Preoperative Prostate Research Articles

PI-RADS v2 Findings of MRI and Positive Biopsy Core Percentage would Predict Pathological Extraprostatic Extension in Patients who Underwent Robot Assisted Radical Prostatectomy: A Retrospective Study.

This study aimed to examine whether preoperative Prostate Imaging Reporting and Data System v2 (PI-RADS v2) can predict pathological extracapsular extension (EPE) after radical prostatectomy. We also studied the preoperative factors which can predict EPE. In our institute, 294 patients underwent robot assisted radical prostatectomy (RARP) between December 2012 and August 2016. In this era, we performed MRI after biopsy to determine clinical stage before surgery. PI-RADS v2 scores were retrospectively reviewed using biparametric MRI and EPE in pathological mapping of resected specimens for each lobe. In the excised specimen, EPE was observed in 73 lobes (12%). The percentage of EPE by PI-RADS v2 score was score '1': 6% (17/297 lobes), '2': 3% (1/33 lobes), '3': 12% (8/67 lobes), '4': 19% (27/139 lobes), and '5': 38% (20/52 lobes). The higher the PI-RADS score, the higher the percentage of EPE (P <0.01). When classified as PI-RADS score ≥4 and <4, the positive predictive value (PPV) was 24.6% (47/191 lobes, 95%CI: 0.187 - 0.313) and negative predictive value (NPV) was 93.5% (371/397 lobes, 95%CI: 0.906 - 0.957). By multivariate analysis, positive biopsy core percentage ≥60%, and PI-RADS score ≥4 were independent factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively. PPV and NPV of PI-RADS ≥4 for predicting pathologic EPE were 24.6% and 93.5%, respectively. PI-RADS ≥4 and positive biopsy core percentage ≥60% were independent risk factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively.

Efficacy and Safety of Transurethral Enucleation of Prostate

Background: Benign Prostatic Hyperplasia (BPH) is one of the most common urological diseases seen in aging men. Surgical treatment is recommended for patients unresponsive to medical therapy or those who have developed BPH-related complications. Enucleation procedure distinguished itself as a successful treatment option in large BPH patients, mimics open prostate enucleation, characterized by good surgical efficiency, reduced complications, faster postoperative recovery, similar prostatic tissue ablation capabilities and satisfactory follow-up results compared with the open technique. Objectives: To assess the safety and efficacy of transurethral enucleation of prostate. Methods: Patients aged above 45 years with symptoms of bladder outlet obstruction due to BPH, with maximal urinary flow rate (Qmax) of &lt;15 ml/s, failure to relieve symptoms by medications or acute urinary retention failing at least one trial without catheter or recurrent gross hematuria due to prostatomegaly or upper urinary tract changes due to bladder outlet obstruction due to BPH and patient willing to undergo Transurethral Resection of the Prostate (TUEP) were included in this study. Results: In our study patients aged between 55-90 years were enrolled. Most common presenting complaints were frequency and acute urinary retention. Mean preoperative prostate size was 102.9 ± 10.90g with a range of 84-126 g. Mean operative time was 86.71 ± 5.24 minutes. The mean postoperative ID catheter was 2.1+1.63 days. Postoperative uroflowmetry and International Prostate Symptom Score (IPSS) improved significantly. Conclusion: TUEP represents a promising endoscopic approach in large Benign Prostate Enlargement (BPE) cases, mimics conventional open method of enucleation of the prostate while having all the advantages of a minimally invasive surgery.

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

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

Effects of 5-alpha reductase inhibitors prior to Holmium Laser Enucleation of the prostate: Does increased adenoma density result in prolonged morcellation times?

IntroductionThe use of 5-alpha reductase inhibitors (5-ARIs) has been shown to improve lower urinary tract symptoms (LUTS) and decrease prostate size in men with benign prostate hyperplasia (BPH). 5-ARI therapy could increase prostate tissue density through increased collagen deposition and contraction of stromal/epithelial components. Increased tissue density could prolong morcellation times, but the effects of preoperative 5-ARI exposure on morcellation efficiency during Holmium Laser Enucleation of the Prostate (HoLEP) are not well described. Herein, we examine outcomes after HoLEP of patients on pre-operative 5-ARIs.MethodsA retrospective review of patients undergoing HoLEP by an expert surgeon from Jan – Oct 2021 was performed. Student t-tests and chi-square tests were performed for continuous and categorical variables, respectively. Matched-pair analysis was performed using SPSS v28 (IBM, 2022). A p-value &amp;lt;0.05 was determined statistically significant. All other statistical analyses were performed using SAS v9.4 (SAS, 2019).ResultsA total of 322 patients underwent HoLEP during the study period and 84 patients had pre-operative 5-ARI exposure. Patients in the 5-ARI group had larger preoperative prostate size (p = 0.016). Morcellation time was longer (p=0.01), specimen weight was higher (p=0.02), and morcellation efficiency (p=0.02) was lower in the 5-ARI group. After matching, there were 67 patients in each chort (total 134) and these associations for size, morcellation time, specimen weight, and morcellation efficiency were no longer seen (p=0.8, 0.6, 0.5, and 0.7, respectively). Furthermore, no associations between 5-ARI and post-operative admissions or ED visits were noted.ConclusionIn this retrospective study, preoperative use of 5-ARIs did not affect enucleation or morcellation efficiency. Thus, preoperative 5-ARI therapy does not appear to alter outcomes after HoLEP.

