Preoperative Prostate Volume Research Articles

Prospective Assessment of Learning Curve of Holmium Laser Enucleation of the Prostate for Treatment of Benign Prostatic Hyperplasia Using a Multidimensional Approach

Despite being endorsed in most guidelines, wide adoption of holmium laser enucleation of the prostate is hindered by learning difficulties. We prospectively assessed the learning curve using a multidimensional approach. We prospectively report all perioperative safety and efficacy outcome measures as well as the need for reoperation and continence status. Case difficulty and learning curve characterization variables were considered, looking for predictors of different outcome measures. Our analysis included the first 313 procedures done by a total of 3 surgeons. Prostate volume and the number of previously performed cases independently predicted operative and enucleation efficiency (mean ± SD 0.76 ± 0.36 and 1.2 ± 0.6 gm per minute, respectively). Both measures plateaued only after the first 40 procedures. The mean percent reduction in postoperative prostate specific antigen was 80% ± 19%. A significantly lower decrease was independently predicted by the transrectal ultrasound depiction of a grossly multinodular prostate (p = 0.000, R2 = 0.59). Perioperative safety measures showed significant improvement after the first and second 20 procedures apart from hospital stay and catheter time. Urinary incontinence was reported in 89 (28.5%), 26 (8.3%) and 7 cases (2.2%) at 1, 4 and 12 months, respectively. Only the number of previously performed cases predicted urinary incontinence at 1 month, which was significantly reduced following the first 20 procedures (plateau) (OR 0.99, 95% CI 0.98-0.999, p = 0.03). The I-PSS (International Prostate Symptom Score) preoperative storage subdomain (OR 0.7, 95% CI 0.4-0.9, p = 0.04), case density (OR 0.3, 95% CI 0.2-0.6, p = 0.01) and number of previously performed cases (OR 0.97, 95% CI 0.98-0.999, p = 0.02) predicted urinary incontinence at 4 months, which was significantly reduced after the first and second 20 procedures. Persistent urinary incontinence at 12 months was significantly associated with fewer previously performed cases (median 60, range 0 to 211 vs 20, range 0 to 99, p = 0.04) with no plateauing through the curve. Plateauing through the learning curve of holmium laser enucleation of the prostate is a moving target. Looking at different outcome measures, different levels of experience are needed to reach the plateau. Preoperative prostate volume, the number of previously performed cases and case density are the main influential factors in the curve. Urinary incontinence is the most relevant clinical outcome that was significantly affected by learning, although its transient nature is assuring.

Prostatic vascular damage induced by cigarette smoking as a risk factor for recovery after holmium laser enucleation of the prostate (HoLEP)

PurposeTo evaluate the relationship between prostatic vessel changes induced by cigarette smoking and the perioperative outcome of holmium laser enucleation of the prostate (HoLEP).Materials and MethodsA total of 268 postoperative patients with benign prostatic hyperplasia (BPH) were prospectively analysed in our department. They were divided into two groups (smokers and non-smokers) according to smoking history. Transrectal colour Doppler ultrasound was performed to evaluate the prostate vascular changes. Pathologically, HE staining, CD31 and CD34 were analysed in prostatic section chips. Furthermore, postoperative outcomes were determined during a 6-month follow-up period.ResultsThe preoperative prostate volume was significantly decreased in smoking patients (P = 0.04). CPI was significantly lower in smoking BPH patients (P < 0.01), whereas RI was significantly increased in smokers compared with non-smokers (P < 0.01). Histological assays revealed elevated CD34 in the smoking BPH individuals presenting an increased number of microvessels. The HoLEP duration was increased in smokers. Interestingly, we identified significantly increased overactive bladder syndrome score (OABSS) and decreased Qmax in smoking individuals during the 6-month follow-up with no difference being observed preoperatively. However, no significant difference between the groups was observed for the International Prostate Symptom Score (IPSS).ConclusionsThe significantly lower CPI and higher RI values in smoking BPH patients indicated the presence of considerable vascular damage in these subjects. Moreover, cigarette smoking extended the surgical duration and prolonged the recovery period of overactive bladder (OAB) syndrome. Thus, integrated treatment should be suggested for various BPH individuals.

Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size.

To investigate the effect of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP). This is a retrospective analysis of 294 patients with organ-confined prostate cancer treated with RS-RALP in a high-volume centre from November 2012 to February 2015. Patients were divided into three groups based on their transrectal ultrasonography estimated PV as follows: group 1, <40 mL (231 patients); group 2, 40-60 mL (47); group 3, >60 mL (16). Perioperative, oncological, and continence outcomes were compared between the three groups. The median [interquartile range (IQR)] PV for each group was; 26.1 (22-31) mL, 45.9 (41-50) mL, and 70 (68-85) mL. Blood loss was higher in group 3 compared to groups 2 and 1; at a median (IQR) of 475 (312-575) mL, 200 (150-400) mL, and 250 (150-400) mL, respectively (P = 0.001). The intraoperative transfusion rate was higher in group 3 patients (P = 0.004), while the complication rate did not differ (P = 0.05). The console time was slightly higher but was not statistically significant in group 3 compared to groups 2 and 1; at a mean (sd) of 100 (35) min, 92 (34.4) min, and 93 (24.8) min, respectively (P = 0.70). Biochemical recurrence and the continence rate did not differ between the three groups (P = 0.89 and P = 0.25, respectively). RS-RALP is oncologically and functionally equivalent for all prostate sizes but technically demanding for larger prostates. We therefore recommend that surgeons initiate their RS-RALP technique with smaller prostates.

