Prostatectomy For Benign Prostatic Hyperplasia Research Articles

New multipulse® laser prostatectomy for benign prostate hyperplasia: Priliminary experience in shin kong memorial hospital

New multipulse® laser prostatectomy for benign prostate hyperplasia: Priliminary experience in shin kong memorial hospital

AB205. Open prostatectomy vs. laparoscopic prostatectomy for benign prostatic hyperplasia with large volume prostate: a meta-analysis

ObjectiveTo compare laparoscopic prostatectomy with open prostatectomy for benign prostatic hyperplasia with large volume.MethodsThe literature was identified systematically using Medline, Embase. Meta-analysis was performed by Review Manager 5.0.ResultsThree CCTs were included. There was no difference between LP and OP in terms of IPSS, Qmax. LP was associated with significantly less blood loss, a shorter irrigation, catheterization and hospital stay time except longer operating time. LP and OP were similar in terms of urethral stricture, incontinence, transfusion requirement and rate of reintervention.ConclusionsLP served a significant improvement in IPSS, Qmax as well as OP. Although more operating time and less resected tissue, LP has several advantages over OP. It was as safe as OP in terms of adverse events.

Determinants of peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia.

BackgroundThe objective of this study was to determine the factors responsible for peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia and thus offer a guide for blood product management for the procedure.MethodsThis was a prospective study of 200 consecutive patients who underwent open prostatectomy for BPH from January 2010 to September 2013 at the Korle Bu Teaching Hospital, Accra. The data analyzed included the pre-operative blood haemoglobin level (Hb), presence of co-morbidities, the case type, indication for the surgery, ASA score, anaesthetic method used, systolic blood pressure, status of the operating surgeon, duration of surgery and the operative prostate weight. The transfusion of blood peri-operatively was also documented.ResultsThe mean age of the patients was 69.1 years. Elective cases formed 83.5 % with refractory retention of urine being the commonest indication for surgery (68.0 %). The mean pre-operative Hb was 12.1 g/dl. Consultants performed 56.0 % of the prostatectomies. Transvesical approach was used in 90.0 % of the cases. The mean operative time was 101.3mins (range 35.0–240.0) with a mean operative prostate weight of 110.8 g (range 15–550 g). Most of the patients (82.0 %) had spinal anaesthesia. The blood transfusion rate was 23.5 %. The transfusion rate was significantly higher in patients with anaemia (p = .000), emergency cases (p = .000), the use of general anaesthesia (p = .002), a resident as the operating surgeons (p = .034), prostate weight >100 g (p = .000) and duration of surgery (p = .011). In a multivariable logistic regression analysis however only the pre-operative Hb (p = .000. OR 0.95, 95 % CI [0.035–0.257]) and the duration of surgery (p = .025, OR 1.021, 95 % CI [1.003–1.039]) could predict blood transfusion in open prostatectomy for BPH in this series.ConclusionsA ‘group and save’ policy should be the preferred blood ordering procedure for patients with Hb ≥ 13.0 g/dl scheduled for an elective open prostatectomy for BPH under spinal anaesthesia. A long operative time however may increase the need for blood transfusion.

Editorial Comment

This well-written analysis clearly demonstrates that the overall number of simple prostatectomies being performed for benign prostatic hyperplasia is trending downwards. 1 Pariser J.J. Pearce S.M. Patel S.G. Bales G.T. National trends of simple prostatectomy for benign prostatic hyperplasia with an analysis of risk factors for adverse perioperative outcomes. Urology. 2015; 86: 721-726 Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar The incremental increase seen in the use of minimally invasive surgical techniques has not stopped the overall decline. National Trends of Simple Prostatectomy for Benign Prostatic Hyperplasia With an Analysis of Risk Factors for Adverse Perioperative OutcomesUrologyVol. 86Issue 4PreviewTo examine the national trends of simple prostatectomy (SP) for benign prostatic hyperplasia (BPH) focusing on perioperative outcomes and risk factors for complications. Full-Text PDF ReplyUrologyVol. 86Issue 4PreviewSimilar to our findings, insidious racial disparities have been reported across multiple urologic procedures. For example, black race has been associated with worse perioperative outcomes during open and minimally invasive radical prostatectomy.1,2 Interestingly, for radical prostatectomy, black men have a markedly lower use of high volume hospitals and surgeons.2 More specifically, for benign prostatic hyperplasia, non-Caucasian race has been shown to be an independent predictor of increased morbidity and mortality during endoscopic surgery. Full-Text PDF

