Prostatic Obstruction Research Articles

Prostatic arterial embolization as a micro-invasive treatment option for benign prostatic obstruction: A subtle balance between short-term follow-up patient-reported outcomes and de-obstructive effectiveness

PurposeThe study evaluated the effectiveness of prostatic arterial embolization (PAE) in the relief of benign prostatic obstruction (BPO) beyond the patient-reported outcomes.MethodsRetrospective evaluation of patients who underwent PAE (March 2015–December 2019). All patients underwent prostate MRI to assess prostate volume (PVol), uroflowmetry to assess Qmax, and were administered IPSS + QoL. MRI, and IPSS were repeated 3 months postoperatively. Patients were contacted for urological consultation, including uroflowmetry with post-voiding residual volume (PVR), IPSS + QoL. Additionally, patient satisfaction was assessed. Sexual function, including ejaculation and complications, was recorded.ResultsFifty-two patients were analyzed. At baseline, PVol was 66 ml (IQR 48–67), Qmax 13.5 ml/s (IRQ 11.5–19), IPSS 23 (IQR 18–25), and QoL 4.5 (IQR 4–5). At 3-month follow-up, MRI showed a 27% (IQR 18–36) reduction in PVol (p <0.001). The IPSS decreased by 81% (IQR 58–91, p <0.001). At a median follow-up of 14 months (IQR 10.5–27.5), IPSS decreased by 40% (IQR 26–54, p <0.001) and QoL by 50% (IQR 20–75, p = 0.002) versus baseline. The absolute Qmax was 12.2 ml/s (IQR 9.5–14). Median %variation of Qmax vs baseline was −7.3% (IQR −33.9; +25.5, p = 0.7). All sexually active patients maintained ejaculation. Thirty-eight (73%) were satisfied with the treatment they received. One patient reported post-operative erectile dysfunction. All patients who were counseled for adjuvant endoscopic treatment refused surgery except for one.ConclusionIn our analysis, PAE provided significant improvement in the short-term follow-up patient-reported outcomes. Most patients were satisfied, and ejaculation was maintained. On the other hand, the effectiveness of PAE on the relief of BPO seemed virtually intangible in most of the cases.

Influence of transurethral enucleation with bipolar of the prostate on erectile function: Prospective analysis of 51 patients at 12-month follow-up.

Transurethral enucleation with bipolar (TUEB) is a safe and effective surgery for benign prostatic obstruction (BPO). However, few data exist concerning the influence of TUEB on erectile function (EF) in patients with BPO. To evaluate the influence of TUEB on EF in patients with BPO at 3- and 12-month follow-up. We prospectively enrolled 51 patients who underwent TUEB from June 2016 to April 2020. We evaluated maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) preoperatively and at 3- and 12-month follow-up. We classified the patients according to their preoperative IIEF-5 score into group 1 (IIEF-5 ≥10; n = 24) and group 2 (IIEF-5 <10; n = 27), and for further evaluation of EF, into subgroups a: severe (IIEF-5 5-7), b: moderate (8-11), c: mild to moderate (12-16), d: mild (17-21), and e: no erectile dysfunction (22-25). Data are displayed as median or median (interquartile range). The study comprised 51 patients with a median age of 75 (70.5-79.5) years. Median prostate and transition zone volumes were 69.5 (46.5-78.8) mL and 30.5 (19-43) mL, respectively. Urinary function improved significantly when comparing respective preoperative, 3-month, and 12-month follow-up values: Qmax (7.6, 12.9, 15.2 mL/s), PVR (50, 0, 0 mL), IPSS (20.5, 9, 6), and QoL (5, 2, 2), respectively. There was no significant change in IIEF-5 score across the three time points: 9, 7, 8. The IIEF-5 score slightly but significantly increased between the preoperative and 12-month follow-up values in group 2 (5, 5, 6) and subgroup a (5, 5, 5). TUEB was effective and safe surgery for patients with BPO and showed no significant influence on EF at 12-month follow-up after TUEB in patients with BPO.