Incidencia y factores asociados al uso de medicamentos y retratamiento quirúrgico posterior a resección transuretral de próstata

IntroductionTransurethral resection of the prostate (TURP) is a standard procedure for obstructive prostatic growth. Medical retreatment with anticholinergics, alpha-blockers, and 5 alpha reductase inhibitors is from 16 to 50%. A second surgical retreatment is associated with internal urethrotomy, cervicotomy, and re-TURP between 5 and 13% at 5 years. Re-TURP is associated with residual tissue. AimTo determine the incidence of and factors associated with the use of medications and surgical retreatment after TURP. Material and methodsA retrospective study was conducted on patients that underwent TURP within the time frame of January 2010 and December 2011 with follow-up to the present. Preoperative, intraoperative, and postoperative variables were analyzed and the chi-square test was used for the statistical analysis. ResultsFollow-up was carried out on 158 patients that underwent TURP. The overall accumulated incidence of retreatment was 43%, surgical retreatment was 17.7%, and medical treatment was 30.4%. TURP retreatment was 7.6% and transvesical prostatectomy was 1.3%. The mean time until prostate surgery retreatment was 30.5 months. Postoperative medical treatment was: anticholinergics 17.1%, alpha-blockers 15.2%, 5 alpha reductase inhibitors 6.3%, and combination 8.2%. During follow-up, 22.8% of the patients had residual tissue, which was the main cause of retreatment. Preoperative prostatic volume>80g was associated with residual tissue (p=0.024). ConclusionsIn our study, the incidence of surgical retreatment was higher than that reported in the literature, at 17.7% vs. 13%, respectively, and medical treatment was lower at 30.4% vs. 50%, respectively. Anticholinergics were the most utilized medications. Adequate patient selection will reduce complications and risk for retreatment.

Modified urethrovesical anastomosis during robot-assisted simple prostatectomy: Technique and results.

BackgroundDespite significant developments in transurethral surgery for benign prostatic hyperplasia, simple prostatectomy remains an excellent option for patients with severely enlarged glands. The objective is to describe our results of robot-assisted simple prostatectomy (RASP) with a modified urethrovesical anastomosis (UVA).MethodsFrom May 2011 to February 2014, RASP with UVA was performed in 34 patients by a single surgeon (O.C.) using the da Vinci S-HD surgical system. The UVA was performed between the bladder neck and urethral margin using the Van Velthoven technique. Demographic, perioperative, and outcome data were recorded. Complications were recorded with the Clavien–Dindo system.ResultsThe mean (standard deviation) age was 68 years (62–74 years). The median preoperative prostate volume (interquartile range) was 117 cc (99–146 cc). Operative time was 96 minutes (78–126 minutes), estimate blood loss was 200 mL (100–300 mL), and two (5.8%) patients required a blood transfusion. No conversion to open surgery was needed. The median specimen weight on pathological examination was 76 g (58–100 g). The average hospital stay was 2.2 days (1–4 days) and average Foley catheter time was 4.6 days (4–6 days). No intraoperative complications were recorded. There were seven (20.5%) postoperative complications, most of them Clavien less than or equal to Grade II.ConclusionThe results of our study show that RASP with UVA is a feasible, secure, and reproducible procedure with low morbidity. Additional series with larger patient cohorts are needed to validate this approach.

PD21-10 MORCELLATION EFFICIENCY IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE: COMPARATIVE STUDY OF TWO GENERATIONS OF MORCELLATORS

INTRODUCTION AND OBJECTIVES: Tissue morcellation is an important step during Holmium laser enucleation of the prostate (HoLEP). This study compares the efficiency of the new VersaCut+ tissue morcellation system and the older VersaCut tissue morcellator system. METHODS: The first 20 patients who underwent HoLEP and tissue morcellation using the new VersaCut tissue morcellation system at our institute were included in this study (group1). These patients were matched based on the enucleated tissue weight to patients from our prospectively maintained HoLEP database (group 2) with a 2:1 matching ratio. Peri-operative characteristics, operative times, morcellation times and complications were reported and compared between the two groups. Morcellation efficiency (defined as the weight of morcellated tissue per morcellation time) was calculated and compared between the two groups. RESULTS: The preoperative prostate volume was not different between the two groups [96.9 gm (SD 42) for group 1 vs 97.3 gm (SD 39.8) for group 2, (p1⁄4 0.967)]. There were no differences in the enucleated weight between the two groups [51.2 gm (SD 26.3) for group 1 vs 50.7gm (SD25.9) for group 2, (p1⁄40.949)]. Total operative times were not different between the two groups [123.5 minutes (SD 44.1) for group 1 and 152 minutes (SD 55.4) for group 2, p1⁄4 0.781). When the new morcellator was used, mean morcellation time was 19.9 minuts (SD13.7) whereas mean morcellation time was 14.6 minutes (SD11.6) with the older morcellator (p1⁄40.122). Morcellation efficiency was comparable between the two groups [3.33 gm/minute (SD1.82) for group 1 vs 4.44 gm/minute (SD 2.45) for group 2]. There were no complications in both groups. When the morcellated tissue was examined postoperatively, there were no differences in the incidence of prostatitis or prostate cancer in the two groups. CONCLUSIONS: When matched by the resected prostatic tissue weight, there were no differences identified in the efficiency of the old VaersaCut and the new VersaCut+morcellation systems.

