Relief Of Bladder Outlet Obstruction Research Articles

Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function.

Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies. Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation. Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.

Open prostatectomy for benign prostatic hyperplasia: A critical analysis of patient presentation and surgical outcomes in a contemporary series.

Open prostatectomy (OP) is still a valid treatment option for benign prostatic hyperplasia (BPH), but it needs to be constantly reevaluated in the context of minimally invasive treatments (MITs). Our purpose is to present contemporary data on patient presentation and surgical outcomes of OP with which other OP series and MITs can be compared. A retrospective study of all OP was carried out in our institution from January 2011 to December 2020. All patients had a thorough preoperative workup and optimization of comorbidities before surgery. Data were collected in a predesigned pro forma and analyzed. The mean age of the 148 patients studied was 66.2 (±7.9) yrs. The mean duration of symptoms before surgery was 32.2 (±33.7) mos. The mean preoperative prostate volume was 118.0 (±67.1) cm3. There was a 54.4% comorbidity rate with diabetes mellitus (DM) topping the list (16.0%). An incidental prostate cancer rate of 6.1% was found. The overall complication rate was 45.3%. Perioperative hemorrhage requiring blood transfusion (BT) was the most common complication (26.1%). There was no significant difference in age, duration of surgery, and prostrate volume between subjects with and without BT (P > 0.05). Wound infection was significantly associated with diabetes (P = 0.043, OR = 3.507, 95% CI = 1.042-11.805). The reoperation rate was 1.4%, and mortality rate was 0.7%. The International Prostate Symptom Score (IPSS), quality-of-life (QOL) score, and post-void residual urine (PVR) volume were significantly improved (P < 0.001). OP was found to be a safe and effective procedure for the relief of bladder outlet obstruction (BOO) secondary to BPH. However, it was associated with high morbidity and low reoperation rate.

Surgical outcome of male patients with chronic central nervous system disorders and voiding dysfunction due to bladder outlet obstruction.

Voiding dysfunction is common in patients with chronic central nervous system (CNS) diseases and has great impact on quality of life. Patients with chronic CNS disorders might have concomitant detrusor overactivity, detrusor underactivity, and voiding dysfunction. Although bladder outlet surgeries could relieve bladder outlet obstruction (BOO), patients might have persistent or exacerbated storage symptoms. This study investigated surgical outcome of patients with chronic CNS disorders after bladder outlet surgery. A total of 63 male patients with cerebrovascular accident (CVA, n = 44), Parkinson's disease (PD, n = 11), and early-stage dementia (n = 8), had received bladder outlet surgery after videourodynamic proven BOO refractory to medical treatment. The preoperative and postoperative lower urinary tract symptoms (LUTS) and uroflowmetry parameters were assessed. If the storage symptom subscore decreased or increased by 1, the outcome was considered improved or exacerbated after treatment. When patients had improvement in maximum flow rate (Qmax) and voiding efficiency (VE) and decreased voiding symptom subscore, they were considered having improvement of voiding dysfunction. The mean age was 71.1 ± 9.8years and mean duration from diagnosis of BOO to surgical intervention was 15.1 ± 25.0months. Overall, there was significant improvement in voiding LUTS and urinary retention after surgery. The post-void residual volume (PVR), corrected Qmax (cQmax), and VE significantly improved after surgery. In subgroup analysis, although voiding symptoms improved in CVA patients, urgency and exacerbated urgency incontinence persisted after surgery. In PD patients, there was improvement in voiding condition such as PVR, cQmax and VE, but the storage symptoms did not change after surgery. Patients with dementia had no improvement both in storage and voiding symptoms. Bladder outlet surgeries are effective to relieve voiding dysfunction in patients with CVA and PD, but have little effect on storage LUTS in patients with chronic brain lesions.

