Resection Of Prostate Research Articles

Vesicourethral Anastomotic Stenosis Following Radical prostatectomy: Risk Factors, Natural History, and Treatment Outcomes.

Vesicourethral anastomotic stenosis (VUAS) after radical prostatectomy (RP) is a complication with significant adverse quality of life implications. Herein, we identify groups at risk for VUAS and further characterize natural history and treatment patterns. Years 1987-2013 of a prospectively maintained RP registry were queried for patients with the diagnosis of VUAS, defined as symptomatic and inability to pass a 17Fr cystoscope. Patients with follow up less than 1-year, preoperative anterior urethral stricture, transurethral resection of prostate, prior pelvic radiotherapy, and metastatic disease were excluded. Logistic regression was performed to identify predictors of VUAS. Functional outcomes were characterized. Out of 17,904 men, 851 (4.8%) developed VUAS at a median 3.4 months. Multivariable logistic regression identified associations with VUAS including adjuvant radiation, BMI, prostate volume, urine leak, blood transfusion, and non-nerve sparing techniques. Robotic approach (OR 0.39, P < .01) and complete nerve sparing (OR 0.63, P < .01) were associated with reduced VUAS formation. VUAS was independently associated with 1 or more incontinence pads/day at 1 year (OR 1.76, P < .001). Of the patients treated for VUAS, 82% underwent endoscopic dilation. The 1- and 5-year VUAS retreatment rates were 34% and 42%, respectively. Patient related factors, surgical technique, and perioperative morbidity influence the risk of VUAS after RP. Ultimately, VUAS is independently associated with increased risk of urinary incontinence. Endoscopic management is temporizing for most men with a high rate of retreatment by 5 years.

Efficacy of 1 Versus 3 Days of Intravenous Amikacin as a Prophylaxis for Patients Undergoing Transurethral Resect Prostate: A Prospective Randomized Trail

Background: The goal of the current study was to investigate the safety of a single dose of IV Amikacin given a period of three days as compared to a single dose of one and two days, when used as a surgical prophylactic antibiotic prior to transurethral prostate resection. Study Design: This was a randomized and prospective study conducted at Urology Department of Niazi Medical &amp; Dental College Sargodha for the duration of six-months from May 2022 to October 2022. Methods: There were 300 men who participated in total and had their prostates transurethral resected (TURP). Three groups, A, B, and C, each with 100 participants, were created randomly from among the participants. The participants will either be assigned at random to receive a single dose of Amikacin that complies with recommendations for groups A, B, and C on days 1, 2, and 3. Follow Up until day 30 following surgery, routinely gathered data from TURP will be the end of the study. Within 60 minutes of the incision, all patients received a single dose of prophylactic antibiotics. Results: The Groups A and B had higher rates of significant bacteriuria than Group C, the intention-to-treat analysis determined that this difference was not statistically significant. The results of a per-protocol analysis were similar. (p=0.88; 0.13). This suggests that postoperative bacteriuria poses a significant risk for the emergence of UTI symptoms (p=o.oo2**). Antibacterial drug resistance has a significant relationship with the progression of infectious complications and was associated with a history of diabetes (95% [CI]]: 0.08-3.11, OR=0.33; p=0.01*) and surgical history and ESBL positivity were indicate infection-related issues (95% [CI]: 1.51-1.86, OR=5.1; p=0.023 and 95% [CI]: 2.55-13.1, OR=4.90; p&lt;0.0001***). Conclusions The Amikacin was safe for surgical prophyaxis in single dose until 3 days as compared to 1 and 2 days because of the incidence of postoperative complication such as UTI reduced. It was greater role to decrease antibiotic resistance. Keyword: Bacterial infection, Urinary tract, Antibiotics.

Clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and the efficacy of treating lower urinary tract symptoms

Introduction. Benign prostatic hyperplasia (BPH) is a common condition in aging men that is often associated with lower urinary tract symptoms (LUTS).Objective. To determine the clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and develop an algorithm for improving the efficacy of treating lower urinary tract symptoms in benign prostatic hyperplasia.Materials &amp; methods. The study included 112 BPH-patients who received tamsulosin therapy or a combination of tamsulosin + solifenacin for three months. After three months of therapy, the patients were divided into two groups depending on the effectiveness of therapy: group 1 — a positive result (n = 77); group 2 — no positive effect (n = 35). Due to the lack of efficacy in patients of group 2, a multichannel urodynamics was performed, according to the results of which the patients were prescribed treatment with a subsequent assessment of the result after 3 months.Results. After 3 months of therapy in patients of group 1, a decrease in pollakiuria was noted. Regression of obstructive and irritative symptoms was also observed, and the urination-associated quality of life (QoL) improved. The maximum urine flow rate (Q max) remained unchanged mainly. By the sixth month, the frequency of urination continued to decrease (11.05 vs 9.32 episodes; p = 0.022), as well as the improvement of other parameters (IPSS, QoL, Q max and post-void residual urine volume (PVR) (80.87 vs 56.17 ml; p = 0.012). The indicators of patients of group 2 following three months of therapy remained without significant changes. Sixteen patients underwent transurethral prostate resection, 19 patients underwent therapy correction, which allowed reducing the number of episodes of daily pollakiuria. The total IPSS score decreased by 4.37 compared to baseline (IPSS (obstructive) — 13.79 vs 7.26 pts; p = 0.032). The QoL value was 2.84 pts, Q max — 14.90 mL/s, PVR — 10.58 mL.Conclusion. 19.8% of BPH-patients are resistant to drug therapy. The ineffectiveness of therapy may be due to the severe BOO. In the absence of the effect of the therapy within 3 months, it is recommended to perform multichannel urodynamics. Correction of therapy according to the multichannel urodynamics data improves its effectiveness by the sixth month of treatment. Indicators of IPSS, Q max and PVR after 3 months of therapy allow predicting the effectiveness of therapy, or suspect the need for surgical treatment.

