Prostate Size Research Articles

Effects of a proprietary mixture of extracts from Sabal serrulata fruits and Urtica dioica roots (WS®1541) on prostate hyperplasia and inflammation in rats and human cells.

Introduction: Phytotherapeutics, particularly extracts from Sabal serrulata (saw palmetto) fruit or Urtica dioica (stinging nettle) root, are popular for the treatment of male lower urinary symptoms in many countries, but their mechanism of action is poorly understood. We performed in vivo and in vitro studies to obtain deeper insight into the mechanism of action of WS®1541, a proprietary combination of a Sabal serrulata fruit and an Urtica dioica root extract (WS® 1473 and WS®1031, respectively) and its components. Methods: We used the sulpiride model of benign prostatic hyperplasia in rats and tested three doses of WS®1541 in comparison to finasteride, evaluating weight of prostate and its individual lobes as well as aspects of inflammation, oxidative stress, growth and hyperplasia. In human BPH-1 cells, we studied the effect of WS®1473, WS®1031, WS®1541 and finasteride on apoptosis, cell cycle progression and migrative capacity of the cells. Results: WS®1541 did not reduce prostate size in sulpiride treated rats but attenuated the sulpiride-induced changes in expression of most analyzed genes and of oxidized proteins and abrogated the epithelial thickening. In vitro, WS®1473 and WS®1031 showed distinct profiles of favorable effects in BPH-1 cells including anti-oxidative, anti-proliferative and pro-apoptotic effects, as well as inhibiting epithelial-mesenchymal-transition. Conclusion: This data supports a beneficial effect of the clinically used WS®1541 for the treatment of lower urinary tract symptoms associated with mild to moderate benign prostate syndrome and provides a scientific rationale for the combination of its components WS®1473 and WS®1031.

Evaluation of early apical release with bipolar Collins knife versus Thulium-Yag laser enucleation of large-sized prostate. A randomized study

ABSTRACT Introduction and objectives Anatomical endoscopic enucleation of the prostate (AEEP) provides durable management for patients with lower urinary tract symptoms (LUTS) secondary to large-sized prostate over other surgical modalities. We aimed to assess the early outcomes of Collins knife-assisted bipolar enucleation (BipolEP) versus Thulium-Yag enucleation (ThuLEP) in a group of patients with LUTS secondary to a prostate larger than 80 grams. Methods We included patients with benign prostatic hyperplasia (BPH) having a prostate volume > 80 grams, international prostate symptom score (IPSS) >7, urine flow (Q-max) <15, and post-void residual (PVR)>150 ml. We excluded those with a history of previous prostatic surgery, stone, or neurogenic bladder. Bipolar enucleation with early apical release was performed using Collins knife at an 80/100-watt setting (Lamidey Noury), while ThuLEP was conducted using 550- micron fiber and 40/15-watt energy (Lisa Laser). Patients were evaluated before then 2 weeks and 3, 6,12 months postoperatively for changes in IPSS, Q- max, PVR, and the incidence of stress incontinence. Result One hundred and twenty patients were equally randomized with a mean prostate size of 104 ± 25 gram. The mean IPSS score was 25 ± 6, Qmax 7.6 ± 1.3 mL/S, and PVR 225 ± 39. There was no significant difference regarding enucleation time, morcellation time, and enucleated tissue volume. Irrigation volume and post-operative hemoglobin drop were significantly lower in the bipolar group (p = 0.008, p = 0.0002), respectively. At the third-month follow-up, IPSS, Q-max, and PVR were comparable across both groups, with stress incontinence at 3.3% in the bipolar group versus 1.6% in the thulium group, showing an insignificant difference (p = 0.5).” Conclusion Both BipolEP and ThuLEP, with early apical release, provide a safe and effective management of large-size prostate resulting in significant decrease in post-operative stress incontinence incidence during early follow-up. Intraoperative irrigation saline volume, and post-operative hemoglobin drop favored the bipolar group.