Transperineal laser ablation of the prostate with EchoLaser™ system: perioperative and short-term functional and sexual outcomes

ObjectiveTo date, several ultra-minimally-invasive surgical techniques are available for the treatment of male LUTS due to benign prostatic obstruction (BPO). Herein we report our preliminary experience with SoracteLite™ TPLA for the treatment of carefully selected patients with LUTS due to BPO.MethodsData from all consecutive patients undergoing TPLA at our institution between April 2021 and February 2022 were prospectively collected in a specific database. Data regarding functional and sexual outcomes evaluated by validated questionnaires and uroflowmetry were analyzed. All the procedure were performed in an outpatient setting, under local anesthesia and conscious sedation, using EchoLaser device, a multisource diode laser generator.ResultsOverall, 38 patients underwent TPLA at our institution during the study period. The median prostate volume was 46 ml (IQR 38-71). The median time to complete the procedure was 31 min (IQR 28-37). All patients but one were discharged within 8 hours of hospital stay. No perioperative Clavien-Dindo grade ≥2 complications were recorded. Median improvement in Qmax was 17%, 24% and 32% at 1 month, 3 months and last follow-up after surgery; as a result, the median postoperative IPSS at 1 month, 3 months and at last follow-up decreased by -14%, -36% and -35%, respectively. All patients preserved ejaculatory and sexual function. Two patients (5%), catheter carriers before the procedure, experienced acute urinary retention after TPLA treatment and required replacement of an indwelling catheter.ConclusionsTPLA can be a feasible, safe and effective ultra-minimally-invasive procedure for carefully selected patients with LUTS due to BPO.

Thulium Fiber Laser Enucleation of the Prostate: Prospective Study of Mid- and Long-Term Outcomes in 1328 Patients.

Objective: The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). Materials and Methods: We analyzed patients who underwent ThuFLEP due to lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, postvoid residual (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen level, and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization, and data on hospital stays were also collected. A subgroup analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. Results: A total of 1328 patients were included in the analysis. The mean age was 66.9 ± 7.5 years. Mean prostate volume was 86.9 ± 41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p < 0.05) and showed durable improvement up to 3 years of follow-up. The frequency of late complications was as follows: stress urinary incontinence-1.2%; urethral stricture-1.1%; and bladder neck contracture-0.9%. Subgroup analyses revealed increased urinary tract infection frequency in older patients (3.5% vs 0.8%, p = 0.003) as well as higher rate of stress urinary incontinence (0.4% vs 1.8%, p = 0.002) and higher rate of clot retention (11.3% vs 4.4%, p < 0.001) in those with larger glands. Conclusions: Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be a promising alternative to holmium laser enucleation of the prostate for treatment of LUTS associated with BPO.

Long-term outcomes of bipolar transurethral enucleation and resection of the prostate on patients with benign prostatic obstruction: a 10-year follow-up.

We aimed to explore the long-term outcomes of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in patients with benign prostatic hyperplasia (BPH). A total of 1195 patients with BPH who underwent B-TUERP from July 2006 to June 2010 were enrolled in this retrospective study. Preoperative data, particularly urodynamic study (UDS) parameters, were collected by questionnaire and examination. Postoperative follow-up was performed at 3, 6, 12, 36, 60 and 120 months, respectively. Demographic, perioperative and functional data were analysed. International Prostate Symptom Score, quality of life and overactive bladder syndrome score (OABSS) were used to assess the functional scores. Predictors of postoperative urgency incontinence were identified by univariate analysis. Long-term outcomes of functional score were significantly better than the preoperative values. All UDS variables, including maximum urinary flow rate, postvoid residual urine volume, compliance, maximum cystometric capacity (MCC), bladder outlet obstruction index, prostatic urethral pressure and detrusor pressure at maximum urinary flow rate, were all significantly improved. No one required reoperation due to recurrent BPH. The postoperative rate of transient urinary incontinence was 31.7%, while the long-term incontinence rate was 0%. Retrograde ejaculation occurred in 44.3% patients who remained sexually active after operation. Patients who had transient urge incontinence were older with preoperative higher OABSS, prostate-specific antigen (PSA) and detrusor overactivity rate and lower MCC. B-TUERP is a safe, successful and highly effective treatment for BPH at 10-year follow-up. Increased age, OABSS, PSA level and detrusor overactivity rate are potential predictors for urge incontinence after B-TUERP.