A comparative study between Holmium Laser Enucleation of Prostate (HoLEP) and Transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia

Background: Benign Prostatic Hyperplasia (BPH) is one of the most frequent diseases in men. The laser treatment for BPH has challenged TURP due to advances in laser technology, a better understanding of tissue-laser interactions, and rowing clinical experience.1 The objective of this work is to evaluate the safety and efficacy of Holmium Laser Enucleation of Prostate (HoLEP) and compare it to Bipolar Transurethral resection of the prostate (TURP). Methods: This is a prospective study to evaluate the outcomes in BPH patients undergoing surgery by HoLEP and Bipolar TURP done between January 2018 to December 2019. A total of 80 Patients were enrolled, forty undergoing HoLEP and the other forty went for Bipolar TURP for BPH. All patients with symptomatic BPH and who were candidates for surgical treatment were included. Patients with previous prostate surgery, urethral surgery, history of prostate cancer, or neurogenic bladder were excluded.1,2Results: Baseline parameters were almost similar between both groups in terms of age (years), International Prostatic Symptom Score (IPSS), Quality of life (QOL), Q max(ml/s), Post Void Residue (PVR), and gland size(grams) [Table 1]. Operative time and resected gland weight were more in HoLEP arm (p &lt; 0.001). Catheter time and Hospitalization period were significantly lower in the HoLEP group (p &lt; 0.0001). Haemoglobin drop was not significant between the two groups (p = 0.148). IPSS at three months was similar in both groups (p = 0.608). Qmax improved significantly in both groups, with 18.87 in TURP and 17.87 in HoLEP with a p-value of 0.261. PVR and QOL were similar between the two groups (P = 0.914 and P = 0.781) [Table 2]. Conclusion: Both Bipolar TURP and HoLEP were effective in relieving bladder outlet obstruction (BOO). HoLEP has equal efficacy compared to conventional bipolar TURP, with decreased hospital stay and catheter indwelling time.

Efficacy of Holmium laser enucleation of the prostate in men with impaired bladder contractility: A review

Introduction: Since Holmium laser enucleation of the prostate (HoLEP) was introduced in the 1990s as an endoscopic deobstructing modality for benign prostatic hyperplasia (BPH), several reports have concluded that HoLEP has compared favourably to transurethral resection of prostate (TURP) in relieving Bladder Outlet Obstruction (BOO). However, there has been no consensus regarding the efficacy of surgical management of men with Detrusor Underactivity (DU) and BOO. Methods: We performed a literature search of PubMed, Google Scholar, Scopus, and Web of Science databases. All studies that provided data on the effectiveness of HoLEP in men with BOO and DU were assessed. Data collected included the number of patients, median follow-up, International Prostate Symptom Score (IPSS), Qmax, post-void residual (PVR) and catheter dependency pre- and post-intervention. Results: Nine studies were identified in the literature with a follow-up range between 6 and 60 months. Only one prospective study was identified where investigators performed urodynamic studies (UDSs) before and after the intervention. In addition to a significant improvement of voiding parameters, they reported partial recovery of detrusor muscle contractility in approximately 80% of patients. Furthermore, all other studies reported an improvement in all outcome parameters and proved the efficacy of HoLEP in patients with DU and BOO. Conclusion: The current literature underpins the efficacy of HoLEP in patients with impaired bladder contractility. However, current research is limited and the majority of the published data are retrospective in nature. Therefore, more well-conducted prospective randomised studies are needed to reinforce high-level evidence for this hypothesis. Level of evidence: Not applicable.

Evaluation of Adding Desmopressin to Alpha Blockers in Treatment of Nocturia in Cases of Benign Prostatic Hyperplasia: A Prospective Randomized Clinical Study

Background: Nocturia is one of the most bothersome symptom of lower urinary tract symptoms in males with Benign Prostatic Hyperplasia (BPH). Alpha blockers has good effect in relieving bladder outlet obstruction. Objective: The aim of the present study was to provide best available medical treatment for nocturia in patients of BPH. Patients and methods: This prospective study was carried out on 44 male patients complaining of lower urinary tract symptoms (LUTS) of BPH with nocturia, were enrolled in this prospective randomized study for 12 weeks. They were divided randomly into 2 groups, each group included 22 patients. Group A: the patient received oral desmopressin added to tamsulosin once daily. Group B, the patient received oral tamsulosin daily. Results: The mean serum Na of patients at group A was 142.35. No significant difference regarding in-between groups before treatment but at after 12 week of treatment; group A was (mean of Na=137.68±2.033) significantly lower than group B and significantly decreased from before to after treatment. There was no significant difference between groups in both nocturnal void and nocturnal volume before treatment and after treatment as group A was significantly lower and both groups significantly changed and improved from before to after treatment. No significant difference was found at before treatment regarding total International Prostate Symptom Score (IPSS) but group A was significantly lower regarding total IPSS after treatment and both groups significantly decreased after treatment (6.36±2.59 in group A and 10.55±4.13 in group B). Conclusion: Addition of desmopressin to α-blockers is an active therapy for men with BPH and suffering nocturia and is preferred than α-blockers therapy alone.