A new promising indicator in prostate cancer screening: Prostate-specific antigen fluctuation rate

ObjectivesTo evaluate whether PSA fluctuation can be used to predict the risk of prostate cancer. Materials and methodsThe study included 1244 patients who underwent prostate biopsy at Kartal Dr. Lutfi Kirdar City Hospital between 2013 and 2021 (848 in non-cancer; 396 in cancer). The patient's age, last two PSA values (PSA1 and PSA2) within three months before the biopsy, the duration between two PSAs (days), prostate size (g) and PSA density (PSAD) were all recorded. PSA fluctuation rate (PSAfr) was defined as the change rate between two PSA values. ResultsPSAfr was significantly higher in the non-cancer group than in the prostate cancer group (15.2% (20.5) and 9.6% (14.4), P=.019). A Simple linear regression was used to examine the relationship between PSAfr and other factors such as age, PSA, PSAD, and prostate volume, but it was shown that these had no effect on PSA fluctuations. ROC analysis revealed a relatively low Area Under the Curve (AUC) for PSAfr (AUC, 0.584 (0.515–0.653)). However, the cut-off value of 12.35% was found to be significant, with a sensitivity of 58% and a specificity of 59% (P:.019, 95%CI). The odds ratio, adjusted for age, PSAD, and PSA2, was calculated as 0.545 (0.33−0.89) using logistic regression analysis to show the relationship between prostate cancer and PSAfr. As a result, those with high PSAfr were found to be 1.83 times less likely to be diagnosed with prostate cancer than those with low fluctuations. ConclusionPSAfr could be used in nomograms to predict prostate cancer risk and reduce the number of unnecessary biopsies.

Effects of Prostatic Inflammation on Clinical Outcomes in Patients with Benign Prostate Hyperplasia

Background: Benign prostate hyperplasia (BPH), a non-cancerous enlargement of the prostate gland, prevalently impacts the aging male population, often disrupting the quality of life with its accompanying urinary symptoms. The intersection between BPH and prostatic inflammation has emerged as a focal point in urological research, with inflammation speculated to exacerbate BPH progression and symptoms. Understanding this relationship is pivotal in refining therapeutic approaches and improving patient outcomes. Objective: This study aimed to elucidate the effects of prostatic inflammation on the clinical outcomes of patients with BPH, focusing on symptom progression, treatment efficacy, and long-term complications. Methods: This Study Conducted at Gajju Khan Medical College Swabi, KPK, Pakistan, in the duration from January, 2023 to June, 2023. This prospective cohort study involved 126 men with BPH, categorized into two groups based on the presence (n=63) or absence (n=63) of prostatic inflammation. Data were collected over three years, with assessments including demographic information, clinical histories, and prostate examinations. Primary outcomes measured were the progression of BPH symptoms, urinary function, and prostate size. Secondary outcomes included quality of life, acute urinary retention, the need for surgical intervention, medication efficacy, and long-term complications. Statistical analyses employed included Chi-square tests, t-tests, and ANOVA, with SPSS software. Results: The group with prostatic inflammation showed significantly more severe symptom progression (p &lt; 0.01), impaired urinary function (p &lt; 0.01), and increased prostate size (p &lt; 0.01) compared to the non-inflamed group. Secondary outcomes also favored the non-inflamed group with better quality of life scores (75.2 ± 5.2 vs. 78.8 ± 4.8, p &lt; 0.01), lower rates of acute urinary retention (20.3% vs. 15.5%, p &lt; 0.01). Conclusion: Prostatic inflammation significantly worsens the clinical outcomes of BPH, affecting symptom progression, treatment response, and the likelihood of long-term complications. These findings suggest the need for integrated therapeutic strategies that address both BPH and prostatic inflammation to optimize patient care.

(122) Preservation of Sexual Function: 12-month Outcomes from a Randomized, Double-Blind, Sham Controlled Study Evaluating the Optilume BPH System, a Novel Drug Coated Balloon