PD24-11 MULTICENTER INTERNATIONAL EXPERIENCE OF 180W LBO LASER PHOTO-VAPORIZATION IN MEN WITH LARGE PROSTATES (PROSTATE VOLUME>100CC): LONG-TERM OUTCOMES OF 434 PATIENTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2016PD24-11 MULTICENTER INTERNATIONAL EXPERIENCE OF 180W LBO LASER PHOTO-VAPORIZATION IN MEN WITH LARGE PROSTATES (PROSTATE VOLUME>100CC): LONG-TERM OUTCOMES OF 434 PATIENTS Pierre-Alain Hueber, Malek Meskawi, Roger Valdivieso, Tristan Martel, Mounsif Azizi, Franck Bruyère, Vincent Misrai, Georges Fournier, Ravi Munver, Ganesh Sivarajan, Matthew Rutman, Alexis Te, Bilal Chughtai, Dean Elterman, and Kevin Zorn Pierre-Alain HueberPierre-Alain Hueber More articles by this author , Malek MeskawiMalek Meskawi More articles by this author , Roger ValdiviesoRoger Valdivieso More articles by this author , Tristan MartelTristan Martel More articles by this author , Mounsif AziziMounsif Azizi More articles by this author , Franck BruyèreFranck Bruyère More articles by this author , Vincent MisraiVincent Misrai More articles by this author , Georges FournierGeorges Fournier More articles by this author , Ravi MunverRavi Munver More articles by this author , Ganesh SivarajanGanesh Sivarajan More articles by this author , Matthew RutmanMatthew Rutman More articles by this author , Alexis TeAlexis Te More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Dean EltermanDean Elterman More articles by this author , and Kevin ZornKevin Zorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1776AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate volume (PV) >100cc remains challenging for endoscopic BPH management. Although PVP using XPS-180 system is feasible for patients with large PV, long-term outcome data supporting its use is still lacking. The aim was to evaluate the outcomes and durability at 4 years in a large, multi-center experience. METHODS This is a retrospective study of 434 men with pre-operative TRUS PV>100cc that were treated in 8 centers in North-America (Canada, USA) and in Europe (France) with the Greenlight-XPS laser using PVP for the treatment LUTS associated with BPH. To assess efficacy, IPSS, Qmax, prostate volume (PV), postvoid residual (PVR) and PSA were measured at 6, 12, 36 and 48 months. Durability was evaluated using re-treatment rate at 24, 36 and 48 months. RESULTS Median prostate size and PSA were 121cc (IQR 108-150) and 6.3ng/mL. 42.3% of men had an indwelling catheter at the time of surgery. Median operative time and energy applied were 60min (IQR: 40-74) and 424kJ, with ≥2 fibers used in 40% of the cases. Median energy delivery was 3.4kJ/cc per case. Median length of stay was 24h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months (fig.1). Surgical BPH retreatment was 5.3% at 24 months which rose to 11.9% at 36 months. Interestingly, characteristics of re-treated men include energy delivery that was 2.4kJ (vs 3.4kJ) and PSA reduction at 12 months of 29% (vs46%). CONCLUSIONS PVP treatment using Greenlight XPS-180W can potentially provide durable improvements with regards to functional outcomes including IPSS at 4 years. However retreatment rate rising after 3 years is a concern. This data highlights the need of utilizing a standardized technique with an operative endpoint of an enucleation-like-defect (down to the surgical capsule). Other than encouraging the use of transrectal imaging preoperatively, benchmark perioperative parameters of energy use (KJ/cc), 12-month PSA reduction and rising PSA during followup may serve as a surrogate markers for predicting durability. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e515-e516 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Pierre-Alain Hueber More articles by this author Malek Meskawi More articles by this author Roger Valdivieso More articles by this author Tristan Martel More articles by this author Mounsif Azizi More articles by this author Franck Bruyère More articles by this author Vincent Misrai More articles by this author Georges Fournier More articles by this author Ravi Munver More articles by this author Ganesh Sivarajan More articles by this author Matthew Rutman More articles by this author Alexis Te More articles by this author Bilal Chughtai More articles by this author Dean Elterman More articles by this author Kevin Zorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD06-02 MANUALLY CONTROLLED TRANS-PERINEAL TARGETED BIOPSY WITH REAL-TIME FUSION IMAGE OF MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGE AND TRANS-RECTAL ULTRASOUND IMAGE FOR THE DIAGNOSIS OF PROSTATE SIGNIFICANT CANCER BASED ON PROSTATE IMAGE-REPORTING AND DATA SYSTEM VERSION 1

