Recurrent Lower Urinary Tract Symptoms Research Articles

Retreatment for Lower Urinary Tract Symptoms After Water Vapor Thermal Therapy

ObjectivesTo identify predictors of retreatment for symptomatic recurrence among men who undergo water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA), a minimally invasive surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). MethodsWe retrospectively reviewed patients treated with WVTT at a single institution from August 2017 to February 2022. Patients who underwent a second BPH procedure for persistent or recurrent LUTS within 2 years of original treatment were compared to the remaining cohort who did not undergo retreatment. Multivariate analysis was used to assess for predictors of retreatment. ResultsData was obtained from 192 patients. 10 (5%) patients were retreated. The retreatment cohort had smaller prostate volumes (50.4 + 18.2 cc vs 48.5 + 35.7 cc; p=0.003) and received a greater number of water vapor injections (4.4 + 1.8 vs 5.2 + 3.9; p<0.001). At 6 month follow-up, total International Prostate Symptom Score (IPSS; 10.13 ± 7.40 vs 18.5 ± 11.55, p=0.044) and voiding sub-scores (4.59 ± 4.39 vs 9.5 ±7.84, p=0.006) were significantly worse in the retreatment group. On multivariate analysis, >1 treatment per lobe was independently associated with increased risk of retreatment (HR 8.509, 95% CI [1.109 – 65.293]; p=0.039). ConclusionsWVTT has a low retreatment rate. Men who required retreatment received more injections and showed worsened voiding symptom scores 6 months postoperatively. Decreasing the number of injections may help reduce treatment failure rates.

Comparison of Holmium Laser Enucleation of Prostate versus Bipolar Resection of Prostate in Patients with Benign Prostatic Hyperplasia: A Prospective Interventional Study

Introduction: Surgical treatment for Benign Prostatic Hyperplasia (BPH) has advanced significantly in recent years. Transurethral Resection of the Prostate (TURP) is a minimally invasive procedure associated with a low risk of complications and clinical limitations, including life-threatening Transurethral Resection (TUR) syndrome, as, well as higher costs due to longer hospital stays and challenges in managing large glands. Aim: To compare the safety and effectiveness of prostate enucleation using Holmium Laser Enucleation of the Prostate (HoLEP) with bipolar resection of the prostate in cases of BPH. Materials and Methods: A hospital-based prospective interventional study was conducted in the Department of Urology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from January 2020 to July 2022. The study included 60 patients, divided into two groups of 30 each. Males aged ≥45 years with recurrent Lower Urinary Tract Symptoms (LUTS) secondary to BPH, with or without Acute Urinary Retention (AUR) (drug-refractory) or with failed medical therapy (alpha-blockers, 5-alpha reductase inhibitors), were included in the study. In the first group, HoLEP was performed (Group I), while in the second group (Group II), patients underwent bipolar resection. Data were analysed and statistically evaluated using Statistical Package for the Social Sciences (SPSS) software version 21.0. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of patients in the HoLEP group was 60.25 years, while in the Bipolar TURP (B-TURP) group, it was 59.67 years. Both groups had similar proportions of patients with moderate urinary symptoms {International Prostate Symptom Score (IPSS)} and large prostates (&gt;80 grams). The mean amount of irrigation fluid used (40.83±9 litres vs. 21.2±5.9 litres) and the duration of surgery (106.33±14.24 min vs. 67.4±9.73 minutes) were significantly higher in the HoLEP group compared to the B-TURP group (p-value&lt;0.001). Postoperative catheterisation time (1.003±0.23 days vs. 2.38±0.52 days) (p&lt;0.001) and length of hospital stay (3.2±0.65 days vs. 4.67±1.32 days) (p&lt;0.001) were significantly longer in the B-TURP group compared to the HoLEP group. Both the HoLEP and bipolar resection of the prostate groups did not experience significant intraoperative or immediate postoperative complications; however, one patient in the HoLEP group developed urethral stricture as a late complication. Conclusion: The B-TURP procedure is an equally effective and feasible method for treating BPH patients, with a smaller learning curve and lesser financial burden.