Abstract Introduction Many front-line treatments for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), such as medications and transurethral resection of the prostate, have well established negative effects on sexual function. New minimally invasive surgical therapy (MIST) for LUTS/BPH need to preserve sexual function to meet the needs of men. Data from the randomized controlled blinded study of the Optilume BPH System was analyzed to evaluate the sexual side effects of this novel treatment. Objective The PINNACLE study is a prospective, randomized, double-blind, sham controlled study evaluating the Optilume BPH System. Optilume BPH is a novel MIST that combines mechanical dilation with delivery of paclitaxel for treatment of LUTS/BPH. The mechanical dilation with Optilume BPH achieves an anterior commissurotomy, while delivery of paclitaxel is intended to maintain luminal patency during healing, while preserving sexual function. Methods 148 subjects with symptomatic LUTS/BPH and a prostate size between 20-80 grams were randomized in a 2:1 fashion (Optilume to Sham) at 18 centers in the US and Canada. Follow-up is complete through 12-months. To evaluate the effect of the treatment on sexual function, the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire to assess Ejaculatory Dysfunction (MSHQ-EjD) questionnaires were used. Questionnaires were administered at baseline and 3, 6, and 12-months post procedure, regardless of sexual activity at baseline. A sub-set of 15 non-randomized subjects treated with Optilume BPH underwent further testing for semen quality and measurement of the amount of paclitaxel found in semen post-treatment. Results The average IIEF-EF score at baseline was 15-16 for both arms, mild to moderate erectile dysfunction (Figure 1). Scores across all domains improved slightly from baseline through 12 months, indicating that treatment with the Optilume BPH device had no significant impact on perceived sexual function. This finding is consistent when looking at men who were sexually active at baseline (Figure 2). Ejaculatory function also showed slight improvement from baseline to 12 months in both the overall population and the subset of men who were sexually active at baseline (Figure 1, Figure 2). There is no appreciable change in ejaculation bother from baseline to 12-months in the overall population and the sexually active subset (Figure 1, Figure 2). Overall semen quality parameters did not change post-procedure (Table 1). A slight decrease in sperm concentration was noted post-treatment, although this decrease was not significant at the 3- and 6-month timepoints. Paclitaxel was detected in semen in the majority of subjects tested at 30 days and 3 months post-procedure. The paclitaxel concentration in semen steadily decreased over time, nearing the limit of quantitation of the method by 6 months post-procedure. Conclusions Treatment with Optilume BPH preserved erectile and ejaculatory function. IIEF and MSHQ-EjD scores were not different from control at any time point. New MISTs for LUTS/BPH need to preserve sexual function to meet the needs of men and Optilume appears to meet this objective. Disclosure Yes, this is sponsored by industry/sponsor: Urotronic. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Urotronic.

Thirty versus 60-Watt thulium laser enucleation of prostate: Toward the development of low-power anatomical enucleation of the prostate.

We aimed to study whether using 30 W versus 60 W thulium enucleation of the prostate (ThuLEP) would affect postoperative outcomes in patients with benign prostatic hyperplasia (BPH). We prospectively identified male patients with moderate or severe lower urinary tract symptoms due to BPH. We randomized patients into 30 W (Group 1) or 60 W (Group 2) thulium yag laser with a 550 μm laser fiber and a 26 Fr continuous flow resectoscope. We collected data related to prostate size, enucleation time, morcellation time, laser time, perioperative complications, and 1-year functional outcomes. A total of 120 patients were included, with a mean age of 67 years and a mean prostate size of 105 g. The preoperative characteristics were similar across both groups. The mean operative time was shorter in the 60 W group, 74 ± 27 vs. 91 ± 33 min in the 30 W group (P = 0.001), and the mean laser time was 55 ± 20 in 60 W versus 71 ± 25 in 30 W (P = 0.0001). The mean hospital stay was 1 day in both groups and at 1-year follow-up; there was a similar improvement in mean Qmax and International Prostate Symptom Score symptom scores. Both 30 and 60 W ThuLEP provided a safe and comparable outcome with a relatively shorter operative time for the 60 W groups. Perhaps using a 30-W setting would be beneficial in the early learning curve or cases with more bleeding capsular perforators; besides, the financial benefit of manufacturing low-cost low-power devices that may help in the widespread of AEEP.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

ObjectiveTo investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study. MethodsOne hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. ResultsA total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. ConclusionIntra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

Early experience of "En bloc" holmium laser enucleation of the prostate in Saudi Arabia.

Holmium laser enucleation of the prostate (HoLEP) showed higher efficacy than transurethral resection for treating benign prostatic hyperplasia (BPH). The present study aims to report the outcome of BPH treatment by HoLEP in a tertiary center. An observational prospectively collected data for consecutive symptomatic BPH patients undergoing HoLEP between January 2020 and December 2021. Demographic and perioperative data were collected with the International Prostate Symptom Score (IPSS), quality of life, peak flow rate (Qmax), residual urine postvoid residual (PVR), and prostate-specific antigen (PSA) changes, in addition to perioperative and late adverse events. One hundred patients were included with a median age of 73 years (range 65-80). The IPSS improved by 80% postoperatively (25 vs. 5, P < 0.001). Similarly, Qmax significantly improved. Seven patients were found to have incidental prostate cancer. No patient needed a perioperative blood transfusion. Compared to its preoperative values, follow-up PSA has been reduced by 75% (P < 0.001). Urethral stricture and bladder neck contracture were noted in < 2% of the patients. HoLEP is feasible for all prostate sizes and a safe and effective treatment for BPH patients; our results are consistent with the reported data in the literature regarding functional outcomes, complication rates, and urinary incontinence rates.

