Preoperative International Prostate Symptom Score Research Articles

PD61-05 EARLY POSTOPERATIVE EJACULATORY AND ERECTILE FUNCTION FOLLOWING PHOTOVAPORIZATION OF THE PROSTATE (PVP) AND BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE (BPVP)

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV (PD61)1 Apr 2020PD61-05 EARLY POSTOPERATIVE EJACULATORY AND ERECTILE FUNCTION FOLLOWING PHOTOVAPORIZATION OF THE PROSTATE (PVP) AND BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE (BPVP) Lina Posada Calderon*, Mitali Kini, Hudson Pierce, Alexis Te, James A. Kashanian, and Bilal Chightai Lina Posada Calderon*Lina Posada Calderon* More articles by this author , Mitali KiniMitali Kini More articles by this author , Hudson PierceHudson Pierce More articles by this author , Alexis TeAlexis Te More articles by this author , James A. KashanianJames A. Kashanian More articles by this author , and Bilal ChightaiBilal Chightai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000978.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: GreenLight Photovaporization of the Prostate (PVP) and PlasmaButton bipolar plasma vaporization of the prostate (BPVP) use different energy delivery systems to ablate prostatic tissue in patients with benign prostatic hyperplasia (BPH). Although erectile and ejaculatory dysfunction are an ongoing concern following surgical therapies for BPH, immediate changes and early erectile function following these techniques have not been described. We aimed to describe the erectile changes occurring post-operatively and how they evolve for the first 6 months after surgery. METHODS: Patients with lower urinary tract symptoms (LUTS) secondary to BPH, an International Prostate Symptom Score (IPSS) >12, a prostate volume <80 ml and maximum flow rate (Qmax) <15 ml/s were screened to undergo PVP or BPVP. Male Sexual Health Questionnaire (MSHQ) as well as IPSS and Qmax were assessed preoperatively and at 1, 3 and 6 months postoperatively. Mean values for total MSHQ score as well as for the erection and ejaculation subscales were assessed at each of the time points for each of the procedures. A student’s t-test was performed to compare MSHQ scores at baseline and 6 months post-operatively. RESULTS: A total of 27 patients received PVP (n=13) or BPVP (n=14). Median age was 62.5 (Interquartile range (IQR) 70.3-71.8), median preoperative IPSS 18 (IQR 15.5 – 22), median prostate volume 51.3 (IQR 41-57) and median Qmax 9.4 (IQR 6.1-11.3). Mean baseline MSHQ was 64.6 (standard deviation (SD) 29.5) and mean postoperative measures were 55.7 (SD 32.4), 73.8 (SD 34.4) and 52.7 (SD 44.8) at 1 month, 3 months and 6 months, respectively. The mean change between MSHQ preoperatively and at 6 months was 11.9 points, which was not statistically significant (p=0.166). The change in score for each of the items of the questionnaire is shown in Table 1. Within the PVP group, the mean MSHQ change between baseline and at 6 months was -3.5 (p=0.786) and within the BPVP the mean change was -19.6 (p=0.095). CONCLUSIONS: Early erectile function following prostate ablation with PVP and BPVP drops slightly after the first month but recovers, achieving non-significantly different values compared to baseline. Patients should be counseled on early erectile changes and expectation for the first 6 months after surgery. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1281-e1282 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lina Posada Calderon* More articles by this author Mitali Kini More articles by this author Hudson Pierce More articles by this author Alexis Te More articles by this author James A. Kashanian More articles by this author Bilal Chightai More articles by this author Expand All Advertisement PDF downloadLoading ...

Salvage radical prostatectomy following focal therapy: functional and oncological outcomes.

To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes. In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61(8.25)years. FT modalities included high-intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9(17.6)months. There were no rectal or ureteric injuries. Two (5.9%) patients had iatrogenic cystotomies and four (11.8%) developed bladder neck contractures. The mean (sd) hospital stay was 2.5(2.1)days. The T-stage was pT2 in 14 (41.2%) patients, pT3a in 16 (47.1%), and pT3b in four (11.8%). In all, 13 (38%) patients had positive surgical margins (PSMs). Six (17.6%) patients received adjuvant radiotherapy (RT). At a mean follow-up of 4.3years, seven (20.6%) patients developed biochemical recurrence (BCR), and of these, six (17.6%) patients required salvage RT. PSMs were associated with worse BCR-free survival (hazard ratio 6.624, 95% confidence interval 2.243-19.563; P<0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7(4.5-9.5) and 23.5(15.75-25) respectively, while in the final follow-up the median (IQR) values were 7(3.5-11) and 6(5-12.25), respectively (P=0.088 and P<0.001). At last follow-up, 31 (91.2%) patients were continent, two (5.9%) had moderate (>1 pad/day) incontinence, and one (2.9%) required an artificial urinary sphincter. sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.