Treatment with CoreTherm in 570 patients with prostate volumes of 80-366 ml: an evaluation of short- and long-term retreatment risk

Introduction CoreTherm (ProstaLund AB, Lund, Sweden) is an outpatient treatment option in men with lower urinary tract symptoms and catheter-dependent men with chronic urinary retention caused by benign prostatic obstruction (BPO). CoreTherm is high-energy transurethral microwave thermotherapy with feedback technique. Modern treatment with CoreTherm includes transurethral intraprostatic injections of mepivacaine and adrenaline via the Schelin Catheter (ProstaLund AB, Lund, Sweden) and is often referred to as the CoreTherm Concept. Objectives The aim of this study was to evaluate the short- and long-term retreatment risk in men with large prostates and BPO or chronic urinary retention, all primarily treated with CoreTherm. Material and Methods All men from the same geographical area with prostate volumes ≥ 80 ml treated 1999–2015 with CoreTherm and having BPO or were catheter-dependent due to chronic urinary retention, were included. End of study period was defined as December 31, 2019. Results We identified and evaluated 570 men treated with CoreTherm, where 12% (71 patients) were surgically retreated during the follow-up. Mean follow-up was 11 years, and maximum follow-up was 20 years. The long-term retreatment rate in our study was 23%. A majority of these could be retreated with CoreTherm or TURP, with only 3% requiring open surgery. Conclusion We conclude that CoreTherm is a suitable outpatient treatment option in patients with profoundly enlarged prostates, regardless of age, prostate size, and reason for treatment.

Treatment of overactive bladder in men: Is it really different?

Overactive bladder (OAB) in men is a topic that is gaining increasing attention as there is a wider understanding that OAB is not a female condition. There are several treatments; however, data in male populations are lacking compared to female cohorts. The high likelihood of concomitant benign prostatic hyperplasia (BPH)and benign prostatic obstruction (BPO) adds to the complexity of the treatment algorithm. The overlap in urinary storage symptoms also makes the interpretation of the literature challenging. Articles that evaluated men with OAB and men with OAB and BPH/BPO were evaluated and assessed. Behavioral interventions can offer a significant benefit to male patients with OAB. Medical therapies that have been studied in men with OAB include anticholinergics, beta-3 agonists, and phosphodiesterase-5 inhibits. These agents can be offered in addition to alpha-blockers for men with coexisting BPH/BPO.The literature on Onabotulinumtoxin-A and neuromodulation modulation in the male population is growing and shows promising results. Male OAB is complex; however, there is a growing body of literature to help guide treatments. Many treatments are available and they haveshown considerable success.

What to consider when tailoring benign prostatic hyperplasia treatment

While there is a prolific list of minimally invasive procedures for lower urinary tract symptoms due to benign prostatic obstruction, the American Urological Association has yet to define their roles in the treatment algorithm. Therefore, it remains a challenge for urologists to identify the most appropriate treatment option for a particular patient.

Comparison of postoperative functional results in holmium laser enucleation of the prostate, green laser photovaporization of the prostate and transurethral resection of the prostate in the treatment of obstructive prostatic hyperplasia

Objective: To compare the functional results in patients undergoing transurethral resection of the prostate (TURP), photovaporization of the prostate with GreenLight ® laser (FTV) and prostate enucleation with Holmium laser (HOLEP), for the treatment of benign prostatic obstruction at the Central Military Hospital. Material and methods: The international index of prostate symptomatology questionnaire (IPSS), Uroflowmetry (Qmax), pre and post void ultrasonography (PVR) were applied to patients undergoing TURP, VTF and HOLEP pre and postoperatory from January 2018 to March 2019. Shapiro-Wilks tests were analyzed for quantitative variables; parametric behavioral data were analyzed with ANOVA tests, and non-parametric data were analyzed with Mann-Whitney and Kruskal-Wallis U tests. GraphPad PRISM v7.0 statistical package was used. Results: 46 patients underwent to TURP, 62 to HOLEP and 17 to VFT were evaluated, removing those who did not achieve complete postoperative follow-up; describing the demographic characteristics, the most frequent comorbidities and the parameters evaluated preoperatively. At follow-up, HOLEP was slightly better than FTV or TURP; without finding statistical significance between the groups, observing an important improvement in the reference values of IPSS, Qmax and PVR after surgery in all populations. Conclusions: No superiority of any technique was proven in short-term postoperative functional results, so we propose to perform long-term studies, considering adding trans and postoperative parameters in order to demonstrate superiority of these techniques.

Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP.

To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP). This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS > 20 or Qmax < 10ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12weeks and 6months were collected. Data on 163 participants were included (77-HoLEP, 86-ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p > 0.05). Total ICIQ-MLUTS, bother and voiding scores at 1 and 3months significantly increased compared with the baseline in both groups (p < 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54). The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms.Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates.

