Prostate Surgery Research Articles

IDEAL-D Phase 0 Evaluation of the Avatera System in Robot-Assisted Prostate, Bladder and Renal Surgery.

Purpose: To evaluate the utilization of novel Avatera system in urological operations according to the IDEAL-D framework recommendations for high-risk invasive surgical devices. Materials and Methods: Three surgeons attempted to perform 23 upper and lower urinary tract operations on human cadavers and in live porcine models using the Avatera system. Total operative time and the duration of the substeps were evaluated. Surgical performance was assessed with the Global Evaluative Assessment of Robotic Skills (GEARS) score. Suturing was rated using the technical checklist for the assessment of suturing in robotic surgery. Attending surgeons rated their satisfaction with the Avatera system on a scale of 1-5. Results and Limitation: Seventeen out of 18 operations performed on cadavers were completed, while one pyeloplasty was discontinued. All five operations performed in porcine models were completed. Although 1 pig was euthanized on the fifth postoperative day, its symptoms were unrelated to surgery. Mean GEARS and Suturing scores in the upper urinary tract were 29 ± 0.7 and 29.5 ± 0.95, respectively, and in the lower urinary 28.5 ± 1.2 and 29.5 ± 0.5, respectively. Surgeons' satisfaction was high or very high for all procedures. Conclusions: The Avatera system was associated with good surgical performance and high surgeons' satisfaction rates. All urological procedures performed were shown to be feasible, with comparable risks to other robot-assisted surgery systems.

Inguinal hernia leads to worse immediate urinary continence after robot-assisted radical prostatectomy.

Patients with inguinal hernia (IH) may have voiding dysfunction and weak urethra-stabilizing periurethral fascial tissues, contributing to urinary incontinence. This study aimed to review the association between IH and urinary continence after robotic-assisted radical prostatectomy (RARP). This single-institution retrospective study included 251 consecutive cases of RARP between April 2019 and June 2022. Patients with concurrent IH or a history of adult IH repair were examined. The urine loss rate (ULR), defined as 24-h urine loss volume divided by the total urine volume immediately after urinary catheter removal (i.e., 6 or 7 postoperative days), was compared between the groups with (n = 33) and without IH (n = 214). Possible contributing factors for ULR were assessed, including age, body mass index (BMI), after benign prostatic hyperplasia surgery, prostate weight, and nerve-sparing. ULR was compared intergroup after propensity score matching countering selection biases. Patients with IH were older (71.3 versus. 66.8years, p < 0.01), had lower BMI (22.8 versus. 24.3, p < 0.01), and had higher ULR (14.5% versus. 5.1%, p < 0.01). In a multiple linear regression analysis (adjusted R2 = 0.084), IH (p < 0.01) was an independent contributing factor for ULR besides advancing age (p < 0.03). After propensity score matching adjusted for patient's age and nerve-sparing, patients with IH had higher ULR (14.1% versus. 5.7%, p < 0.03) as well. This study first reported that IH may be one of the risk factors of urinary incontinence after RARP.

Outcomes of lateral approach in robot-assisted radical prostatectomy: insights from a single-surgeon experience

In the era of robotic prostate surgery, various techniques have been developed to improve functional outcomes. Urinary continence has shown satisfactory results, but the preservation of lateral nerves to the periprostatic capsule is only achievable by sparing the pubovesical complex. This study aims to present the first cases of lateral-approach robot-assisted radical prostatectomy (LRRP) performed by a novice surgeon. We conducted a retrospective analysis of 70 prostate cancer patients who underwent LRRP between October 2019 and September 2021, analyzing the perioperative and functional outcomes. The median operative time and intraoperative blood loss were 102 (92–108) minutes and 150 (130–180) mL, respectively. Five minor postoperative complications were reported, and the median hospital stay was 2 (1–2) days. Eleven positive surgical margins occurred. Potency and urinary continence recovery were achieved in 59 (84%) and 66 (94%) patients, respectively, 12 months after surgery. Our analysis shows that LRRP is a safe and effective procedure for prostate cancer surgery. Continence and potency recovery required a short learning curve, with an acceptable recovery rate even in the initial cases.