Toxicity in patients treated with permanent prostate brachytherapy using intraoperatively built custom-linked seeds versus loose seeds.

PurposeLow-dose-rate brachytherapy (BT) with permanent iodine-125 radioactive seeds is a highly effective treatment option for low- and favorable intermediate-risk prostate cancer. However, optimal implantation is not always achieved due to edema or seeds loss. One way to improve seed placement is the use of stranded seeds called “intraoperatively built custom-linked seeds (IBCLS)” in an opposition to loose seeds (LS). To date, there are few data comparing toxicity rates between these two techniques. The aim of this study was to compare dosimetric parameters and toxicity rates at 2 years between both procedures in a matched-paired population.Material and methodsPatients were considered for BT according to European guidelines. Among 548 patients treated at our institution, 105 patients in the loose seeds cohort were individually matched to 105 patients in the IBCLS group according to age, prostate volume, pre-operative international prostate symptom score (IPSS), clinical stage, and Gleason score. Erectile function was scored using the five-item international index of erectile function (IIEF-5) score. A multivariable linear mixed-effects model was applied to examine the association between total and individual scores (repeated measures) and covariates.ResultsOverall, 61 (29%) patients presented with a favorable intermediate-risk prostate cancer. There were no significant changes in IPSS over time (p = 0.57). During follow-up, the IIEF-5 was similar in the two groups, except at one month, where it was lower in the IBCLS group (10.9 vs. 6.9, p = 0.029). Also, there was no difference in grade ≥ 2 rectal toxicity. At 1 month, D90Gy, V150%, and V100% were higher in the LS group compared to the IBCLS group.ConclusionsLow-dose-rate prostate brachytherapy using IBCLS is a safe technique, with comparable toxicity profiles at 2 years compared to LS brachytherapy.

Predictive factors for persistence of preoperative overactive bladder symptoms after transvaginal mesh surgery in women with pelvic organ prolapse.

We aimed to evaluate the effect of transvaginal mesh surgery on overactive bladder symptoms in women with pelvic organ prolapse and to identify predictive factors for persistence of a preoperative overactive bladder after surgery. We retrospectively evaluated 102 patients who underwent transvaginal mesh surgery. All patients had stage 2 or greater pelvic organ prolapse accompanied by cystocele. The Overactive Bladder Symptom Score, International Prostate Symptom Score, uroflowmetry, and postvoid residual urine volume were evaluated preoperatively and 6 months postoperatively. To identify predictive factors for the persistence of a preoperative overactive bladder after surgery, preoperative parameters were statistically compared between patients with and without the persistence of preoperative overactive bladder symptoms. Receiver operator characteristic curves were generated, and the area under the curve was calculated. Preoperatively, 54 women (53%) had an overactive bladder. After surgery, the symptoms disappeared in 34 (63%) and persisted in 20 (37%) women. There were no significant differences in preoperative parameters including age, body mass index, parity, or severity of pelvic organ prolapse between patients with and without persistent preoperative overactive bladder. Preoperative Overactive Bladder Symptom Score and International Prostate Symptom Score were significantly higher in patients with persistent preoperative overactive bladder symptoms. The International Prostate Symptom Score storage subscore had the highest area under the curve, with a cutoff value of 9.5. Transvaginal mesh surgery eliminates overactive bladder symptoms in about two-thirds of pelvic organ prolapse patients. The preoperative International Prostate Symptom Score storage subscore was the most useful predictive factor for the persistence of preoperative overactive bladder symptoms after surgery.

Anterior gland focal cryoablation: proof-of-concept primary prostate cancer treatment in select men with localized anterior cancers detected by multi-parametric magnetic resonance imaging