Predictors of reoperation after transurethral resection of the prostate in a diverse, urban academic centre

Objective: To evaluate predictors of reoperation after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) in a diverse patient population. Materials and methods: A retrospective chart review was performed on men who underwent TURP between 2013 and 2016 at our institution with follow-up data post-operatively. Variables collected included patient demographics and clinical characteristics. Primary outcomes included whether the patient underwent repeat TURP and months elapsed since initial TURP. Results: A total of 304 men underwent TURP during the study period. Thirty men (10%) underwent repeat TURP at a mean interval of 26 months. Reoperation after TURP was not associated with race, body mass index (BMI), 5-alpha-reductase inhibitor (5-ARI) use, or pre-operative prostate volume. An elevated pre-operative haemoglobin A1c (HbA1c) was associated with both reoperation (odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.03–1.69), 30 day readmission (OR = 1.96, 95% CI: 1.17–3.28) and 30-day hematuria (OR: 2.37, 95% CI: 1.29–4.38). Pre-operative prostate specific antigen (PSA) levels &gt; 4 and hydronephrosis on imaging were also associated with a higher risk of reoperation. Conclusions: Reoperation after TURP occurred in 10% of our study cohort at a median of 26 months after surgery. Elevated HbA1c prior to surgery was associated with reoperation, 30-day readmission and 30-day hematuria. Higher risk of post-operative complications in patients with poorly controlled diabetes should be communicated at the time of decision for surgery. Future studies should evaluate whether optimising diabetes control prior to TURP reduces risk of reoperation or whether this risk is non-modifiable due to permanent changes in the lower urinary tract due to chronic hyperglycaemia. Level of evidence: III

Prediction of recovery time of urinary incontinence following robot-assisted laparoscopic prostatectomy.

Postoperative urinary incontinence recovery following robot-assisted laparoscopic prostatectomy is an important outcome. We investigated whether factors that affect urinary incontinence can predict the duration of postoperative incontinence recovery. A total of 310 patients underwent robot-assisted laparoscopic prostatectomy. Continence recovery was defined as either pad-free or a safety pad only status. Univariate and multivariate analyses were performed on clinical variables to identify those that were associated with continence recovery. A scoring system to predict recovered continence was constructed using statistically significant variables. The validity of this tool was tested in a new cohort of 273 patients. Factors associated with recovery of urinary incontinence were membranous urethral length, preservation of bilateral neurovascular bundles, and a preoperative Prostate Imaging Reporting and Data System score of ≥3 in the apex. Age was related only to incontinence recovery at 1 month. To prepare the score, weighting was performed using the estimated values. Using the developed scoring system, participants in the verification set were divided into three groups. The early recovery group had a median incontinence recovery of 4 (4-12) weeks, the medium recovery group, 12 (4-24) weeks, and the late recovery group, 24 (24-48) weeks, which was a significant difference (p < 0.001). The applied scoring system based on preoperative factors related to incontinence and derived from patient groups was significantly associated with continence recovery time. In patients undergoing robot-assisted laparoscopic prostatectomy, our unit-weighted regression model of clinical variables can predict the duration of continence recovery.

Robotic versus open simple prostatectomy for benign prostatic hyperplasia in large glands: single-centre study.