National Trends of Simple Prostatectomy for Benign Prostatic Hyperplasia With an Analysis of Risk Factors for Adverse Perioperative Outcomes

To examine the national trends of simple prostatectomy (SP) for benign prostatic hyperplasia (BPH) focusing on perioperative outcomes and risk factors for complications. The National Inpatient Sample (2002-2012) was utilized to identify patients with BPH undergoing SP. Analysis included demographics, hospital details, associated procedures, and operative approach (open, robotic, or laparoscopic). Outcomes included complications, length of stay, charges, and mortality. Multivariate logistic regression was used to determine the risk factors for perioperative complications. Linear regression was used to assess the trends in the national annual utilization of SP. The study population included 35,171 patients. Median length of stay was 4 days (interquartile range 3-6). Cystolithotomy was performed concurrently in 6041 patients (17%). The overall complication rate was 28%, with bleeding occurring most commonly. In total, 148 (0.4%) patients experienced in-hospital mortality. On multivariate analysis, older age, black race, and overall comorbidity were associated with greater risk of complications while the use of a minimally invasive approach and concurrent cystolithotomy had a decreased risk. Over the study period, the national use of simple prostatectomy decreased, on average, by 145 cases per year (P = .002). By 2012, 135/2580 procedures (5%) were performed using a minimally invasive approach. The nationwide utilization of SP for BPH has decreased. Bleeding complications are common, but perioperative mortality is low. Patients who are older, black race, or have multiple comorbidities are at higher risk of complications. Minimally invasive approaches, which are becoming increasingly utilized, may reduce perioperative morbidity.

MP3-10 REDUCTION OF ENLARGED PROSTATE DECREASES THE INCIDENCE OF INGUINAL HERNIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2015MP3-10 REDUCTION OF ENLARGED PROSTATE DECREASES THE INCIDENCE OF INGUINAL HERNIA Yu-Hua Fan, Hsiao-Jen Chung, Eric Huang, Alex Lin, and Kuang-Kuo Chen Yu-Hua FanYu-Hua Fan More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung More articles by this author , Eric HuangEric Huang More articles by this author , Alex LinAlex Lin More articles by this author , and Kuang-Kuo ChenKuang-Kuo Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.113AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with benign prostatic obstruction may need to strain to void and this effort over time may have a direct impact on the abdominal wall contributing to the development of inguinal hernia (IH). Furthermore, the published data showed that patients with IH present higher intensity of lower urinary tract symptoms. It is interesting to know whether transurethral prostatectomy for benign prostatic hyperplasia (BPH) could reduce the incidence of IH. METHODS We recruited male patients who were newly diagnosed with BPH and aged 50 years or older from a urology dataset including 3,431,366 individuals selected from the National Health Insurance Research Database for the year 2006 to 2010. According to treatment strategies, patients were assigned to one of the following categories: transurethral resection of prostate (TURP), alpha-1 blockers only, 5alpha-reductase inhibitors ± alpha-1 blockers. All subjects were followed up to the end of 2010 or the development of IH. Patients were excluded if they had prostatic cancer, constipation, chronic obstructive pulmonary disease, or IH developed within 6 months of diagnosis of BPH. The age-adjusted cox time-dependent model was used to calculate the risk of IH between different treatment groups. RESULTS We identified 171965 incident male patients with newly diagnosed BPH. Of the BPH patients, 8294 (4.82 %) underwent TURP (TURP group), 151753 (88.25%) received alpha-1 blockers only (AB group), 11918 (6.93%) received 5alpha-reductase inhibitors plus alpha-1 blockers or not (5ARI group). The incidences of IH in different treatment group were as follows: 93 (1.12%) in TURP group, 2334 (1.54%) in AB group, 147 (1.23%) in 5ARI group. Both the incidences of IH in TURP and 5ARI group were significantly lower than that in AB group (both P < 0.001). There was no difference in incidence rates of IH between TURP and 5ARI group. We further subdivided the TURP group into two subgroups according the weight of resected specimens and these were < 15 gm and >=15 gm. There was no difference in incidence rates of IH between the two subgroups of TURP. No matter what the weight of the resected specimens, no significant differences in incidence rates of IH were noted between TURP and 5ARI group. However, both subgroups of TURP group have significantly lower incidence rates of IH than AB group (both P < 0.001). CONCLUSIONS Prostate size-reducing treatments, including TURP and 5ARI, could significantly reduce the incidence of inguinal hernia in BPH patients compared with alpha-1 blockers. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e22 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yu-Hua Fan More articles by this author Hsiao-Jen Chung More articles by this author Eric Huang More articles by this author Alex Lin More articles by this author Kuang-Kuo Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcomes of minimally invasive simple prostatectomy for benign prostatic hyperplasia: a systematic review and meta-analysis.