BackgroundDue to their location away from the nerve bundles, anterior prostate cancers (APC) represent a rational target for image-guided cryoablation. This report describes the feasibility and short-term outcomes of anterior focal cryosurgery.MethodsA retrospective review between 2012 and 2016 of patients with clinically localized APC treated with anterior gland cryoablation was performed. Descriptive statistics were used to report: age, PSA, prostate volume, prostate cancer grade group (PGG), median time to follow-up, and changes in functional status measured with the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF-5) score.ResultsA total of 17 patients underwent anterior focal cryoablation with a median follow-up of 15 months. Median age and PSA at diagnosis were 67 years and 8.7 ng/mL. Pre-operative PGG1 was identified in 12 (71%) men and PGG2 in 5 (29%) men. Median (IQR) lesion volume was 2 mL(0.86, 3.1). Preoperative median IIEF-5 and IPSS scores were 19.5 and 5, and decreased to 19 and 4, post-operatively. All patients remained continent with no change in sexual function. All post-procedure targeted biopsies of the treated cancers were negative.ConclusionOur pilot study demonstrates the feasibility of treating APCs with image-guided targeted focal cryoablation as a good balance between short-term oncologic control and near complete preservation of genitourinary function. Further follow-up is necessary to examine the potential benefits long-term.

Correlation between prostatic urethral angulation and symptomatic improvement after surgery in patients with lower urinary tract symptoms according to prostate size.

To investigate the effect of prostate anatomical factors on the changes in lower urinary tract symptoms (LUTS) and uroflowmetric values after surgery. The medical records of 448 patients who underwent transurethral resection of the prostate (TURP) from January 2006 to December 2018 were analyzed retrospectively. Changes in the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual urine volume (PVR) at 3months after TURP were evaluated. Prostate volume, intravesical prostatic protrusion (IPP), and prostatic urethral angulation (PUA) were measured using transrectal ultrasonography, and their effect on the changes in LUTS after TURP was analyzed using multivariable linear regression. Among patients with prostate volume < 50mL, preoperative IPSS total score (IPSS-t), voiding symptom score (IPSS-vs), and storage symptom score (IPSS-ss) were significantly better in patients with a smaller PUA (< 51°) than in those with a larger PUA (≥ 51°) (p = 0.001, < 0.001, and 0.020, respectively). Changes in IPSS-t, IPSS-vs, IPSS-ss, and PVR at 3months after TURP were significantly correlated with PUA (p ≤ 0.001, < 0.001, 0.048, and 0.012, respectively). Multivariable linear regression revealed PUA to be independently associated with changes in IPPS-t and IPSS-vs (p = 0.025 and < 0.001, respectively) only in patients with prostate volume < 50mL. Prostatic urethral angulation was significantly associated with postoperative changes in LUTS only in patients with small prostate, and had no clinical significance in patients with large prostate. In patients with small prostate and large PUA, surgery should actively be considered.

Efficacy of bipolar transurethral resection of the prostate using TURIS: our short term experience

Background: Objective of the study was to report our short term experience regarding efficacy of bipolar transurethral resection of prostate using TURIS (transurethral resection in saline) system.Methods: Between May 2016 to April 2017 49 consecutive patients underwent bipolar transurethral resection of prostate (B-TURP) at our institute. All patients were evaluated preoperatively by physical examination, ultrasonography and laboratory studies, including measurement of hemoglobin, serum sodium, and prostate specific antigen levels. Patients were assessed postoperatively at three, six and 18 months.Results: The mean age of the patients was 64.83±7.47 years and mean preoperative prostate volume was 64.73±13.59 ml. The mean preoperative hemoglobin was 13.32±0.9 g/l and mean postoperative hemoglobin was 12.09±1.11 g/l. The mean resection time was 57.02±14.37 minutes and mean resected specimen weight was 41.69±12.15 gm. The mean preoperative maximum urinary flow rate (Qmax) was 8.6±1.17 ml/s and mean Qmax at three, six and 18 months follow up was 18.85±2.15, 19.43±1.49 and 18.98±1.6 ml/s respectively. The mean preoperative international prostate symptom score (IPSS) was 26.32±2.69 and mean IPSS at three, six and 18 months follow up was 6.68±1.36, 6.47±0.79 and 6.30±0.9 respectively. Only one patient developed urethral stricture during follow up.Conclusions: The B-TURP is efficacious and results in significant improvement in IPSS and Qmax. The urethral stricture rate after B-TURP is not different from monopolar TURP.

Predictors for immediate recovery of continence following Retzius-sparing robot-assisted radical prostatectomy: a case-control study.