Benefits of Repeat Prostatic Artery Embolization on Persistent or Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia

To evaluate the benefits of repeat prostatic artery embolization (rePAE) for patients with persistent or recurrent symptoms after initial prostatic artery embolization (PAE). This is a single-center retrospective study of all patients who underwent a rePAE between December 2014 and November 2020 for persistent or recurrent lower urinary tract symptoms. Symptoms were assessed before and after PAE and rePAE, using the International Prostate Symptom Score and quality of life (QoL) questionnaires. Patient characteristics, anatomical presentations, technical success rates, and complications of both procedures were collected. Clinical failure was defined as one of the following: less than 2 points' decrease in QoL, a QoL score higher than 3, acute urinary retention, and secondary surgery. A total of 21 consecutive patients (mean age: 63.8 ± 8.1; [40-75] years) who underwent rePAE were included. The median follow-up after PAE was 27.7 [18.1-36.9]) months and 8.9 [3.4-10.8] months after rePAE. rePAE was performed at a mean of 19 ± 11.1 [6.9-49.6] months following PAE, and the overall clinical success rate was 33% (7/21). In patients undergoing rePAE because of persistent symptoms, the clinical success rate (18%) was non-significantly lower than that for patients treated for recurrent symptoms (50%) [OR 4.5 (95% CI 0.63-32 P = 0.13)]. The main anatomical revascularization pattern was recanalization of the native prostatic artery (29/45, 66%). Patients who experience recurrent symptoms after PAE may benefit more from rePAE than those with persistent symptoms after PAE. Clinical success rates seem to be relatively low in both clinical scenarios.

MP51-14 RE-TREATMENT FOR LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER WATER VAPOR THERMAL THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP51-14 RE-TREATMENT FOR LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER WATER VAPOR THERMAL THERAPY Vi Nguyen, Michelle C. Leach, Clara Cerrato, Mimi V. Nguyen, and Seth K. Bechis Vi NguyenVi Nguyen More articles by this author , Michelle C. LeachMichelle C. Leach More articles by this author , Clara CerratoClara Cerrato More articles by this author , Mimi V. NguyenMimi V. Nguyen More articles by this author , and Seth K. BechisSeth K. Bechis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Water vapor thermal therapy (Rezum, Boston Scientific, Marlborough, MA, USA) has become increasingly used as a minimally invasive surgical treatment for LUTS due to benign prostatic hyperplasia (BPH) with a low re-treatment rate. We sought to identify predictors of re-treatment or symptom recurrence. METHODS: We retrospectively reviewed patients treated with water vapor thermal therapy at a single institution from August 2017 to February 2022. Patient demographics, pre- and peri-operative data, and international prostate symptom scores (IPSS) were evaluated. Patients who underwent a second BPH procedure (“re-treatment”) for persistent or recurrent LUTS within 2 years of original treatment were compared to the remainder of the cohort who did not undergo re-treatment. Multivariate analysis (MVA) was used to assess for predictors of re-treatment. RESULTS: Data from 192 consecutive patients undergoing water vapor thermal therapy were collected and analyzed. 10 (5%) patients were re-treated. Men in the re-treatment cohort had smaller prostate volumes (48.5 vs 50.4, p=0.003) and received a greater number of water vapor injections (5 vs 4, p<0.001). Baseline IPSS score or median lobe treatment was not associated with re-treatment (Table 1a). At 6-month follow-up, total IPSS (10.13 vs 18.5, p=0.044) and IPSS voiding sub-scores (4.59 vs 9.5, p=0.006) were significantly worse in the re-treated group (Table 1b). On MVA, ≥3 total treatments (>1 per lobe) during an initial Rezum procedure were independently associated with increased risk of re-treatment (HR 8.51, p=0.039). Increasing prostate volume, catheter duration, and treatment of the median lobe were not significantly associated with an increased risk of re-treatment in these patients (Table 1c). CONCLUSIONS: We found that water vapor thermal therapy has a good performance with a low re-treatment rate, consistent with larger published studies. Men who did require re-treatment of their LUTS from BPH tended to receive more vapor injections and showed significant worsening of voiding symptom scores around 6 months post-operatively. Decreasing the number of vapor injections when possible may help further reduce treatment failure rates. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e698 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vi Nguyen More articles by this author Michelle C. Leach More articles by this author Clara Cerrato More articles by this author Mimi V. Nguyen More articles by this author Seth K. Bechis More articles by this author Expand All Advertisement PDF downloadLoading ...