Are all procedures for benign prostatic hyperplasia created equal? A systematic review on post-procedural PSA dynamics and its correlation with relief of bladder outlet obstruction.

To evaluate and provide a comprehensive literature review of Prostate specific antigen (PSA) dynamics after various surgical procedures for benign prostatic hyperplasia (BPH). A thorough PubMed database search was performed over last 30years including terms "PSA" and various surgical procedures for BPH. PSA nadir after various procedure was evaluated. The post-operative improvement in International Prostate Symptom Score, maximum void rates and post-void residue after surgeries were recorded. An indirect correlation was made between PSA nadir and outcome of various BPH surgical procedures. Enucleation procedures like simple prostatectomy and endoscopic enucleation of prostate (EEP) produced maximum drop in PSA level after surgery and were associated with the highest improvement in post-operative parameters. The PSA nadir following resection techniques like transurethral resection of prostate and Holmium laser resection of prostate and vaporization technique was variable and less robust when compared to EEP. Newer techniques like Aquablation, Rezum, Urolift, Prostate artery embolization and Temporary implantable nitinol devices (iTIND) produce relatively less reduction in PSA and lesser percentile improvement in post-operative parameters. Various surgical procedures for BPH result in varying PSA nadirs level. Enucleation procedures and simple prostatectomy produce the most drastic and sustained decrease in PSA. There is a possible indirect evidence suggesting that the level of PSA nadir corresponds closely with the degree of post-operative improvement and durability of the procedure. Establishing the new PSA nadir at 3-6months after the procedure is recommended as a part of routine surveillance for prostate cancer in eligible patients.

Reasons to consider prostatic artery embolization.

Prostatic artery embolization (PAE) has emerged as a truly minimally invasive treatment option for patients with lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) over the last few years and is now supported by evidence-based international guidelines. Here, we provide an overview on the profile of PAE based on the most relevant and recent literature. A comprehensive review of literature on PAE was conducted on PubMed-Medline. The most relevant literature was summarized narratively. While there is still a lack of long-term data, efficacy and safety data have been published for the short to mid-term. As with any minimally invasive technique, relief of bladder outlet obstruction is less pronounced after PAE compared to more invasive resective techniques. This is likely to be associated with higher re-intervention rates during the longer term. However, due to its beneficial safety profile, PAE represents an interesting option for many patients and could fill a niche between pharmacotherapy and formal surgical intervention. Given its unique treatment approach, i.e. endovascular instead of transurethral, PAE has a clearly different profile compared to other minimally invasive treatments. Performance with local anesthesia with possible continuation of anticoagulant drugs and no upper prostate size limit are the most important advantages of PAE. PAE represents a valuable supplement in the treatment armamentarium of LUTS/BPH if patients are selected appropriately.

Efficacy, safety, and perioperative outcomes of holmium laser enucleation of the prostate\u2014a comparison of patients with lower urinary tract symptoms and urinary retention

Holmium laser enucleation of the prostate (HoLEP) is a valid treatment option to relieve bladder outlet obstruction in patients with large prostate volumes (PV). Its efficacy, tolerability, and safety are comparable to the ones of other laser treatments of the prostate and resection techniques. However, safety and efficacy of HoLEP have not been compared between patients with and without preoperative urinary retention. We included 350 patients (mean age 71.2 years) who had undergone HoLEP due to lower urinary tract symptoms (LUTS) or urinary retention caused by prostatic hyperplasia. We evaluated the differences in peri- and postoperative outcomes and complications between patients with and patients without preoperative urinary retention. The mean PV was 115 cm3. PV was > 100 cm3 in 61.9% and < 100 cm3 in 38.1% of the patients. Perioperative complications occurred in 23 patients (6.6%), 15 of which (4.3%) required operative revision. We found no significant differences in terms of complication rates between patients with PV > 100 cm3 and patients with PV < 100 cm3. Mean catheterization-duration was 3.3 days. Preoperatively, 140 patients (40%) had a suprapubic or transurethral indwelling catheter; they did not differ from patients without preoperative catheter regarding postoperative catheter removal success rate, early postoperative complications, and functional outcomes. Prostate cancer was diagnosed in 43 patients (12.3%). Median postoperative PSA-decline was 6.1 ug/l (89.8% drop). HoLEP is a safe and effective treatment for patients with LUTS or urinary retention and large PV. PV > 100 cm3 was not associated with higher complication rates or successful catheter-removal. Furthermore, functional outcomes were independent of preoperative catheterization.