We evaluated urinary continence in a series of consecutive patients who underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) to identify the preoperative predictors of the return to immediate urinary continence. 110 consecutive patients who underwent RS-RARP for clinically localized prostate cancer were retrospectively collected. Patients reported freedom from using safety pad (0pad/day) within 7days after removal of urinary catheter were defined as immediate urinary continent. A total of 85 patients (77.27%) were immediate urinary continent after RS-RARP. Patients with immediate urinary continence were significantly younger (66.92 ± 5.73 vs. 69.68 ± 4.99 years, p = 0.031) than those who were incontinent. Furthermore, the prostate volume was significantly smaller (30.90 vs. 44.60ml, p = 0.001) and preoperative international prostate symptom score (IPSS) was significantly lower (Mild 76.5% vs. 24.0%, Moderate 20.0% vs. 32.0%, and Severe 3.5% vs. 44.0%, p = 0.000) in patients with immediate urinary continence compared with those who were not. On univariable regression analysis, patient's age (OR 0.907, p = 0.035), prostate volume (OR 0.935, p = 0.000), moderate (OR 0.196, p = 0.007), and severe IPSS (OR 0.025, p = 0.000) (compared with mild IPSS) were independent adverse predictors of immediate urinary continence. On multivariable analysis, prostate volume (OR 0.955, p = 0.032) and severe preoperative IPSS (OR 0.044, p = 0.000) (compared with mild IPSS) were independent adverse predictors of immediate urinary continence after RS-RARP. RS-RARP hastens the recovery of urinary continence after surgery. Prostate volume and severe preoperative IPSS were independent adverse predictors of the return to immediate urinary continence.

The clinical application of combination suprapubic prostatectomy with transurethral resection of the prostate (TURP) in patients with large volume benign prostatic hyperplasia (BPH)

To investigate the safety and efficacy of the combination of suprapubic prostatectomy with transurethral resection of the prostate (TURP) for the treatment of large volume benign prostatic hyperplasia (BPH). We retrospectively analyzed the clinical data of two methods of treatment with 60 cases of a large volume BPH (>100 g) from January 2011 to 2017; the methods were suprapubic prostatectomy and suprapubic prostatectomy combination with TURP, in which the single open group comprised 30 cases, treated using the former method, and the combined open group comprised the other 30 cases, treated using the latter method. In the combined open group, the residual prostate gland was removed by TURP. We compared both the groups of patients using age, prostate volume, international prostate symptom score (IPSS), prostate-specific antigen (PSA), maximum flow rate, residual urine, operation time, hospitalization time, postoperative washing time, blood transfusion rate, and decreased amount of intraoperative hemoglobin in operation, and compared the preoperative and postoperative IPSS, maximum flow rate, and residual urine volume. There was no significant difference between the two groups in age, prostate volume, IPSS, PSA, maximum flow rate, residual urine, and other clinical data (P > 0.05); the single group operation time, postoperative bladder irrigation time, hospitalization time, blood transfusion rate, and decreased amount of intraoperative hemoglobin were significantly greater in the single open group than in the combined open group, and statistically significant differences were observed between both the groups (P < 0.05). Postoperative voiding function improved significantly compared with the preoperative, and a statistically significant difference was observed (P < 0.05). The combination of suprapubic prostatectomy with TURP is an effective and a safe surgical method for the treatment of patients with large volume BPH. It is certainly worthy of clinical application.

'En Bloc' HoLEP with early apical release in men with benign prostatic hyperplasia.

HoLEP represents an excellent treatment option for benign prostatic hyperplasia. Recently, 'en bloc' techniques resulting in improved visualization, shorter surgical times, and easier recognition of the dissection plane have been described. In this paper we describe the 'En bloc' HoLEP technique with early apical release. Between January 2015 and March 2017, 137 consecutive patients were subjected to this technique by a single surgeon. The following parameters were measured pre- and post-procedure: International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual urine (PVR) and PSA. Complications were recorded. Mean (SD; range) age was 66years (8.0; 51-84), mean PSA was 4.8ng/ml (7.0; 0.3-70), mean prostate volume was 75.63ml (42.1; 37-253), mean volume of prostatic tissue removed was 65.9ml (35.8; 30-217). Mean surgical duration was 47.58min (21.3; 15-120min): enucleation 31.5min (14.9; 5-80min), morcellating 6.9min (6.6; 1-60min). Mean hospitalization duration was 1.2days (range 1-3), mean catheterization time was 1.2days (range 1-5). The rate of stress urinary incontinence (SUI) was 5.8, 1.5 and 0.7% at 1, 3, and 6months post-operation, respectively. Compared to pre-operative values, IPSS, Qmax, and PVR showed significant improvements at 1, 3, 6, and 12months following the operation (p < 0.05). 'En Bloc' HoLEP with early apical release is a safe technique that allows for easier recognition of the surgical plane and preserves the external sphincter's mucosa to provide low rates of post-operative stress incontinence and significant functional results.

Intravesical prostatic protrusion is not always the same shape: Evaluation by preoperative cystoscopy and outcome in HoLEP.