Urinary Bladder Stone: A Late Complication of Bulkamid® Periurethral Bulking Injection

Polyacrylamide hydrogel bulking agent (Bulkamid® [Axonics, Irvine, California, USA]) injection is used as a minimally invasive treatment for stress and mixed urinary incontinence in females. Several studies have demonstrated the short- and medium-term efficacy and safety of Bulkamid. However, there are limited data available on the long-term safety of this procedure. The authors report an unexpected and late complication associated with Bulkamid periurethral injection. An 80-year-old female, who had undergone Bulkamid periurethral injection for stress urinary incontinence 10 years previously, was referred to the authors’ clinic with recurrent lower urinary tract symptoms and dysuria. Investigations with ultrasound and cystoscopy confirmed a single 2 cm bladder stone adhered to an exposed Bulkamid agent at its injection site. Exposed intravesical Bulkamid can act as a foreign body with lithogenic potential to cause urinary bladder stone formation. This article highlights urinary bladder stone formation as a late potential complication of Bulkamid periurethral injection.

A Rare Case Report of Giant Urinary Bladder Stone Causing Recurrent Dysuria in a Woman

Background Large urinary bladder stones are not common and even less common in females. We report a case of large bladder stone presented with acute retention of urine in a female patient. Case Report. A 62-year-old female presented in emergency department with retention of urine for 12 hours with history of recurrent UTIs for last 1 year. She was also complaining of mild dull lower abdominal pain for last 6 months. She had no history of incontinence of urine and fever. On physical examination, hard mass was palpable on suprapubic region on palpation of abdomen. Urine culture shows Escherichia coli for which antibiotics was given. An X-ray kidney ureter bladder showed a radio-opacity in the pelvic region measuring 9 × 8 cm in size. Ultrasonography revealed bilateral mild hydronephrosis with a large bladder stone. Open cystolithotomy was performed, and the stone was taken out. Stone biochemical analysis showed predominantly urate crystals. Patient had uneventful postoperative course, and she was discharged on 4th postoperative day and was followed up for 1 months after operation. Conclusions Large urinary bladder stones are not common and even less common in females. Clinician should have think regarding large bladder stone as a cause of recurrent lower urinary tract symptoms like dysuria and should assess renal function for proper treatment. Open cystolithotomy is choice of operation in large bladder stone.

Rezum to the rescue: Early outcomes of Rezum on patients with recurrent lower urinary tract symptoms after surgical interventions for benign prostatic enlargement.

We aim to report the short-term outcomes of patients undergoing Rezum as a re-treatment intervention for recurrent lower urinary tract symptoms after prior surgical treatment for benign prostate enlargement. Data from two institutions for baseline International Prostatic Symptom Score with Quality of life item, prostate size, and maximum flow-rate was acquired. Patients were assessed 3-month post-treatment. Outcomes were compared with unpaired t-tests and Fisher's exact tests. Nineteen patients were included. Prior surgical interventions included transurethral resection of the prostate (31.6%, n=6), Urolift (26.3%, n=5), transurethral bladder neck incision (15.8%, n=3), prostate artery embolization (10.5%, n=2), transurethral needle ablation, greenlight photovaporization of prostate and Rezum (5.3%, n=1 each). Median age was 69.0 years (IQR 14; range 59-87 years) with a median prostate volume of 65.0ml (IQR 63; range 22-160 ml). The median time to Rezum treatment was 48 months (IQR 78; range 9-240 months). 63.1% (n=12) were re-started on benign prostatic enlargement medication and 36.8% (n=7) had recurrent bothersome symptoms before re-treatment with Rezum. At 3-month follow up, median International Prostatic Symptom Score decreased from 23 to 9 (p < 0.001) and Quality of life from 4 to 2 (p < 0.001). Median maximum flow-rate improved after treatment from 8.6 to 14.8ml/s (p < 0.001). None of the patients were required to restart medication for benign prostate enlargement.