Robot-assisted simple prostatectomy (RASP) for benign prostatic hyperplasia (BPH) is a recently described surgical approach, but comparison with open simple prostatectomy (OSP) lack in the literature. We compared perioperative outcomes of OSP versus RASP. Patients who underwent simple prostatectomy between 2017 and 2020 were included in this retrospective study. OSP was performed by the transvesical technique and RASP was performed with a DaVinci Xi robot, using the transvesical extraperitoneal approach. Perioperative and postoperative data were compared and complications risk factors for complications were identified. and limitations. Overall, 103 patients were included (median age 72years [IQR = 67-76]). Forty-seven underwent RASP and 56 OSP. The median volume of the prostate gland was 130mL [IQR = 100-180] in the RASP group and 126mL [IQR = 100-160] in the OSP group. RASP was associated with a significant reduction in blood loss (median 200 vs. 400mL; p < 0.001), shorter hospital stay (5 vs. 10days; p < 0.001) and median catheterisation time (4 vs. 9days; p < 0.001). In the RASP group, there were fewer grade ≥ 2 complications (2 (4.3%) vs. 13 (23.2%); p = 0.005) and less need for transfusions (0 vs. 6 (11%), p = 0.005). Preoperative prostate volume was a risk factor for complications (OR = 1.2 [95% CI 1.1-1.5]; p = 0.01) while robot-assisted surgery was a protective factor (OR 0.3 [95% CI 0.05-0.9]; p = 0.05). Functional outcomes between the two groups were identical at 12months follow up. RASP is a safe and effective procedure. When compared with OSP, RASP was associated with decreased morbidity as well as reduced hospital stay and catheterisation time. Functional outcomes were comparable to the open approach.

Single-port Robotic Transvesical Partial Prostatectomy for Localized Prostate Cancer: Initial Series and Description of Technique

BackgroundPartial prostatectomy has been described as an alternative to focal therapy for the management of localized low- and intermediate-risk prostate cancer. ObjectiveTo describe early outcomes and technique for single-port (SP) transvesical partial prostatectomy. Design, setting, and participantsA retrospective analysis was performed for nine patients with low-volume, localized, low- to intermediate-risk prostate cancer (Gleason ≤7) undergoing SP transvesical partial prostatectomy replicating the inclusion criteria for focal therapy by a single surgeon from November 2020 to March 2022. Surgical procedureThe daVinci SP access port was inserted percutaneously into the bladder and pnuemovesicum was achieved. The camera, robotic instruments, assistant port, and flexible suction tubing were introduced through the access port. The Koelis transrectal ultrasound with preoperative prostate magnetic resonance imaging fusion was used for intraoperative guidance. MeasurementsDemographic information, intraoperative variables, and postoperative outcomes were collected in an institutional review board–approved database, and a descriptive statistical analysis was performed. Results and limitationsAll cases were completed without requiring extra ports or conversion. No intraoperative complications were noted, and all patients were discharged on the day of surgery. Pathology showed Gleason scores of 3 + 3 = 6 in one case, 3 + 4 = 7 in seven cases, and 4 + 3 = 7 in one case, all with negative intraoperative margin assessment. At 6 wk, the median prostate-specific antigen was 0.5 and the median Sexual Health Inventory for Men score was 17.5 from 23 preoperatively. All patients were continent at 6 wk. The limitations include a small number of patients, short follow-up, and single-surgeon experience. ConclusionsWe demonstrated the feasibility of the SP robotic transvesical partial prostatectomy. Early functional outcomes show impressive time to continence and erectile function. Continued follow-up will evaluate long-term oncologic outcomes. Patient summaryWe performed partial prostatectomies in selected patients as an alternative to focal therapy using a novel transvesical single-port approach. Our approach was safe and feasible, with fewer complications and promising initial return to continence and erectile function.

Effect of digital-enabled multidisciplinary therapy conferences on efficiency and quality of the decision making in prostate cancer care

ObjectivesTo investigate the impact on efficiency and quality of preprostatectomy multidisciplinary therapy conferences (MDT) at Karolinska University Hospital related to the use of a digital solution compared with standard of...

Salvage versus primary holmium laser enucleation of the prostate: trends, outcomes and safety analysis.

To study the safety, efficacy and trends in index procedures leading to salvage holmium laser enucleation of the prostate (S-HoLEP). This was a single-institution retrospective review of HoLEPs performed between 2006 and 2020. Patients who underwent S-HoLEP were compared to those undergoing primary holmium laser enucleation of the prostate (P-HoLEP). The endpoint of primary interest were functional outcomes. Changes in index procedures over the study period were analyzed. A total of 633 HoLEPs were performed during the study, with 217 being S-HoLEP. The S-HoLEP cohort was older than P-HoLEP cohort, 71.2years vs 68.8years (p = 0.03). All other factors were well matched. The most common index procedures prior to S-HoLEP included transurethral resection of the prostate (TURP) (87, 40.1%), transurethral microwave thermotherapy (TUMT) (44, 20.3%), photoselective vaporization of the prostate (PVP) (24, 11.1%) and prostatic urethral lift (PUL) (24, 11.1%). Preoperative prostate volume, IPSS and Qmax were similar between groups. Intra-operatively, S-HoLEP had longer procedure and morcellation times (p = 0.01 and 0.007). Postoperatively, the S-HoLEP cohort had longer catheter duration and hospitalization (both p < 0.001). Postoperative Qmax, IPSS and 90-day complication rates were similar. On temporal analysis, minimally invasive surgical therapies (MIST) have become more prevalent as index procedures. S-HoLEP is safe and efficacious for patients requiring additional BPH surgical intervention. S-HoLEP patients had longer operative times and hospital stays but equivalent postoperative functional outcomes compared to P-HoLEP. As MIST mature and gain traction, it is expected that rates of S-HoLEP will continue to rise.