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2016PD06-02 MANUALLY CONTROLLED TRANS-PERINEAL TARGETED BIOPSY WITH REAL-TIME FUSION IMAGE OF MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGE AND TRANS-RECTAL ULTRASOUND IMAGE FOR THE DIAGNOSIS OF PROSTATE SIGNIFICANT CANCER BASED ON PROSTATE IMAGE-REPORTING AND DATA SYSTEM VERSION 1 Sunao Shoji, Taro Higure, Masayoshi Kawakami, Mayura Nakano, Toshiro Terachi, and Toyoaki Uchida Sunao ShojiSunao Shoji More articles by this author , Taro HigureTaro Higure More articles by this author , Masayoshi KawakamiMasayoshi Kawakami More articles by this author , Mayura NakanoMayura Nakano More articles by this author , Toshiro TerachiToshiro Terachi More articles by this author , and Toyoaki UchidaToyoaki Uchida More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2622AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report clinical results of manually controlled targeted trans-perineal biopsy with real-time fusion image of multi-parametric magnetic resonance image (mpMRI)-trans-rectal ultrasound (TRUS) for the diagnosis of prostate significant cancer based on prostate image-reporting and data system version 1 (PI-RAD v1). METHODS The patients with PSA level less than 20 ng/ml were performed mpMRI prospectively. All mpMRI images including T2WI, dynamic, DWI, and ADC map. We performed trans-perineal targeted biopsies for each cancer-suspicious lesion and 12-cores systematic biopsies using the BioJet® (D&K Technologies GmbH, Barum, Germany). Three-dimensional prostate models were reconstructed with MRI, TRUS images, and biopsy results (Fig 1a). The relationships between mpMRI finding, biopsy pathological findings and whole-mount prostate specimen (Fig 1b) were analyzed. RESULTS Two hundred patients were included in this study. Median age of the patients was 67 years (range: 50 to 89 years). Median preoperative PSA value was 6.9 ng/ml (range: 3.54 to 20.0). Median preoperative prostate volume was 35 ml (range: 22 to 68). We detected 118 cancers (59%), with a median Gleason score of 7 (range: 6 to 9). Detection rates of targeted areas with PI-RAD classification 4 and 5 in the transition zone (TZ) and the peripheral zone (PZ) were 24% and 88% in classification 4 and 56% and 97% in classification 5, respectively. Cancer detection rate (p<0.0001), positive core length (p = 0.004), positive core percent (p < 0.0001), and Gleason score (p = 0.006) were also significantly different between targeted and systematic biopsies. In 27 patients who underwent radical prostatectomy, geographic locations and pathological grades of significant cancers (n=37) in whole-mount prostate specimens corresponded to the pathological results of the targeted biopsies. CONCLUSIONS The present targeted biopsy method was superior to 12-cores systematic biopsy, and clinically significant cancers with a spatial relationship were detected accurately in the present study. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e174 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sunao Shoji More articles by this author Taro Higure More articles by this author Masayoshi Kawakami More articles by this author Mayura Nakano More articles by this author Toshiro Terachi More articles by this author Toyoaki Uchida More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Changing patients' profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective.

We assessed the change of patients' profile presenting for symptomatic benign prostatic hyperplasia (BPH) over 16 years and its impact on surgical outcomes over this time. We reviewed a prospectively maintained database of patients treated with laser for symptomatic BPH since March 1998. Patients were divided into 3 consecutive time-based groups: Group 1 for patients who underwent surgery before April 2004; Group 2, between April 2004 and March 2009; and for Group 3 from April 2009 to August 2014. We reviewed demographic and preoperative data, including prostate volume; international prostate symptoms score (IPSS), quality of life (QoL), and peak flow rate (Qmax). We also recorded any perioperative and long-term complications. A total of 1835 patients were included in our study, including 542 (29.5%) in Group 1, 614 (33.5%) in Group 2, and 679 (37%) in Group 3. Preoperative prostate volume was positively correlated with age at surgery (r = 0.62, p < 0.001), total energy used (r = 0.47, p < 0.001), and total operative time (r = 0.47, p < 0.001). Patients in Group 3 were significantly older (75.28 ± 8.47 in Group 3 vs. 71.11 ± 8.9 in Group 2 vs. 65.3 ± 9.04 years in Group 1, p <0.001), were more coagulopathic (18.7% Group 3 vs. 12.3% Group 2 vs. 5.9% Group 1, p < 0.001), and had significantly larger prostates (87.96 ± 49.80 in Group 3 vs. 78.44 ± 50.84 in Group 2 vs. 74.50 ± 46.53 Group 1, p < 0.001). Preoperative prostatic medications significantly increased over time (72.6% in Group 1 vs. 85.5% in Group 2, vs. 87.4% Group 3, p < 0.001). IPSS, QoL and Qmax were significantly abnormal in patients in Group 3 (p < 0.001). After a mean follow-up of 3 years, the number of patients who did not require reoperation progressively increased (94.1% Group 1 vs. 96.1% Group 2 vs. 98.3% Group 3). Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with postoperative urinary incontinence. Patients presenting for surgery due to symptomatic BPH over the last 16 years were significantly older, more morbid, and had larger prostates and more abnormal voiding parameters. Over time, patients used prostatic medications more frequently. Despite the changes in patient profiles, perioperative safety and complication rates between groups were comparable, likely due to advancements in laser technology and techniques. Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with reversible postoperative urinary incontinence.

Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon's experience with robot-assisted radical prostatectomy.