Bipolar radiofrequency thermotherapy vs. transurethral resection of the prostate: Effect on nocturia as a result of benign prostatic obstruction.

The purpose of this study was to investigate and compare the effects of radiofrequency thermotherapy (RF) thermotherapy and transurethral resection of the prostate (TURP) on nocturia and associated quality of life in patients diagnosed with benign prostatic obstruction (BPO) under medical treatment who have complaints of persistent nocturia. The results of patients who underwent RF thermotherapy and TURP procedures between February 2019 and February 2022 were examined, and their three-month results were compared based on their uroflowmetry values, International Prostate Symptom Score (IPSS) values, nocturia frequency, and Nocturia Quality of Life Questionnaire scores. While the frequency of nocturia in the RF thermotherapy group that was 4.5±1.6 before the procedure decreased to 2.3±1.4 after the procedure (p=0.002), this value in the TURP group decreased from 5.1±2.42 to 3.9±2.1 (p=0.044). RF thermotherapy was found to be more effective than TURP (p<0.005). Significantly, more noticeable improvements were observed in most nocturia-related next-day complaints and nocturia-related concerns in the RF thermotherapy group than the TURP group. It was observed that RF thermotherapy had a more acceptable effect on obstructive complaints in comparison to TURP, and it could be more effective on nocturia and associated quality of life. RF ablation treatment may be offered as an appropriate option to treat nocturia complaints in suitable patients.

The Efficacy and Safety of Laser and Electrosurgical Transurethral Procedures for the Treatment of BPO in High-Risk Patients: A Systematic Review.

ObjectiveTo compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO).MethodsWe conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age >80 years and/or significant comorbidity. Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints.ResultsA total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2−29 falling to 2.3−10.8 for IPSS, 0−19 mL/s increasing to 7.5−34.1 mL/s for Qmax and 41.4−954 mL falling to 5.1−138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP.ConclusionsLaser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.

Do men with bladder stones benefit from treatment of benign prostatic obstruction?

To identify whether men aged ≥40 years with bladder stones (BS) benefit from treatment of benign prostatic obstruction (BPO). A regional, retrospective study of patients undergoing BS surgery between January 2011 and December 2018 was performed using a prospectively collected database. The primary outcome was BS recurrence after successful removal. Kruskal-Wallis and chi-squared statistical tests were used. A total of 174 patients underwent BS removal and 71 (40.8%) were excluded due to BS formation secondary to causes other than BPO. Hence, 103 men aged ≥40 years had BS successfully removed, of which 40% had a history of upper tract urolithiasis. These men were divided into three groups: those undergoing contemporaneous medical, surgical, or no BPO treatment. Age, diabetes, previous urolithiasis and previous BPO surgery were well matched between the BPO treatment groups. In all, 18 of these men (17%) had BS recurrence after 46 months follow-up. Recurrences were significantly lower following BPO surgery; one of 34 (3%) men versus five of 28 (18%) with no BPO treatment (P = 0.048) and 12 of 41 (29%) with medical BPO treatment (P = 0.003). Recurrences after medical and no BPO treatment were similar (P = 0.280). In all, 34 men (33%) had BPO complications that were similar between groups (P = 0.378). This is the largest reported cohort of men, with the longest follow-up after BS removal. Most men aged ≥40 years with BS benefit from BPO surgery. However, the study findings also support a multifactorial aetiology for BS, which questions the dogma that BS are an 'absolute indication' for BPO surgery, as is stated in the Non-neurogenic Male Lower Urinary Tract Symptoms European Association of Urology Guideline. Assessment and management of all causative factors is likely to enable selection of which men will benefit from BPO surgery and to reduce BS recurrence rates.

Risk factors for the postoperative bladder neck contracture in patients with small-volume prostatic hyperplasia

This study was to explore the risk factors for postoperative bladder neck contracture (BNC) after transurethral operation of prostate in patients with small-volume prostatic obstruction. Clinicopathologic data at our center from February 2016 to January 2020 were retrospectively collected and analyzed. Clinicopathological characteristics between patients with and without BNC were compared. Multivariate logistic regression was used to determine the risk factors for postoperative BNC. There were a total of 39 patients (8.53%) with postoperative BNC. Multivariate logistic regression analysis demonstrated that preoperative bladder neck diameter (BND), intravesical prostatic protrusion (IPP), surgical methods (transurethral resection of prostate (TURP)/anatomical endoscopic enucleation of the prostate (AEEP)), and postoperative urinary tract infection (UTI) were independent risk factors for postoperative BNC in patients with small-volume prostatic obstruction (P<0.05). The incidence of postoperative BNC in patients undergoing AEEP was significantly decreased compared with those undergoing TURP. The optimal cut-off value of preoperative IPP was 6.10mm while the optimal cut-off value of preoperative BND was 2.52cm. Larger preoperative bladder neck and higher preoperative IPP lead to decreased incidence of postoperative BNC in patients with small-volume prostatic obstruction. Active management of postoperative UTI could effectively prevent the occurrence of postoperative BNC. Compared with TURP, complete AEEP would contribute to reduce BNC in patients with small-volume prostatic obstruction.