Effect of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Prostatectomy on Trifecta Outcomes: A Randomized Clinical Trial.

Planning complex operations such as robotic-assisted radical prostatectomy requires surgeons to review 2-dimensional magnetic resonance imaging (MRI) cross-sectional images to understand 3-dimensional (3D), patient-specific anatomy. We sought to determine surgical outcomes for robotic-assisted radical prostatectomy when surgeons reviewed 3D, virtual reality (VR) models for operative planning. A multicenter, randomized, single-blind clinical trial was conducted from January 2019 to December 2020. Patients undergoing robotic-assisted laparoscopic radical prostatectomy were prospectively enrolled and randomized to either a control group undergoing usual preoperative planning with prostate biopsy results and MRI only or to an intervention group where MRI and biopsy results were supplemented with a 3D VR model. The primary outcome measure was margin status, and secondary outcomes were oncologic control, sexual function and urinary function. Ninety-two patients were analyzed, with trends toward lower positive margin rates (33% vs 25%) in the intervention group, no significant difference in functional outcomes and no difference in traditional operative metrics (p >0.05). Detectable postoperative prostate specific antigen was significantly lower in the intervention group (31% vs 9%, p=0.036). In 32% of intervention cases, the surgeons modified their operative plan based on the model. When this subset was compared to the control group, there was a strong trend toward increased bilateral nerve sparing (78% vs 92%), and a significantly lower rate of postoperative detectable prostate specific antigen in the intervention subset (31% vs 0%, p=0.038). This randomized clinical trial demonstrated patients whose surgical planning involved 3D VR models have better oncologic outcomes while maintaining functional outcomes.

Clinicopathological significance of 114 cases with positive surgical margin in radical prostatectomy specimens

Objective: To analyze the clinicopathological features of positive surgical margins (PSM) after radical prostatectomy and to explore its associated factors. Method: A retrospective analysis was conducted on 274 patients who underwent radical prostatectomy in Beijing Hospital from June 2018 to June 2021. The margins of these specimens of radical prostatectomy were directly inked with black ink. According to the margin status (tumor present versus not), the patients were divided into PSM and negative surgical margin (NSM) groups. The clinicopathological characteristics were compared between two groups, including age, preoperative prostate specific antigen (PSA), number of tumors, tumor's location, postoperative pathological Gleason score, tumor burden and postoperative pathological staging. Results: Among the 274 cases, 114 showed PSM, and 160 showed NSM. PSM accounted for 41.6% of the cases. The mean age was 68.3 years, while the PSM group's mean age was 68.0 years, and that of the NSM group was 68.6 years, with no statistical significance between groups (P>0.05). The mean preoperative PSA was 15.8 μg/L in all patients, 21.5 μg/L in the PSM group and 11.3 μg/L in NSM group. PSA in the PSM group was statistically higher than that in the NSM group (P<0.001). The PSA level (10 μg/L, 10-20 μg/L, and >20 μg/L) was associated with the PSM rate (31.1%, 48.7%, and 69.4%). Regarding tumor numbers, 118 cases had a single focus, including 40 cases with PSM (33.9%). In the 156 cases of multiple foci, 74 cases had a PSM (47.4%). There were statistically more PSM cases in the cases with multi-focal disease (P<0.05). Tumors were seen in the transit zone of 44 cases, while 107 cases showed tumors in the peripheral zone, and 123 cases in the whole zone. The PSM rate was 27.3% (12/44), 40.2% (43/107), and 48.0% (59/123) by tumor location, respectively, but the difference among groups was not statistically significant (P>0.05). The postoperative Gleason scores were 3+3=6 in 51 cases, 3+4=7 in 98 cases, 4+3=7 in 81 cases, and ≥8 in 44 cases, with PSM rates of 19.6% (10/51), 38.8% (38/98), 45.7% (37/81) and 65.9% (29/44), respectively (P<0.001 for rate differences). The tumor burden was <30% in 157 cases, 30%-60% in 91 cases, and>60% in 26 cases, with PSM rate of 21.0% (33/157), 65.9% (60/91) and 80.8% (21/26), respectively (P<0.001 for rate differences). Moreover, there were 181 cases of pathological stage T2 (PSM rate, 29.3%) and 93 cases of pathological stage T3 (PSM rate, 65.6%), with statistical difference in PSM rates (P<0.001). The multivariable logistic regression analysis indicated that preoperative PSA >20 μg/L, postoperative Gleason score ≥8, high tumor burden and pathological stags were different between the PSM and NSM groups (P<0.05). Conclusions: The PSM of radical prostatectomy is closely related to the preoperative PSA level, the number of lesions, postoperative Gleason score, tumor burden and pathological stage. Preoperative PSA level >20 μg/L, postoperative Gleason score ≥8, high tumor burden and pathological stage are independent predictors for PSM.