To assess the impact of preoperatively estimated prostate volume (PV) using transrectal ultrasonography (TRUS) on surgical and oncological outcomes in robot-assisted radical prostatectomy (RARP). We analyzed the experience of a single surgeon at our hospital who performed 436 RARPs without neoadjuvant hormone therapy between August 2006 and December 2013. Patients were divided into three groups according to their preoperative PV calculated using TRUS (PV≤20cm(3): group 1, n=61; 20<PV<50cm(3): group 2, n=303; PV≥50cm(3): group 3, n=72). Blood loss was significantly higher in group 3 than in group 1 and group 2. In stage pT2 patients, the rate of positive surgical margin (PSM) was significantly lower in group 3 than in group 1. In addition, perioperative complications significantly increased with increasing PV, while the extraprostatic extension (EPE) rate significantly decreased with increasing PV. The preoperative biopsy Gleason score, prostate-specific antigen (PSA) density, and clinical T2 stage were inversely correlated with increasing PV. Biochemical recurrence-free survival after RARP was significantly lower in group 1 than in groups 2 and 3. A large prostate size was significantly associated with increased blood loss and a higher rate of perioperative complications. A small prostate size was associated with a higher PSM rate, PSA density, Gleason score, EPE rate, and biochemical recurrence rate. These results suggest that RARP was technically challenging in patients with large prostates, whereas small prostates were associated with unfavorable oncological outcomes.

Transperineal targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound

Objective To evaluate the value of transperineal targeted biopsy with real-time fusion images of transrectal ultrasound (TRUS) and multiparametric magnetic resonance imaging (mpMRI) for the diagnosis of prostate cancer (PCa). Methods Clinical and imaging data of 62 consecutive patients suspected of PCa at the mpMRI scan and PSA>4.0 μg/L were retrospectively analyzed. Targeted biopsies (TB) were carried out for each cancer-suspicious lesion, and followed a systematic 12-core biopsy (SB) protocol. Pathological findings of TB and SB were analyzed. Results The age of the patients was (68.38±6.57)years (range 51-79 years). The preoperative PSA value was (10.21±5.57)μg/L (range 4.5-30.1 μg/L). Preoperative prostate volume was (34.05±9.86)ml (range 19-64 ml). The PCa patients detected by SB and/or TB were 34 (54.8%). Cancer-detected rates of SB and TB cores were 7.53% and 26.2%, respectively (P<0.001). The positive core length of SB and TB cores were (3.71±2.77)mm (range 1-14 mm) and (5.00±3.04)mm (range 2-17 mm), respectively (P=0.016). The positive core percent of SB and TB cores were (28.77±20.13)% (range 7-100%) and (35.76±18.73)% (range 11%-100%), respectively (P=0.048). Moreover, clinically cores detected by the SB and TB for final diagnosis of PCa were 19 cores (2.6%) and 48 cores (18.5%), respectively (P<0.001). Conclusions Transperineal TB using real-time TRUS and mpMRI fusion imaging can improve sampling quality and elevate clinically detection rate of PCa when application combined with SB. Key words: Endosonography; Magnetic resonance imaging; Fusion image; Prostatic neoplasms; Biopsy, needle

Comparative study of transperitoneal laparoscopic radical prostatectomy and open radical prostatectomy

Objective To compare the clinical efficacy and safety of transperitoneal laparoscopic radical prostatectomy (LRP) and open radical prostatectomy (ORP) for treatment of localized prostate cancer. Methods From March 2003 to December 2014, 395 consecutive cases of radical prostatectomy were retrospectively analyzed. The patients were divided into 2 groups: LRP group with 325 cases and ORP group with 70 cases. There were no significant differences in age (P=0.364), body mass index (P=0.360), preoperative PSA level (P=0.076), preoperative Gleason score (P=0.839) and prostate volume (P=0.241) between LRP group and ORP group. Therapeutic effect was compared between the 2 groups. Results The differences of operative time (LRP: 114±29 min, ORP: 150±39 min, P=0.002), blood loss (248±96, 569±166 ml, P<0.001), intestinal function recovery time (2.2±0.9, 3.0±0.8 d, P=0.031), postoperative hospital stay (7.1±1.4, 8.9±1.6 d, P=0.028) and complication rate(P<0.001) were significantly between the 2 groups. There were no significant differences in positive surgical margin rate(P=0.397) and 1–year or 2–year biochemical recurrence rate (P=0.664, P=0.238) between the 2 groups. Conclusion In the present cohort, compared with open surgery, LRP had advantages of fewer traumas, quicker recovery and fewer complications, while the tumor control was similar. Key words: Prostatic neoplasms; Laparoscopes; Radical prostatectomy; Open surgery; Treatment outcome

Impact of prostate volume on oncologic, perioperative, and functional outcomes after radical prostatectomy.

The impact of prostate volume (PV) on oncologic, perioperative and functional outcomes after radical prostatectomy (RP) remains controversial, as recent studies present inconsistent results. We studied the influence of PV on outcomes in a large single center dataset and summarized the existing literature. 5,477 patients who underwent RP between January 2008 and December 2011 were analyzed. The impact of PV on biochemical recurrence (BCR) and metastasis-free survival (MFS) was assessed using Kaplan-Meier curves and multivariate Cox proportional hazard model. Uni- and multivariate logistic regressions were used to estimate the impact of PV on surgical margin (SM), 1-week, 3-months and 12-months continence and 3-months and 12-months potency. Finally, the impact of PV on intraoperative blood loss was analyzed using uni- and multivariate linear regressions. Median follow-up was 36.1 months. Overall, 16.5% of patients recurred during the follow-up period. The mean preoperative PV was 43.3 ml. One-week, 3-months and 12-months continence rates were 55.6%, 69.3%, and 87.4% for patients with PV ≥ 70 compared to 64.4%, 78.3%, and 92.1% for patients with PV < 30, respectively. Three-months and 12-months potency rates were 37.1% and 54.8% for men with large glands (≥70) and 56.3% and 65.0% for men with PV < 30. In multivariate analysis, continence at 1 week, 3 months and 12 months was significantly worse in patients with glands ≥70 ml, while potency was not influenced by PV in multivariate analysis. There was a higher mean blood loss (P < 0.001) in patients with larger glands. In univariate analysis, higher PV was significantly associated with lower BCR (P = 0.019), but not with metastasis free survival (P = 0.112). PV significantly influences BCR-free survival only in univariate analysis. Especially early (1-week and 3-months) postoperative continence is negatively affected by higher PV in multivariate analysis, while PV did not influence potency after adjusting for further covariates in a specialized high-volume institution.