Association of high-grade prostatic intraepithelial neoplasia immunohistochemical profile with acinar adenocarcinoma of the prostate

Prostate carcinoma is the second leading cause of cancer and the fifth cause of cancer death in men worldwide. To know high-grade prostatic intraepithelial neoplasia and prostate acinar adenocarcinoma immunohistochemical profiles. Observational, analytical, cross-sectional, retrospective study of specimens obtained by cutting needle biopsy and prostate resection from subjects diagnosed with acinar adenocarcinoma of the prostate and high-grade prostatic intraepithelial neoplasia between January 2015 and December 2020. Tissue microarrays were performed and, subsequently, immunohistochemical studies for BCL2, EGFR, p53, Her2/neu and Ki67. Descriptive statistics were used to analyze clinicopathological factors. Qualitative variables were compared with Fisher's exact test. Twenty-three patients were studied; eight (34%) with angiolymphatic invasion, 14 (60.8%) with perineural invasion, five (21.2%) with prostatitis, and four (17.3%) with fibroadenomatous hyperplasia. HER2/neu (p = 0.1023), p53 (p = 1) and BCL2 expression (p = 0.4136) was observed. HER2/neu increased expression was identified in high-grade prostatic intraepithelial neoplasia and acinar adenocarcinoma of the prostate.

MP51-05 SAFETY AND TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023MP51-05 SAFETY AND TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA Dhaval Jivanji, Benjamin Shpeen, Michael West, Eitan Katlowitz, Michael Lee, Payam Hakimian, Jacob Khurgin, and Ariel Schulman Dhaval JivanjiDhaval Jivanji More articles by this author , Benjamin ShpeenBenjamin Shpeen More articles by this author , Michael WestMichael West More articles by this author , Eitan KatlowitzEitan Katlowitz More articles by this author , Michael LeeMichael Lee More articles by this author , Payam HakimianPayam Hakimian More articles by this author , Jacob KhurginJacob Khurgin More articles by this author , and Ariel SchulmanAriel Schulman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The armamentarium for surgical management of benign prostatic hyperplasia (BPH) continues to grow. However, the rates of adoption of multiple techniques over the gold standard have largely been unstudied. Therefore, this study aims to elucidate the most recent trends and safety profile of surgical management for BPH. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, patients who underwent a BPH procedure from 2016 to 2020 were included (CPT: 52601, 52630, 52648, 55821, 55831, 53854, 52649). Demographic characteristics and the use of each modality were analyzed. The safety profile was assessed by comparing complication rates to transurethral resection of prostate (TURP), which included transfusion rates, urinary tract infection, sepsis, readmission, and death. Chi-square analysis was utilized to determine any significant differences. RESULTS: Overall, 60,291 BPH procedures were performed in the time period studied with an annual average of 12,058. The median age of men undergoing any of the studied modalities ranged from 69-74 years old. White men comprised the largest proportion of the total cohort (63.4%, n=38,222) followed by Black men (6.4%, n=3,884). At least two-thirds of all procedures each year were TURP (Figure 1). A significant decline was seen in the use of photovaporization of prostate (PVP) (24.4% in 2016 vs. 21.0% in 2020, p<0.001). In 2020, 7.5% of all BPH procedures were HoLEP, which is a significant growth from 4.8% in 2016 (p<0.001). Rezum was introduced in 2019 and accounted for 1% of procedures in 2020. Every procedure studied had limited mortality risk (all <1.0%). Compared to TURP, open prostatectomy had the biggest difference in transfusion rates (12.2% vs. 1.5%, p<0.001) and readmissions (7.5% vs. 5.6%, p<0.001), while Rezum has the biggest difference in urinary tract infections (9.7% vs. 5.2%, p=0.006) and sepsis (2.7% vs. 1.0%, p=0.02). CONCLUSIONS: TURP remains the gold standard for BPH management; however, HoLEP continues to see increased adoption over time. Significant morbidity is seen with open prostatectomy. Infection and sepsis rates from Rezum procedures should be further studied as more patient data becomes available. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e694 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dhaval Jivanji More articles by this author Benjamin Shpeen More articles by this author Michael West More articles by this author Eitan Katlowitz More articles by this author Michael Lee More articles by this author Payam Hakimian More articles by this author Jacob Khurgin More articles by this author Ariel Schulman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-17 INITIAL EXPERIENCE OF TRANSURETHRAL BLUE LASER VAPORIZATION OF PROSTATE USING A NOVEL DUAL WAVELENGTH LASER SYSTEM

You have accessJournal of UrologyCME1 Apr 2023MP51-17 INITIAL EXPERIENCE OF TRANSURETHRAL BLUE LASER VAPORIZATION OF PROSTATE USING A NOVEL DUAL WAVELENGTH LASER SYSTEM Lin Yang, Zhihui Zou, Xiaofeng Xu, Weimin Gan, Liyue Mu, and Dalin He Lin YangLin Yang More articles by this author , Zhihui ZouZhihui Zou More articles by this author , Xiaofeng XuXiaofeng Xu More articles by this author , Weimin GanWeimin Gan More articles by this author , Liyue MuLiyue Mu More articles by this author , and Dalin HeDalin He More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our preclinical study confirmed that compared with the commonly used 532 nm, 980 nm and 1470 nm lasers, under the same power, the 450 nm laser has the advantages of higher vaporization efficiency, thinner coagulation layer and lower noise, theoretically it’s more suitable for BPH surgery. In this study, we reported the initial experience of transurethral blue laser vaporization of prostate (BLVP). METHODS: The novel blue laser surgical system is a dual wavelength laser system, which output 450 nm laser (Max: 200 W) and 976 nm laser (Max: 50 W), which are respectively used for tissue vaporization and coagulation by foot switch. Between May and September 2022, four centers were selected to perform BLVP using this novel blue laser surgical system and photo-selective prostate vaporization (PVP) was served as control with the patients ratio of 1:1. The international prostate symptom score (IPSS), Quality of life (QoL), maximum urinary flow rate (Qmax) before and 1 month after operation were collected, and also the operation time and bleeding. The evaluation of blue and green laser surgery from 8 operators was also collected. RESULTS: Total 101 BPH patients were enrolled and 51 received BLVP, 50 received PVP, 8 cases of PVP and 3 cases of BLVP convert to transurethral resection of prostate (TURP) mainly due to uncontrollability bleeding, the other 90 patients completed the follow-up. The novel 200 W 450 nm laser vaporized visible more rapidly than PVP. In surgeons with PVP experience, they found it’s easier to perform BLVP than PVP duo to the reliable hemostatic function by 976 nm laser. In surgeons with no PVP experience, it took 3-5 operations to overcome the desire of "TURP conversion" for BLVP and 5-10 operations for PVP. There was no significant difference between the two groups in baseline data, IPSS, QoL, Qmax and bleeding before and after operation, however, there were no difference of the operation time between two groups. The mainly reason was the power of the blue laser is very strong, which can lead to "bursting" of optical fiber once touch the tissue. It took about 10-20 operations to adapt to this "non-contact" vaporization mode. CONCLUSIONS: The novel blue laser surgical system has high vaporization efficiency, rapid and reliable hemostasis, therefore safe and effectiveness, and easy to learn. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e700 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lin Yang More articles by this author Zhihui Zou More articles by this author Xiaofeng Xu More articles by this author Weimin Gan More articles by this author Liyue Mu More articles by this author Dalin He More articles by this author Expand All Advertisement PDF downloadLoading ...