To examine how morphological differences in intravesical prostatic protrusion (IPP) predict outcome of Holmium laser enucleation of prostate (HoLEP) treatment. We analyzed 173 patients who had undergone HoLEP in our hospital. The protrusion shape was evaluated by outpatient preoperative flexible cystoscopy and classified into five groups: A, no protrusion; B, middle lobe only; C, unilateral lobe only; D, bilateral lobes; and E, B + C or B + D. Paired-match analysis that adjusted for preoperative International Prostate Symptom Score (IPSS) voiding/storage subscores and IPP was performed between the group with middle lobe protrusion (B + E) and the group without it (C + D). Type A prostate shape was found in 23 patients, type B in 14, type C in 31, type D in 71, and type E in 34. Groups with middle lobe protrusion (B and E) had better changes in the total IPSS (P < 0.05) and the IPSS storage subscore (P < 0.01). Pair matching identified 37 patients each with or without middle lobe protrusion. The group with middle lobe protrusion had significantly more improved total IPSS (-17.5 ± 7.5 vs -13.5 ± 8.3, P < 0.05) and IPSS storage subscore (-6.9 ± 3.4 vs -4.8 ± 3.3, P < 0.05) than did those without middle lobe protrusion. Patients with middle lobe protrusion had greater IPSS improvement after HoLEP than those having comparable-length IPP but without middle lobe protrusion. IPP is not always the same shape and should be clinically divided into at least two groups.

Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients

ObjectiveWe aimed to determine safety and feasibility of thulium laser transurethral vapoenucleation of prostate (ThuVEP) for treatment of obese patients affected by benign prostatic hyperplasia (BPH). MethodsWe retrospectively analysed data of 452 patients with BPH who underwent ThuVEP from February 2012 to March 2016 in a single center. Patients were divided into three groups according to body mass index (BMI, kg/m2): Normal weight (18.5 ≤ BMI < 25; Group A), overweight (25 ≤ BMI < 30; Group B) and obese (BMI ≥ 30; Group C), for a total of 412 patients evaluable for this study. Preoperative total serum prostate-specific antigen (PSA), digital rectal examination of the prostate, transrectal ultrasound (TRUS), renal ultrasound, urine culture, uroflowmetry, International Prostate Symptoms Score (IPSS), and Quality of Life (QoL) score were analyzed. Post-operative complications, hospital stay and days of catheterization, questionnaires and uroflowmetry at 1 and 3 months after surgery were evaluated. Preoperative data, surgical outcomes, complication rate and clinical outcomes were compared between groups. ResultsThe median age of patients was 69 years (Interquartile Range [IQR 10]). The preoperative median IPSS among groups was 19 (IQR 8.75), 20 (IQR 10), and 18 (IQR 10) respectively. At 1 and 3 months of follow-up, this value was 8 (IQR 7), 8 (IQR 4), 7 (IQR 5) and 5 (IQR 6.25), 5 (IQR 6), 6 (IQR 5), respectively (all p between groups > 0.05). There was no statistically significant difference among three groups as for hospital stay and days of catheterization (p > 0.05). ConclusionOur results showed that ThuVEP was safe and feasible even in overweight patients with substantially enlarged prostate.

Urethral stricture disease after bipolar prostatectomy: Is it a concern?