(1) To assess the outcomes of minimally invasive simple prostatectomy (MISP) for the treatment of symptomatic benign prostatic hyperplasia in men with large prostates and (2) to compare them with open simple prostatectomy (OSP). A systematic review of outcomes of MISP for benign prostatic hyperplasia with meta-analysis was conducted. The article selection process was conducted according to the PRISMA guidelines. Twenty-seven observational studies with 764 patients were analyzed. The mean prostate volume was 113.5 ml (95 % CI 106-121). The mean increase in Qmax was 14.3 ml/s (95 % CI 13.1-15.6), and the mean improvement in IPSS was 17.2 (95 % CI 15.2-19.2). Mean duration of operation was 141 min (95 % CI 124-159), and the mean intraoperative blood loss was 284 ml (95 % CI 243-325). One hundred and four patients (13.6 %) developed a surgical complication. In comparative studies, length of hospital stay (WMD -1.6 days, p = 0.02), length of catheter use (WMD -1.3 days, p = 0.04) and estimated blood loss (WMD -187 ml, p = 0.015) were significantly lower in the MISP group, while the duration of operation was longer than in OSP (WMD 37.8 min, p < 0.0001). There were no differences in improvements in Qmax, IPSS and perioperative complications between both procedures. The small study sizes, publication bias, lack of systematic complication reporting and short follow-up are limitations. MISP seems an effective and safe treatment option. It provides similar improvements in Qmax and IPSS as OSP. Despite taking longer, it results in less blood loss and shorter hospital stay. Prospective randomized studies comparing OSP, MISP and laser enucleation are needed to define the standard surgical treatment for large prostates.

Is determination of transition zone volume by transrectal ultrasound in patients with clinically benign prostatic enlargement sufficiently reliable in the clinical setting?

IntroductionControversies exist regarding the accuracy of transrectal ultrasound (TRUS) determination of transition zone volume (TZV) when compared with enucleated adenoma weight.AimTo determine the accuracy and reliability of measurements of the TZV by TRUS, by comparing preoperative radiological findings with the enucleated prostate adenoma volume, measured by fluid displacement volumetry (FDV), after retropubic prostatectomy performed by the Millin method, and, moreover, to evaluate changes in the surgical capsule size in the intermediate postoperative period.Material and methodsWe measured TZV preoperatively using TRUS and postoperatively with FDV in 112 patients who underwent retroperitoneal prostatectomy for benign prostatic hyperplasia (BPH).ResultsThe TRUS volume correlated well with specimen volumes (r = 0.945, p < 0.0001). The median (quartile 1, quartile 3) absolute error was 7.35 ml (4.15 ml, 9.28 ml) and the median percent error was 9.12% (4.75%, 14.98%). Percent error, but not absolute error, was significantly related to TRUS TZV (p < 0.001 and 0.217, respectively). Adenomas > 80 cc were associated with lower percent error. The median volume of the residual prostate tissue measured 3.5 years after prostatectomy was 92.65 cc (65.75 cc, 109.58 cc), whereas the median volume of the surgical capsule, depending on the equation used for its calculation, was 24.80 cc (16.25 cc, 37.37 cc) and 31.43 cc (23.14 cc, 43.32 cc).ConclusionsThe TRUS TZV correlated well with values determined by FDV. It can be reliably used in clinical management of BPH.