Bladder neck contracture following transurethral surgery of prostate: a retrospective single-center study.

Bladder neck contracture (BNC) is a rare but intolerant complication after transurethral surgery of prostate. The present study aims to investigate the incidence and risk factors of BNC in patients diagnosed benign prostate hyperplasia (BPH) and following transurethral resection or enucleation of the prostate (TURP/TUEP). This retrospective study included 1008 BPH individuals who underwent transurethral surgery of the prostate between January 2017 and January 2022. Patients' demographics, medical comorbidities, urologic characteristics, perioperative parameters, and the presence of BNC were documented. Univariate and multivariate analyses were conducted to identify the risk factors. A total of 2% (20/1008) BPH patients developed BNC postoperatively and the median occurring time was 5.8months. Particularly, the incidences of BNC were 4.7% and 1.3% in patients underwent Bipolar-TURP and TUEP respectively. Preoperative urinary tract infection (UTI), elevated PSA, smaller prostate volume (PV), bladder diverticulum (BD), and B-TURP were significantly associated with BNC in the univariate analysis. Further multivariate logistic regression demonstrated preoperative UTI (OR 4.04, 95% CI 2.25 to 17.42, p < 0.001), BD (OR 7.40, 95% CI 1.83 to 31.66, p < 0.001), and B-TURP (OR 3.97, 95% CI 1.55 to 10.18, p = 0.004) as independent risk factors. All BNC patients were treated with transurethral incision of the bladder neck (TUIBN) combined with local multisite injection of betamethasone. During a median follow-up of 35.8months, 35% (7/20) of BNC patients recurred at a median time of 1.8months. BNC was a low-frequency complication following transurethral surgery of prostate. Preoperative UTI, BD, and B-TURP were likely independent risk factors of BNC. TUIBN combined with local multisite injection of betamethasone may be promising choice for BNC treatment.

Progress of fluorescence imaging in lymph node dissection surgery for prostate and bladder cancer.

Fluorescence imaging is a relatively new imaging method used to visualize different tissue structures to help guide intraoperative operations, which has potential advantages with high sensitivity and contrast compared to conventional imaging. In this work, we review fluorescent contrast agents and devices used for lymphatic system imaging. Indocyanine green is the most widely utilized due to its high sensitivity, specificity, low background fluorescence, and safety profile. In prostate and bladder cancer lymph node dissection, the complex lymphatic drainage can result in missed metastatic nodes and extensive dissection increases the risk of complications like lymphocele, presenting a significant challenge for urologists. Fluorescence-guided sentinel lymph node dissection facilitates precise tumor staging. The combination of fluorescence and radiographic imaging improves the accuracy of lymph node staging. Multimodal imaging presents new potential for precisely identifying metastatic pelvic lymph nodes.

The Effect of Low-Flow versus High-Flow Anesthesia on Postoperative Cognitive Functions in Geriatric Patients Undergoing TUR-P Surgery

Introduction: This paper investigates the effect of low-flow anesthesia applications on postoperative cognitive function in geriatric age group (≥65 years old) patients who underwent elective transurethral resection of the prostate surgery. Materials and Method: A total of 98 patients aged 65 and over who underwent elective transurethral resection of the prostate surgery under general anesthesia between December 2021 and November 2022 in Hatay Mustafa Kemal University Research Hospital’s Department of Anesthesiology and Reanimation were included in the study. The patients were subjected to a mini mental test the day before the operation and postoperatively at six hours, one day, three days, and seven days. Visual analogue scale scores were evaluated at 3, 6, 12, 24, 48, and 72 hours. The data obtained were compared between the patient groups who underwent low-flow (1 L/min, n: 49) and high flow (4 L/min, n: 49) anesthesia. P&lt; 0.05 was considered statistically significant. Results: A comparison between the postoperative 6thhour, 1st day, 2nd day, 3rd day, and 7th day mini mental testing scores of the low-flow anesthesia and high flow anesthesia groups did not exhibit any notable variations (p: 0.668, 0.785, 0.745, 0.705, respectively). The visual analogue scale scores of the cases at 3, 6, 12, 24, 48, and 72 hours did not differ statistically according to the type of flow applied (p: 0.316, 0.925, 0.651, 0.548, 0.624, 0.466, respectively). Conclusion: It is thought that low-flow anesthesia can be applied safely, but it does not have a significant effect on cognitive functions compared to high flow anesthesia. Keywords: Anesthesia, General; Sevoflurane; Cognitive Dysfunction; Geriatrics.