A STUDY ON TRANS URETHRAL RESECTION OF PROSTATE FOR SYMPTOMATIC BPH PRESENTING IN A TERTIARY CARE HOSPITAL

Introduction: Benign prostatic hyperplasia (BPH) is a common chronic progressive disease resulting in urinary obstruction in aging men. It is a pathologic process that consists of androgen-dependent increases in the number of epithelial and stromal cells in the periurethral area of the prostate. BPH contributes to, but is not the sole cause of, lower urinary tract symptoms in aging men. Many patients require surgical treatment and presently TURP (Trans Urethral Resection of Prostate) is considered the gold standard in surgical management of BPH. Aim: To observe and assess the outcome of TURP being done in Narayan Medical College and Hospital Sasaram, Bihar. Materials and Methods: The records of patients who presented to the surgical OPD with LUTS and were assessed to undergo TURP for prostatic hyperplasia. We present our experience with series of 47 patients and can say that TURP can be used for most patients presenting with BPH in peripheral areas. Result: In the study period 47 TURP procedures were performed for BPH. The mean age of the cohort was 67.9 years;( ranging from 56 to 84 years). The mean prostatic volume was 44.06 grams (range 32 to 76 grams) and mean operating time was 48 minutes (range 29 to 85 minutes). Blood transfusion was required in 3 patients (6.3%). No patients required open intervention and there were no mortalities. The common complications were bleeding (12%), UTI and clot retention. Conclusions: TURPis not available to majority of rural population having symptomatic benign prostatic hyperplasia (BPH) due to lack of facility but remains the treatment of choice provided trained surgeons and facilities are there. The overall cost of TURP is marginally higher for an average rural patient as compared to open surgery but is worthwhile in view of its inherent minimal trauma, short hospital stays and early recovery and huge cost advantage over newer therapies like HoLEPor PVP

MP06-06 SINGLE-USE PLASTIC WASTE IN COMMON ENDOUROLOGIC CASES: CHARACTERIZATION OF A GROWING ENVIRONMENTAL CRISIS AND IMPACT OF POSSIBLE INTERVENTIONS

You have accessJournal of UrologyCME1 Apr 2023MP06-06 SINGLE-USE PLASTIC WASTE IN COMMON ENDOUROLOGIC CASES: CHARACTERIZATION OF A GROWING ENVIRONMENTAL CRISIS AND IMPACT OF POSSIBLE INTERVENTIONS John M. Masterson, Peris Castaneda, Aurash Naser-Tavakolian, Jeremiah Dallmer, Lior Taich, Jordan Kramer, Andrew Chen, Paige Kuhlmann, Maurice M. Garcia, and Timothy J. Daskivich John M. MastersonJohn M. Masterson More articles by this author , Peris CastanedaPeris Castaneda More articles by this author , Aurash Naser-TavakolianAurash Naser-Tavakolian More articles by this author , Jeremiah DallmerJeremiah Dallmer More articles by this author , Lior TaichLior Taich More articles by this author , Jordan KramerJordan Kramer More articles by this author , Andrew ChenAndrew Chen More articles by this author , Paige KuhlmannPaige Kuhlmann More articles by this author , Maurice M. GarciaMaurice M. Garcia More articles by this author , and Timothy J. DaskivichTimothy J. Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Operating room waste is often in the form of single-use plastics (SUP), which contribute to landfill waste and ocean pollution and have been shown to have a detrimental impact on public health. We quantified the weight of SUP waste generated by three common endourologic cases—ureteroscopy/laser lithotripsy (URSLL), ureteral stent placement, and transurethral resection of prostate (TURP)—and projected annual SUP waste for these cases at a national level. We also estimated potential impact of waste reduction strategies: including removal of frequently unused SUP items from standard supply packs, replacement with reusable alternatives, and recycling. METHODS: We prospectively sampled 20 URS/LL, 20 ureteral stent placement, and 20 TURP cases; then recorded used items in the EMR case supplies list and contemporaneously recorded unused SUP items in real time. Individual SUP items were weighed to create a standard metric. We projected our findings to annual case volumes at a national level using Urologic Diseases in America (UDA) 2012 data. We then modeled the potential impact of waste reduction by removing, replacing, and recycling SUP items based on current viable pathways. RESULTS: Across our analytic sample of 60 patients, URSLL, stent placement, and TURP generated a mean (SD) of 6.27 (0.76), 5.23 (0.55), and 8.18 (0.68) lbs of SUP waste per case, respectively. Unused plastic waste for URSLL, stent placement, and TURP were 2.16 (0.78), 2.60 (0.62), and 0.73 (0.57) lbs per case, respectively. This amounts to a total of 1.3 million lbs of SUP waste annually. Removal of variable-use SUP items, replacing SUP items with reusable alternatives, and recycling SUP items by current potential pathways would reduce this number by 47,029 (4%), 368,892 (29%), and 166,528 pounds (13%), respectively, for a total SUP waste reduction of 582,451 pounds (46%) (Table 1). CONCLUSIONS: Common outpatient endourologic cases generate a substantial amount of SUP plastic waste, which has a negative impact on environmental and public health. Our field should take an active role in mitigating this health risk for future generations. Small changes such as removal of unused items from standard supply packs or replacement with reusable items can significantly reduce SUP waste. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e55 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Peris Castaneda More articles by this author Aurash Naser-Tavakolian More articles by this author Jeremiah Dallmer More articles by this author Lior Taich More articles by this author Jordan Kramer More articles by this author Andrew Chen More articles by this author Paige Kuhlmann More articles by this author Maurice M. Garcia More articles by this author Timothy J. Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-20 NATIONAL UPTAKE OF HOLEP IS INCREASING IN AMBULATORY SURGERY SETTINGS