Determinants of peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia

Determinants of peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia

Incidence Of VTE Following Genitourinary Surgery In Korea and Evidence-Based Korean Guidelines For Preventing VTE In Patients Undergoing Genitourinary Surgery

IntroductionVenous thromboembolism (VTE) is a major cause of morbidity and mortality after gynecologic and urologic surgeries and previously reported VTE incidence in major genitourinary surgery without VTE prophylaxis was 15-40% in Western countries. VTE is a preventable complication using thromboprophylaxis, however, pharmacologic thromboprophylaxis after major abdomino-pelvic surgery may involve serious bleeding complication. Here, we evaluated the exact incidence and risk factors of VTE following major genitourinary surgery in Korean patients and proposed evidence-based VTE prevention guidelines in such patients. MethodsIn March 2012, the committee for the development of guidelines for preventing VTE in Korea was organized by receiving recommendations from the VTE working party members in the Korean Society on Thrombosis and Hemostasis (KSTH). Using nation-wide date from Korea Health Insurance Review and Assessment Service (HIRA) from 2007 to 2011, symptomatic VTE frequencies after major genitourinary surgeries were retrospectively collected and evaluated. For the categorization of those patients by their VTE incidences, we used the methods described in AT9 guidelines (American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 9th ed.) ResultsAccording to the HIRA database, 255,324 and 85,191 patients' data were collected and evaluated their incidence of VTE and risk factors, which underwent major gynecologic and urologic surgeries, respectively. In detail, there were 87,136 hysterectomies for benign uterine diseases (76,284) and uterine cervical cancer (10,852), 168,188 oophorectomies for benign ovarian diseases (156,697) and ovarian cancer (11,491), 35,970 prostatectomies for benign prostatic hyperplasia (BPH, transurethral, 26,590) and prostatic cancer (retropubic, 9,380), 12,462 nephrectomies for renal cell cancer and 36,759 radical cystectomies for bladder cancer. As shown in Table 1, most Korean patients undergoing genitourinary surgeries were identified as very low VTE risk category. In the aspect of gynecologic cancer surgery, ovarian cancer showed highest rate of VTE incidence (1.21%, moderate risk; 0.70% deep vein thrombosis, DVT + 0.51% pulmonary embolism, PE) and cervical cancer showed 0.59% (low risk; 0.47% DVT + 0.12% PE). On the basis of these data and a literature search results, the recommendation was made by a consensus of the guideline development committee. To take the advice of outside experts, survey and review for the developed guidelines were performed by other KSTH members and the related Academic Societies. [Display omitted] ConclusionsEven when considering relatively lower incidence of VTE in Asian people than that in Western, Korean genitourinary surgery patients revealed very low incidence of VTE. As stated above, abdomino-pelvic surgery is a procedure for high risk of bleeding complications. Therefore, it is reasonable to assume that the recommendation of pharmacologic thromboprophylaxis for other gynecologic surgeries except ovarian cancer surgery should be deferred until they reveal hard evidence of higher incidence of VTE in Korea. Disclosures:No relevant conflicts of interest to declare.

Transvesical open prostatectomy for benign prostatic hyperplasia in the era of minimally invasive surgery: Perioperative outcomes of a contemporary series

ObjectiveTo assess the perioperative morbidity of transvesical open prostatectomy (OP) and its predictors as a treatment for benign prostatic hyperplasia (BPH), and to update knowledge about the morbidity of OP using a standardised morbidity scale (Clavien), thus providing a platform for comparison with the newly developed techniques. Patients and methodsWe retrospectively review men with BPH who were treated with transvesical OP between April 2002 and December 2012. Preoperative patients’ data were reviewed for relevant variables. Operative details, the postoperative course, and 30-day relevant data were assessed. The study cohort was stratified based on the resected prostate weight, with group 1 having a resected weight of ⩽120g and group 2 >120g. ResultsThe review identified 163 patients. The mean (SD, range) duration of catheterisation after OP was 7.9 (2.2, 5–20) days and the duration of hospitalisation after OP was 8.1 (1.8, 5–15) days; both were significantly longer in group 2. All patients were able to void spontaneously by the first follow-up visit. Of 163 OP procedures, there were 106 perioperative complications in 69 (42.3%). Low-grade complications (grade ⩽2) included 38 (45.2%) and 53 (67%) in groups 1 and 2, respectively (P=0.8). High-grade complications (⩾3) included 3 (3.5%) and 12 (15.1%) in groups 1 and 2, respectively (P=0.02). The blood transfusion rate was 24.5%, the perioperative mortality rate was 1.2% and the re-admission rate within the first 30days after OP was 1.2%. High-grade complications were significantly associated with a greater resected prostate weight (odds ratio 1.08, 95% CI 1.001–1.17, P=0.046). ConclusionThe OP procedure is associated with a significant perioperative morbidity that correlated significantly with the resected prostate weight, especially for high-grade complications.