Men with chronic urinary retention: treatments, complications, and consequences

AbstractThe aim of this study was to explore treatment options for chronic urinary retention (CUR) in men, including complications and consequences. Male patients diagnosed with a non-neurogenic, symptomatic and/or high-risk, CUR &gt; 150 mL were included. Data for treatments, complications, and consequences were recorded and incidence rate ratios (IRRs) calculated. We enrolled 177 patients, most initially received a urethral catheter (74%) and some form of catheterization as final treatment (87%), 49 (28%) underwent de-obstructive prostate surgery. Catheterization was more likely to be stopped after surgery (16/49 patients), compared with non-surgical cases (8/128 patients) (IRR 4.18; p &lt; 0.001). Urinary tract infection (IRR 3.68; p &lt; 0.001) and macroscopic hematuria (IRR 5.35; p &lt; 0.001) were more common with catheterization, but post-renal problems were more likely in patients without catheterization (IRR 25.36; p &lt; 0.001). The lowest complication rate was with clean intermittent catheterization. In conclusion, most patients received catheterization for CUR, with clean intermittent catheterization preferred due to its comparatively lower complication risk. De-obstructive prostate surgery increases the chance of stopping catheterization.

Diode laser surgery for benign prostate hyperplasia: a comparative analysis of the efficacy and safety of two techniques

Introduction. The urgency of the issues evaluating the effectiveness of various laser surgery techniques in patients with benign prostatic hyperplasia (BPH) is determined by the presence of a significant number of various complications.Objective. To conduct a comparative analysis of the efficacy and safety of two methods of diode laser surgery for benign prostate hyperplasia.Materials &amp; methods. Retrospective study by monitoring and analysing histories included 52 patients with BPH to compare the efficacy and safety of two techniques of diode laser surgery of BPH. The surgical intervention (prostate enucleation — DiLep or vaporization — DiVap) was performed using diode laser with power of 150 W and wavelength of 980 nm ("MILON" Ent., St. Petersburg, Russian Federation). The efficacy of laser technologies was evaluated according to the following criteria: surgery time (min), prostate volume (cx), post-void residual urine volume (ml), severity of LUTS and quality of life related to urination according to the IPSS-QoL scale (points).Results. The DiLep time for prostate volume 71.3 ± 20.2 cc was 62 - 95 min (71.3 ± 12.6 min), whereas for prostate volume 70.4 ± 21.3 cc the DiVap duration was 50 – 67 min (59.8 ± 8.6 min) with a significant difference between the groups (p = 0.0001). The mean length of hospital stay for patients in the DiLep group was 3.4 ± 1.2 bed-days, whereas in the DiVap patient group it was significantly shorter and averaged 2.2 ± 1.1 bed-days (p = 0.008).Conclusion. Diode laser vaporization (DiVap) requires significantly less surgery time and length of hospital stay than hyperplasia enucleation (DiLep).

Comparative analysis of conventional penile clamps and Uriclak device in managing male incontinence following radical, turp, or laser prostate surgery.

This article examines the impact of various prostate surgery techniques on male urinary incontinence, evaluating the feasibility, efficacy, and safety of penile clamps as a post-prostate surgery treatment. The study compares the characteristics and applications of conventional penile clamps and the Uriclak urethral compression device, highlighting their differences and potential for managing male incontinence.