You have accessJournal of UrologyCME1 Apr 2023MP13-20 NATIONAL UPTAKE OF HOLEP IS INCREASING IN AMBULATORY SURGERY SETTINGS Neil A. Mistry, Jenny Guo, Matt Lee, Mark Assmuss, and Amy Krambeck Neil A. MistryNeil A. Mistry More articles by this author , Jenny GuoJenny Guo More articles by this author , Matt LeeMatt Lee More articles by this author , Mark AssmussMark Assmuss More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) has evidenced-based advantages in treating benign prostatic hypertrophy (BPH) relative to other interventions. Unfortunately, adoption of HoLEP has remained relatively low in Medicare and NSQIP populations. Its role as an inpatient surgical intervention is changing as advancements in the technique and systems have demonstrated the feasibility of same-day discharge. Thus, our objective was to evaluate national HoLEP trends in ambulatory surgery settings from 2016-2019. METHODS: The Nationwide Ambulatory Surgery Sample (NASS) is the largest national all-payer database of ambulatory surgical encounters, managed by the Agency for Healthcare Research and Quality. A cross-sectional, retrospective analysis of the 2016 and 2019 NASS was performed. Rates of BPH surgeries were calculated and stratified by age, census region, and primary payer to compare across time-points for trends. Chi-squared and ANOVA was completed for categorical and continuous variables, respectively. RESULTS: The total number of BPH surgeries fell 20% between 2016 (n=124,538) and 2019 (n=100,593) (Figure 1). In 2016, HoLEP lagged behind prostatic photovaporization (PVP) and Transurethral Resection of Prostate (TURP) with 4.7% of surgeries, but rose to the second most-common procedure in 2019 with 8.3% of total surgeries (Table 1). TURP was the most common intervention (62.6% in 2016, 90.7% in 2019). Simple prostatectomy was the most expensive intervention. By US census region, more HoLEPs were done in the South (43.1% in 2016, 37.5% in 2019) and Midwest (26.8% in 2016, 31.7% in 2019). CONCLUSIONS: Overall, HoLEP uptake is increasing in ambulatory settings. HoLEP has replaced greenlight PVP as the second-most frequently used intervention. The rate of ambulatory HoLEPs has nearly doubled despite a general decrease in the overall number of BPH surgeries. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e181 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neil A. Mistry More articles by this author Jenny Guo More articles by this author Matt Lee More articles by this author Mark Assmuss More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-16 TRANSPERINEAL LASER ABLATION VERSUS TRANS-URETHRAL RESECTION OF PROSTATE FOR BENIGN PROSTATIC OBSTRUCTION: A RANDOMIZED CLINICAL TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP51-16 TRANSPERINEAL LASER ABLATION VERSUS TRANS-URETHRAL RESECTION OF PROSTATE FOR BENIGN PROSTATIC OBSTRUCTION: A RANDOMIZED CLINICAL TRIAL Riccardo Bertolo, Valerio Iacovelli, Chiara Cipriani, Marco Carilli, Matteo Vittori, Michele Antonucci, Francesco Maiorino, Marta Signoretti, Filomena Petta, and Pierluigi Bove Riccardo BertoloRiccardo Bertolo More articles by this author , Valerio IacovelliValerio Iacovelli More articles by this author , Chiara CiprianiChiara Cipriani More articles by this author , Marco CarilliMarco Carilli More articles by this author , Matteo VittoriMatteo Vittori More articles by this author , Michele AntonucciMichele Antonucci More articles by this author , Francesco MaiorinoFrancesco Maiorino More articles by this author , Marta SignorettiMarta Signoretti More articles by this author , Filomena PettaFilomena Petta More articles by this author , and Pierluigi BovePierluigi Bove More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal interstitial laser ablation (TPLA) is among one of the latest ultra-minimally invasive technique to treat benign prostatic obstruction (BPO). No study investigated the actual rate of preservation of the ejaculatory function after TPLA, in comparison to the reference standard trans-urethral resection of prostate (TURP). We aimed to evaluate the reliability of TPLA in preserving the ejaculation compared to TURP. METHODS: In this single-center, prospective, randomized, open-label study, consecutive patients with indication to surgical treatment for BPO were enrolled between January 2020 and September 2021 (NCT04781049). Randomization defined two treatment arms: Group A: patients assigned to TPLA (experimental); Group B: patients assigned to TURP (standard). Primary endpoints included comparison of visual analogue scale (VAS), change in ejaculatory function (by EJ-MSHQ), and changes in sexual function (by IIEF-5) at 1 month after surgery. Secondary endpoints included ΔIPSS and ΔQoL, and Qmax improvement at 6 months. RESULTS: Fifty-one patients (26 TPLA versus 25 TURP) were analyzed. No differences were found in the perception of pain assessed by VAS. No differences in IIEF-5 score were found between groups. Distribution of ejaculatory function assessed by the EJ-MSHQ remained unmodified after TPLA (p=0.2) while a median 31% decrease in EJ-MSHQ score (IQR -67;-14%) was observed after TURP (p=0.01). Retrograde ejaculation was reported in one patient within the TPLA group (18 patients s/p TURP). A statistically significant difference between the treatment groups was found in terms of postoperative Qmax (15.2 (IQR 13.5–18.3) versus 26.0 (IQR 22.0–48.0) ml/s, TPLA versus TURP, p<0.001). Qmax was statistically significantly improved with respect to baseline after TPLA (%ΔQmax+42 (+24; +76), p<0.001). Both treatments significantly improved IPSS and QoL with respect to baseline, with TURP impacting more significantly (%ΔIPSS -35.9 (IQR -54.5; -1.3) versus -66.7 (-82.8; -46.7) and %ΔQoL -33.3 (-50; -8) versus -60.0 (IQR -80; -33), TPLA versus TURP, all p-values <0.03). CONCLUSIONS: TPLA allowed for maintaining ejaculation in 96% of the cases, confirming to be valid option in patients seeking for pairing the relief from BPO to the high probability of preserving ejaculatory function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e699 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Bertolo More articles by this author Valerio Iacovelli More articles by this author Chiara Cipriani More articles by this author Marco Carilli More articles by this author Matteo Vittori More articles by this author Michele Antonucci More articles by this author Francesco Maiorino More articles by this author Marta Signoretti More articles by this author Filomena Petta More articles by this author Pierluigi Bove More articles by this author Expand All Advertisement PDF downloadLoading ...