Case Report Tuberculosis of The Prostate: Findings of Post Transurethral Resection of Prostate (TURP) Procedure

Background: Prostate tuberculosis (PTB) is one of extra pulmonary tuberculosis which potentially has more frequent fatal complications and more severe quality of life deterioration. It is a very rare disease, with prevalence of 2.6% of all urogenital tuberculosis (UGTB). Prostate tuberculosis may be a sexually transmitted disease and leads to sexual dysfunction. Case: Male, 54 years old, with urinary retention, dysuria, flank pain in the last 1-month, recurrent urinary tract infection in the past 1 year and decrease body weight of 8 kg in 1 month. Physical examination demonstrates enlarged prostate. Patient was referred to Wangaya Hospital with benign prostate hyperplasia (BPH) and suspect malignancy. After underwent clinical and supporting examination, patient underwent TURP procedure. Histopathology examination revealed PTB. Patient was then treated with first line anti-tuberculosis drug (ATD). Discussion: Multiple risk factors are involved in TB disease. PTB spread occur through hematogenous, lymphatic, or direct routes. Clinical features and supporting examinations of PTB are non-specific. Diagnosis often made through incidental histology finding post TURP. Standard ATD regiment administered based on World Health Organization (WHO) guideline. Duration can be prolonged due to suboptimal concentration to prostate tissue. Conclusion: Multidisciplinary approach for extra pulmonary TB is needed. Thorough history taking, and high index of suspicion are important aspects. PTB diagnosis should be considered in patients with recurrent lower urinary tract symptoms refractory to standard therapy in TB endemic area.

Ketamine Induced Cystitis: An Important Differential Diagnosis in Patients Pre- senting with Recurrent Lower Urinary Tract Symptoms

Ketamine Induced Cystitis: An Important Differential Diagnosis in Patients Pre- senting with Recurrent Lower Urinary Tract Symptoms

Ligating clip migration after robot-assisted laparoscopic radical prostatectomy: a single-center experience.

BackgroundLigating clip migration (LCM) after robot-assisted laparoscopic radical prostatectomy (RARP) is a rare but troublesome complication, that may result in calculus formation, bladder neck contracture, and anastomotic stricture. Herein, we describe our experiences with LCM after RARP and explore its risk factors, potential pathogenesis, and preventive measures.MethodsWe retrospectively reviewed patients who underwent RARP at our medical center between December 2015 and June 2019, identifying individuals with LCM. Clinical and surgical data were collected from these patients.ResultsOf the 682 patients who underwent RARP at our institution, 26 (3.8%) had LCM. The duration from RARP to the identification of LCM ranged from 1 to 37 (13±10) months. Clips migrated into the urethrovesical anastomosis in 22 patients (84%), prompting cytoscopic extraction to remove the migrated clips. The length of stay after RARP was longer in LCM-positive patients than in LCM-negative patients (13.5 vs. 9.4 days, P=0.034). Additionally, the rates of urine leakage (15% vs. 6%, P=0.046) and anastomotic stenosis (54% vs. 5%, P=0.000) were higher among LCM-positive patients. More positive urethra/apex margins were found in LCM-positive patients (38% vs. 21%, P=0.039).ConclusionsThe incidence of clip migration after RARP may not be as low as previously thought. Cystoscopy is recommended in post-RARP patients with recurrent lower urinary tract symptoms (LUTS) and/or urinary retention. Prolonged length of stay after the first RARP, urine leakage, anastomotic stenosis, and positive urethra/apex margin might be predictors of LCM. We recommend reduced ligating clip usage and electrotome near the urethrovesical anastomosis to reduce clip migration incidence. Meanwhile, more researches are needed to determine the practicality of reducing the risk of clip migration after RARP.

Safety and efficacy of holmium laser enucleation of prostate as salvage procedure for persistent or recurrent lower urinary tract symptoms secondary to bladder outlet obstruction after prior prostate artery embolization: a match analysis.

To evaluate safety and efficacy of Holmium laser enucleation of Prostate (HoLEP) for management of persistent or recurrent lower urinary tract symptoms after prior prostate artery embolization (PAE). We also evaluated histopathological changes in prostate after PAE. Ten patients who underwent HoLEP after prior PAE were matched according to age, weight of resected prostate tissue, and anticoagulation status in 1:2 ratio with patients who underwent HoLEP without prior PAE by a researcher who was blinded to patient's outcome at the time of matching. Histopathological examination of prostate tissue was performed to look for changes related to prior PAE. Patient's demographics, perioperative parameters, and follow-up data were retrospectively compared. The median interval between PAE and HoLEP was 25months [IQR 14.5-37.5]. Patients demographic were comparable in both groups. Intra-operatively plane of enucleation were well-maintained in spite of prior PAE. The differences in duration of surgery, enucleation efficiency, hemoglobin drop, duration of catheterization and hospital stay, and complications were statistically insignificant. Incidental prostate cancer was identified in 10% specimens from both groups. Post-PAE prostate specimens demonstrated evidence of remote-healed infarction represented by dense hyalinized paucicellur connective tissue with surrounding squamous metaplasia. There were no statistically significant differences in AUA symptom scores, maximum urine flow rate, post-void residual urine volume, and PSA at 3- and 6-month follow-up between both groups. Plane of enucleation is well-maintained after prior PAE. Salvage HoLEP is safe and effective after previous PAE and provide outcome comparable with HoLEP as a primary procedure.

