Symptomatic Benign Prostatic Enlargement Research Articles

Sonographic Correlations between Intravesical Prostatic Protrusion and Bladder Outlet Obstruction in Patients with Symptomatic Benign Prostatic Hyperplasia in Ibadan, Nigeria

Background: Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p = 0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP.

Factors associated with depressive symptoms in patients with benign prostatic enlargement.

Depression is a common condition that may lead to suicide at its worst. It is considered one of the primary causes of morbidity globally. Among the urological causes of depression is benign prostatic enlargement (BPE). To determine the prevalence and factors associated with depressive symptoms among BPE patients. This study was conducted in the Urology and Family Medicine Clinic at the Aga Khan University Hospital, Nairobi and Urology clinic at the Aga Khan Hospital Mombasa. The study was a cross-sectional design recruiting 308 males above the age of 40. Patient Health Questionnaire-9 and International Prostate Symptom Score (IPSS) were used to assess depressive symptoms and lower urinary tract symptoms (LUTS), respectively. Association between depressive symptoms and LUTS was determined. Factors associated with depressive symptoms were analysed by logistic regression. Prevalence of depressive symptoms among patients with symptomatic benign prostatic enlargement (sBPE) was 42.90%. Factors associated with depressive symptoms included comorbid conditions, medication side effects, reduced libido, alcohol use, disturbed sleep at night and anxiety in regard to the prostate condition. There is a high prevalence of depressive symptoms among men with BPE. Assessment and early intervention for depressive symptoms among men with BPE should be initiated before clinical depression sets in.Contribution: The study has created a knowledge base on factors associated with depressive symptoms among men with sBPE in the African context.

MP24-17 TAMSULOSIN VERSUS TADALAFIL FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT: ASSESSMENT OF TREATMENT DISCONTINUATION RATE AND SYMPTOMS IMPROVEMENT

You have accessJournal of UrologyCME1 Apr 2023MP24-17 TAMSULOSIN VERSUS TADALAFIL FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT: ASSESSMENT OF TREATMENT DISCONTINUATION RATE AND SYMPTOMS IMPROVEMENT Ahmed Elqaffas, Ahmed Elshal, Adel Nabeeh, and Ahmed M Shoma Ahmed ElqaffasAhmed Elqaffas More articles by this author , Ahmed ElshalAhmed Elshal More articles by this author , Adel NabeehAdel Nabeeh More articles by this author , and Ahmed M ShomaAhmed M Shoma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: both tamsulosin and tadalafil 5 mg are used for treatment of symptomatic benign prostatic enlargement. Nevertheless, the incidence and causes of treatment discontinuation (TD) was not evaluated. A randomized trial is conducted to compare TD rate and symptoms improvement between the two drugs. METHODS: A randomized controlled trial (RCT) is conducted with estimate sample size of 160 cases. Sexually active LUTS/BPO patients with concomitant ED were included and randomly allocated in two groups: the first received tadalafil 5 mg once daily and the second one received tamsulosin for twelve months. The therapeutic outcomes are assessed at 2 weeks , 4 weeks , 12 weeks, 6 months and 12 months. The evaluation includes International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-15) questionnaire, quality of life (QoL), uroflowmetry, post voiding residual (PVR) and incidence and causes of (TD). RESULTS: In tadalafil group 5 patients lost follow up. thirty out of 80 patients showed drug discontinuation (37.5%), 6 of them developed adverse effects in view of headache and musculoskeletal pain, other 24 patients developed no response. IPSS, QoL & IIEF-15 improved in 12 months follow-up compared to baseline criteria (Table 1). In tamsulosin group, 7 patients lost follow up. Eighteen out of 80 patients showed drug discontinuation (22.5%), 5 of them developed adverse effects in view of dizziness and orthostatic hypotension, while 13 patients showed no response. IPSS, QoL & Qmax improved in 12 months follow-up compared to baseline criteria. (Table 1) CONCLUSIONS: When both groups were compared, discontinuation was higher in tadalafil group due to lack of response with significant statistical difference with comparable adverse events. IPSS & QoL were improved in both drugs. Source of Funding: mansoura urology and nephrology center (UNC) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e324 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Elqaffas More articles by this author Ahmed Elshal More articles by this author Adel Nabeeh More articles by this author Ahmed M Shoma More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of short-term Dutasteride treatment on prostate-specific membrane antigen expression in a mouse xenograft model.