Introductionbipolar Transurethral Surgery of Prostate (BTUSP) is growing increasingly popular in the management of Benign prostatic hyperplasia related lower urinary tract symptoms (BPH-related LUTS). Compared to monopolar transurethral resection of the prostate (TURP), BTUSP has the potential advantages of less toxicity related to irrigation fluid absorption, and better hemostasis. However, there have been reports of BTUSP being associated with increased incidence of urethral stricture disease (USD). We aim at 2 years results of B-TUSP with special emphasis on USD and continence. Patients and methodsThis is a retrospective study of patients who underwent BTUSP (resection, vaporization and enucleation) for BPH-related LUTS at Cairo University Hospital from January 2013 to December 2014. Perioperative parameters were assessed. Patients were evaluated 2 years postoperative to assess international prostate symptom score (IPSS), continence, urinary tract infection (UTI) uroflowmetry and post voiding residual urine (PVR). For patients with suspicion of USD (maximum flow rate “Qmax” ≤15ml/s, PVR ≥100cc,), retrograde and voiding cystourethrogram and/or cystoscopy were done. ResultsA 2-years follow-up was available for 32 patients. Mean age was 66.2±8.2years. 16/32 patients were catheter dependent due to bladder outlet obstruction. Mean preoperative flowmetry, IPSS and adenoma size were 9.1±3.02ml/s, 23.1±2.3 and 60.1±28.1g, respectively. Of our patients 11/32 (34%), 14/32 (44%) and 7/32 (22%) underwent BTU-enucleation, resection and vaporization of prostate, respectively. There was a difference in mean adenoma size for vaporization, enucleation and resection patients (29.57±11.9g, 83.36±26.49g and 58.71±17.82g, respectively) (p<0.05). Mean postoperative catheter time was 2.7±1.3days, IPSS, Qmax, and PVRU at 2 years, were 4.53±1.29 (2–7), 17.94±2.7 (11–22) and 3.13±7.7 (0–35) respectively, this was significantly different from preoperative Qmax and IPSS (p<0.05). Eight patients with Qmax ≤15ml/s (11–15ml/s) were assessed and found not to have USD. None of our patients reported incontinence. At 2 years, there was no significant difference in mean Qmax for vaporization, resection and enucleation (18ml/s±3.4, 18.71ml/s±2.86, and 16.9ml/s±1.86, respectively) (p=0.267). ConclusionBTUSP is a safe and effective modality for surgical management of BPH-related LUTS. With no evidence of increased incidence of USD, and with significant improvement of flowmetry and IPSS after 2 years follow up.

The effect of prostatic inflammation on clinical outcomes in patients with benign prostate hyperplasia.

BackgroundTo investigate the effect of asymptomatic inflammatory prostatitis on clinical outcomes of patients undergoing trans urethral resection of prostate due to benign prostatic hyperplasia.Materials and methodsA total of 514 patients were enrolled in the study. Clinical parameters and pathological results were compared before and one year after surgery.ResultsOf the patients 310 were diagnosed with purely benign prostatic hyperplasia and the others were diagnosed with both prostatic inflamation (cathegory IV) and benign prostatic hyperplasia. No statistical significance was observed between two groups among the parameters including age, prostate volume and post voiding residue (P > 0.05). Patients with prostate inflammation presented higher preoperative International Prostate Symptom Score and lower Qmax values when compared to those without inflammation before trans urethral resection of prostate.ConclusionAsymptomatic prostate inflammation can lead to worsen lower urinary tract symptoms and urinary flow rate in patients with benign prostatic hyperplasia. Furthermore, the improvement of the complaints after surgery was worse in patients with asymptomatic prostate inflammation. Further well designed prospective-randomised studies are needed to support our findings.

Transurethral bipolar plasmakinetic vapo-enucleation of the prostate: Is it safe for patients on chronic oral anticoagulants and/or platelet aggregation inhibitors?

ObjectivesTo assess the safety and efficacy of bipolar plasmakinetic enucleation and resection of the prostate (PKERP) for the management of benign prostatic hyperplasia (BPH) in patients on oral anticoagulant (OAC) therapy and/or platelet aggregation inhibitors (PAIs). Patients and methodsIn all, 91 patients were recruited and underwent PKERP whilst they were receiving PAIs (aspirin, 56 patients; clopidogrel, three; aspirin and clopidogrel, 11). In all, 15 patients were receiving an OAC drug perioperatively, whilst another six patients were on dual PAIs and OACs. The primary outcomes were the perioperative morbidity and mortality rates. The secondary outcomes were functional outcomes including maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS), and post-void residual urine volume (PVR). ResultsThe mean (SD) age of the patients was 65 (5.9)years, preoperative adenoma volume was 80.9 (30.4)mL, and the operative time was 67 (23)min. No patient developed serious perioperative cardiovascular complications. The mean (SD) duration of hospital stay was 1.79 (1)days and the postoperative catheterisation time was 1.14 (0.76)days. The mean (SD) haemoglobin drop was 0.74 (0.61)g/dL, blood transfusion rate was 2.2%, and the clot retention rate was 2.2%. The mean (SD) postoperative Qmax was 18.6 (4.37)mL/s as compared to 7.2 (3.2)mL/s preoperatively (P < 0.001), and the preoperative IPSS was reduced from 24.3 (6.1) to 5.7 (2.3) postoperatively (P < 0.05). Prostate volume measured by transrectal ultrasonography was significantly reduced from a mean (SD) of 80.9 (30.4)mL preoperatively to 29.5 (10.6)mL postoperatively (P < 0.001). ConclusionMinimally invasive PKERP may be considered as a safe and effective treatment option for managing patients with BPH receiving OAC/PAI drugs.