Palliative MRI-guided transurethral ultrasound ablation for symptomatic locally advanced prostate cancer

Purpose Locally advanced prostate cancer can cause bladder outlet obstruction, gross hematuria and frequent hospitalization. While these complications are commonly treated by palliative transurethral resection of the prostate, the improvement is often insufficient. The purpose of this study was to evaluate the safety and feasibility of MRI-guided transurethral ultrasound ablation as an alternative palliative treatment option (pTULSA) for men suffering from symptomatic locally advanced prostate cancer. Methods This prospective, phase one study included 10 men in need of palliative surgical intervention due to urinary retention and gross hematuria caused by locally advanced prostate cancer. Patients were followed for 1 year at 3-month intervals. Time without catheter, time without hematuria, reduction in hospitalization time, and adverse events were measured. Results Ten patients with locally advanced prostate cancer were enrolled, all having continuous catheterization due to urinary retention and nine had gross hematuria before treatment. At 1 week post-pTULSA five patients were catheter-free. At last follow-up catheter-free and gross hematuria-free rates were 70% and 100%, respectively. Average hospitalization time from local complications reduced from 7.3 to 1.4 days in the 6 months before and after pTULSA. No > Grade 2 treatment related adverse events were reported, with all five being urinary tract infections. Conclusions pTULSA appears safe and feasible for palliative ablation of locally advanced prostate cancer. The therapy seems to accomplish long-term hematuria control, can relieve bladder outlet obstruction in selected patients, and seems to reduce the burden of hospitalization due to local complications. Trial Registration Number: NCT03350529

Diagnostic Assessment of Lower Urinary Tract Symptoms in Men Considering Prostate Surgery: A Noninferiority Randomised Controlled Trial of Urodynamics in 26 Hospitals

BackgroundProstate surgery can improve lower urinary tract symptoms (LUTS) by relieving bladder outlet obstruction (BOO). However, surgery is less effective without BOO, or if detrusor underactivity is present. Urodynamics (UDS) can identify BOO and measure detrusor activity, but evidence in clinical practice is lacking. ObjectiveUrodynamics for Prostate Surgery Trial: Randomised Evaluation of Assessment Methods (UPSTREAM) aimed to evaluate whether a care pathway including UDS would reduce surgery without increasing urinary symptoms. Design, setting, and participantsUPSTREAM is a pragmatic, noninferiority, randomised controlled trial in men with bothersome LUTS, in whom surgery was an option, in 26 hospitals in England (ISRCTN56164274). InterventionParticipants were randomised (1:1) to routine care (RC) diagnostic tests, or RC plus UDS. Outcome measurements and statistical analysisThe primary outcome was the International Prostate Symptom Score (IPSS; patient-reported outcome scale from 0 to 35 points) 18 mo after randomisation, with a noninferiority margin of 1 point. Urological surgery rates were a key secondary outcome. The primary outcome was compared between the arms using linear regression, analysed on an intention-to-treat basis. Results and limitationsBetween October 2014 and December 2016, 820 men (median age 68 yr) were randomised (393 and 427 in the RC and UDS arms, respectively). The UDS arm showed noninferiority of the mean IPSSs (UDS 12.6; RC 13.1; adjusted difference at 18 mo −0.33 [95% confidence interval {CI} −1.47, +0.80]). In the UDS arm, 153/408 (38%) received surgery compared with 138/384 (36%) in the RC arm (adjusted odds ratio 1.05; 95% CI 0.77, 1.43). A total of 428 adverse events (UDS 234; RC 194) were recorded, with related events similar in both arms and 11 unrelated deaths. ConclusionsIn this population, the UDS randomised group was noninferior to RC for the IPSS but did not reduce surgical rates. This study shows that routine use of UDS in the evaluation of uncomplicated LUTS has a limited role and should be used selectively. Patient summaryFor men with uncomplicated lower urinary tract symptoms, symptom improvements after treatment and the number of operations performed are similar, irrespective of whether or not urodynamic tests are conducted in addition to routine tests. Accordingly, routine use of urodynamics has a limited role in this population group.

