. Patients with IPSS < 15 had a stable median IPSS of 6 before treatment and at 60 months. Conclusion. Urologic toxicity at five years with image-guided PT has been uncommon and transient. Patients with pretreatment IPSS of < 15 had stable urinary function five years after PT, but patients with 15–25 showed substantial improvement (decline) in median IPSS, a finding not explained by initiation or dose adjustment of alpha blockers. This suggests that PT provides a minimally toxic and effective treatment for low and intermediate prostate cancer patients, including those with significant pretreatment GU dysfunction (IPSS 15–25).

Comparison of Techniques for Transurethral Laser Prostatectomy: Standard Photoselective Vaporization of the Prostate Versus Transurethral Laser Enucleation of the Prostate

Transurethral laser enucleation of the prostate (TLEP) using the potassium-titanyl-phosphate (KTP) laser offers an alternative technique to traditional photovaporization. The study objective was to determine the comparative efficacy between transurethral photovaporization of the prostate (PVP) with a TLEP technique using the 80W 532 nm KTP laser. A series of 97 vs 170 patients who underwent PVP vs TLEP, respectively, with the KTP laser system at Weill Cornell Medical College from September 2001 to May 2009 was studied retrospectively. Outcome measures included laser time, prostate volume lased per unit time, International Prostate Symptom Score (IPSS), postvoid residual (PVR), and maximum flow rate (Qmax). Statistical analyses were performed using the Shapiro-Wilk, Mann-Whitney, Wilcoxon, and unpaired t tests. Baseline parameters were similar between groups, although volume was greater in the TLEP group (83 vs 63 cc, P=0.04). Median laser time was longer in the TLEP group (90 vs 50 min, P<0.001) with a higher median energy used (308 vs 165 kJ, P<0.001). The volume lased per unit time was shorter, however, for TLEP (0.92 cc/min) than for PVP (1.26 cc/min). A greater median number of fibers were used in TLEP (2.5 vs 2.0, P=0.001). Improvements in median IPSS and PVR were seen in the TLEP group (5.0, P<0.001; 55.5, P=0.02, respectively) but not in the PVP group (P=0.40 and 0.30). Median Qmax and prostate-specific antigen (PSA) level improved similarly in both groups. Final IPSS was lower for the TLEP group (P<0.001), but other final parameters were statistically equivalent. In our series, both PVP and TLEP techniques were safe and effective. Although changes in Qmax and PSA were similar between the two techniques, improvement in urinary symptoms and PVR was superior with the TLEP technique. The TLEP technique was a more efficient method for laser prostatectomy.

Patterns and Predictors of Amelioration of Genitourinary Toxicity After High-dose Intensity-modulated Radiation Therapy for Localized Prostate Cancer: Implications for Defining Postradiotherapy Urinary Toxicity

BackgroundTreatment-related toxicity and quality of life (QoL) considerations are important when counseling patients with localized prostate cancer (PCa). ObjectiveTo determine the incidence and longitudinal pattern of late genitourinary (GU) toxicity and QoL after high-dose, intensity-modulated radiotherapy (IMRT). Design, setting, and participantsA total of 268 patients with localized PCa were treated between June 2004 and December 2008 at a tertiary referral center. Median follow-up was 5 yr (range: 3–7.7 yr). InterventionPatients underwent IMRT to a total dose of 86.4Gy; 50% of patients underwent neoadjuvant and concurrent androgen-deprivation therapy. Outcome measurements and statistical analysisPatients were evaluated with the prospectively obtained International Prostate Symptom Score (IPSS) questionnaire. GU toxicity was also scored using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0; toxicity events were defined as increase over baseline. Differences in increases in IPSS sums and QoL index between baseline IPSS sum and QoL index groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests. Univariate and multivariate Cox regression models were applied. Results and limitationsThe overall median IPSS sum increase during follow-up was 3 and was less pronounced among patients with severe baseline symptoms compared with those with mild baseline symptoms (median increase: 0 vs 4; p<0.0001). Overall QoL index was unchanged after IMRT but appeared to improve in patients with dissatisfied baseline QoL compared with satisfied baseline QoL (p<0.0001). Fifty-five (20%) and 2 (1%) patients developed grade 2 and 3 late GU toxicities, respectively; however, in 28 of 57 patients (49%), toxicity resolved during follow-up. Even though the IPSS data were prospectively obtained, most patients were not treated within a prospective protocol. ConclusionsLate GU toxicity after high-dose IMRT was mild; severe, late GU toxicity was rare. Changes in IPSS sum and QoL index were dependent on the baseline GU function, which might be useful for future patient counseling.