The effect of transurethral resection of the prostate on sexual life quality in patient spouses

AbstractThe purpose of this study was to determine the effect of transurethral resection of the prostate (TURP) surgery on quality of sexual life in patients' spouses. A pre/post‐operative test, quasi‐experimental design with no control group was employed. The research was conducted in the urology clinics of two hospitals in the west of Turkey between 30 June and 30 September 2022. It was completed with 172 patient spouses recruited using non‐probability sampling. The study data were collected using an individual information form and the Sexual Quality of Life‐Female questionnaire. The preoperative test applied prior to surgery was administered by the face‐to‐face interview method, while the postoperative test was completed by telephone interviews 8 weeks after the initial data collection. The mean age of the individuals undergoing TURP surgery in this study was 62.69 ± 7.98 years (min 40, max 77), and the mean age of the spouses was 57.91 ± 7.46 (min 39, max 73). Sexual Quality of Life‐Female scores after surgery were significantly higher than the pre‐surgical values (p &lt; 0.001). A significant difference in sex life quality was determined in terms of age, education, employment status, presence of chronic disease, number of children, and ‘love marriages’ (p &lt; 0.05). The sexual life quality of the spouses of patients exposed to TURP surgery increased significantly 8 weeks after the procedure. The quality of sex life was higher among individuals with higher education levels, working individuals, and those who ‘married for love’, but decreased in line with age and number of children.

How older men live with stress urinary incontinence: Patient experience and navigation to treatment.

To explore the context in which older men navigate treatment for stress urinary incontinence (SUI) following prostate surgery by characterizing lived experience of men with symptomatic SUI. Mixed method study using surveys and semistructured interviews to examine a cohort of men who underwent evaluation for treatment of postprostatectomy SUI. Thirty-six men were interviewed after consultation for SUI and 31 had complete quantitative clinical data. Twenty-six underwent surgery and 10 chose no surgical intervention. In qualitative interviews, respondents experienced substantial decline in quality of lifedue to incontinence citing concerns associated with use of pads and worrying about incontinence. Most patients reported "workarounds"-efforts to mitigate or manage incontinence including Kegels, physical therapy, and garments. Participants also reported lifestyle changes including less strenuous physical activity, less sexual activity, and/or fewer social gatherings. Patients then described a "breaking point" where incontinence workarounds were no longer sufficient. After seeking evaluation, men described challenges in exploring treatment for SUI, including access to care and provider knowledge of treatment options. In a novel study of patients living with SUI a predictable lived experience was observed that culminated in a desire for change or "breaking point."In all men, this led to treatment-seeking behaviors and for many it led to SUI intervention. Despite effective treatments, patients continue to meet barriers gaining access to SUI evaluation and treatment.

Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta-analysis.

Men with detrusor underactivity (DUA)and concomitant bladder outlet obstruction (BOO)due to benign prostatic enlargement (BPE)may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC). This review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short- and long-term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta-analysis was performed using Review Manager (RevMan) software. There were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eightTURP (transurethral resection of the prostate) studies, fourGreenLight PVP (photoselective vaporization of the prostate) studies, twoHoLEP (Holmium laser enucleation of the prostate) studies, oneGreenLight PVP/HoLEPstudy, oneHolmium laser incision of the prostate study, and onestudy did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long-term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS),lower quality-of-life (QoL) score, better maximum flow rate (Qmax), and lower post-voiding residual (PVR)of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow-up. In this meta-analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow-up period after surgery.