BackgroundDutasteride has been shown to increase expression of the prostate‐specific membrane antigen (PSMA) in prostate cancer cells in previous in vitro studies. This 5‐alpha‐reductase inhibitor is commonly used for the treatment of symptomatic benign prostatic enlargement. The modulation of PSMA expression might affect PSMA‐based prostate cancer imaging and therapy.AimThe purpose of this work was to further analyze concentration‐dependent effects of Dutasteride on PSMA expression in a mouse xenograft model.Methods and resultsFour groups of mice bearing LNCaP xenografts were treated for 14 days with daily intraperitoneal injections of either vehicle control or different concentrations of Dutasteride (0.1, 1, 10 mg/kg). Total expression of PSMA, androgen receptor (AR), and caspase‐3 protein was analyzed using immunoblotting (WES). In addition, PSMA, cleaved caspase‐3 and Ki‐67 expression was assessed and quantified by immunohistochemistry. Tumor size was measured by caliper on day 7 and 14, tumor weight was assessed following tissue harvesting.The mean PSMA protein expression in mice increased significantly after treatment with 1 mg/kg (10‐fold) or 10 mg/kg (sixfold) of Dutasteride compared to vehicle control. The mean fluorescence intensity significantly increased by daily injections of 0.1 mg/kg Dutasteride (1.6‐fold) as well as 1 and 10 mg/kg Dutasteride (twofold). While the reduction in tumor volume following treatment with high concentrations of 10 mg/kg Dutasteride was nonsignificant, no changes in AR, caspase‐3, cleaved caspase‐3, and Ki‐67 expression were observed.ConclusionShort‐term Dutasteride treatments with concentrations of 1 and 10 mg/kg significantly increase the total PSMA protein expression in a mouse LNCaP xenograft model. PSMA fluorescence intensity increases significantly even using lower daily concentrations of 0.1 mg/kg Dutasteride. Further investigations are needed to elucidate the impact of Dutasteride treatment on PSMA expression in patients.

Efficacy and safety of aquablation of the prostate for patients with symptomatic benign prostatic enlargement: a systematic review.

The aim of this systematic review is to summarize the contemporary literature on aquablation and evaluate its safety and efficacy for the treatment of symptomatic BPE. A systematic search of English language literature was performed using the PubMed-MEDLINE and Web of Science libraries up to 24 July 2019 by combining PICO (patient population, intervention, comparison, and outcome) terms. We retrieved 16 studies, including 446 patients treated with aquablation eligible for data extraction and analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. We identified a randomized controlled trial (RCT) comparing aquablation to transurethral resection of the prostate (TURP) with 6-month, 1-year, and 2-year outcomes, three single-center and single-arm studies, three multicenter and single-arm studies, and five subgroup analyses. Aquablation significantly improved International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QoL), maximum urinary flow rate (Qmax) and post void residual (PVR) from baseline to last follow-up in all prospective studies. At 2-year follow-up, aquablation showed non-inferior symptom relief compared to TURP, witha lower risk of anejaculation favoring aquablation and no significant differences regarding Clavien-Dindo events. Although a significant hemoglobin drop was reported in all aquablation single-arm studies and when compared to TURP, it did not translate into increased transfusion rates. Data from the WATER trial demonstrates that aquablation is comparable to TURP in effectively improving symptom scores and functional parameters related to BPE and bladder outlet obstruction. The evidence provided supports the safety of aquablation assessed by procedure-related adverse events.

Thulium Laser Enucleation of the Prostate (ThuLEP) as a Technique for Treatment of BPH: Evaluation of a Six-Year Experience at a Single Institution

Background and objective Transurethral resection of the prostate (TURP) has been the undisputed reference standard for elderly men with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE). However, morbidity after TURP remains significant, with increased risks of bleeding and TUR syndrome. In recent years, there has been a gradual increase in the role of laser technology for the treatment of symptomatic BPE. The aim of our study was to evaluate the efficacy and safety of the novel technique Thulim laser enucleation of prostate (ThuLEP) developed for the first time in 2009 by Imkamp et al. in treating symptomatic BPE. Materials and methods Analysis of the data from electronic records, case notes, clinic letters all the patients who had undergone ThuLEP using a 70 W thulium laser (Revolix) for symptomatic outflow obstruction over a 6-year period was done. We looked at the pre-procedure PSA, maximum urinary flow rate (Qmax), Post void residual (PVR) and haemoglobin, comparing it with the postoperative haemoglobin. Results Two-hundred twenty-two patients underwent ThuLEP procedure performed by 2 surgeons. We found a 159 % improvement in Q max, a 61 % improvement in PVR. No mortalities occurred and only 1 patient required post operative blood transfusion. ThuLEP represents a safe, effective surgical option in patients with symptomatic BPH with relatively little complications, producing significant improvements in both Qmax and PVR.