Prostate resection weight matters in severely obstructed men undergoing transurethral resection of the prostate.

Transurethral resection of the prostate (TURP) remains one of the goldstandard surgical treatments for benign prostatic hyperplasia/lower urinary tract symptoms. The usefulness of a complete adenoma resection is questionable, with studies reporting no impact of the amount of resected tissue on surgical outcomes, irrespective of prostate volume. The aim of this study was to assess whether in less obstructed patients a less extensive TURP may be considered. Retrospective analysis of 185 men undergoing TURP in one university hospital. Retrieved data included pre-operative prostate volume and Qmax, as well as resected prostate weight and post-operative Qmax. Patients were divided in two groups according to pre-operative Qmax < 10mL/s and ≥ 10 mL/s. A correlation was found between absolute resected prostate weight and post-operative Qmax in the group of patients with pre-operative Qmax < 10 mL/s (r2 = 0.038, p = 0.032), independently of the pre-operative prostate volume. This association was neither observed in the group of patients with pre-operative Qmax ≥ 10 mL/s (r2 = -0.033, p = 0.796) nor in whole population analysis (r2 = 0.019, p = 0.064). Likewise, in the group of patients with pre-operative Qmax < 10 mL/s, the improvement in Qmax was correlated with absolute resected weight and percentage of prostate resected weight (r2 = 0.036, p = 0.037 and r2 = 0.040, p = 0.029, respectively). None of these correlations was found in the group of patients with pre-operative Qmax ≥ 10 mL/s (r2 = 0.009, p = 0.463 and r2 = -0.018, p = 0.294, respectively). Patients with pre-operative Qmax ≥ 10 mL/s may do well with less profound prostate resections, whereas patients with lower pre-operative Qmax seem to benefit from a complete adenoma resection.

Radiomics-Based Machine Learning Models for Predicting P504s/P63 Immunohistochemical Expression: A Noninvasive Diagnostic Tool for Prostate Cancer.

ObjectiveTo develop and validate a noninvasive radiomic-based machine learning (ML) model to identify P504s/P63 status and further achieve the diagnosis of prostate cancer (PCa).MethodsA retrospective dataset of patients with preoperative prostate MRI examination and P504s/P63 pathological immunohistochemical results between June 2016 and February 2021 was conducted. As indicated by P504s/P63 expression, the patients were divided into label 0 (atypical prostatic hyperplasia), label 1 (benign prostatic hyperplasia, BPH) and label 2 (PCa) groups. This study employed T2WI, DWI and ADC sequences to assess prostate diseases and manually segmented regions of interest (ROIs) with Artificial Intelligence Kit software for radiomics feature acquisition. Feature dimensionality reduction and selection were performed by using a mutual information algorithm. Based on screened features, P504s/P63 prediction models were established by random forest (RF), gradient boosting decision tree (GBDT), logistic regression (LR), adaptive boosting (AdaBoost) and k-nearest neighbor (KNN) algorithms. The performance was evaluated by the area under the ROC curve (AUC) and accuracy.ResultsA total of 315 patients were enrolled. Among the 851 radiomic features, the 32 top features were derived from T2WI, in which the gray-level run length matrix (GLRLM) and gray-level cooccurrence matrix (GLCM) features accounted for the largest proportion. Among the five models, the RF algorithm performed best in general evaluations (microaverage AUC=0.920, macroaverage AUC=0.870) and provided the most accurate result in further sublabel prediction (the accuracies of label 0, 1, and 2 were 0.831, 0.831, and 0.932, respectively). In comparative sequence analyses, T2WI was the best single-sequence candidate (microaverage AUC=0.94 and macroaverage AUC=0.78). The merged datasets of T2WI, DWI, and ADC yielded optimal AUCs (microaverage AUC=0.930 and macroaverage AUC=0.900).ConclusionsThe radiomic-based RF classifier has the potential to be used to evaluate the presurgical P504s/P63 status and further diagnose PCa noninvasively and accurately.