1470 nm laser is better for prostate hyperplasia treatment with different volume size via transurethral enucleation

IntroductionThe large amount of intraoperative bleeding and the high incidence of postoperative hematuria are still common factors affecting the prostate surgery treatment effect. Our research aimed to observe the effect of prostatic enucleation using 1,470 nm semiconductor laser on the amount of bleeding in patients with different sizes of prostate hyperplasia.MethodsAccording to the size of the prostate, forty eligible patients with benign prostatic hyperplasia (BPH) were enrolled and divided into low and high volume group in this study. Hemoglobin decline, urinating condition, complications and erectile function were collected and compared before and after surgery.ResultsOur data showed that hemoglobin decline was (10.0 ± 6.2) g/L and (12.1 ± 7.8) g/L, respectively for two group after surgery (P = 0.363). Urination was significantly improved following surgery in both groups of patients (P < 0.05), and no permanent urinary incontinence and sexual dysfunction and so no serious complications occurred.ConclusionThe above results suggested that prostatic enucleation using 1,470 nm semiconductor laser can be safe and effective for prostatic hyperplasia, and this surgery produced no significant effect on the amount of bleeding in whatever size of the prostate.

Utilisation and impact of predict prostate on decision-making among clinicians and patients in a specialist tertiary referral centre: A retrospective cohort study.

Patients with intermediate-risk prostate cancer are faced with the decision of whether to undergo radical treatment. Decision-making aids, such as Predict Prostate, can empower both clinicians and patients to make treatment decisions with personalised information, but their impact on multi-disciplinary team (MDT) decision-making and uptake of radical treatment remains unknown. The objective of this study is to assess the utilisation and utility of Predict Prostate in informing treatment decisions for patients with intermediate-risk prostate cancer. A retrospective cohort study was conducted in Cambridge University Hospitals (CUH) of patients referred to the prostate cancer specialist multi-disciplinary team (pcSMDT) and robotic prostatectomy clinic (ROPD) between September 2019 and August 2021 for consideration of radical prostatectomy (RARP). Data on patient characteristics, use of PredictProstate and management decisions were collected from the Epic electronic medical record (EMR) of 839 patients, of whom 386 had intermediate-risk prostate cancer. The use of Predict Prostate at the pcSMDT increased in the second half of the study period (34.5% vs. 23.8%, p< 0.001). The use of Predict Prostate was associated with an increased likelihood of attending ROPD for men with CPG2 prostate cancer (OR =2.155, 95% CI =1.158-4.013, p= 0.015) but a reduced likelihood of proceeding with RARP for men with CPG2 (OR =0.397, 95% CI =0.209-0.753, p= 0.005) and CPG3 (OR =0.305, 95% CI =0.108-0.861, p= 0.025) prostate cancer. Our study showed that the use of Predict Prostate for patients with intermediate-risk prostate cancer is associated with increased attendance at specialist surgical clinic and a reduced chance of undergoing radical prostate surgery.

Dynamic simulation and analysis of the influence of urethral morphological changes on urodynamics after benign prostatic hyperplasia surgery: A computational fluid dynamics study

Background and objectiveComputational fluid dynamics (CFD) technology has been widely used in medicine to simulate and analyse urine flow characteristics in urology. In previous studies, researchers have modelled the analysis with a simple circular urethra, ignoring the effect of the patient's true urethral morphology on the urinary flow rate. Moreover, the studies tended to be steady-state simulations rather than dynamic simulations. Therefore, this study is established a relatively realistic model of the posterior urethra based on MRI data combined with the urodynamic data of patients and analysed the urodynamic characteristics of the posterior urethra model after benign prostatic hyperplasia (BPH) surgery using a CFD dynamic simulation. MethodsBased on clinical MRI data, a three-dimensional real urethral model was established for two patients with BPH after surgery. The boundary conditions were set according to the patients’ real urodynamic data, and a Reynolds averaged Navier‒Stokes model was used for transient simulations. The dynamic simulation depicted the entire urination process, and the urine flow characteristics were studied under real urethral morphology after surgery. Results1. By comparing the three-dimensional trajectory of urine and the vortex identification cloud map based on the Q criterion, we intuitively observed the distribution of the vortex in the model, and a ‘gourd-shaped’ urethra was more likely to generate a vortex than a ‘funnel-shaped’ urethra. 2. After surgery for BPH, the changes in the posterior urethral pressure were mainly concentrated in the urethral membrane, and the velocity increased while the pressure decreased. The curve of the posterior urethral pressure changes during urination was simulated and calculated. The posterior urethral pressure gradients of the two patients were 6.6 cmH2O and 5.26 cmH2O. ConclusionsThe complete urinary discharge process can be dynamically simulated using CFD techniques. By comparing the simulation results, the posterior urethral morphology can have an important impact on the urinary flow characteristics. Determining the location of vortex generation can lay a foundation for personalized surgical plans for patients in the future. Furthermore, numerical simulations can provide a new method for the study of non-invasive posterior urethral pressure gradients.