MONOPOLAR VERSUS BIPOLAR TRANSURETHRAL ENUCLEATION OF THE PROSTATE FOR LARGE VOLUME BENIGN PROSTATIC HYPERPLASIA

Background: The choice of treatment modality in patients with Benign Prostatic Hyperplasia (BPH) is one of the most discussed issues in urology. In recent years, the surgical treatment of prostates of large sizes by means of enucleation has become increasingly popular. The emergence of special loops to perform bipolar and monopolar enucleation using standard equipment for TURP has opened up new possibilities for the treatment of patients by transurethral monopolar enucleation.Aim of the Work: To evaluate the efficacy and safety of Monopolar versus Bipolar Transurethral Enucleation of the Prostatefor Large volume Benign Prostatic Hyperplasia. Patients and Methods: 40 patients with BPH were randomly divided into two groups: Group 1 underwent Monopolar Transurethral Enucleation of the Prostate (M-TUEP) (n=20), and Group 2 underwent Bipolar Transurethral Enucleation of the Prostate (B-TUEP) (n=20). Operation time, incidence of hyponatremia,estimated blood loss by drop of haemoglobin, improvement of International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score, Uroflowmetry (Qmax and Qave), Post Voiding Residual Urine (PVR) and Prostate volume and other complications ( as reintervention for clots and bleeding control, recatheterization, UTI, incidence of TUR syndrome, incidence of infarction, incontinence, bladder neck contracture and urethral stricture) were compared. Results: Operation was successfully performed in all 40 cases, and no open surgery was converted in any case or blood transfusion was needed. There was no statistically significant difference between both groups in operative time, postoperative haemoglobin and serum sodium levels decline, or improvement in postoperative IPSS, QoL score, Qmax, Qave, Prostate volume and PVR. All patients were followed up to 6 months postoperatively, and no complications occurred except one patient in Group 1 (5% of Group 1 and 2.5 % of the whole study) developed Urethral stricture. Conclusion: M-TUEP was shown to be a safe and highly effective technique for relief of Bladder Outlet Obstruction (BOO). The clinical efficacy of M-TUEP is sustainable for up to 6 months of follow-up. Our single-center results show that M-TUEP has the same efficacy as B-TUEP for the surgical treatment of symptomatic BPH, so M-TUEP can replace B-TUEP with the same efficacy and comparable safety.

Anatomical endoscopic enucleation of the prostate: The next gold standard? Yes!

Anatomical endoscopic enucleation of the prostate (AEEP) differs from other surgical techniques for benign prostatic obstruction (BPO) in that it removes the entire benign prostatic hyperplasia (BPH) component of the prostate. We summarise the main advantages of AEEP compared to other surgical techniques for BPO. These include better urodynamic relief of bladder outlet obstruction, superior outcomes for urinary retention even in the presence of impaired detrusor contractility, safe and effective for any size prostate, and superior durability compared to vaporisation and resection techniques. We summarise evidence that suggests AEEP offers outcomes that are independent of patient age and prostate volume. We conclude that AEEP is the gold standard surgical treatment for men with either lower urinary tract symptoms (LUTS) or urinary retention, regardless of prostate volume, detrusor contractility and age. It offers the ability to safely and effectively treat a wider range of patients than any other BPO procedure. More widespread use of mentorship programmes, that take advantage of the growing number of experienced mentors, is recommended to train more urologists in AEEP.

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article.

Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

An exceptionally rare cause of fetal megacystis in a male fetus

Megacystis in a male fetus is most commonly due to posterior urethral valves (PUV). Reported incidence ranges from 1:5000–1:8000 births. Other causes of megacystis in a male fetus include prune belly syndrome, neurogenic bladder, bilateral high grade V-U reflux etc. We are presenting a case of megacystis diagnosed at 27 weeks gestation, due to large tortuous ectopic ureter from a single system inserting into the prostatic urethra. This case highlights the interesting diagnostic and management challenges encountered with an exceptionally rare malformation causing bladder outlet obstruction. The antenatal ultrasound at 20 week gestation was normal. By 33 weeks, bilateral pelvicalyceal dilatation and bilateral hydroureter was seen; additionally, bladder appear enlarged. Ultrasound at 39 week gestation suspected the right ureteric insertion to be ectopic into the bladder neck. Follow up scans demonstrated worsening hydroureteronephrosis and megacystis. The amniotic fluid volume remained within normal limits. Working diagnosis was bladder outlet obstruction due to PUV. His post-natal ultrasounds, MCUG and MRU confirmed a single system on the right side with ectopic insertion into the prostatic urethra causing bladder outlet obstruction. On the left a low lying malrotated kidney & grade 4-5 vesicoureteric reflux was noted. Serum creatinine was high in the neonatal period. He underwent cystoscopy to confirm the ectopic right ureteric insertion. The right ureter was disconnected from prostatic urethra and an end cutaneous ureterostomy was performed to relieving bladder outlet obstruction and allowing better decompression of right ureter. At 9 months follow-up his renal function had normalized and he had a good urinary stream. The right ureter will be re-implanted to the bladder at 2 years of age. There are few similar cases of similar cases of megacystis in the literature. Ectopic ureters inserting into posterior urethra causing bladder outlet obstruction in all case reports are diagnostic conundrum and must be considered as rarer differential diagnoses to PUV.

Functional outcome and complications of palliative transurethral resection of prostate (pTURP): 5years single centre (Eastern India) experience

Background: Notable number of prostatic carcinoma patients presented with bladder outlet obstruction. Among various treatment options like antiandrogen therapy, catheterisation, laser therapy, prostatic stent and pTURP, pTURP offers expeditious relief of symptoms. As, there is paucity of literature regarding outcome and complication of pTURP in Indian context. So, author did single centre indication (of surgery) matched retrospective case control study to know functional outcomes and morbidity of pTURP in eastern Indian population.Methods: Author did retrospective review of 29 patients who underwent pTURP during study period (January 2013 to January 2018) after exclusion. Same number of TURP (for benign disease) patients were selected. Functional outcome and complications of pTURP were compared with TURP group. Author also tried to find factors associated with un-favourable outcomes.Results: Despite of older pTURP group patients, operative duration, post-operative hospital stay, post-operative catheter duration and post-op maximum urinary flow rate, were statistically similar to TURP group. However, statistically similar but clinically more complication was noted in pTURP arm in terms of failed voiding trial, incontinence and re-operation rate. One capsular tear was noted only in TURP arm. Eight patients developed unfavourable outcome (1 persistent incontinence, 5 needed re-surgery and 2 required re-catheterisation in follow up period). Higher PSA, longer operative time and hormone refractory metastatic prostatic carcinoma were found to be associated with unfavourable outcome.Conclusions: pTURP is safe and effective procedure to relieve bladder outlet obstruction. Hormone refractory status, higher PSA and prolonged operative time may be risk factors of poor outcome.

Contemporary outcomes of palliative transurethral resection of the prostate in patients with locally advanced prostate cancer

BackgroundAdvanced prostate cancer may cause significant local complications which affect quality of life, including bladder outlet obstruction and hematuria. We performed a detailed review of our outcomes of palliative transurethral resection of the prostate (pTURP) in the era of taxane chemotherapy and potent androgen receptor antagonists at our tertiary-care institution. MethodsUsing hospital coding data, we identified patients with a diagnosis of prostate cancer who underwent a TURP at Hotel-Dieu Hospital in Quebec City between 2006 and 2016 for detailed chart review. Co-morbidities were classified using the Charlson comorbidity index (CCI). Cox regression analyses assessed predictors of perioperative mortality and morbidity. ResultsOf 137 patients identified, 58 were included in our study. Median age was 68 years; 27 (47%) men had castration-resistant prostate cancer and 28 (48%) were metastatic at time of pTURP. Mean follow-up from the first pTURP was 2.2 years, with an estimated 5-year overall survival of 16.3% (95% CI: 6.5%–29.8%). Castration-resistant prostate cancer, CCI ≥5, and age predicted poorer survival. Primary indication for pTURP was bladder outlet obstruction (69%) or hematuria (22%). Postoperative Clavien 0, 1, 2, 3, 4, 5 complications occurred in 20 (34%), 16 (28%), 18 (31%), 3 (5%), 0, and 1 (2%) patients, respectively. Overall, 17 (27%) men underwent ≥1 redo pTURPs and 16 (28%) eventually had an indwelling catheter. Nephrostomy tubes or ureteral stents in place before pTURP remained indefinitely in all cases. ConclusionsWe conclude palliative TURP remains an important surgical option to relieve bladder outlet obstruction in patients with locally advanced prostate cancer, but is ineffective to relieve ureteral obstruction.