Abstract No. 39 Prostatic artery embolization in patients with recurrent lower urinary tract symptoms following failed transurethral resection of the prostate

This study examines the safety and efficacy of prostatic artery embolization (PAE) in treating benign prostatic hyperplasia (BPH) with refractory lower urinary tract symptoms (LUTS) following transurethral resection of the prostate (TURP).

Ventral meatotomy as management of female urethral stricture: a case report

Introduction: Female urethral stricture is considered a rare condition. This condition may lead to recurrent lower urinary tract symptoms and urinary retention. Several techniques have been reported to overcome this disease with some advantages and disadvantages. This case report shows the author's experience in treating female urethral stricture using the ventral meatotomy technique.Case description. A 63-year-old female suffered from poor urinary flow, recurrent urinary tract infection and lower urinary tract symptoms. Physical examination and urethrocystoscopy showed narrow urethral opening and severe trabeculation, respectively, which indicated bladder outlet obstruction due to urethral stricture. A ventral meatotomy was performed, followed by an indwelling catheter for a week. The patient showed improvement of the symptoms postoperatively.Conclusion. Urethral reconstruction in female urethral stricture should be decided as definitive therapy, and an individualized approach must be applied based on patient factors and surgeon experience.

Prostatic Artery Embolization for the Treatment of Recurrent Lower Urinary Tract Symptoms following Transurethral Resection of the Prostate

PurposeTo evaluate the safety and efficacy of prostatic artery embolization (PAE) in patients with recurrent lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) who underwent a previous transurethral resection of the prostate (TURP). Materials and MethodsThis retrospective study analyzed 15 of 19 patients who underwent PAE for recurrent LUTS after TURP between February 2014 and April 2019. The technical and clinical success rates and complications related to the procedure were recorded. International Prostate Symptom Score (IPSS), quality of life (QoL), and prostatic volume (PV) were evaluated at baseline and 3- and 12-mo follow-up. ResultsThe intervals from TURP to recurrent symptoms and from TURP to PAE were 4.3 y ± 3.2 and 5.6 y ± 3.8, respectively. Technical success was achieved in all patients. The clinical success rate for LUTS relief at 12 mo was 93.3% (14 of 15). IPSS significantly reduced from 22.5 ± 4.1 at baseline to 9.9 ± 4.9 at 12-mo follow-up, and QoL score improved from 4.7 ± 1.0 to 2.1 ± 1.1 (P < .05 for both). There was a significant mean reduction of 26.6% in PV at 12 mo, improving from 100.7 cm3 ± 38.5 to 73.9 cm3 ± 29.4 (P < .05). No severe complications were encountered. ConclusionsPAE may be a safe and effective treatment option for the management of recurrent LUTS secondary to BPH in patients who have previously undergone TURP.

An insight into the management of urinary bladder diverticulum: a retrospective observational study

Background: The aim of the study is to retrospectively analyse the best mode of treatment for patients presenting with urinary bladder diverticulum. Methods: This study includes 46 patients who presented to the outpatient department between January of 2018 to March of 2020. They had lower urinary tract symptoms (LUTS) and were later found on investigations with imaging like ultrasound and voiding cystourethrogram (VCUG) as having bladder diverticulum with some cases associated with bladder outlet obstruction. Secondary causes were treated surgically or conservatively with clean intermittent catheterisation (CIC). Diverticulum was addressed with diverticulectomy when conservative management failed with recurrent LUTS or if the diverticulum was of a large size with significant post void residual urine. Results: Most of the patients with diverticulum associated with prostatomegaly or stricture urethra fared well after treatment of the underlying cause except one who underwent subsequent diverticulectomy. Four out of 5 patients with neurogenic bladder did well with CIC alone barring one who underwent diverticulectomy for a large sized diverticulum and refractory LUTS. Two patients with bladder growth involving the neck of diverticulum underwent partial cystectomy along with diverticulectomy. Four out of the remaining 8 patients with primary diverticulum were taken up for diverticulectomy directly and one underwent subsequent diverticulectomy for failed CIC. Conclusions: Not all urinary bladder diverticulum required surgical management per se. Most fared well with treatment of the underlying cause. So only those with large size, recurrent LUTS and failed management with CIC should be considered for diverticulectomy.