In Benign Prostate Hyperplasia Where does Prostate Artery Embolization Stand?

Benign Prostatic Obstruction (BPO) involves about 50% of men aged 50-60 years. They suffer from Lower Urinary Tract Symptoms (LUTS) characterized by voiding and storage problems. Surgical treatment may be required when conservative alternatives fail.

Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review

ObjectivesTo systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary...

A systematic review and meta-analysis of efficacy and safety comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for patients with prostate volume less than 100 mL or 100 g.

BackgroundTo assess the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) for patients with prostate volume less than 100 mL or 100 g.MethodsWe searched PubMed, Embase, Cochrane Library and Web of Science from inception to July 2021 to collect randomized controlled trials. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies by using the Cochrane risk of bias tool. Review Manager 5.3 software was used for meta-analysis. We synthesised effect estimates using risk ratios (RR), mean difference (MD), and standardized mean differences (SMD).ResultsA total of eight studies were included, involving 764 patients, 384 patients in the HoLEP group and 380 patients in the TURP group. The meta-analysis showed that the catheterization time (SMD =−1.44; 95% CI: −2.17 to −0.70; P=0.0001), hospital stay (SMD =−1.01; 95% CI: −1.58 to −0.44; P=0.0005), haemoglobin loss (MD =−0.29; 95% CI: −0.52 to −0.07; P=0.01), and transfusion rate (RR =0.16; 95% CI: 0.05–0.49; P=0.001) in the HoLEP group were lower than those in the TURP group. In addition, the 12-month postvoid residual volume (PVR) of the HoLEP group (MD =−9.93 95% CI: −18.59 to −1.27; P=0.02) were superior to the TURP group. Although the operation time of the HoLEP group was longer (MD =17.89; 95% CI: 9.18–26.60; P<0.0001), more tissues were removed (SMD =0.47; 95% CI: 0.10–0.85; P=0.01).DiscussionCompared with TURP, HoLEP has a shorter catheterization time and hospital stay, with more tissue removed, a lower blood transfusion rate and better results in the short-term follow-up after surgery. Therefore, HoLEP has better efficacy and safety in the treatment of small- and medium-sized benign prostatic obstruction. Our results found that HoLEP is also suitable for patients with prostate volume <100 mL/100 g, suggesting that it is necessary to redefine the prostate size that is best for HoLEP. Overall, the certainty of evidence was assessed to be moderate to low due to potential risk of bias and inconsistent outcome indicators in some studies. More data on the efficacy of HoLEP and TURP on small- and medium-sized prostates are needed to determine the optimal prostate volume of HoLEP.

Predictors of Unfavorable Pathology in Patients with Incidental (pT1a–T1b) Prostate Cancer

BackgroundIncidental prostate cancer (IPCa) is encountered in 10% of surgical procedures for benign prostatic obstruction (BPO). Identification of patients with underlying detrimental prostate cancer is paramount for tailored treatment decision-making, but guideline recommendations for this setting are lacking. ObjectiveTo highlight clinical and histological characteristics related to BPO surgery that may predict IPCa with unfavorable pathology. Design, setting, and participantsWe included men with IPCa who underwent radical prostatectomy (RP) in the short term after IPCa diagnosis. Two cohorts were built according to final pathology for the RP specimen: unfavorable pathology (International Society of Urological Pathology [ISUP] grade group [GG] ≥3 and/or ≥pT3a and/or pN1) versus favorable pathology. Outcome measurements and statistical analysisWe performed multivariate regression analysis for the endpoint, which was unfavorable pathology for the RP specimen. Using the model estimates for prostate-specific antigen (PSA), ISUP GG, age, and prostate volume, we established a model for estimating the risk of unfavorable histopathology. Results and limitationsOverall, 112 patients were included in the final assessment. On multivariate analysis, PSA (odds ratio [OR] 1.083, 95% confidence interval [CI] 1.003–1.170; p = 0.042), ISUP GG for the specimen from BPO surgery (OR 3.090; 95% CI 1.129–8.457; p = 0.028), and age (OR 1.121, 95% CI 1.026–1.225; p = 0.012) were independent predictors for unfavorable histopathology. On receiver operating characteristic analysis, the area under the curve was 0.751. A novel calculator was developed to predict adverse pathology for men with IPCa. The study is limited by its retrospective design. ConclusionsFor men with IPCa, PSA before surgery for BPO, ISUP GG, and age are independent predictors of unfavorable disease. Our results might improve preoperative risk assessment for patient counseling. Patient summaryWe developed a novel calculator to estimate the risk of underlying detrimental disease in men diagnosed with prostate cancer at surgery for benign prostatic obstruction.