MP24-12 ASSOCIATION OF RARE MONOGENIC VARIANTS WITH DIAGNOSIS OF BPH USING WHOLE EXOME SEQUENCING IN THE UK BIOBANK

You have accessJournal of UrologyCME1 Apr 2023MP24-12 ASSOCIATION OF RARE MONOGENIC VARIANTS WITH DIAGNOSIS OF BPH USING WHOLE EXOME SEQUENCING IN THE UK BIOBANK Clark Judge, David Nusbaum, Jun Wei, Zhuqing Shi, Andrew Rifkin, S. Lilly Zheng, Brian Helfand, Alexander Glaser, and Jianfeng Xu Clark JudgeClark Judge More articles by this author , David NusbaumDavid Nusbaum More articles by this author , Jun WeiJun Wei More articles by this author , Zhuqing ShiZhuqing Shi More articles by this author , Andrew RifkinAndrew Rifkin More articles by this author , S. Lilly ZhengS. Lilly Zheng More articles by this author , Brian HelfandBrian Helfand More articles by this author , Alexander GlaserAlexander Glaser More articles by this author , and Jianfeng XuJianfeng Xu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) is a common condition that leads to bothersome lower urinary tract symptoms. Polygenic heritability of BPH has been demonstrated using genetic risk scores derived from common single nucleotide polymorphisms, but rare monogenic gene mutations associated with BPH have not been well described. The objective of this study was to determine the impact of rare monogenic variants on the development of BPH. METHODS: A total of 83,631 men from the UK Biobank (UKB) with whole exome sequencing data were included and categorized based on ICD10 diagnosis of BPH (N40). Of men with BPH, 9,697 were further characterized as undergoing transurethral resection of prostate (TURP). The robust SKAT-O, a novel gene-based analysis of pathogenic/likely pathogenic mutations that properly controls for type I error rates due to unbalanced case-control ratio, was used for association tests adjusting for age at recruitment and genetic background. RESULTS: Nineteen candidate genes were identified as associated with BPH in 9,697 cases compared to 73,934 controls at p<0.001 using SKAT-O (Table). However, none of these associations was significant after adjusting for multiple testing (FDR<0.05). For most of these genes, higher carrier rates in patients undergoing TURP was also found. CONCLUSIONS: In this large study of nearly 84,000 men, several candidate genes were identified. Confirmation in independent study populations is required. Identification of monogenic gene mutations associated with BPH may advance our understanding of disease etiology and identify potential therapeutic targets. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e322 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clark Judge More articles by this author David Nusbaum More articles by this author Jun Wei More articles by this author Zhuqing Shi More articles by this author Andrew Rifkin More articles by this author S. Lilly Zheng More articles by this author Brian Helfand More articles by this author Alexander Glaser More articles by this author Jianfeng Xu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP76-12 PROSTATIC URETHRAL LIFT EFFICACY IN PATIENTS WITH PRIOR BENIGN PROSTATE HYPERTROPHY TREATMENT AND PRIOR RADIATION THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP76-12 PROSTATIC URETHRAL LIFT EFFICACY IN PATIENTS WITH PRIOR BENIGN PROSTATE HYPERTROPHY TREATMENT AND PRIOR RADIATION THERAPY Young Son, Emma Troyer, Ryan Moriarty, Sage Grenz, Maya Sengha, Dayna DeVincentz, Benjamin Fink, and Thomas Mueller Young SonYoung Son More articles by this author , Emma TroyerEmma Troyer More articles by this author , Ryan MoriartyRyan Moriarty More articles by this author , Sage GrenzSage Grenz More articles by this author , Maya SenghaMaya Sengha More articles by this author , Dayna DeVincentzDayna DeVincentz More articles by this author , Benjamin FinkBenjamin Fink More articles by this author , and Thomas MuellerThomas Mueller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms (LUTs) caused by benign prostatic hyperplasia (BPH) in men is one of the most frequently encountered complaints in the urologist's office. Prostatic urethral lift (PUL) has been shown to be an efficacious and a minimally invasive treatment for BPH. There is a paucity of data with salvage PUL in BPH. The aim of the study is to determine the effect of PUL in patients with previously treated BPH and radiation therapy. METHODS: A retrospective chart review was performed on 445 patients between 6/2016 to 5/2022 of a single surgeon’s experience with PUL. Patients were subgrouped into those that had previous transurethral resection of prostate (TURP), transurethral needle ablation (TUNA), PUL, or radiation therapy (external beam radiation or brachytherapy). The previously treated groups were then compared to those undergoing primary PUL (no previous treatment for BPH). Patient demographics, international prostate symptom score (IPSS) and quality of life (QOL) were assessed through 24 months. RESULTS: A total of 444 patients were retrospectively reviewed. The previous prostatic urethral lift group consisted of 8 (1.8%) patients, previous TUNA had 12 (2.7%) patients, previous TURP had 15 (3.3%) patients and the previous radiation group had 14 (3.1%) patients of the total cohort. The previous urolift group were older (80.9 years) and had larger prostate volume (69.9 grams). The previous TURP group had the largest post void residual (PVR) at 276.1ml. The decrease in IPSS was seen in all groups that were noninferior to primary PUL (no prior treatment group). There was statistical significance for IPSS for the prior radiation group compared to primary PUL at 18 months (4.97 vs. 3.0). CONCLUSIONS: Efficacy of PUL has not been well studied in patients with previous prostatic treatments. Our study is one of the largest single surgeon’s experiences with patients with PUL. We show that repeated PUL in patients that had previous PUL, TUNA, TURP, or radiation can be effective. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1095 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Young Son More articles by this author Emma Troyer More articles by this author Ryan Moriarty More articles by this author Sage Grenz More articles by this author Maya Sengha More articles by this author Dayna DeVincentz More articles by this author Benjamin Fink More articles by this author Thomas Mueller More articles by this author Expand All Advertisement PDF downloadLoading ...