Patterns of Reperfusion and Clinical Findings in Repeat Prostate Artery Embolisation for Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia.

To present our experience of the patterns of revascularisation of the prostate and efficacy of repeat prostate artery embolisation (rPAE) in patients with recurrence of lower urinary tract symptoms. We retrospectively analysed 12 patients who underwent rPAE at a single centre between November 2015 and March 2020. The patients had their intraprocedural angiography and cone beam CT images as well as their pre-procedural CT retrospectively reviewed to establish the patterns of revascularisation. Clinical follow-up occurred at a minimum of 3months. 11/12 patients (91.6%) had significant international prostate symptom score (IPSS) reduction following rPAE with change in mean IPSS from 18.4 to 8.1 at 3months (p < 0.0001). Mean prostate volume was reduced by 41.6% (p = 0.03). 8/12 (75%) had a complete clinical success. 20/24 hemiprostates demonstrated revascularisation angiographically, of which 16 (80%) had prostatic arterial supply at rPAE by the main prostatic artery. Other mechanisms of revascularisation included supply from capsular prostatic artery branches and supply from other internal iliac pelvic branches. Unilateral embolisation at rPAE, where bilateral embolisation was not feasible (4/12), resulted in no difference in clinical outcomes compared with bilateral rPAE (p = 0.55). We have found rPAE to be an effective treatment for recurrent lower urinary tract symptoms in patients who had good clinical response to initial PAE. The mechanisms of revascularisation are variable, but most patients that underwent rPAE had recanalisation of their main prostatic artery.

Angiographic Findings during Repeat Prostatic Artery Embolization

PurposeTo describe mechanisms of prostate revascularization based on imaging findings during repeat prostatic artery embolization (PAE; rPAE). Materials and MethodsThis is a retrospective analysis of 10 rPAEs performed between October 2012 and September 2018 in patients with recurrent lower urinary tract symptoms (LUTS) after PAE (mean age, 68.2 y ± 4.5). Two interventional radiologists reviewed PAE and rPAE images and defined 6 patterns of revascularization. Correlation between embolization of the posterolateral (PL) prostatic branch during previous PAE and prostate revascularization on rPAE was assessed by Fisher exact test. One hemiprostate was excluded because no detectable revascularization was observed. ResultsAll patients showed LUTS improvement after previous PAEs (P < .01 for 5 outcome measures) and had recurrence during follow-up. rPAEs were performed a mean of 40.9 months after previous PAEs (18–96 mo). Of 19 hemiprostates analyzed, 11 presented revascularization by 2 or more branches (57.9%). The PL branch (29.0%) and the recanalized main prostatic artery (25.8%) were the most frequent revascularizing branches observed, followed by distal branches of obturator (12.9%), internal pudendal (12.9%), superior vesical (12.9%), and contralateral arteries (6.5%). Embolization of the PL branch during previous PAE significantly reduced the incidence of revascularization by this branch (P = .002). ConclusionsMechanisms of revascularization in rPAE are diverse and complex. Revascularization by the PL branch and recanalization of the previously embolized prostatic artery were the most frequent patterns observed. Embolization of the PL branch may reduce the incidence of prostate revascularization and LUTS recurrence after PAE.