Robot-assisted Simple Prostatectomy for Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Enlargement: Surgical Technique and Outcomes in a High-volume Robotic Centre

BackgroundRobot-assisted simple prostatectomy (RASP) is a minimally invasive procedure for treatment of patients with lower urinary tract symptoms (LUTS) due to large benign prostatic enlargement (BPE). ObjectiveTo present the perioperative and short-term functional outcomes of RASP in a large series of patients with LUTS due to BPE treated in a high-volume referral center. Design, setting, and participantsWe retrospectively collected data for 67 consecutive patients who underwent RASP from October 2008 to August 2014. Surgical procedureRASP was performed using a Da Vinci S or Si system with a transvesical approach. MeasurementsComplications were graded according to the Clavien-Dindo system. Continuous variables are reported as median and interquartile range (IQR). Comparison of preoperative and postoperative outcomes was assessed by Wilcoxon test. A two-sided value of p<0.05 was considered statistically significant. Results and limitationsThe median preoperative prostate volume was 129ml (IQR 104–180). For the 45 patients who did not have an indwelling catheter, the median preoperative International Prostate Symptom Score (IPSS) was 25 (20.5–28), the median maximum flow rate (Qmax) was 7ml/s (IQR 5–11), and the median post-void residual volume (PVRV) was 73ml (IQR 40–116). The median operative time was 97min (IQR 80–127) and the median estimated blood loss was 200ml (IQR 115–360). The postoperative complication rate was 30%, including three cases (4.5%) with grade 3b complications (major bleeding requiring cystoscopy and coagulation). The median catheterization time was 3 d (IQR 2–4) and the median length of stay was 4 d (IQR 3–5). The median follow-up was 6 mo (IQR 2–12). At follow-up, the median IPSS was 3 (IQR 0–8), the median Qmax was 23ml/s (IQR 16–35), and the median PVRV was 0ml (IQR 0–36) (all p<0.001 vs baseline values). The retrospective design is the major study limitation. ConclusionsOur data indicate good perioperative outcomes, an acceptable risk profile, and excellent improvements in patient symptoms and flow scores at short-term follow-up following RASP. Patient summaryWe analyzed the perioperative and functional outcomes of robot-assisted simple prostatectomy in the treatment of male patients with lower urinary tract symptoms due to large prostatic adenoma. The procedure was associated with a relatively low risk of complications and excellent functional outcomes, including considerable improvements in symptoms and flow performance. We can conclude that the procedure is a valuable option in the treatment of such patients. However, comparative studies evaluating the efficacy of the procedure in comparison with endoscopic treatment of large prostatic adenomas are needed.

Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia Using the 180 Watt System: Multicenter Study of the Impact of Prostate Size on Safety and Outcomes

We evaluated photoselective vaporization of the prostate using the GreenLight™ XPS™ 180 W system for benign prostatic hyperplasia treatment in a large multi-institutional cohort at 2 years. We particularly examined safety, outcomes and the re-treatment rate in larger prostates, defined as a prostate volume of 80 cc or greater, to assess the potential of photoselective vaporization of the prostate as a size independent procedure. A total of 1,196 patients were treated at 6 international centers in Canada, the United States, France and England. All parameters were collected retrospectively, including complications, I-PSS, maximum urinary flow rate, post-void residual urine, prostate volume, prostate specific antigen and the endoscopic re-intervention rate. Subgroup stratified comparative analysis was performed according to preoperative prostate volume less than 80 vs 80 cc or greater on transrectal ultrasound. Median prostate size was 50 cc in 387 patients and 108 cc in 741 in the prostate volume groups less than 80 and 80 cc or greater, respectively. The rate of conversion to transurethral prostate resection was significantly higher in the 80 cc or greater group than in the less than 80 cc group (8.4% vs 0.6%, p <0.01). I-PSS, quality of life score, maximum urinary flow rate and post-void residual urine were significantly improved compared to baseline at 6, 12 and 24 months of followup without significant differences between the prostate size groups. The re-treatment rate at 2 years reported in 5 of 411 patients was associated with the delivery of decreased energy density (2.1 vs 4.4 kJ/cc) in the group without re-treatment. Photoselective vaporization of the prostate using the XPS 180 W system is safe and efficacious, providing durable improvement in functional outcomes at 2 years independent of prostate size when treated with sufficient energy.