Predictive Value of Voiding Efficiency After Active Void Trial in Men Undergoing BPH Surgery

ObjectivesTo determine the predictive value of voiding efficiency on acute urinary retention after discharge from BPH surgery. Materials and methodsWe performed a prospective observational cohort study of three surgeons’ practices from 2019 to present. All men included underwent trial of void on post-operative day one after transurethral resection of prostate or Holmium enucleation of prostate . Active filling void trials were performed on all patients and voiding efficiency (percent of bladder volume emptied) was calculated. Multivariable logistic regression was performed to determine predictors of developing acute urinary retention. ResultsDuring the study period, 188 men met inclusion criteria. 110 (59%) men underwent Holmium enucleation of prostate , and 78 (41%) underwent transurethral resection of prostate. The median age of our cohort was 70 (IQR 65-75). The median prostate size was 100g (IQR 61-138g). Nineteen patients (10%) returned after discharge with acute urinary retention requiring catheterization. On post-operative day one, the median voiding efficiency was 75% (IQR 55%-94%). On multivariable analysis, patients with a voiding efficiency less than 50% were 3.8 times more likely (95% confidence interval 1.1-12.8) to develop subsequent retention compared to a voiding efficiency of greater than 75%. Increasing pre-operative prostate size was associated with lower risk of urinary retention after discharge (aOR 0.8, 95%CI 0.6-0.9). ConclusionsVoiding efficiency after an active void trial helps stratify risk of urinary retention in patients undergoing benign prostate surgery. High-risk patients include those with voiding efficiencies less than 50% and smaller pre-operative prostate sizes (<80g).

Elevated IsoPSA Selects for Clinically Significant Prostate Cancer Without a Preference for Any Particular Adverse Histopathologic or Radiographic Feature

OBJECTIVETo explore if elevated IsoPSA selects for particular adverse radiographic or histopathologic features among men destined to undergo radical prostatectomy (RP) because of clinically significant prostate cancer identified at biopsy. MATERIALS AND METHODSSingle center, retrospective review of patients who had undergone IsoPSA testing, prostate biopsy and RP at our institution from 2019-2021. A consecutive cohort of patients whom had undergone RP within the same period without pre-operative IsoPSA served as controls. Pre-operative prostate Magnetic Resonance Imaging (MRI) was included in our analysis. Adverse histopathologic and MRI features were compared between both groups. Concordance, downstaging, and upstaging grade group rates (GG) was evaluated. Pearson Chi-Square test was used to compare categorical variables, Wilcoxon-Rank sum test for quantitative variables, and binary logistic regression to identify predictors of upstaging at RP. RESULTSEighty-three patients underwent IsoPSA and RP while 44 patients were controls. The IsoPSA group had significantly higher pre-operative PSA (IsoPSA group: 7.8 ng/mL vs Control group: 5.2 ng/mL, P<.001 ). Elevated IsoPSA index (>6.0) did not select for any specific adverse histopathologic features at RP. Excluding PSA density, elevated IsoPSA was not selective for adverse MRI features. There were no differences in concordance, downstaging, and upstaging GG rates from biopsy to RP. IsoPSA testing was not a predictor of GG upstaging (Odds Ratio: 0.63, P .58). CONCLUSIONElevated IsoPSA is a diagnostic tool that can detect clinically significant prostate at the time of biopsy. In doing so, it does not select for any particular adverse prostate MRI or pathologic feature at RP.

Morphometric Analysis of Prostate Zonal Anatomy After Transurethral Resection of Prostate and Holmium Laser Enucleation of Prostate Using Magnetic Resonance Imaging: A Pilot Study.

The primary purpose was to compare the completeness of adenomectomy and zonal anatomy of prostate on magnetic resonance imaging prostate after transurethral resection of prostate and Holmium enucleation of prostate. The secondary purpose was to investigate the relationship between preoperative total prostate volume and postoperative transition zone and peripheral zone volume after both procedures. A retrospective review of all patients who underwent transurethral resection of pros- tate or Holmium enucleation of prostate over 3 years (2017-2020) and had at least 1 postoperative magnetic resonance imaging prostate was performed. Volume estimations of the prostate and individual zones were per- formed, and statistical comparisons were made to evaluate morphometric changes between the 2 procedures. A total of 9 patients (mean age, 71.8 years) underwent transurethral resection of prostate and 12 patients (mean age, 66.9 years) underwent Holmium enucleation of prostate. The median pre-operative prostate volume in the Holmium enucleation of prostate group was higher than the transurethral resection of prostate group (101.5 g vs. 62 g; P =.102). However, there was a significant difference in the resected tissue weight favoring Holmium enucleation of prostate over transurethral resection of prostate (P value=.004). The postoperative transition zone and peripheral zone volume as calculated by magnetic resonance imaging remained relatively constant in both procedures. The peripheral zone volume on postoperative magnetic res- onance imaging was found to be independent of transition zone volume even for very large-sized prostates. A well-performed transurethral resection of prostate or Holmium enucleation of prostate cannearly completely eliminate the transition zone volume, irrespective of the size of the prostate as confirmed by magnetic resonance imaging prostate. Additionally, the peripheral zone volume is consistent across the entire spectrum of the prostate size.