Two-year follow-up comparing Rezūm therapy versus bipolar transurethral resection of the prostate for treating benign prostatichyperplasia. A prospective randomized study.

Comparison of the efficacy and safety of Rezūm therapy and bipolar transurethral resection of prostate (B-TURP) for the management of benign prostatic hyperplasia (BPH) of 50-120 g size. One hundred patients with BPH who met the inclusion criteria were included and split into two equal groups to undergo Rezūm therapy or B-TURP. The two groups were compared for efficacy using international prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), operative time, catheter time, hospital stay, post-void residual urine (PVR), prostate-specific antigen (PSA), and residual prostate size and safety using the incidence of complications. Rezūm significantly ameliorated IPSS from the baseline score by 55.3%, QoL by 50%, Qmax by 62.5%, International Index of Erectile Function (IIEF) by 7.1%, PVR by 50%, residual prostate size by 28.1% and PSA by 42% at 2 years. Meanwhile, the improvement in B-TURP was significantly higher than Rezūm group, Rezūm therapy had a significantly shorter duration of operative time and hospital stay. Also, it had fewer complications in comparison with B-TURP. Rezūm is a minimally invasive procedure that provides significantly improved symptomatic relief of BPH and quality of life with preservation of erectile and ejaculatory functions. However, it is not as effective as B-TURP.

Correlation of Prostate Volume, Uroflowmetry Variables and BMI in Patients Having Clinical Benign Prostatic Hyperplasia.

Background: Benign Prostatic Hyperplasia (BPH) causing urinary obstruction is a common entity in a man over 40 years old. Enlarge prostate causes compression of the prostatic part of the urethra leading to bladder outflow obstruction, causes LUTs (lower urinary tract symptoms) of BPH and decreases quality of life.Objectives: To find out the correlation of prostate volume, and BMI with Uroflowmetry variables, of patients having BPH symptoms.Materials and Methods: A total of 44 patients having BPH symptoms, ages ranging from 48 to 85 years, who underwent transabdominal ultrasound and uroflowmetry in a standing position, were included in this study. The patients were divided into 4 age groups and 4 grades of prostate size for comparison. Height in cm and weight in Kg were recorded for BMI calculation.Results: Among the patients, the mean age was 66.25, with a mean prostate size of 39.73 g, with a Qmax of 14.45 ml/sec, Qave 5.96 ml/sec, mean voided volume 327.14 ml and PVR 57.91 ml with mean flow time 61 sec.In age group l, there were 3 patients, ages ranged 40 to 50 years. In age group ll, there were 11 patients, age range 51 to 60 years. In age group lll, there were 17 patients, ages ranged 61 to 70 years. In age group lV, there were 13 patients, age range 71 to 84 years. In grade l of prostate size (prostate &lt;30 g), there were 13 patients. In grade ll prostate size (prostate 30-&lt;50 g ), there were 25 patients. In grade lll, prostate size (50- &lt;85 g), there were 4 patients. In grade lV (prostate size is &gt;85 g), there were 2 patients. No significant difference was found among 4 age groups and 4 grades of prostate volume. However, there was a weak correlation between prostate size and uroflowmetry variables without a significant difference.Conclusion: There was a correlation between prostate volume and different uroflowmetry variables of age-related groups and grades of the prostate but the correlation was weak. KYAMC Journal Volume: 14, No: 03, October 2023: 138-144.

The natural history of benign prostatic hyperplasia-related voiding symptoms following penile prosthesis implantation.

There is a rising prevalence of benign prostatic hyperplasia (BPH)-related urinary symptoms along with erectile dysfunction in the aging male population. Therefore, assessment of lower urinary tract symptoms (LUTS) is advised before penile prosthesis surgery with some men requiring preoperative transurethral surgical management to reduce the risk of post-procedure complications. However, less is known about the natural history of men with uncomplicated LUTS who do not require surgical management for BPH before penile prosthesis. We sought to assess the natural history of BPH-related uncomplicated LUTS in men following penile prosthesis surgery. Single institution retrospective review. Following institutional review board approval, we performed a retrospective review of all adult males with a preoperative diagnosis of LUTS undergoing penile prosthesis surgery at our institution from January 2017 to November 2022. The primary outcome was progression to transurethral surgery. From 2017 to 2022, 211 patients with preexisting LUTS underwent penile prosthesis surgery and met all criteria for inclusion including no history of transurethral surgery. The median (interquartile range, IQR) AUA symptom score (AUA-SS) was 12 (12). Post-void residual was below 200 cc in 96.2% of patients preoperatively and 99.1% of patients after surgery. At a median (IQR) follow-up duration of 9 (23) months after surgery, 5.7% (12/211) of patients had progressed to bladder outlet surgery and 35.5% of patients endorsed LUTS bother with a median (IQR) AUA-SS of 14.5 (11.8). The majority of patients with uncomplicated LUTS did not require bladder outlet surgery following penile prosthesis implantation and could be managed with conservative or pharmacologic measures alone. Prostate gland size was significantly larger in patients who progressed to bladder outlet surgery. While the results are overall reassuring, further study is needed to identify specific factors associated with pursuing bladder outlet surgery in this small subset of patients.