Prostatic Artery Embolization for Benign Prostatic Obstruction: Single-Centre Retrospective Study Comparing Microspheres Versus n-Butyl Cyanoacrylate.

To compare the safety and efficacy of n-butyl cyanoacrylate glue (NBCA) versus microspheres for prostatic artery embolization (PAE) in patients with benign prostatic obstruction (BPO). This institutional review board-approved, single-centre, retrospective study included consecutive patients undergoing PAE from September 2017 to July 2020. Age, medical history, previous treatment, pre- and post-PAE prostatic volumes and International Prostate Symptom Scores (IPSSs) were systematically analysed. Procedural duration, dosimetry, immediate and delayed complications were recorded. Patients at the beginning of the study were treated with microspheres and patients at the end of the study with NBCA. The main outcome measures were the absolute and relative changes in IPSS at 3months. Statistical analyses comprised unpaired t-tests, Wilcoxon tests, Chi-2 tests, uni- and multivariate linear regressions. Sixty-two patients were included (median age: 65.9years). Thirty-two patients were treated with microspheres and 30 with NBCA. There were no significant baseline differences between the two groups except for the baseline PSA (P = 0.0251). Average procedural and fluoroscopy times, and radiation exposure were significantly lower in the NBCA group versus the microspheres group (80.7 ± 22.5 versus 112 ± 42.1min [P = 0.0011], 24.2 ± 9.6min versus 42.1 ± 20.2min [P = 0.0001], 12,004.6 ± 6702 uGy.m2 versus 25,614.9 ± 15,749.2 uGy.m2 [P = 0.0001], respectively). Immediate complications were all minor, and there were no significant differences between the two groups (4/32 [12.5%] with microspheres versus 7/30 [23.3%] with NBCA, P = 0.4335), nor for delayed complications (P = 1). No association was found between the PAE techniques and the absolute change in IPSS at 3months (-10.2 ± 7.9 with microspheres versus -9.5 ± 7.6 with NBCA, P = 0.7157). PAE using NBCA was safe and effective for symptomatic BPO, with faster procedures, lower radiation exposure and similar safety and efficacy compared to microspheres. Operator learning curve could have biased the procedural times and radiation exposure between groups favouring NBCA.

Holmium: yttrium-aluminum-garnet laser with Moses: does it make a difference?

Moses effect is an inherent physical principle of Ho:YAG laser functioning. Moses Technology is a pulse modulation modality of Ho:YAG laser, which became commercially available for the treatment of two urological conditions: urinary stones and benign prostatic obstruction. The purpose of this narrative review is to distinguish between Moses effect and Moses Technology, as well as to summarize the latest evidence on Moses Technology and its main application in the urological field. During laboratory lithotripsy, Moses Technology seems to reduce stone retropulsion and determine higher ablation volume compared with regular lithotripsy. However, this technology presents similar characteristics to long pulse Ho:YAG laser, and several studies showed no significant difference between Moses Technology and standard lasers. When used in prostate enucleation, Moses Technology promises to reduce operating time by increasing the efficiency of prostate resection and improve the hemostasis. Moreover, some studies state that it is possible to reduce the HoLEP morbidity. Despite this, the clinical impact of the time reduction remains uncertain and different studies either present relevant limitations or are burdened by significant bias. Although Moses effect has been extensively described and characterized, and several studies have been published on the usage of Moses Technology for both laser lithotripsy and laser enucleation of the prostate with Holmium YAG, solid clinical evidence on the real improvement of surgical outcomes is still missing.