V5-01 HOLMIUM LASER ENUCLEATION OF THE PROSTATE AS RETREATMENT AFTER UROLIFT DEVICE: FEASIBILITY AND TECHNICAL CONSIDERATIONS

You have accessJournal of UrologyBPH and Voiding Dysfunction1 Apr 2017V5-01 HOLMIUM LASER ENUCLEATION OF THE PROSTATE AS RETREATMENT AFTER UROLIFT DEVICE: FEASIBILITY AND TECHNICAL CONSIDERATIONS Sean McAdams and Mitchell Humphreys Sean McAdamsSean McAdams More articles by this author and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this video we demonstrate the feasibility of Holmium laser enucleation of the prostate (HoLEP) for retreatment of persistent lower urinary tract symptoms (LUTS) after previous treatment with the UroLift device. Technical considerations with regards to both enucleation and morcellation of resected tissue are discussed. Benign prostatic hyperplasia (BPH) affects millions of men worldwide. The UroLift system (NeoTract Inc., Pleasanton, CA) was recently introduced as a means to perform prostatic urethral lift (PUL) procedure for lateral lobe hypertrophy in patients with obstructive voiding symptoms. Urolift has been associated with a retreatment rate of 7% at 2 years and 14% at 4 years. Retreatment with TURP, photovaporization of the prostate and repeat UroLift has been described without notable issue, but retreatment with HoLEP has not yet been described. METHODS We included two patients who had undergone PUL with UroLift system at outside institutions and presented with recurrent LUTS. Patients were evaluated by cystoscopy, uroflowmetry, transrectal ultrasound of the prostate, and urodynamics to define the etiology of their urinary symptoms and determine appropriate therapy. HoLEP was performed under general anesthesia as previously described. Morcellation of the resected adenoma was performed with the VersaCut reciprocating morcellator (Lumenis Inc, Santa Clara, CA). RESULTS Enucleation was successfully completed in both patients. Monofilament sutures of the Urolift device were easily visualized and transected with the holmium laser. At the bladder neck, both patients were unexpectedly found to have the outer nitinol tab portions of UroLift devices located within the capsule of the prostate, rather than in the intended extracapsular location. Auxiliary maneuvers were required for removal of these nitinol tabs. The inner stainless steel portions of the UroLift device were encountered during morcellation of the resected adenoma. In each instance, the metal tabs became lodged in the reciprocating blades of the morcellator, requiring withdrawal of the morcellator instrument and manual removal of the tab from the morcellator blade. This resulted in brief disruptions in the procedure. There were no operative complications. CONCLUSIONS To our knowledge, we present the first description of HoLEP with morcellation of adenoma tissue after previous prostatic urethral lift surgery with the UroLift device. HoLEP can be performed safely and effectively post Urolift, however morcellation of the adenoma tissue is complicated by the metallic implants of the Urolift device. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e599 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sean McAdams More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation and Management of Lower Urinary Tract Symptoms After Outlet Surgery for Benign Prostatic Hyperplasia.

There are many options available in the surgical treatment of outlet obstruction secondary to benign prostatic hyperplasia (BPH). While most patients exhibit improvement in their lower urinary tract symptoms (LUTS) following intervention, up to 35 % of patients may exhibit persistent or recurrent LUTS. In the present review, we discuss the patho-physiology of LUTS after bladder outlet surgery and discuss considerations in evaluating and managing such patients. We highlight the crucial role of thorough evaluation with complete urodynamics testing, as pure obstruction only accounts for a minority of post-operative LUTS. Hence, detrusor contractility, detrusor overactivity, urethral sphincter function, and urinary incontinence must be assessed to appropriately guide subsequent therapy and improve patients' quality of life.

Refractory urinary tract infection in a male with colovesical fistula

A colovesical fistula is a communication between the lumen of the colon and the bladder, which sometimes results from diverticulitis. The left or sigmoid colon is the most commonly involved segment. The most usual presenting symptoms are pneumaturia and fecaluria, followed by dysuria, abdominal pain and, rarely, hematuria; these patients also often present with symptoms of recurrent/chronic urinary tract infection. Â We present here the case of a 57-year-old man complaining of recurrent lower urinary tract symptoms followed by pneumaturia and fecaluria. Computed tomography of the abdomen and pelvis revealed a colovesical fistula due to sigmoid diverticulitis. After locating the fistula, the lesion was totally removed, including the segmental sigmoid colon and partial bladder. The anastomosis was completed with a circular stapler and the bladder defect wall was repaired with double suture. The patient was doing well 3 months post-operatively and showed no evidence of urinary tract infection. Patients with repeated and refractory urinary tract infections should be considered for anatomical disorders such as colovesical fistula.