English

AIM: Suprapubic prostatectomy is frequently performed in areas with poor socio- economic condition due to nonavailability of endoscopic equipment and surgical experts. The aim of this retrospective study is to analyse and bring our experience about the open prostatectomy operation. METHODS: A retrospective study was done on150 consecutive patients with BPH underwent open prostatectomy operation between February 2010 and May 2013. Analyzed factors were age, complaints, comorbidities (especially cardiac and respiratory), early and late complications and mortality. RESULTS: The total complication rate was 37.30% while early complication rate was 24.64 % late complication rate was 12.66 %. There were no deaths. Early complications were clot retention (1.33%) severe intraoperative bleeding (3.33%), wound infection (10.66%) vesico-cutaneous leak (1.33%) and reoperation for clot retention (1.33%) late complications were urinary tract infection (5.33%) epididymo-orchitis (2.00%) prolonged incontinence (2.00%) and bladder neck or urethral stricture (3.33%). CONCLUSION: Our study demonstrated that open prostatectomy for benign prostatic hyperplasia (BPH) is an acceptable option with a high degree of safety and efficacy in areas where the TUR-P equipment is lacking or

Plasmakinetic Enucleation of the Prostate Versus Transvesical Open Prostatectomy for Benign Prostatic Hyperplasia >80 mL: 12-Month Follow-up Results of a Randomized Clinical Trial

To prospectively evaluate perioperative results and 12-month follow-up after plasmakinetic enucleation of the prostate (PKEP) and transvesical open prostatectomy (OP) for benign prostatic hyperplasia (BPH) >80 mL. A total of 83 patients with a prostate >80 mL were randomized to either PKEP or OP. Perioperative and postoperative outcome data were obtained during a 12-month follow-up. No statistical differences were observed in the preoperative data. Both groups resulted in a similar and significant postoperative improvement in International Prostate Symptom Score (IPSS), quality of life (QOL), maximum uroflow rate (Qmax), postvoid residual (PVR) urine volume and prostate specific antigen (PSA), but no significant difference was found between the groups at the 12-month follow-up. Compared to OP, operation time (111.2 ± 27.1 minutes vs 109.6 ± 28.2 minutes, P= .708) were not significantly different between the groups, but blood loss was significantly less (10.2 ± 4.5 g/l vs 15.1 ± 4.3 g/l, P<.001), and bladder irrigation (2.4 ± 1.0 days vs 4.3 ± 1.1 days, P<.001), catheterization time (3.3 ± 1.1 days vs 6.2 ± 1.3 days, P<.001), and hospital stay (5.4 ± 1.2 days vs 9.3 ± 1.1 days, P<.001) were significantly shorter in the PKEP group. Effects on erectile function were similar in both groups, but adverse events were less frequent in the PKEP group. PKEP can be performed safely and is an equally effective procedure for treatment of large BPH with OP, with minimal complications and faster postoperative recovery. The PKEP helps to reduce the morbidity associated with OP and may become the attractive alternative to OP for patients with large BPH.

2007 BIPOLAR PLASMA VAPORIZATION VERSUS STANDARD TUR IN CASES OF SECONDARY BLADDER NECK SCLEROSIS – A PROSPECTIVE, MEDIUM TERM, RANDOMIZED COMPARISON