LBA01-20 DETRUSOR ULTRASTRUCTURAL STUDY PREDICTS LONG TERM VOIDING OUTCOMES IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY WHO UNDERWENT TRANSURETHRAL RESECTION OF PROSTATE (TURP)

You have accessJournal of UrologyCME1 Apr 2023LBA01-20 DETRUSOR ULTRASTRUCTURAL STUDY PREDICTS LONG TERM VOIDING OUTCOMES IN MALE PATIENTS WITH DETRUSOR UNDERACTIVITY WHO UNDERWENT TRANSURETHRAL RESECTION OF PROSTATE (TURP) Amanda Chung, Vincent Tse, and Lewis Chan Amanda ChungAmanda Chung More articles by this author , Vincent TseVincent Tse More articles by this author , and Lewis ChanLewis Chan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with detrusor underactivity (DU) have a variable voiding outcome after TURP which may not be predicted by urodynamics. Our previous detrusor ultrastructural studies demonstrated that features of ‘myohypertrophy pattern’ were associated with bladder outlet obstruction(BOO) and poor short term voiding outcomes. We report the largest ultrastructural study on DU and correlate detrusor ultrastructure features with long term voiding outcomes in men with urodynamic proven DU who have had TURP. METHODS: Patients with urodynamic diagnosis of DU or BOO who underwent TURP were studied. Detrusor biopsies were obtained at cystoscopy and processed for electron microscopy. Detrusor ultrastructural features including myohypertrophy pattern (cell size, irregularity), degeneration and elastosis were assessed using a simplified protocol with observers blinded to clinical data. Postoperative voiding outcomes (mean 16yrs) were correlated with ultrastructural features and urodynamic parameters. RESULTS: 27 patients (mean age 78 yrs) were recruited (23 DU and 4 BOO). In DU patients, the mean postvoid residual urine (PVR) was 630ml (IQR 240-985). Postoperatively all BOO patients voided, 9 DU patients (39%) were catheter-free at 3 months, 14 patients (61%) required catheterisation. At long term follow-up, only 29% DU (6/21) patients were catheter-free. Functional parameters including PVR, Voiding efficiency and Bladder contractility index did not correlate with voiding outcomes. Ultrastructural studies of DU patients showed voiding outcome after TURP was significantly associated with myocyte irregularity/derangement (p=0.034) and collagenosis (p=0.041). Overall, moderate to severe changes of ‘myohypertrophy’ pattern (myocyte size variation, increased cell separation, increased intercellular collagen, degeneration) predicted poor long term voiding outcomes (p=0.029, OR of catheter-dependence 5.5). CONCLUSIONS: Detrusor ultrastructural features of myocyte irregularity, degeneration, collagenosis (moderate to severe ‘myohypertrophy pattern’) are associated with impaired detrusor contractility and predicted poor long term voiding outcomes and catheter dependence after TURP. Detrusor biopsy with ultrastructural analysis can be a useful diagnostic and prognostic tool in men with DU considering surgery. Source of Funding: Royal Australasian College of Surgeons Foundation Scholarship © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1185 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Chung More articles by this author Vincent Tse More articles by this author Lewis Chan More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-18 NEW MINIMALLY INVASIVE TECHNIQUES VERSUS GOLD STANDARD TREATMENT FOR MIDDLE VOLUME (30-80 ML) PROSTATES: A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP51-18 NEW MINIMALLY INVASIVE TECHNIQUES VERSUS GOLD STANDARD TREATMENT FOR MIDDLE VOLUME (30-80 ML) PROSTATES: A PROSPECTIVE RANDOMIZED STUDY Antonio Luigi Pastore, Yazan Al salhi, Andrea Fuschi, Alessia Martoccia, Alessandro Sciarra, Stefano Salciccia, De Nunzio Cosimo, Andrea Tubaro, Costantino Leonardo, Giorgio Franco, Paolo Pietro Suraci, Onofrio Antonio Rera, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan Al salhiYazan Al salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Alessia MartocciaAlessia Martoccia More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , De Nunzio CosimoDe Nunzio Cosimo More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Giorgio FrancoGiorgio Franco More articles by this author , Paolo Pietro SuraciPaolo Pietro Suraci More articles by this author , Onofrio Antonio ReraOnofrio Antonio Rera More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the last years minimally invasive endoscopic approaches have been proposed and introduced with the aim to reduce the morbidity related to TURP, such as: convective water vapor energy (Rezum) and heat free water-jet ablation (Aquablation).The aim of this prospective randomized study is to compare the perioperative and functional outcomes between gold standard surgery (TransUrethral Resection of Prostate, TURP) and these two new minimally invasive approaches (Rezum and Aquablation). METHODS: Patients with benign prostatic obstruction were prospectively enrolled and randomized for the three surgical approaches between January 2021 and September 2022. All patients were preoperatively evaluated with digital rectal examination, PSA value and abdominal ultrasound for prostate volume measurement. Preoperatively and 6 months after surgery, patients were studied as follows: Uroflowmetry (Qmax and Qave) with postvoid residual (PVR), International Prostatic Symptoms Score (IPSS), Male Sexual Health Questionnaire (MSHQ) and International Index of Erectile Function (IIEF-5). All patients were also investigated by urodynamics. Operating time, days of hospital stay, intraoperative and postoperative bleeding, postoperative catheterization time were evaluated for each procedure. RESULTS: 252 patients with mean age of 64.6 years old were included in the study. Patients were prospectively randomized to the following treatment groups: 61 subjects underwent Rezum (group A), 92 patients Aquablation (group B), and 99 patients bipolar TURP (group C). Postoperative IPSS resulted lower in patients underwent TURP and AQUABEAM than Rezum (p<0.001). Postoperative IIEF5 mean scores significantly increased in groups A and B (25 and 24, respectively) than in group C (18, p<0.001). The antegrade ejaculation was spared in all Rezum and Aquablation subjects, whereas all TURP patients reported retrograde ejaculation. The TURP group reported mean flowmetry parameters significantly better when compared to Aquabeam and Rezum groups (p<.005). Operating time and length of hospital stay were longer after TURP (respectively 75 min, 3 days) when compared to the other two groups (8 min, 0.6 days; 5.2 min, 1 day, in group A and B, respectively). The mean estimated blood loss (evaluated as postoperative drop in Hb) was significantly higher in group C (DHb 1.2 mg/dl) than in the other two groups (DHb 0.1 mg/dl observed in both groups, p<.005). CONCLUSIONS: This prospective randomized study is the first to compare new endoscopic approaches to gold standard surgery in the treatment of non-neurogenic LUTS secondary to BPH for prostate volumes 30-80 ml. Our results condrm that Rezum and Aquablation are safe and effective. Postoperative outcomes are better in new approaches in terms of sexual function and overall satisfaction, especially related to the preservation of the antegrade ejaculation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e700 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Luigi Pastore More articles by this author Yazan Al salhi More articles by this author Andrea Fuschi More articles by this author Alessia Martoccia More articles by this author Alessandro Sciarra More articles by this author Stefano Salciccia More articles by this author De Nunzio Cosimo More articles by this author Andrea Tubaro More articles by this author Costantino Leonardo More articles by this author Giorgio Franco More articles by this author Paolo Pietro Suraci More articles by this author Onofrio Antonio Rera More articles by this author Antonio Carbone More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-08 DEVICE-RELATED ADVERSE EVENTS DURING BENIGN PROSTATIC HYPERTROPHY SURGERY: REVIEW OF THE MANUFACTURER AND USER FACILITY DEVICE EXPERIENCE DATABASE