MP11-08 MANUALLY CONTROLLED TARGETED BIOPSY WITH REAL-TIME FUSION IMAGE OF MULTIPARAMETRIC MAGNETIC RESONANCE IMAGE AND TRANSRECTAL ULTRASOUND IMAGE FOR THE DIAGNOSIS OF PROSTATE CANCER BASED ON PROSTATE IMAGE-REPORTING AND DATA SYSTEM

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2015MP11-08 MANUALLY CONTROLLED TARGETED BIOPSY WITH REAL-TIME FUSION IMAGE OF MULTIPARAMETRIC MAGNETIC RESONANCE IMAGE AND TRANSRECTAL ULTRASOUND IMAGE FOR THE DIAGNOSIS OF PROSTATE CANCER BASED ON PROSTATE IMAGE-REPORTING AND DATA SYSTEM Sunao Shoji, Shinichiro Hiraiwa, Akio Hashimoto, Kazunobu Hashida, Jun Endo, Tetsuro Tomonaga, Mayura Nakano, Takuma Tajiri, Toshiro Terachi, and Toyoaki Uchida Sunao ShojiSunao Shoji More articles by this author , Shinichiro HiraiwaShinichiro Hiraiwa More articles by this author , Akio HashimotoAkio Hashimoto More articles by this author , Kazunobu HashidaKazunobu Hashida More articles by this author , Jun EndoJun Endo More articles by this author , Tetsuro TomonagaTetsuro Tomonaga More articles by this author , Mayura NakanoMayura Nakano More articles by this author , Takuma TajiriTakuma Tajiri More articles by this author , Toshiro TerachiToshiro Terachi More articles by this author , and Toyoaki UchidaToyoaki Uchida More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.389AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report clinical results of manually controlled targeted biopsy with real-time multiparametric magnetic resonance image (mpMRI)-transrectal ultrasound (TRUS) fusion images for the diagnosis of prostate cancer based on prostate image-reporting and data system (PI-RAD). METHODS The patients with PSA level greater than 4.0 ng/ml and less than 20 ng/ml were performed mpMRI prospectively. All mpMRI images including T2WI, dynamic, DWI, and ADC map (Fig 1a). We performed targeted biopsies for each cancer-suspicious lesion and 12 systematic biopsies using the BioJet® (GeoScan, Lakewood Ranch, USA). Using the interactive needle guide system in the deivce, the biopsy template coordinates were shown on the monitor when the operator marked the target point of the region of interest (ROI) (Fig 1b) on the workstation. The operator inserted the needle at the template coordinates, and could get the prostate specimens by viewing the sagittal image of the prostate (Fig 1c). Pathological findings of targeted and systematic biopsies were analyzed. RESULTS Eighty one patients were included in this study. Median age of the patients was 69 years. Median preoperative PSA value was 6.8 ng/ml. Median preoperative prostate volume was 36 ml. The number of the cancer-detected cases was 45 (56%). Positive core length (p = 0.004), positive core percent (p < 0.0001), and Gleason score (p = 0.006) were also significantly different between targeted and systematic biopsies. Cancer detection rate of the patients with PI-RAD classification of 5 in TZ and PZ were 50% and 95%, respectively (p<0.0001). In 15 patients who underwent radical prostatectomy, the geographic locations and pathological grades of clinically significant cancers corresponded to the pathological results of the targeted biopsies. CONCLUSIONS The cancers detected by targeted biopsies with the present biopsy method had significantly higher grades and larger volumes length compared with those detected by the systematic biopsies. Further studies and the comparison to the pathological findings of whole-gland have potential to give a larger role to the present biopsy in areas such as patient selection of focal therapy and active surveillance. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e122 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunao Shoji More articles by this author Shinichiro Hiraiwa More articles by this author Akio Hashimoto More articles by this author Kazunobu Hashida More articles by this author Jun Endo More articles by this author Tetsuro Tomonaga More articles by this author Mayura Nakano More articles by this author Takuma Tajiri More articles by this author Toshiro Terachi More articles by this author Toyoaki Uchida More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Free-hand transperineal targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound: single-center experience in China.

To report our experience with free-hand transperineal targeted biopsy with real-time transrectal ultrasound (TRUS) and multiparametric magnetic resonance imaging (mpMRI) fusion images for the diagnosis of prostate cancer (PCa). A total of 62 consecutive patients suspicious of PCa at the mpMRI scan and PSA >4.0 ng/mL were recruited prospectively. Targeted biopsies (TBs) were carried out for each cancer-suspicious lesion and followed a 12-core systematic biopsy (SB) protocol. Pathological findings of TB and SB were analyzed. The age of the patients was 68.38 ± 6.57 years (range 51-79 years). The preoperative PSA value was 10.21 ± 5.57 ng/mL (range 4.5-30.1 ng/mL). Preoperative prostate volume was 34.05 ± 9.86 mL (range 19-64 mL). The PCa patients detected by SB and/or TB were 34 (54.8%). Cancer-detected rates of SB and TB cores were 7.53 and 26.2%, respectively (P < 0.001). The positive core length of SB and TB cores was 3.71 ± 2.77 mm (range 1-14 mm) and 5.00 ± 3.04 mm (range 2-17 mm), respectively (P = 0.016). The positive core percent of SB and TB cores was 28.77 ± 20.13% (range 7-100%) and 35.76 ± 18.73 (range 11-100%), respectively (P = 0.048). Moreover, clinically significant PCa cores detected by the SB and TB were 19 cores (2.6%) and 48 cores (18.5%), respectively (P < 0.001). Free-hand transperineal TB using real-time TRUS and mpMRI fusion imaging has the ability to improve sampling quality and detect more clinically significant PCa compared with SB.