MP04-16 THULIUM YAG VS THULIUM FIBER LASER ENUCLEATION OF THE PROSTATE (THULEP VS TFLEP): A MULTI-INSTITUTION TRIAL TO COMPARE INTRA AND EARLY POSTOPERATIVE OUTCOMES

You have accessJournal of UrologyCME1 May 2022MP04-16 THULIUM YAG VS THULIUM FIBER LASER ENUCLEATION OF THE PROSTATE (THULEP VS TFLEP): A MULTI-INSTITUTION TRIAL TO COMPARE INTRA AND EARLY POSTOPERATIVE OUTCOMES Matteo Maltagliati, Lorenzo Berti, Salvatore Micali, Umberto Besana, Carlo Buizza, Bernardo Rocco, Maria Chiara Sighinolfi, Andrea Pacchetti, Jean Baptiste Roche, and Giorgio Bozzini Matteo MaltagliatiMatteo Maltagliati More articles by this author , Lorenzo BertiLorenzo Berti More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , Umberto BesanaUmberto Besana More articles by this author , Carlo BuizzaCarlo Buizza More articles by this author , Bernardo RoccoBernardo Rocco More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Andrea PacchettiAndrea Pacchetti More articles by this author , Jean Baptiste RocheJean Baptiste Roche More articles by this author , and Giorgio BozziniGiorgio Bozzini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare clinical intra and early postoperative outcomes between Thulium laser Enucleation of the Prostate (ThuLEP) and Thulium Fiber Laser Enucleation of the Prostate (TFLEP) in the treatment of benign prostatic hyperplasia (BPH). METHODS: 240 patients suffering from lower urinary tract symptoms due to BPH were consecutively enrolled and randomized to either BPH to ThuLEP (n=117) or TFLEP (n=123). Patients were evaluated preoperatively using the International Prostate Symptom Score (IPSS), Quality of Life score (QoL), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). Preoperative prostate volume, PSA and haemoglobin were also recorded. All the patients were evaluated postoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. 3 months after surgery micturition improvement was evaluated using the IPSS, Qmax and PVR. RESULTS: No significant differences were found between the patients in the two study arms. Compared with TFLEP, ThuLEP determined a shorter operative time (63.69 ± 41.44 vs 79.66 ± 48.70 minutes, p=0.045). No significant differences were found between ThuLEP and TFLEP in terms of haemoglobin decrease (0.45 vs 0.47 g/dl, p=0.32), catheterization time (1.9 vs 2.1 days, p=0.37), irrigation volume (29.4 vs 32.8 l, p=0.43), and hospital stay (2.2 vs 2.6 days, p=0.22). During the 3 months of follow-up, the procedures did not demonstrate significant differences in Qmax, IPSS, PVR, and QoL. CONCLUSIONS: ThuLEP and TFLEP both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TFLEP in terms of duration of the procedure. Catheterization time, irrigation volume, hospital stay and operative time were comparable. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e64 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matteo Maltagliati More articles by this author Lorenzo Berti More articles by this author Salvatore Micali More articles by this author Umberto Besana More articles by this author Carlo Buizza More articles by this author Bernardo Rocco More articles by this author Maria Chiara Sighinolfi More articles by this author Andrea Pacchetti More articles by this author Jean Baptiste Roche More articles by this author Giorgio Bozzini More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD54-03 ARTIFICIAL INTELLIGENCE IN ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY: DEVELOPING PREDICTIVE MODELS FOR POSITIVE SURGICAL MARGINS