Patient satisfaction after holmium laser enucleation of the prostate (HoLEP): A prospective cohort study.

ObjectiveTo investigate patient satisfaction after holmium laser enucleation of the prostate (HoLEP) in a prospective study.Subjects and methodsFrom May 2012 to December 2014, 397 patients underwent HoLEP by a single surgeon and enrolled in our prospective registry. Baseline data included age, PSA, transrectal ultrasonography, the international prostate symptom score (IPSS), and overactive bladder symptom score (OABSS). Subjective assessment of surgical outcomes was performed at 6 months postoperatively using self-administered questionnaires consisting of ‘satisfaction with treatment question’ (STQ), ‘overall response assessment’ (ORA), and ‘willingness to undergo surgery question’ (WSQ).ResultsA total of 331 patients (mean age 69.6±7.0 years) were included in the analysis. Mean total prostate volume was 69.5 (±42.2) ml. Mean preoperative IPSS score was 18.5 (±7.8). The STQ showed that most patients (91.8%) were satisfied after the surgery. Only 11 (3.3%) patients responded with ‘dissatisfied’, and no patients replied with ‘very dissatisfied’. The WSQ showed that 311 (94.0%) patients were willing to undergo the surgery again if they had to reconsider the surgical decision. The ORA showed that all patients (99.4%) experienced an improvement. When compared with satisfied patients, neutral/dissatisfied patients had lower IPSS quality of life scores (2.7 vs. 0.9, p<0.001), higher IPSS voiding symptom scores (7.0 vs. 1.4, p<0.001), and more frequent episodes of urgency urinary incontinence in OABSS (1.0 vs. 0.3, p = 0.017) at 6 months postoperatively.ConclusionsThe overall level of satisfaction after HoLEP was high. The most common reason for dissatisfaction was the occurrence of urgency urinary incontinence after the surgery.

The Advantages of Transurethral Resection of the Prostate in Patients with an Elevated or Rising Prostate Specific Antigen, Mild or Moderate Lower Urinary Tract Symptoms, Bladder Outlet Obstruction and Negative Prostate Cancer Imaging or Prostate Biopsies: A Prospective Analysis in 105 Consecutive Patients

Objective: To investigate elevated or rising prostate specific antigen (PSA) as a marker for bladder outlet obstruction (BOO) in patients with minor lower urinary tract symptoms (LUTS) and without prostate cancer. Materials and Methods: One hundred and five consecutive patients were prospectively analyzed between 2005 and 2013. All patients were referred to the principal investigator by their general practitioner as a result of an elevated and/or rising PSA. Only patients with minor LUTS [International Prostate Symptom Score (I-PSS) 0-19] and without suspicion for prostate cancer were included. All patients had BOO, shown by full urodynamics, and underwent transurethral resection of the prostate. The resected tissue was histologically examined and PSA and I-PSS were evaluated after 3, 6 and 12 months and later on yearly. Results: Mean pre-operative PSA and I-PSS values were 8.8 ng/ml and 11.1, respectively. The mean detrusor pressure at maximum flow was 93.6 cmH₂O. The mean resected volume was 52 g and the mean prostate biopsy rate was 1.8. Eighty-three of 105 patients (79%) had no malignancy and were diagnosed with BOO due to benign prostate hyperplasia (subgroup 1). Their mean PSA decreased from 9.2 to 0.7 ng/ml and 0.9 ng/ml after 6 and 12 months post-operation, respectively. The mean I-PSS declined from 11 to 3 after 6 and 12 months. Sixteen of 105 patients (15%) were treated for prostate cancer (subgroup 2). Radical prostatectomy was performed in 11 patients, brachytherapy in 3 patients and external beam radiotherapy in 2 patients. Six of 105 patients (5.7%) had active surveillance (subgroup 3). Conclusion: BOO can cause an elevated or rising PSA in patients with minor LUTS and negative screening for prostate cancer. Transurethral resection of the prostate is an adequate treatment for these patients.

Causative factors for de novo inguinal hernia after robot-assisted radical prostatectomy.

To determine causative factors for de novo inguinal hernia (IH), after robot-assisted radical prostatectomy (RARP). This was a retrospective, single-center study, which included patients undergoing RARP for prostate cancer at our institution, from February 2012 to January 2015. Cox proportional hazards models were used to determine the relationships between de novo IH and various factors. A total of 284 patients were included in the analysis. Forty-two (14.7%) patients developed IH at a median period of 8months after RARP. On multivariate analysis, preoperative international prostate symptom score question 6>2, and a patent processus vaginalis were significantly correlated with de novo IH (hazard ratio (HR) 4.17, 95% confidence interval (CI) 2.07-8.37, p<0.001; HR 3.67, 95% CI 2.36-5.69, p<0.001). Preoperative urinary straining and a patent processus vaginalis were predictive of de novo IH after RARP.