Efficacy and safety evaluation of imidafenacin administered twice daily for continency recovery following radical prostatectomy in prostate cancer patients: Prospective open-label case-controlled randomized trial.

This study aims to prospectively analyze the effects of anticholinergic therapy using imidafenacin on detrusor overactivity occurring after robot-assisted radical prostatectomy (RARP). Patients were followed-up at outpatient visits 2-4 weeks post-surgery (visit 2) to confirm the presence of urinary incontinence. Those confirmed with urinary incontinence were randomly assigned in a 1:1 ratio to the anticholinergic medication group (imidafenacin 0.1 mg twice daily) or the control group. Patients were followed-up at 1, 3, and 6 months post-surgery for observational assessments, including the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). A total of 49 patients (25 in the treatment group and 24 in the control group) were randomized for the study. There were no differences observed between the groups in terms of age, comorbidities, prostate size, or pathological staging. According to the IPSS questionnaire results, there was no statistically significant difference between the medication and control groups (p=0.161). However, when comparing storage and voiding symptoms separately, there was a statistically significant improvement in storage symptom scores (p=0.012). OABSS also revealed statistically significant improvement in symptoms from 3 months post-surgery (p=0.005), which persisted until 6 months post-surgery (IPSS storage: p=0.023, OABSS: p=0.013). In the case of urinary incontinence that occurs after RARP, even if the function of the intrinsic sphincter is sufficiently preserved, if urinary incontinence persists due to changes in the bladder, pharmacological therapy using imidafenacin can be beneficial in managing urinary incontinence.

Computerized metric assessment of glandular tissue volume within the peripheral zone of the prostate using combined magnetic resonance imaging and histopathology: Possible pathophysiological implications on prostate cancer development.

Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are prevalent urological ailments in elderly males. Numerous clinical studies have revealed an invert association between BPH/prostate size and PCa growth. This study investigates the association between prostate size and total glandular tissue volume of the peripheral zone (GVPZ) using a unique blend of magnetic resonance imaging (MRI) and histo-anatomical imaging technique. Patients were selected who underwent both radical prostatectomy and preoperative MRI scans. MRI scans provided quantitative measurements of prostatic zone dimensions, while histo-anatomical slides yielded quantitative data on glandular density of the peripheral zone (PZ) using imaging software. Integration of MRI and histopathology enabled the assessment of the GVPZ. Statistical analysis identified relationships between total prostate volume (TPV) and GVPZ. Seventy-two patients were selected and 40 cc was determined to be the optimal cutoff for small-to-moderate versus large prostates. Once the two subgroups in TPV were formed, the relationship between TPV and GVPZ was found to be highly significant (p<0.001). The combination of MRI and histopathology offers a novel approach for precise quantification of glandular tissue within the prostatic PZ. This study corroborates the hypothesis of PZ compression via an enlarging transition zone in larger BPH prostates, resulting in PZ glandular atrophy. Given that most PCa originates in the PZ, these results shed light on the potential protective role of larger BPH prostates against PCa growth.