Heme-pigment nephropathy after transurethral resection of prostate cancer

Introduction:Transurethral resection of the prostate is one of the most common surgical procedures performed in men to relieve bladder outlet obstruction, most often due to benign prostatic hyperplasia. However, transurethral resection of the prostate may also be used in patients with metastatic prostate cancer who have bladder outlet obstruction. Acute kidney injury after transurethral resection of the prostate has been described and attributed to a variety of mechanisms, including acute tubular necrosis, rhabdomyolysis, and hemolysis with heme-pigment nephropathy. However, to our knowledge, no case of kidney biopsy-proven heme-pigment nephropathy due to hemolysis from a transurethral resection of the prostate procedure has been published to date.Case description:We describe a case of an 82-year-old man with metastatic prostate cancer who presented with severe oliguric renal failure 2 weeks after transurethral resection of the prostate for bladder outlet obstruction. Laboratory studies showed evidence of hemolysis, and a kidney biopsy showed heme-pigment cast nephropathy.Conclusions:We hypothesize that the patient’s kidney injury was induced by hemolysis resulting from rapid absorption of hypotonic fluid administered during the transurethral resection of the prostate procedure. Patients with prostate cancer undergoing transurethral resection of the prostate for bladder outlet obstruction may experience severe complications related to rapid absorption of hypotonic fluid. Our case illustrates the importance of nephrology evaluation and kidney biopsy in patients with benign and malignant prostate conditions who experience post-transurethral resection of the prostate syndrome and acute kidney injury in order to better characterize these complications, and to develop preventative strategies for future cases.

Corrigendum: Improvement of Persistent Detrusor Overactivity through Treatment with a Phytotherapeutic Agent (WSY-1075) after Relief of Bladder Outlet Obstruction.

This corrects the article on p. 153 in vol. 36, PMID: 29076300.

Improvement of Persistent Detrusor Overactivity through Treatment with a Phytotherapeutic Agent (WSY-1075) after Relief of Bladder Outlet Obstruction

PurposeMany patients with benign prostatic hyperplasia need treatment for remaining storage symptoms after surgery. Therefore, we evaluated the effect of the phytotherapeutic agent WSY-1075 on persistent detrusor overactivity (DO) after the relief of bladder outlet obstruction (BOO).Materials and MethodsRats were assigned to 3 groups: control (n=6), persistent DO (n=6), and persistent DO treated with the phytotherapeutic agent WSY-1075 (n=6). Persistent DO after relief of partial BOO was generated in the rat model, and 6 of the rats with this condition were orally administered WSY-1075. After 4 weeks of administration, cystometry was performed. Additionally, 8-hydroxy-2-deoxyguanosine and superoxide dismutase were measured to evaluate oxidative stress in the bladder. Pro-inflammatory cytokines, such as interleukin-8 and tumor necrosis factor-α, were analyzed, as were the M2 and M3 muscarinic receptors of the bladder.ResultsSignificantly increased contraction pressure and a decreased contraction interval were observed in the persistent DO group after relief of BOO. Moreover, oxidative stress, pro-inflammatory cytokines, and M3 muscarinic receptors were significantly increased. After treatment with WSY-1075, significantly reduced DO was observed by cystometry in comparison with the persistent DO group. Additionally, significantly decreased levels of oxidative stress, pro-inflammatory cytokines, and M3 muscarinic receptors in the bladder were observed after treatment with WSY-1075.ConclusionsTreatment with WSY-1075 improved persistent DO after the relief of BOO mediated by antioxidative and anti-inflammatory effects. Further studies are necessary to identify the exact mechanism of the treatment effect of WSY-1075.