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (II)1 Apr 20132007 BIPOLAR PLASMA VAPORIZATION VERSUS STANDARD TUR IN CASES OF SECONDARY BLADDER NECK SCLEROSIS – A PROSPECTIVE, MEDIUM TERM, RANDOMIZED COMPARISON Bogdan Geavlete, Cristian Moldoveanu, Catalin Iacoboaie, Florin Stanescu, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete Bucharest, Romania More articles by this author , Cristian MoldoveanuCristian Moldoveanu Bucharest, Romania More articles by this author , Catalin IacoboaieCatalin Iacoboaie Bucharest, Romania More articles by this author , Florin StanescuFlorin Stanescu Bucharest, Romania More articles by this author , and Petrisor GeavletePetrisor Geavlete Bucharest, Romania More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2426AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This prospective, randomized, medium term trial aimed to assess the efficiency, safety and postoperative results of the bipolar plasma vaporization (BPV) by comparison to monopolar transurethral resection (TUR) in cases of secondary bladder neck sclerosis (BNS). METHODS A total of 70 patients with BNS secondary to TURP (46 cases), open prostatectomy for benign prostatic hyperplasia (BPH - 18 cases) and radical prostatectomy for prostate cancer (6 cases) were enrolled in the trial. The inclusion criteria consisted of maximum flow rate (Qmax) below10 mL/s and International Prostate Symptom Score (IPSS) over 19. All patients were evaluated preoperatively as well as at 1, 3, 6, 12 and 18 months after surgery by IPSS, quality of life score (QoL), Qmax and post-voiding residual urinary volume (PVR). RESULTS The mean operation time (10.3 versus 14.9 minutes), catheterization period (0.75 versus 2.1 days) and hospital stay (1.1 versus 3.2 days) were significantly reduced in the BPV series. During the immediate postoperative follow-up, the re-catheterization for acute urinary retention only occurred in the TUR group (5.7%). The medium term re-treatment requirements due to BNS recurrence were lower in the BPV study arm (2.8% versus 8.5%). At the 1, 3, 6, 12 and 18 month's assessment, statistically similar parameters were found concerning the IPSS and QoL symptom scores, Qmax and PVR values specific for the two therapeutic alternatives. CONCLUSIONS BPV constitutes a valuable endoscopic treatment approach for secondary BNS patients. The method emphasized superior efficacy, a satisfactory safety profile and similar medium term follow-up features when compared to standard TUR. Results BPV TUR p value IPSS 1 month 3.8 4.0 0.766 3 months 3.6 3.9 0.629 6 months 3.5 3.6 0.892 12 months 3.3 3.5 0.714 18 months 3.4 3.3 0.881 Qol 1 month 1.4 1.5 0.939 3 months 1.2 1.4 0.525 6 months 1.1 1.2 0.962 12 months 1.1 1.1 0.696 18 months 1.2 1.1 0.179 Qmax (mL/s) 1 month 23.0 23.3 0.880 3 months 23.2 23.6 0.817 6 months 23.5 23.8 0.868 12 months 23.9 24.2 0.852 18 months 23.8 24.0 0.922 PVR (mL) 1 month 31 28 0.460 3 months 24 23 0.733 6 months 22 21 0.694 12 months 19 18 0.699 18 months 21 17 0.133 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e824 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Geavlete Bucharest, Romania More articles by this author Cristian Moldoveanu Bucharest, Romania More articles by this author Catalin Iacoboaie Bucharest, Romania More articles by this author Florin Stanescu Bucharest, Romania More articles by this author Petrisor Geavlete Bucharest, Romania More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Desmopressin Add-On Therapy for Refractory Nocturia in Men Receiving α-Blockers for Lower Urinary Tract Symptoms

Alpha-blockers improve lower urinary tract symptoms associated with benign prostatic obstruction. Nocturia, a storage symptom, is a common complaint in men. However, it does not fully respond to α-blocker therapy, likely due to its multifactorial pathophysiology. We evaluated the efficacy and safety of desmopressin as add-on therapy for refractory nocturia in men previously treated with an α-blocker for lower urinary tract symptoms. Eligible patients were men 50 years old or older with lower urinary tract symptoms and persistent nocturia despite α-blocker treatment for a minimum of 4 weeks. The optimum dose of oral desmopressin was determined during a 4-week dose titration period and this dose was maintained for 24 weeks. Flow volume charts, International Prostate Symptom Score total and subscores, uroflowmetry and post-void residual urine volume were assessed. A total of 216 patients were enrolled in the study. Of these patients there were 158 (76%) with nocturnal polyuria, 15 (7.2%) with decreased nocturnal bladder capacity and 35 (16.8%) with nocturia due to both causes. The number of nocturnal voids significantly decreased from a baseline mean of 7.0 to 5.7 episodes for 3 days at the 24-week visit. The average International Prostate Symptom Score total and subscore significantly decreased by 4 weeks and were maintained at 24 weeks. In patients younger than 65 years, International Prostate Symptom Score voiding subscores were significantly improved at 24 weeks compared to those age 65 years or older. Desmopressin add-on therapy for refractory nocturia in men previously treated with an α-blocker for lower urinary tract symptoms improved voiding symptoms as well as nocturia, storage symptoms.