Efficacy of Prostatic Artery Embolization in Symptomatic Benign Enlargement of Prostate (&gt;100 cc): A Hospital-based Prospective Study in a Tertiary Care Center

Abstract Background: Prostatic artery embolization (PAE) has recently emerged as an effective minimally invasive procedure for the treatment of patients with symptomatic benign enlargement of prostate (BEP). Aim and Objective: The objective of the study was to evaluate the efficacy of PAE in BEP patients. Materials and Methods: A prospective observational clinical study was conducted at tertiary care hospital over 1-year from April 2022 to March 2023. This study included patients with lower urinary tract symptoms indicative of BEP and a prostate volume of 100 cc or more. The primary endpoints of the study were determining the International Prostate Symptom Score (IPSS), Q-max, prostate volume, intraprostatic resistive index, and prostate-specific antigen (PSA). Results: A total of 21 patients, with a mean age of 72 years were included in the study. After a 6-month follow-up, 15 patients were catheter-free, while 6 patients required adjunctive surgical treatment in the form of transurethral resection of prostate or holmium enucleation of prostate. The mean IPSS significantly decreased from 22 to 8 after PAE (P = 0.0394 Mean Q-max significantly increased from 8 mL/s to 16 mL/s (P = 0.05), while prostate volume decreased significantly at 6 months’ follow-up (122.0 cc vs. 58.0 cc, P = 0.0334). Intraprostatic resistive index showed a statistically significant increase after embolization of unilateral/bilateral prostatic arteries. 0.62 versus 1.34, P = 0.0317, and serum PSA values were comparable pre- and post- PAE. Conclusion: PAE effectively treats symptomatic BEP with a prostatic volume of 100cc or more, achieving a success rate of 71.5% with improvements in IPSS, increased Q-max values, and reduced prostate size.

Comparison of Modified Single Incision Two Loop Technique and Classical Three Lobe Technique in HoLEP: Experience of 200 Cases of a Single Surgeon

Introduction: We aimed to present our single incision two-lobe technique, which we developed in our own clinic and performed by a single surgeon and to compare the results of this technique with the results of Gilling's 3-lobe technique, which we applied before.&#x0D; Material Method: HOLEP was performed in 200 patients with medically resistant lower urinary tract symptoms (LUTS) and BPH, regardless of prostate size, between December 2018 and August 2022 in our urology clinic. All operations in the study were performed by a single surgeon who had completed the HoLEP learning curve, was well versed in endoscopic surgery, and had high experience. The classical Gilling 3-lobe method was preferred in the first hundred cases after the cases in the first fifty cases learning curve (Group 1, n=100). Due to some difficulties in the technique after the experience in the first hundred cases, the single incision two-lobe technique, which was created by referencing and modifying Scoffone's en bloc no touch technique, was used in the next hundred cases (Group 2, n=100).&#x0D; Results: The average age of a total of 54 patients who underwent surgery due to a retroperitoneal mass was 53.8±10.0 years. While 15 (27.8%) of 54 patients with a retroperitoneal mass were diagnosed incidentally, 39 (72.2%) patients were diagnosed symptomatically. The final pathological outcome of all relapsed patients was liposarcoma. The average operation time was 178.7±85.4 minutes. The average length of stay of the patients was 6.2±3.1 days. Additionally, all of these patients had organ resection. In the Kaplan-Meier survival analysis, it was found that surgical margin had a statistically significant effect on average survival (p

Tasa de fluctuación del PSA: un indicador prometedor para el cribado del cáncer de próstata

ObjectivesTo evaluate whether PSA fluctuation can be used to predict the risk of prostate cancer. Materials and methodsThe study included 1244 patients who underwent prostate biopsy at Kartal Dr. Lutfi Kirdar City Hospital between 2013 and 2021 (848 in non-cancer; 396 in cancer). The patient's age, last two PSA values (PSA1 and PSA2) within three months before the biopsy, the duration between two PSAs (days), prostate size (g) and PSA density (PSAD) were all recorded. PSA fluctuation rate (PSAfr) was defined as the change rate between two PSA values. ResultsPSAfr was significantly higher in the non-cancer group than in the prostate cancer group (15.2% [20.5] and 9.6% [14.4], P=.019). A simple linear regression was used to examine the relationship between PSAfr and other factors such as age, PSA, PSAD, and prostate volume, but it was shown that these had no effect on PSA fluctuations. ROC analysis revealed a relatively low area under the curve (AUC) for PSAfr (AUC: 0.584 [0.515-0.653]). However, the cut-off value of 12.35% was found to be significant, with a sensitivity of 58% and a specificity of 59% (P=.019). The odds ratio, adjusted for age, PSAD, and PSA2, was calculated as 0.545 (0.33-0.89) using logistic regression analysis to show the relationship between prostate cancer and PSAfr. As a result, those with high PSAfr were found to be 1.83 times less likely to be diagnosed with prostate cancer than those with low fluctuations. ConclusionPSAfr could be used in nomograms to predict prostate cancer risk and reduce the number of unnecessary biopsies.