Urodynamic effect of 80 watt photoselective laser vaporization of the prostate

Objective. The aim of the analysis was to measure the pressure–flow urodynamic changes following GreenLight™ laser vaporization of the prostate based on pressure–flow studies. Material and methods. Sixty-two patients suffering from voiding dysfunction due to lower urinary tract symptoms underwent potassium titanyl phosphate (KTP) laser vaporization. A pressure–flow study was performed at baseline and at 3 months postoperatively. Symptoms and quality of life (QoL) were assessed using the International Prostate Symptom Score (IPSS) and questions regarding sexuality were assessed using the International Index of Erectile Function (IIEF). Results. IPSS and QoL scores changed from 24 and 5 at baseline to 6 and 2 at 3 months, respectively. The initial median prostate volume was 35 ml (range 16–60 ml), the median maximum uroflow (Qmax) was 9.2 ml/s (4–14.9 ml/s) and the median postvoiding residual urine was 80 ml (20–400 ml) (95% confidence interval 89.14, 135.44). The median IPSS and QoL score were significantly improved (p < 0.001). There was a significant decrease in median detrusor pressure at Qmax from 83.1 to 40.45 cmH2O, and the median obstruction grade according to Schäfer's classification was also decreased significantly, from 4 to 1 postoperatively. Conclusion. This study showed that significant deobstruction can be demonstrated using a pressure–flow study at 3 months postoperatively.

Dichotomous Estimation of Prostate Volume: A Diagnostic Study of the Accuracy of the Digital Rectal Examination

PurposeTo assess the diagnostic reliability of a dichotomous digital rectal examination (DRE) tool in assessing prostate volume (PV) compared to gold-standard transrectal ultrasound (TRUS) volume measurement.Materials and MethodsMale patients presenting to a single tertiary referral centre urology practice requiring TRUS were prospectively recruited between January 2010 and August 2011. Size was estimated by DRE immediately prior to TRUS measurement. DRE measurements were classed into four groups: <30 mL , 30 to 49 mL, 50 to 99 mL and >100 mL. The primary outcomes were sensitivity, specificity, and the positive and negative likelihood ratios for a 30 mL cut-off.ResultsThree hundred and three patients were recruited to the study. The median age of the study group was 64.9 years. On TRUS analysis, 244 patients had a PV larger than 30 mL and 139 of them, larger than 50 mL. The median PV was 47 mL with a median International Prostate Symptom Score of 10 and prostatic specific antigen (PSA) of 5.7. When analysed for the ability to identify a gland larger than 30 mL, DRE had a high sensitivity and low negative likelihood ratio. The median PSA level (ng/L) for prostates measured by DRE with a 30 mL cut-off was significantly different with higher median PSA values for volumes larger than 30 mL.ConclusionsDRE is a reliable tool for dichotomous assessment of prostatic volumes above 30 mL and 50 mL. These results illustrate the value of re-examining the role of categorical DRE estimations in benign prostatic hyperplasia patients.

Morbidity of Focal Therapy in the Treatment of Localized Prostate Cancer

BackgroundFocal therapy (FT) for prostate cancer (PCa) seems to be part of a natural evolution in the quest to improve the management of early organ-confined disease. ObjectiveTo assess the morbidity of the initial experience of FT in a tertiary referral center for PCa management. Design, setting, and participantsFrom 2009 to 2011, a total of 1213 patients with clinically localized PCa were treated at our institution. Of these patients, 547 were considered to have indolent disease according to the D’Amico criteria for low-risk disease plus unilateral disease with a maximum of three positive biopsies. A total of 106 patients underwent FT using high-intensity focused ultrasonography (HIFU), brachytherapy, cryotherapy, or vascular-targeted photodynamic therapy (VTP). Outcome measurements and statistical analysisComplications were prospectively recorded and graded according to the Clavien-Dindo scale. Data were prospectively collected and retrospectively analyzed. Results and limitationsThis study included 106 patients, median age 66.5 yr (interquartile range [IQR]): 61–73), who had a prostate hemiablation; 50 patients (47%) had cryotherapy, 23 patients (22%) had VTP, 21 patients (20%) received HIFU, and 12 patients (11%) had brachytherapy. The median prostate-specific antigen (PSA) level was 6.1 ng/ml (IQR: 5–8.1), all the patients had a biopsy Gleason score of 6, and the median prostate weight was 43g (IQR: 33–55). The median International Prostate Symptom Score was 6 (IQR: 3–10), and the median International Index of Erectile Function score was 20 (IQR: 15–23). After treatment, the median PSA at 3, 6, and 12 mo was 3.1 2.9, and 2.7 ng/ml (IQR: 2–5.1, 1.1–4.7, and 1–4.4), respectively. Thirteen percent of the patients experienced treatment-related complications. There were 11 minor medical complications (10 grade 1 complications and 1 grade 2 complication), 2 grade 3 complications, and no grade 4 or higher complications. ConclusionsFT for a highly selected population with PCa is feasible and had an acceptable morbidity with <2% major complications.