Sildenafil Effect on the Human Bladder Involves the L-cysteine/Hydrogen Sulfide Pathway: A Novel Mechanism of Action of Phosphodiesterase Type 5 Inhibitors

BackgroundPhosphodiesterase type 5 inhibitors (PDE5-Is) are effective in the treatment of lower urinary tract symptom (LUTS), although their mechanism of action is still unclear. PDE5-Is cause bladder detrusor relaxation, and this effect is partially independent of nitric oxide. Hydrogen sulfide (H2S) is a newly discovered transmitter with myorelaxant properties. It is predominantly formed from L-cysteine by cystathionine-β-synthase (CBS) and cystathionine-γ-lyase (CSE). ObjectiveTo evaluate whether the L-cysteine/H2S pathway contributes to the relaxing effect of sildenafil on the human detrusor dome. Design, setting, and participantsSamples of bladders obtained from men undergoing open prostatectomy for benign prostatic hyperplasia (BPH) were used. The presence of CBS and CSE enzymes was assessed by western blot. H2S production was measured by a colorimetric assay in basal and stimulated conditions with L-cysteine and in response to sildenafil (1, 3, 10, and 30μM), 8-bromo–cyclic guanosine monophosphate (8-bromo–cGMP; 100μM) or dibutyryl–cyclic adenosine monophosphate (dibutyryl-cAMP; 100μM). A curve concentration effect of sodium hydrosulfide (NaHS), H2S donor (0.1μM to 10mM), L-cysteine (0.1μM to 10mM), and sildenafil (0.1–10μM) was performed on precontracted detrusor dome strips. To investigate H2S signaling in a sildenafil effect, CBS and CSE inhibitors were used. Outcome measurements and statistical analysisAnalysis of variance was used, followed by the Bonferroni post hoc test. Results and limitationsCBS and CSE are present in the human bladder dome and efficiently convert L-cysteine into H2S. Both NaHS and L-cysteine relaxed human strips. Sildenafil caused (1) a relaxation of bladder dome strips and (2) a concentration-dependent increase in H2S production. Both effects were significantly reduced by CBS and CSE inhibitors. Similar to sildenafil, both 8-bromo-cGMP and dibutyryl-cAMP caused an increase in H2S production. ConclusionsThe sildenafil relaxant effect on the human bladder involves the H2S signaling pathway. This effect may account in part for the efficacy of PDE5-Is in LUTS. A better definition of the pathophysiologic role of the H2S pathway in the human bladder may open new therapeutic approaches.

113 Serum high density lipoprotein (HDL) levels are strongly correlated to histologic features of inflammatory infiltrate and weight of prostatic adenoma in men treated with prostatectomy for benign prostatic hyperplasia

113 Serum high density lipoprotein (HDL) levels are strongly correlated to histologic features of inflammatory infiltrate and weight of prostatic adenoma in men treated with prostatectomy for benign prostatic hyperplasia

Is There a Way to Predict Stress Urinary Incontinence After Holmium Laser Enucleation of the Prostate?