You have accessJournal of UrologyCME1 May 2022PD54-03 ARTIFICIAL INTELLIGENCE IN ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY: DEVELOPING PREDICTIVE MODELS FOR POSITIVE SURGICAL MARGINS Stephen Schmit, Rebecca Ortiz, Philip Caffery, Christopher Tucci, Carsten Eickhoff, Elias Hyams, and Gyan Pareek Stephen SchmitStephen Schmit More articles by this author , Rebecca OrtizRebecca Ortiz More articles by this author , Philip CafferyPhilip Caffery More articles by this author , Christopher TucciChristopher Tucci More articles by this author , Carsten EickhoffCarsten Eickhoff More articles by this author , Elias HyamsElias Hyams More articles by this author , and Gyan PareekGyan Pareek More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002631.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with localized prostate cancer increasingly elect for robotic-assisted laparoscopic prostatectomy (RALP), but this approach may be less preferred when adjuvant therapy is indicated. Adjuvant therapy improves survival but is associated with significant psychological distress and additional treatment complications. The presence of positive surgical margins after RALP is an important indication for adjuvant therapy. The goal of this study was to explore deep learning models for the prediction of positive surgical margins with preoperative data. METHODS: Patient data from a single academic institution was pre-processed to train two artificial intelligence models: a feedforward multilayer perceptron and a random forest model containing 100 trees. A total of 9 preoperative variables were used for model training (prostate specific antigen value, positive biopsy cores, Gleason score on biopsy, perineural invasion on biopsy, body mass index, tobacco use history, family history of cancer, preoperative prostate volume, and age at diagnosis). Model construction was performed using the Python programming language. RESULTS: Data preprocessing yielded a final sample of 461 patients. The optimized neural network demonstrated successful learning with loss minimization over 100 epochs (Figure 1) and a maximum area under the curve (AUC) of 0.60. The random forest model demonstrated an AUC of 0.55 (Figure 2). CONCLUSIONS: Neither model demonstrated significant accuracy in predicting positive surgical margins with preoperative structured data. The integration of structured data may be insufficient for predicting margin status. Future models that utilize raw imaging information should be explored. For example, a convolutional neural network that is trained on preoperative multiparametric resonance imaging data may be a superior approach. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e916 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Schmit More articles by this author Rebecca Ortiz More articles by this author Philip Caffery More articles by this author Christopher Tucci More articles by this author Carsten Eickhoff More articles by this author Elias Hyams More articles by this author Gyan Pareek More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD27-02 IS CAPSULAR ABUTMENT ON MRI A PREDICTOR OF EXTRAPROSTATIC EXTENSION (EPE) ON RADICAL PROSTATECTOMY?

You have accessJournal of UrologyCME1 May 2022PD27-02 IS CAPSULAR ABUTMENT ON MRI A PREDICTOR OF EXTRAPROSTATIC EXTENSION (EPE) ON RADICAL PROSTATECTOMY? Mohammad Siddiqui, Jonathan Aguiar, Eric Li, Brandon Ansbro, Moataz Soliman, Mary-Kate Keeter, Quan Mai, Edward Schaeffer, and Ashley Ross Mohammad SiddiquiMohammad Siddiqui More articles by this author , Jonathan AguiarJonathan Aguiar More articles by this author , Eric LiEric Li More articles by this author , Brandon AnsbroBrandon Ansbro More articles by this author , Moataz SolimanMoataz Soliman More articles by this author , Mary-Kate KeeterMary-Kate Keeter More articles by this author , Quan MaiQuan Mai More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Ashley RossAshley Ross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002575.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Extraprostatic extension (EPE) on radical prostatectomy (RP) pathology is an established prognostic indicator of recurrence and metastasis. Furthermore, suspicion of EPE guides neurovascular preservation during surgery. Here we investigate whether capsular ‘abutment’ on pre-operative mpMRI of the prostate predicts pathological findings. METHODS: We queried our prospectively collected institutional database from 2018 for all men undergoing radical prostatectomy (RP) who had undergone preoperative prostate MRI. Statistics were performed using t-test, chi-squared analysis, and logistical regressions with significance defined as p <0.05. RESULTS: 539 men underwent RP since March 2018. 307 (56%) men had pre-operative MRI. 163 (53.1%) had abutment of the capsule on MRI. For men with capsular abutment, 75 (46.25%) had EPE at prostatectomy (matched laterality in 42 (56%), on the contralateral side from their MRI lesion in 33 (44%)). 65/144 (45.1%) of men without capsular abutment on MRI had EPE on RP pathology. Men with ipsilateral EPE to their MRI lesions with capsular abutment were more likely to have a higher total prostate health index (PHI) (mean 64.20 vs. 50.95, p-value 0.024), and higher Gleason Grade Group (GG) lesion on diagnostic biopsy (p-value 0.001). Independent predictors of having ipsilateral EPE on multivariable logistic regression analysis include GG3 (OR 3.65, 95% CI 1.2-11.1) and GG4 (OR 4.7, 95%CI 1.2-18.8) on primary biopsy. On multivariable logistic regression analysis, MRI PIRADS scores were not predictive of either presence of ‘any’ EPE or ipsilateral EPE on final RP pathology. CONCLUSIONS: In our series, the presence or absence of “capsular abutment” alone read on MRI was a poor indicator of extra-prostatic extension on final pathology. Source of Funding: UROLOGY CARE FOUNDATION RESIDENCY RESEARCH AWARD © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e493 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammad Siddiqui More articles by this author Jonathan Aguiar More articles by this author Eric Li More articles by this author Brandon Ansbro More articles by this author Moataz Soliman More articles by this author Mary-Kate Keeter More articles by this author Quan Mai More articles by this author Edward Schaeffer More articles by this author Ashley Ross More articles by this author Expand All Advertisement PDF DownloadLoading ...