Photoselective vaporization of the prostate with the 120W lithium triborate laser for the treatment of acute urinary retention

PurposeWhilst photoselective vaporization of the prostate (PVP) is used to treat benign prostatic hyperplasia, there is little reported about its performance in urinary retention. The objective of this study is to evaluate the efficacy and safety of GreenLight™ high performance system 120W lithium triborate laser (American Medical Systems, Inc, Minnetonka, MN) PVP in men with urinary retention.Patients and methodsRetrospective analysis of data of all men in urinary retention who underwent treatment with the 120W lithium triborate laser PVP by a single surgeon from November 2006 to July 2010 was performed (n = 78), median age 71 years (interquartile range, 64–80), median prostate volume 91 mL (interquartile range, 58–121). Perioperative outcomes and functional outcomes at baseline, and at 3 and 12 months post-operation were examined.ResultsPatients managed preoperatively by urethral catheterization (n = 61) and suprapubic catheterization (n = 5) were of greater age (by 8.2 years, P < 0.05) and higher American Society of Anesthesiologists scores (P = 0.000, Fisher’s exact test mid P) than patients managed by intermittent self-catheterization (n = 12), but there was no difference in outcomes. There were three Clavien grade III, two Clavien grade IV, and no Clavien grade V complications. There were also no blood transfusions. Fifty-three men (68%) voided successfully post-PVP and went home catheter-free within 24 hours. At 3 months, 62 out of 64 evaluable men (97%) were voiding well without needing any form of catheterization. At 3 months and 12 months, median International Prostate Symptom Score was 7 and 6; International Prostate Symptom Score Quality of Life Index 1 and 1; peak urinary flow 19 and 22 mL/sec; and post-void ultrasound measured residual urine volume 52 and 60 mL, respectively.ConclusionPVP for urinary retention is an efficacious and safe treatment modality.

Is there any association between the severity of lower urinary tract symptoms and the risk of biopsy‐detectable prostate cancer in patients with PSA level below 20 ng/ml in multi‐core prostate biopsy?

To assess whether the severity of lower urinary tract symptoms (LUTS) is associated with the risk of prostate cancer (PCa) detection via a multi (≥12)-core prostate biopsy. From January 2004 to May 2011, 3,107 patients underwent transrectal ultrasound (TRUS) prostate biopsies due to elevated PSA levels ranging between 3 and 20 ng/ml or abnormal digital rectal exams (DREs). Multivariate logistic analysis was used to assess the potential association of LUTS and PCa detection via biopsy. The predictive accuracy of the multivariate model was assessed based on the receiver operating characteristics-derived area under the curve. The median International Prostate Symptom Score (IPSS) was 11, and the mean PSA was 6.81 ng/ml. Of the total subjects, PCa was detected from biopsy in 931 (30.0%) patients. In a comparison of 1,465 patients with IPSS ≥ 11 and 1,642 patients with IPSS <11, those with a higher IPSS were older, had higher PSA and had a larger prostate, but there were no significant differences in the PCa detection rates. However, in multivariate analysis incorporating other associated variables, a higher IPSS was significantly associated with lower odds of PCa detection (P = 0.016). Nevertheless, addition of the IPSS did not significantly increase the accuracy of the multivariate model devised for the detection of PCa (P = 0.098). Although PCa was detected less commonly among men with higher LUTS, LUTS may not provide additional prognostic information beyond that which can be obtained via previously established prognostic factors.