You have accessJournal of UrologyCME1 Apr 2023PD41-08 DEVICE-RELATED ADVERSE EVENTS DURING BENIGN PROSTATIC HYPERTROPHY SURGERY: REVIEW OF THE MANUFACTURER AND USER FACILITY DEVICE EXPERIENCE DATABASE Daniel Heidenberg, Ethan Nethery, Nathanael Judge, Kevin Wymer, Scott Cheney, and Mitchell Humphreys Daniel HeidenbergDaniel Heidenberg More articles by this author , Ethan NetheryEthan Nethery More articles by this author , Nathanael JudgeNathanael Judge More articles by this author , Kevin WymerKevin Wymer More articles by this author , Scott CheneyScott Cheney More articles by this author , and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) affects most men over 60 years old. The Manufacturer and User Facility Device Experience (MAUDE) database is an FDA maintained public database that contains anonymous, voluntary medical device reports. Herein, we review device-related adverse events reported in the MAUDE database associated with BPH surgeries. METHODS: The MAUDE database was queried for “Aquablation, Rezum, Loop Resection, Morcellator, Greenlight Laser, Holmium Laser, and Urolift” from 2018 through 2021. A complication classification system (Level 1-4) based on the Clavien-Dindo system was used to categorize events based on outcomes. These events were then correlated with device malfunctions and classified as “product related” and “non-product related.” Chi squared analysis was performed to identify associations between BPH surgery type and complication classification distribution. RESULTS: A total of 873 device related events were identified. The entries by surgical subtype included: rezum 304 (35%), urolift 33 (4%), TURP 134 (15%), HOLEP 40 (4%), Aquablation 294 (34%), Greenlight laser 68 (8%). 553 complications (63%) were Level I (mild/none), 138 (16%) were Level II (medical management), 164 (19%) were Level III (surgical management), and 16 (2%) was Level IV (life threatening). The most common level II-IV complications by BPH surgery type: aquablation - hematuria (50%), rezum - lower urinary tract symptoms (23%), HOLEP – retained adenoma (23%), urolift – acute urinary retention (12%), greenlight laser – urethral necrosis (2%), transurethral resection of prostate – bladder perforation (3%). Using chi squared analysis, aquablation (p<0.017) and Rezum (p<0.012) were associated with the highest risk of Level II-IV complications compared with other device classes. Overall, “product related” malfunctions were not associated with level II-IV complications. CONCLUSIONS: Aquablation and rezum were associated with a higher proportion of level II-IV complications. However, this difference is not accounted for by “product related” malfunctions, which highlights surgeon experience or other unknown factors as potential sources for adverse events with newer products. A limitation of this study is the total complications per surgical subtype are not fully captured. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1061 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Heidenberg More articles by this author Ethan Nethery More articles by this author Nathanael Judge More articles by this author Kevin Wymer More articles by this author Scott Cheney More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement PDF downloadLoading ...

Prostatic Artery Embolization for The Treatment of Benign Prostatic Obstruction - A Retrospective Review of The Novel Experience Of 2 Tertiary Urology Centers

Background: Benign Prostatic Hyperplasia (BPH) is common in aging men with worldwide prevalence at 20-62%, while Malaysian prevalence was 39.3% (2001) and increased at 8% per decade. In surgical treatment of BPH, Trans-Urethral Resection of Prostate (TURP) remains the gold standard. Other surgical options would mostly also require general anesthesia (GA). Therefore, more Local-Anaesthesia (LA) based options should be made available for patients who are not fit or unwilling to be under GA. Those currently available LA-based procedure has shown promising results including prostatic stents and trans-urethral lifts, but have drawbacks due to being expensive, not widely available, less suitable in median lobe enlargement or may cause complications including migration, overgrowth of prostatic tissue or foreign-body related complications which may require GA for their treatment. Prostatic Artery Embolization (PAE), initially an LA-based emergency treatment option for persistent life-threatening hematuria from a bleeding BPH, now has been proven to be a safe elective treatment. In Malaysia this novel technique was first reported in 2017 for treatment of post TURP intractable hematuria. Methods and Material: We retrospectively evaluated all 13 catheter-dependent BPH patients in two tertiary urology centres treated with PAE from April 2019 until December 2021 to assess post-treatment efficacy. Results: One patient failed removal of catheter within 3 months post-procedure but 12 out of 13 patients safely got their catheter removed within 1-3 months and resulted in significant IPSS improvement. Conclusion: PAE is a safe and effective treatment option for BPH patients of the Malaysian population but needs prospective evaluation.