Volume of the normal prostate gland in polish boys, aged 1–17 years: Based on transabdominal ultrasound – Prospective study

Until now, there are no established norms for prostate size in children. Prostate volume during development has been analyzed in small study groups. In diagnostic imaging, transabdominal ultrasound and magnetic resonance imaging are used. To establish prostate volume norms for individuals aged 1-17 years using transabdominal ultrasound. Between 2021 and 2023, transabdominal prostate ultrasound was performed on 482 Caucasian boys, aged 1-17 years, who were patients of the urology clinic. Normative data were based on results of 345 boys with normal lower urinary tract, urethral and penile structures. Patients with abnormal external genitalia, Prune Belly Syndrome, Myelomeningocele, chromosomal disorders, or prostate abnormalities found in ultrasound were excluded from the study. Patient eligibility was determined based on medical records and physical examinations. During ultrasound, height, anterior-posterior dimension, and width of prostate were assessed. Prostate volume was calculated using the ellipsoid formula VH x L(AP) x W x 0.523. Measurements were correlated with age, weight, and height. Results were analyzed using descriptive statistics, statistical significance tests for means, and correlation methods. After estimating preliminary results, taking into account the development periods, patients were divided into age groups: 1-4 years (n=70), 5-10 years (n=124), 11-12 years (n=43), 13-15 years (n=65), and 16-17 years (n=43). The table and nomogram shows prostate volumes based on age. Prostate size remains stable up to the age of 8. We noticed a transitional phase at the age of 8-11 years. A significant increase in volume occurs over 11 years of age. There was a statistically significant relationship between prostate size, age, height, and weight. Established norms can serve as a reference for prostate analysis in patients with defects of the genitourinary system. An interesting analysis would be a prostate size assessment in relation to stage of development on Tanner scale. Transabdominal ultrasound, being a non-invasive, painless, and readily accessible examination, allows assessment of prostate size even in boys aged 1 year old. A statistically significant relationship was found between prostate size, weight, and height. Norms for prostate size in boys were established according to age.

Safety of Prostatic Artery Embolization via Transradial Access versus Transfemoral Access

PurposeTo compare prostatic artery embolization (PAE) via transradial access (TRA-PAE) versus transfemoral access (TFA-PAE) to assist access selection. Material and MethodsProcedural outcomes and adverse events were evaluated in 998 patients who underwent PAE at a single center from April 2014 to August 2022; 821 (82%) underwent TRA-PAE (Group R) and 177 (18%) underwent TFA-PAE (Group F). Mean age and prostate size of Groups R and F were 69.2 years (SD ± 8.4) and 117.4 g (SD ± 63.1) and 75.2 years (SD ± 12.1) and 127.2 g (SD ± 83.6), respectively (P < .01 and P = .16; postpropensity matching: P = .38 and P = .35, respectively). Indications for PAE included lower urinary tract symptoms, acute or chronic urinary retention, and hematuria. Procedural and patient-specific metrics were reviewed. Technical success was defined as bilateral PAE. Adverse events were recorded according to the Society of Interventional Radiology (SIR) adverse events classification. Statistical significance was defined as P < .05. ResultsTechnical success was achieved in 798 (97.2%) patients in Group R and 165 (93.2%) patients in Group F. Mean procedural time, single- and continuous-rotation fluoroscopy time, dose area product, and air kerma were significantly lower in Group R than in Group F (P < .001). Moreover, 6 (0.7%) patients in Group R and 9 (5.5%) patients in Group F had access site ecchymoses, whereas 5 (0.6%) patients in Group R and 6 (3.6%) in Group F had access site hematomas. Two patients experienced transient ischemic attacks (TIAs) after TRA-PAE and recovered without intervention. Two occult radial artery occlusions were noted, but no patient experienced hand ischemia. ConclusionsIn a large single interventional radiologist cohort, TRA-PAE demonstrated similar technical success to that of TFA-PAE with lower access site hemorrhagic complications and radiation requirements; however, TIA and occult radial artery occlusions remain a concern.

Extraperitoneal Laparoscopic Simple Prostatectomy for large prostatic adenomas: A single-centre experience on 14 patients with significant lower urinary tract symptoms.