In this study we defined high risk patients at high risk of stress urinary incontinence after holmium laser enucleation of the prostate. We performed a retrospective analysis during a 10-year period of 949 consecutive patients treated with holmium laser enucleation of the prostate by a single surgeon. Patients were divided into group 1--those without postoperative stress urinary incontinence (902) and group 2--those with stress urinary incontinence (47). All preoperative, intraoperative and postoperative clinical variables were compared between the 2 groups. Patient age, preoperative and postoperative prostate specific antigen, preoperative medications, preoperative acute retention and duration of postoperative catheter time were not associated with postoperative stress urinary incontinence. The presence of diabetes mellitus was significantly associated with a higher incidence of stress urinary incontinence (p <0.001). Using medians of the whole cohort, prostate volume greater than 81 gm, operative time greater than 96 minutes and reduction in prostate specific antigen greater than 84% were significantly associated with stress urinary incontinence. On multivariate analysis prostate volume greater than 81 gm, the presence of diabetes mellitus and greater than 84% reduction in prostate specific antigen remained statistically significant. Holmium laser enucleation of the prostate results in stress urinary incontinence at a rate comparable to that of other surgical techniques for the treatment of benign prostatic hyperplasia. The presence of diabetes mellitus, large prostate volume and a greater reduction in postoperative prostate specific antigen remained statistically significant for the development of stress urinary incontinence. Patients with diabetes, especially those with a large prostate, should be encouraged to start Kegel exercises in the immediate postoperative period.

Significance of preoperative detrusor contractility to the postoperative assessment of prostatectomy for benign prostatic hyperplasia

Objective To study the value of the preoperative detrusor contractility to the outcome assessment of prostatectomy for benign prostatic hyperplasia (BPH).Methods A total of 109 patients with BPH were analyzed.Their ages ranged from 62 to 83 years with a mean of 71 years.All patients underwent urodynamic study to confirm a diagnosis of BOO preoperatively.Further more, their BOO was not caused by nervous, endocrine or other diseases.Pateints were divided into two groups based on maximum detrusor contractility.Group Ⅰ (n =61, BPH with maximum detrusor contractility ≥ 40 cm H2O, 1cm H2O =0.098 kPa) underwent TURP or open surgery, respectively.Group Ⅱ (n =48, BPH with maximum detrusor contractility ≤ 20 cm H2O ) underwent TURP and suprapubic punctural cystostomy simultaneously,the bladder fistula was kept open continuously for at least two weeks postoperatively.The difference in outcome between the two grous was assessed by using urodynamic parameters including maximum detrusor contractility, Qmax and residual urine at one and three months postoperatively respectively.Student's t-test was used to compare the result for normally distributed data and Wilcoxon's signed-ranks test for skewed data in this study.Results There was significant difference in preoperative maximum contractility, Qmax between group Ⅰand groupⅡ (78.4 ±37.0 cm H2O) vs (19.2 ±5.4 cm H2O)(P＜0.01), (7.6±2.2 ml/s) vs (2.5 ± 1.1 ) ml/s (P ＜ 0.05) respectively.Although there was significant difference at one month postoperatively in Qmax (17.4 ±2.9)ml/s vs (12.5 ±2.0)ml/s (P＜0.05), no significant difference was found in Qmax between the two groups after three months ( 18.3 ±2.8 ml/s) vs ( 15.2 ± 1.8)ml/s (P ＞ 0.05).Conclusions The Qmax may improve and the impaired detrusor recovered gradually after the BOO was removed.Performing an operation on patients with BOO accompanied with detrusor underactivity may be useful to recover detrusor contractility. Key words: Benign prostatic hyperplasia; Detrusor contract-ility; Controlled clinical trials

Laparoscopic extraperitoneal simple prostatectomy for benign prostate hyperplasia: a two-year experience.

To evaluate the feasibility of laparoscopic simple prostatectomy for large volume prostates. Between October 2007 and July 2009, laparoscopic simple prostatectomy was performed on 16 patients with the prostates over 80 mL. All the patients were operated with transvesical method. Peri-operative and 3rd postoperative month data were recorded and evaluated. The mean prostate volume was 147 mL (range, 80 to 200 mL). The mean operation time, blood loss, duration of hospitalization, and duration of drain placement was 133 minutes (range, 75 to 210 minutes), 134 cc (range, 50 to 300 cc), 3.9 days (range, 2 to 7 days), and 2.1 days (range, 2 to 3 days), respectively. Only one patient required blood transfusion due to postoperative bleeding and clot obstruction in the catheter lumen. Postoperative infection was not seen and recatheterization was not needed in any of the patients. All the patients' pathology reports were noted as benign. Pre-operative and postoperative International Prostate Symptom Score were 9.2 and 25.4, respectively. Maximum urinary flow rate was 4.0 mL/sec pre-operatively, but 24.7 mL/sec postoperatively. Laparoscopic simple prostatectomy is a feasible method with low morbidity and improved postoperative outcomes.