Serial perioperative optic nerve sheath measurements for early diagnosis of the transurethral resection of prostate syndrome: an open label pilot study

BackgroundUltrasound imaging of optic sheath nerve diameter [ONSD] is reported to reflect changes consistent with intracranial pressure changes seen in traumatic brain injury and also in documented serum hyponatremia. We hypothesized that hyponatremia and hypervolemia seen during trans urethral resection of prostate [TURP] surgery may also have some association with different ONSD readings from the baseline perioperatively, resulting in early detection of TURP syndrome. In this prospective observational study, 50 adult male patients scheduled for TURP surgery meeting inclusion criteria were included and the ONSD measurements were serially recorded perioperatively. Patients with measurements ≥ 5.2 mm with either clinical symptoms or electrolyte changes suggested TURP syndrome were taken as true positive.ResultsThe sensitivity, specificity, area under the curve, positive predictive, and negative predictive value at 95%CI of ONSD for early detection of TURP syndrome was {100% [15.81 to 100.00%], 91.67% [80.02 to 97.68%], 0.96 [0.86 to 0.99%], 33.33% [4.33 to 77.72%], 100% [91.96 to 100.00%]} with a diagnostic accuracy of 95.83%. In univariate logistic regressions, the duration of surgery had a positive association with TURP syndrome [odd ratio 1.066, β coefficient 0.064, p = 0.015]. In multivariate logistic regression, we could not validate the association between these factors and TURP syndrome [p > 0.050].ConclusionsThe ONSD measurements have good diagnostic accuracy for detecting TURP syndrome, but we advocate more multi-centric studies with large sample sizes to validate this association in the multivariate regression model.

Effects of Two Weeks Finasteride Therapy on Per-Operative Decrease in Haemoglobin Patients after Transurethral Resection of Prostate (TURP)

Aim: To compare the per-operative mean decrease in haemoglobin level in patients undergoing transurethral resection of prostate taking finasteride for two weeks before transurethral resection of prostate versus without pre-treatment of finasteride. Study Design: Randomized control trial Place and Duration of Study: Department of Urology, Indus Hospital, Karachi from 23rd May 2017 to 22nd November 2017. Methodology: Sixty patients were included and divided into two groups. In Group A, patients were finasteride (5 mg/day) for two weeks before surgery and Group B (control group) no drug will be given before surgery. All patients underwent transurethral resection of prostate and then had intra-operative bleeding noted. Results: Only 4 (8.7%) of the patients had the history of supplement use. No significant difference was observed in age, baseline creatinine, protate size, duration of BPH, before surgery hemoglobin and after surgery hemoglobin between both the groups. There was slight decrease in hemoglobin in placebo group adjusting for age, baseline creatinine, duration of BPH and prostate size. However, the results did not reach statistical significance. Conclusion: Finesteride given 2 weeks prior to surgery does not significantly decrease intra-op bleeding. Keywords: Effect, transurethral resection of prostate (TURP), Finasteride

The role of transurethral resection of prostate (TURP) in patients with underactive bladder: 12 months follow‐up in different grades of detrusor contractility

Male detrusor underactivity (DUA) definition remains controversial and no effective treatment is consolidated. Transurethral resection of the prostate (TURP) is one of the cornerstones surgical treatments recommended in bladder outlet obstruction (BOO). However, the role of prostatic surgery in male DUA is not clear. The primary endpoint was the clinical and voiding improvement based on IPSS and the maximum flow rate in uroflowmetry (Qmax) within 12 months. We analyzed an ongoing prospective database that embraces benign prostata hyperplasia (BPH) male patients with lower urinary tract symptoms who have undergone to TURP. All patients were evaluated pre and postoperatively based on IPSS questionnaires, prostate volume measured by ultrasound, postvoid residual urine volume (PVR), Prostate Specific Antigen measurement and urodynamic study (UDS) before the procedure. After surgery, all patients were evaluated at 1-, 3-, 6- and 12-months. Patients were categorized in 3 groups: Group 1-Detrusor Underactive (Bladder Contractility Index (BCI) [BCI] < 100 and BOO index [BOOI] < 40); Group 2-Detrusor Underactive and BOO (BCI < 100 and BOOI ≥ 40); Group 3-BOO (BCI ≥ 100 and BOOI ≥ 0). It was included 158 patients underwent monopolar or bipolar TURP since November 2015 to March 2021. According to UDS, patients were categorized in: group 1 (n = 39 patients); group 2 (n = 41 patients); group 3 (n = 77 patients). Preoperative IPSS was similar between groups (group 1-24.9 ± 6.33; group 2-24.8 ± 7.33; group 3-24.5 ± 6.23). Qmax was statistically lower in the group 2 (group 1-5.43 ± 3.69; group 2-3.91 ± 2.08; group 3-6.3 ± 3.18) as well as greater PVR. The 3 groups presented similar outcomes regard to IPSS score during the follow-up. There was a significant increase in Qmax in the 3 groups. However, group 1 presented the lowest Qmax improvement. There were different objective outcomes depending on the degree of DUA at 12 months follow-up. Patients with DUA had similar IPSS improvement. However, DUA patients had worst Qmax improvement than men with normal bladder contraction.

The impact of tranexamic acid on perioperative outcomes in urological surgeries: A systematic review and meta-analysis.

Tranexamic acid (TXA) is an antifibrinolytic agent widely used in surgery to decrease bleeding and reduce the need for blood product transfusion. The role of TXA in urology is not well summarized. We conducted a systematic review of studies reporting outcomes of TXA use in urological surgery. A comprehensive search was conducted from the following databases: PubMed, Embase, Cochrane Library, and Web of Science. Two reviewers performed title and abstract screening, full text review, and data collection. Primary outcomes included estimated blood loss (EBL), decrease in hemoglobin, decrease in hematocrit, and blood transfusion rates. Secondary outcomes included TXA administration characteristics, length of stay, operative time, and postoperative thromboembolic events. A total of 26 studies consisting of 3201 patients were included in the final analysis. These included 11 studies on percutaneous nephrolithotomy, 10 on transurethral resection of the prostate, three on prostatectomy, and one on cystectomy. Estimated blood loss (EBL), transfusion rate, hemoglobin drop, operative time, and length of stay were significantly improved with TXA administration. In addition, the use of TXA was not associated with an increased risk of venous thromboembolism (VTE). The route, dosage, and timing of TXA administration varied considerably between included studies. TXA use may improve blood loss, transfusion rates, and perioperative parameters in urological procedures. In addition, there is no increased risk of VTE associated with TXA use in urological surgery; however, there is still a need to determine the most effective TXA administration route and dose. This review provides evidence-based data for decision-making in urological surgery.