Incidence and Risk Factors of Post-Transurethral Resection of the Prostate Urethral Strictures in a Black African Population

Abstract Background: One of the late complications of transurethral resection of the prostate (TURP) is urethral stricture. This is a disturbing problem more so in a resource-poor Black African community. We sought to prospectively study some of the implicated risk factors in literature. Patients and Methods: This was a prospective, observational study carried out at 82 Division Military Hospital, Enugu, Nigeria from 2015 to 2022. Results: One hundred and ninety-four patients that had TURP for BPH were studied. The mean age of the participants was 66.28 years (standard deviation = 8.19). Ten patients (5.15%) had urethral stricture after the surgery. None of the factors studied which include age, previous prostate surgery, preoperative urethral catheter duration, resection time, resected prostate size, the presence of diabetes mellitus, and postoperative urinary tract infection was found to have a significant risk for the development of urethral stricture post-TURP. Conclusion: More studies are required to unravel significant risk factors for urethral stricture following a TURP. It is probably due to the interplay of many factors.

Application of Research-Based Quality Control Circle in Setting a New Management Model and Complete Standardized Care for Continuous Bladder Irrigation After TURP

Objective: To explore the application of research-based quality control circle in setting a new standardized nursing management model for continuous bladder irrigation after transurethral resection of prostate (TURP) surgery, and to provide theoretical basis and evidence-based support for standardizing the nursing management model of continuous bladder irrigation after TURP in the Department of Urology. Methods: A quality control circle was established, focusing on the existing common problems of continuous bladder irrigation. The methods include implementing appropriate measures and other steps, and comparing the incidences of bladder spasms and urinary catheter obstruction, patient satisfaction, nurses’ awareness of relevant knowledge, nurses’ operational satisfaction, number of liquid pours (6000ml per flush), and number of open exposures before and after the activity. Results: Through this quality control circle activity, the incidence of bladder spasms in patients dropped from 42% to 14.3%; the incidence of urinary catheter obstruction dropped from 36% to 12.2%; patient satisfaction increased from 82% to 95.9%; nurses’ knowledge awareness rate increased from 74.2% to 96.8%; nurses’ operational satisfaction increased from 80.6% to 96.8%; the above differences are statistically significant (P &lt; 0.05). Moreover, the number of flushing liquid pours reduced from 5 times to 1 time, and the number of open exposures reduced from 5 times to 0 times. Circle members have improved their application of quality control circle methods, team spirit, and professional knowledge. Conclusion: The research-based quality control circle is suitable for setting a new standardized nursing management model for continuous bladder irrigation after TURP.

The influence of preoperative urodynamic parameters on clinical results in patients with benign prostatic hyperplasia after transurethral resection of the prostate