One day surgery in the treatment of benign prostatic enlargement with thulium laser: A single institution experience.

PurposeVarious articles have previously addressed the introduction of new surgical laser therapies for an enlarged prostate gland causing obstructive symptoms. The objective of this study was to report the feasibility of performing the thulium laser vapo-enucleation of the prostate (ThuVEP) procedure for benign prostatic obstruction in a 1-day surgery.Materials and MethodsFrom September 2011 to September 2013, we conducted a prospective study on patients who underwent ThuVEP in a 1-day surgery. The primary outcomes measured perioperatively included operative time, resected tissue weight, hemoglobin decrease, transfusion rate, postoperative irrigation and catheterization time, and postoperative hospital stay. Also, the preoperative and postoperative International Prostate Symptom Score (IPSS) and results of uroflowmetry performed on the 7th and 30th postoperative days were recorded. All perioperative and postoperative complications were monitored.ResultsA total of 53 patients underwent the surgical treatment in a 1-day surgery. Seven patients continued antiaggregant therapy with aspirin. Mean preoperative prostatic adenoma volume was 56.6 mL. Mean operative time was 71 minutes. The average catheter time was 14.8 hours. The peak urinary flow rate on day 7 improved from 9.3 to 17.42 mL/s (p<0.001) and the IPSS improved from 18 to 10.2 (p<0.01). Patients were routinely discharged on the day of catheter removal. No complications were recorded.ConclusionsThuVEP can be safely conducted as a 1-day surgical procedure. This strategy results in cost savings. ThuVEP shows good standardized outcomes with respect to improvement in flow parameters and length of bladder catheterization.

A prospective, randomized comparative study of monopolar transurethral resection of the prostate versus photoselective vaporization of the prostate with GreenLight 120-W laser, in prostates less than 80 cc.

In this study we aimed to compare photoselective vaporization (PVP) with the GreenLight 120-W Laser and monopolar transurethral resection as surgical treatments of prostates less than 80 cc in men with obstructive benign prostatic hyperplasia. From February 2009 to March 2012 we allocated 101 patients with a prostate glands of less than 80 cc; patients were randomly assigned for surgical treatment with monopolar transurethral resection of the prostate (TURP) (n = 62) or PVP (n = 39). Serum prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax) postmicturition residual (PMR), transrectal ultrasound volumes (TRUS), postvoid urine residual (PVR), complications, re-operations and hospitalization time were collected. The patients were seen in the follow up at 6, 12 and 24 months. Median age was 69 (56-87) years old in the TURP group and 67 (51-87) years old in the PVP group. Mean preoperative prostate volume was 55 cc (40-72) and 60 cc (41-75) cc in the TURP group versus the PVP group. There was no statistically difference in subjectively (IPSS, SHIM) and objectively (Qmax-PMR) parameters and postoperatively complication rates between the two groups (p > 0.05). A significant difference was observed in the PVP group with a 2 (1-4) days hospital stay compared with 5 (3-9) days for the TURP group (p < 0.001). Prostate PVP and TURP are effective surgical treatments for benign prostatic hyperplasia. Postoperative functional improvements were durable and equivalent in the two groups. The two techniques have a similar complication rate.

Incidence of urethral stricture after bipolar transurethral resection of the prostate using TURis: results from a randomised trial.

To assess whether bipolar transurethral resection of the prostate (B-TURP) using the TURis system has a similar level of efficacy and safety to that of the traditional monopolar transurethral resection of the prostate (M-TURP), and to evaluate the impact of the TURis system on postoperative urethral stricture rates over a 36-month follow-up period. A total of 136 patients with benign prostatic obstruction were randomised to undergo either B-TURP using the TURis system or conventional M-TURP, and were regularly followed for 36 months after surgery. The primary endpoint was safety, which included the long-term complication rates of postoperative urethral stricture. The secondary endpoint was the follow-up measurement of efficacy. In peri-operative findings, no patient in either treatment group presented with transurethral resection syndrome, and the decline in levels of haemoglobin and hematocrit were similar. The mean operation time was significantly extended in the TURis treatment group compared with the M-TURP group (79.5 vs 68.6 min; P = 0.032) and postoperative clot retention was more likely to be seen after M-TURP (P = 0.044). Similar efficacy findings were maintained throughout 36 months, but a significant difference in postoperative urethral stricture rates between groups was detected (6.6% in M-TURP vs 19.0% in TURis; P = 0.022). After stratifying patients according to prostate volume, there was no significant difference between the two treatment groups with regard to urethral stricture rates in patients with a prostate volume ≤ 70 mL (3.8% in M-TURP vs 3.8% in TURis), but in the TURis group there was a significantly higher urethral stricture rate compared with the M-TURP group in patients with a prostate volume >70 mL (20% in TURis vs 2.2% in M-TURP; P = 0.012). Furthermore, the mean operation time for TURis was significantly longer than for M-TURP for the subgroup of patients with a prostate volume > 70 mL (99.6 vs 77.2 min; P = 0.011), but not for the subgroup of patients with a prostate volume ≤ 70 mL. The TURis system seems to be as efficacious and safe as conventional M-TURP except that there was a higher incidence of urethral stricture in patients with larger preoperative prostate volumes.