There are various approaches available for surgical management of large prostatic adenomas - open, laparoscopic as well as laser enucleation - but there are no available clear cut consensus or guidelines. We present our experience in Extraperitoneal Laparoscopic Simple Prostatectomy on 14 patients with large prostatic adenoma (>100 g). This is a retrospective analysis on 14 patients with large prostatic adenoma who underwent extraperitoneal laparoscopic prostatectomy (LSP) over a period of 2 years (2021-2023). All selected patients underwent extraperitoneal LSP. The case records were retrospectively reviewed and data were collected regarding age, clinical presentation, prostate size, median surgical time, intra-operative and post-operative events, pre-operative and post-operative assessment of IPSS score, Uroflowmetry and PVR values and duration of hospital stay. A total of 14 patients underwent LSP. The median age was 64.2 years and the median prostatic size was 123.25 g. Median operative time was 150 min. None of the patients required blood transfusion; mean Post-operative day (POD) for drain removal was 2.5 days. The mean duration of hospital stay was 3.5 days. Only one patient had urinary leak and vesico-cutaneous fistula which was managed conservatively by prolonged catheterisation. At 3 months follow-up, there was significant improvement in IPSS Score (mean 7.8 vs 21.3 pre-operatively), uroflow values (mean Qmax of 27.3 vs 6.8 pre-operatively) and PVR (mean 30.5 vs 350 ml pre-operatively). Laparoscopic Simple Prostatectomy is a safe and feasible approach for large prostatic adenomas with lesser morbidity and complications and satisfactory outcome.

Dosimetric predictors for genitourinary toxicity in MR-guided stereotactic body radiation therapy (SBRT): Substructure with fraction-wise analysis.

MR-guided radiation therapy (MRgRT) systems provide superior soft tissue contrast than x-ray based systems and can acquire real-time cine for treatment gating. These features allow treatment planning margins to be reduced, allowing for improved critical structure sparing and reduced treatment toxicity. Despite this improvement, genitourinary (GU) toxicity continues to affect many patients. (1) To identify dosimetric predictors, potentially in combination with clinical parameters, of GU toxicity following SBRT by leveraging MRgRT to accurately monitor daily dose, beyond predicted dose calculated during planning. (2) Improve awareness of toxicity-sensitive bladder substructures, specifically the trigone and urethra. Sixty-nine prostate cancer patients (NCT04384770 clinical trial) were treated on a ViewRay MRIdian MRgRT system, with 40Gy prescribed to 95% of the PTV in over five fractions. Overall, 17 (24.6%) prostate patients reported acute grade 2 GU toxicity. The CTV, PTV, bladder, bladder wall, trigone, urethra, rectum, and rectal wall were contoured on the planning and daily treatment MRIs. Planning and daily treatment DVHs (0.1Gy increments), organ doses (min, max, mean), and organ volumes were recorded. Daily dose was estimated by transferring the planning dose distributions to the daily MRI based on the daily setup alignment. Patients were partitioned into a training (55) and testing set (14). Dose features were pre-filtered using a t-test followed by maximum relevance minimum redundancy (MRMR) algorithm. Logistic regression was investigated with regularization to select dosimetric predictors. Specifically, two approaches: time-group least absolute shrinkage and selection (LASSO), and interactive grouped greedy algorithm (IGA) were investigated. Shared features across the planning and five treatment fractions were grouped to encourage consistency and stability. The conventional flat non-temporally grouped LASSO was also evaluated to provide a solid benchmark. After feature selection, a final logistic regression model was trained. Dosimetric regression models were compared to a clinical regression model with only clinical parameters (age, baseline IPSS, prostate gland size, ADT usage, etc.) and a hybrid model, combining the best performing dosimetric features with the clinical parameters, was evaluated. Final model performance was evaluated on the testing set using accuracy, sensitivity, and specificity determined by the optimal threshold of the training set. IGA had the best testing performance with an accuracy/sensitivity/specificity of 0.79/0.67/0.82, selecting 12 groups covering the bladder (V19.8Gy, V20.5Gy), bladder wall (19.7Gy), trigone (15.9, 18.2, 43.3Gy), urethra (V41.4Gy, V41.7Gy), CTV (V41.9Gy), rectum (V8.5Gy), and rectal wall (1.2, 44.1Gy) dose features. Absolute bladder V19.8Gy and V20.5Gy were the most important features, followed by relative trigone 15.9 and 18.2Gy. Inclusion of clinical parameters in the hybrid model with IGA did not significantly change regression performance. Overall, IGA feature selection resulted in the best GU toxicity prediction performance. This exploratory study demonstrated the feasibility of identification and analysis of dosimetric toxicity predictors with awareness to sensitive substructures and daily dose to potentially provide consistent and stable dosimetric metrics to guide treatment planning. Further patient accruement is warranted to further assess dosimetric predictor and perform validation.