Surgeon Performance Predicts Early Continence After Robot-Assisted Radical Prostatectomy.

There is limited, yet compelling evidence supporting the role of surgeon technical performance in influencing patient outcomes. To date, this concept has been underexplored in endourologic procedures. We hypothesized that a surgeon's technical performance plays a role in predicting an early return to continence after robot-assisted radical prostatectomy (RARP). We conducted a retrospective, matched case-control analysis of prospectively collected unedited RARP endoscopic videos performed by a single surgeon. A blinded observer with expertise in intraoperative video analysis evaluated clinically relevant steps of RARP using the global evaluative assessment of robotic skill (GEARS) and the generic error rating tool (GERT). The primary outcome was continence status at 3 months postoperatively, defined as patient use of less than or equal to a single precautionary pad. Mann-Whitney U tests examined differences in predictor variables between cases and controls, and multivariate analysis was conducted using binary logistic regression models. Twenty-four incontinent patients were matched for age, body mass index, preoperative International Prostate Symptoms Score, use of posterior/anterior hitch, prostate weight, and learning curve position. No statistically significant difference in errors between groups was observed using the GERT. On multivariate analysis, overall case GEARS score was independently predictive of 3-month continence status (odds ratios [OR] = 0.55, 95% confidence interval [CI] 0.33-0.91), as were urethrovesical anastomosis (OR = 0.70, 95% CI 0.50-0.97) and bladder neck GEARS scores (OR = 0.69, 95% CI 0.51-0.94). Our study generates the hypothesis that there may be a link between surgeon technical performance and functional outcomes in RARP. This relationship may have implications for the accreditation and training of future urologists and warrants further investigation.

MP51-15 SURGICAL TECHNICAL PERFORMANCE IMPACTS PATIENT OUTCOMES IN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2017MP51-15 SURGICAL TECHNICAL PERFORMANCE IMPACTS PATIENT OUTCOMES IN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY Mitchell G. Goldenberg, S. Larry Goldenberg, and Teodor P. Grantcharov Mitchell G. GoldenbergMitchell G. Goldenberg More articles by this author , S. Larry GoldenbergS. Larry Goldenberg More articles by this author , and Teodor P. GrantcharovTeodor P. Grantcharov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1624AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The few studies that question the role of individual surgeon′s technical skill in influencing patient outcomes and safety have produced compelling results. To date, this linkage has not been published in urology. We designed a study to understand how surgeon skill and error rating contribute to functional outcomes in robotic-assisted radical prostatectomy (RARP). METHODS We conducted a case-matched analysis of 28 prospectively collected RARP endoscopic videos performed by a single surgeon, between 2008 and 2015. Research Ethics Board approval was granted. Patient information was retrieved from an institutionally maintained database. The primary outcome parameter was continence status at 3 months post-operatively, defined as patient use of more than a single precautionary pad. A blinded observer with expertise in intraoperative video analysis evaluated clinically relevant steps of RARP using the Global Evaluative Assessment of Robotic Skill (GEARS), Robotic Anastomosis Competency Evaluation (RACE) and the Generic Error Rating Tool (GERT). Mann Whitney U tests explored differences in predictor variables between cases and controls (two-tailed, p≤0.05). RESULTS 14 patients deemed to be incontinent at 3 months were matched for age, pre-operative International Prostate Symptoms Score (IPSS), use of posterior/anterior hitch, and prostate weight. Matching also accounted for position of the case on the surgeon′s learning curve. Statistically significant differences were detected on nonparametric testing in RACE (p=0.03) score and GEARS urethrovesical anastomosis score (p=0.02) between case and control groups. There were a greater number of errors committed during bladder neck dissection in the incontinent patient cohort (p=0.01). CONCLUSIONS Our study is the first that suggests a link between surgeon technical performance and continence outcomes in RARP. While this single surgeon, patient-matched case-control design limits confounding, multi-institutional prospective studies studying multiple surgeons of different abilities forms the basis of future research in this area. The implication of our findings are potentially far reaching, and moving forward, stakeholders in education and accreditation of RARP should incorporate both surgeon technical skill and error rating into judgments of surgical quality. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e699 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Mitchell G. Goldenberg More articles by this author S. Larry Goldenberg More articles by this author Teodor P. Grantcharov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...