1195 LONGITUDINAL BLADDER HEALTH OUTCOMES IN MEN MANAGED WITH EXTIRPATIVE SURGERY FOR PROSTATIC DISEASE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy II1 Apr 20121195 LONGITUDINAL BLADDER HEALTH OUTCOMES IN MEN MANAGED WITH EXTIRPATIVE SURGERY FOR PROSTATIC DISEASE Jove Graham and Daniel Rukstalis Jove GrahamJove Graham Danville, PA More articles by this author and Daniel RukstalisDaniel Rukstalis Danville, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1440AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Declining bladder health in aging men, as manifest by LUTS, represents a progressive disorder primarily related to outlet obstruction from prostatic enlargement. While many therapeutic options exist, there is a paucity of patient questionnaire-based longitudinal data to help physicians determine optimal treatments for men over time. Since extirpative procedures are the standard for BPH management, we compared longitudinal data on bladder health for men treated for BPH relative to men treated with radical prostatectomy. METHODS Patients in our urology clinic are asked to fill out the International Prostate Symptom Score (IPSS) at every visit to assess urinary function, and data are entered in a prospective registry. We performed an IRB-approved retrospective analysis of n=3,349 responses from 608 male patients ages 50-79 to compare IPSS scores after procedures for BPH (laser prostectomy, TEVAP or transurethral prostatectomy, n=190) versus robotic radical prostatectomy (RRP) for prostate cancer (n=418) between 2004 and 2011. Patients were stratified into 9 groups by age (50-59, 60-69 and 70-79) and IPSS score prior to surgery (<10, 10-19 and 20-29). Within each stratum, longitudinal outcomes were plotted and median scores were compared between BPH vs. RRP surgery types at 1 and 2 years of followup. RESULTS In 7 of 9 strata, median IPSS scores were almost identical between BPH and RRP patients at 1 and 2 years post-surgery. In the two oldest and most severe symptom groups (age 60-69 and 70-79 with IPSS>20), however, RRP patients had much better median IPSS scores than BPH patients at 2 years (8 vs. 14 and 6 vs. 12, respectively), though these differences did not reach statistical significance (p=0.14). CONCLUSIONS Extirpative procedures of the prostate result in significant improvements in voiding symptoms and bladder health in men of all ages, which is important for men with expected longevity. Importantly, complete removal of the prostate is comparable to endoscopic BPH treatments in men with young age or moderate symptoms but is more effective than BPH treatment in older men with more severe symptoms. This information may support the choice of radical prostatectomy in men with significant LUTS. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e484 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jove Graham Danville, PA More articles by this author Daniel Rukstalis Danville, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

2177 PHOTOSELECTIVEVAPORIZATION OF THE PROSTATE WITH GREENLIGHT 120W LASER COMPARED TO MONOPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL

Background: Evidence supporting the widespread use of GreenLight High Performance System (HPS) 120-W photoselective vaporization of the prostate (PVP) is lacking. Objective: To assess the noninferiority of PVP compared with transurethral resection of the prostate (TURP) on urinary symptoms and the superiority of PVP over TURP on length of hospital stay. Design, setting, and participants: A multicenter randomized controlled trial was conducted. Intervention: Patients underwent monopolar TURP or PVP with the GreenLight HPS 120-W laser. Measurements: International Prostate Symptom Score (IPSS), Euro-QOL questionnaire, uroflowmetry, Danish Prostate Symptom Score Sexual Function Questionnaire, sexual satisfaction, and adverse events were collected at 1, 3, 6, and 12 mo. The two groups were compared using the 95% confidence interval (CI) of median difference for testing noninferiority of the IPSS at 12 mo and the student t test for testing the difference in length of hospital stay. Results and limitations: A total of 139 patients (70 vs 69 men in each group) were randomized. Median IPSS scores at 12-mo follow-up were 5 (interquartile range [IQR]: 3–8) for TURP versus 6 (IQR: 3–9) for PVP, and the 95% CI of the difference of the median was equal to � 2 to 3. Because the upper limit of the 95% CI was >2 (the noninferiority margin), the hypothesis of noninferiority could not be considered demonstrated. Median length of stay was significantly shorter in the PVP group than in the TURP group, with a median of 1 (IQR: 1–2) versus 2.5 (IQR: 2–3.5), respectively ( p < 0.0001). Uroflowmetry parameters and complications were comparable in both groups. Sexual outcomes were slightly better in the PVP group without reaching statistical significance.