PurposeTo identify the urodynamic parameters affecting the clinical outcomes of transurethral resection of the prostate(TURP) surgery for patients with benign prostatic hyperplasia(BPH) by multifactor analysis and establish a regression model with diagnostic values.MethodsThe medical records of patients who underwent TURP surgery for BPH between December 2018 and September 2021 were collected from the urology department of the Second Affiliated Hospital of Kunming Medical University, Kunming, China. The patients’ clinical data and urodynamic parameters were collected before surgery. The urodynamic parameters affecting surgical efficacy were identified by multifactor analysis, and a regression model with diagnostic values was established and evaluated.ResultsA total of 201 patients underwent TURP, of whom 144 had complete preoperative urodynamic data. Each urodynamic factor was subjected to multifactor analysis, and the bladder contractility index (BCI), bladder outflow obstruction index (BOOI), bladder residual urine, and bladder compliance (BC) were found to be independent influence factors on the efficacy of TURP in patients with BPH. The diagnostic value of the regression model was analyzed by receiver operating characteristics (ROC) analysis, and it was found that the AUC = 0.939 (95% CI 0.886–0.972), for which the sensitivity and specificity were 95.19% and 80%, respectively.ConclusionsThe regression model had high diagnostic sensitivity and specificity in predicting the efficacy of surgery, and the diagnostic value was higher than that of individual urodynamic factors. Therefore, BCI, BOOI, bladder residual urine, and BC should be considered as independent influence factors on the efficacy of TURP surgery for BPH.

Protocol for a systematic review and meta-analysis on preoperative risk factors for failure after fixed sling implantation for post-prostatectomy stress urinary incontinence

Background: Post-prostatectomy urinary incontinence (PPI) is a bothersome complication affecting patients undergoing prostate surgery that in up 10% of cases will require an invasive treatment with fixed slings or artificial urinary sphincters (AUS). Although fixed slings have several advantages over AUS, failure rates after slings range between 15% and 45% while current knowledge of predictors of sling efficacy remains limited. By systematically combining and summarizing all relevant literature, the present review and meta-analysis aim to address this research need assessing the association between preoperative risk factors and sling failure. Methods: Studies pertaining to fixed synthetic male perineal slings as treatment for adult male suffering from PPI, will be included. A systematic search will be conducted in PubMED, Scopus, Web of Science and Cochrane databases, and in the reference lists of retrieved articles. Independent reviewers will conduct study selection and data extraction. Outcomes will include failure to achieve the continence cure and overall success (cure plus improvement), measured as per included studies. Exposures will include any preoperative variables evaluated for association with sling failure. The QUIPS tool will be used for study quality assessment and a random-effects DerSimonian-Laird model, with Hartung-Knapp adjustment, will be used to pool adjusted and unadjusted odds ratios separately. Sensitivity analysis will be performed using the leave-one-out methodology and subgroup meta-analyses based on pre-specified studies’ characteristics will be conducted to explain the heterogeneity. Certainty of evidence will be assessed according to GRADE methodology and review reporting will comply with the PRISMA-P statement. Discussion: By summarising all relevant literature in the field, our results will help to incorporate available evidence into clinical practice assisting healthcare professionals managing PPI patients in treatment decision-making. The present review will also provide researchers with the necessary, evidence-based groundwork to perform future high-quality prognostic studies in the field. Registration: CRD42022307160.

Conservative and pharmacological treatment of benign prostatic hyperplasia : The German S2e-guideline 2023-part2

Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH, in German guidelines: benign prostatic syndrome [BPS]) is considered the most common disease of the lower urinary tract in men and can have atremendous impact on the quality-of-life of affected patients. Conservative and pharmacological therapy of this disease are of great importance, both in improving LUTS and reducing progression-related complications. Presentation of the conservative and pharmacological treatment options according to the current German S2eguideline on BPS. Summary and overview of chapters9 and10 of the current German S2eguideline on BPS. In addition to acontrolled watchful waiting for BPS patients without an absolute indication for prostate surgery, avariety of phytopharmacological formulations and synthetic drugs according to the symptomatology and clinical progress are available. Phytotherapy should, due to inconsistent study data, only be considered for mild to moderate symptoms. Synthetic drugs include alpha-blockers, 5α-reductase inhibitors, phosphodiesterase inhibitors, antimuscarinics and, more recently, the β3-agonist mirabegron in the current guideline. In addition, various combination therapies are listed and evaluated according to their indications, effects and side effects. The current German S2eguideline on the diagnosis and treatment of BPS provides an evidence-based foundation for finding the best possible and most effective medication.