Comparison of The Urinary Flow Rate Improvement After Transurethral Incision and Transurethral Resection of Prostate for Small Sized Symptomatic Benign Enlargement

Objective: To compare the mean improvement in urinary flow rate after transurethral resection of prostate (TURP) and transurethral incision of prostate (TUIP) for small sized symptomatic benign prostatic enlargement (SBE). Study design: Randomized controlled trial. Duration of study: January 2016 to December 2017. Setting: Department of Urology Institute of Kidney Diseases Hayatabad Peshawar. Methodology: A total of 216 patients presenting to our OPD having lower urinary tract symptoms due to benign prostatic enlargement were included in the study. Their medical history, physical and digital rectal examination were performed. Urine analysis, urine C/S, Blood Complete, Serum Creatinine Prostate Specific Antigen, Uroflowmetry and Ultrasound were performed. All patients were randomized into two groups; Group A (TURP) and Grouped B (TUIP). Results: Our study shows that in Group A (TURP) mean age was 57 years with standard deviation ± 3.78 while in Group B (TUIP) mean age was 60 years with standard deviation ± 3.13. The status of uroflowmetry (post-operative) among two groups was analyzed as in Group A (TURP) 5(5%) patients had uroflowmetry 15 ml. Mean uroflowmetry was 17 ml with standard deviation ± 3.64. Where as in Group B (TUIP) 9(8%) patients had uroflowmetry 15 ml. Mean uroflowmetry was 16 ml with standard deviation ± 3.55. Mean urinary flow rate was compared between TURP and TUIP in which showed that there is no significant difference between the two surgical procedures in term of urinary flow rate. Conclusion: Our study concludes that there was no significant difference between TURP and TUIP in term of mean urinary flow rate for small sized symptomatic benign prostatic enlargement.

Robotic assisted simple prostatectomy: recent advances.

Robotic assisted simple prostatectomy (RASP) represents a minimally invasive evolution of traditional open simple prostatectomy for the surgical treatment of severe lower urinary tract symptoms (LUTS) because of benign prostatic enlargement (BPE). Aim of the present review is to summarize the most recent evidence on this novel procedure, and to better define its current role in the surgical armamentarium for the treatment of BPE. Several studies demonstrated that RASP can be safely and effectively performed in centers with sufficient expertise. The procedure can duplicate its open counterpart with the advantage of lower perioperative morbidity, and ultimately faster patient recovery. Overall, the status of RASP seems to be well beyond that of an 'investigational' procedure, and guidelines should be amended accordingly.Nevertheless, it remains to be determined what the place of the RASP procedure in the surgical armamentarium for the treatment of symptomatic BPE will be. Over the most recent years, few comparative studies have been reported, allowing in part to draw some conclusions. RASP seems to be attractive when compared with open simple prostatectomy as it can offer less blood loss, and shorter hospital stay. However, its advantages over transurethral enucleation techniques - such as HoLEP - remain unclear. There are some specific indications, such as the presence of concomitant bladder diverticula or stones, for example, where a robotic approach could represent an appealing solution. Ultimately, further research should look at a cost analysis to determine which technique can be more cost effective. Last, the issue of the learning curve for the different procedures for symptomatic BPE remain to be further scrutinized. RASP offers potential advantages over other available techniques for the treatment of large prostate glands. In centers, wherever a solid robotic program is already in place, this procedure is likely to be increasingly implemented.

3:24 PM Abstract No. 6 Prostatic artery embolization (PAE) and prostatic urethral lift (PUL) procedures for symptomatic benign prostatic enlargement (BPH): a retrospective, single-center comparison of outcomes

3:24 PM Abstract No. 6 Prostatic artery embolization (PAE) and prostatic urethral lift (PUL) procedures for symptomatic benign prostatic enlargement (BPH): a retrospective, single-center comparison of outcomes

Histotripsy Treatment of Benign Prostatic Enlargement Using the Vortx Rx System: Initial Human Safety and Efficacy Outcomes

To assess clinical safety (primary) and efficacy (secondary) of histotripsy for treatment of symptomatic benign prostatic enlargement in a first-in human study. Twenty-five male subjects with moderate to severe lower urinary tract symptoms, prostate size between 30 and 80 g, and no evidence of prostate cancer were enrolled at 2 sites in a prospective, single-arm study. Treatment consisted of acoustic energy delivery through the perineum with integrated real-time transrectal ultrasound monitoring using the Vortx Rx system. Follow-up evaluations were performed on postoperative day 1 and 1, 3, and 6 months. Twenty-five men underwent histotripsy treatment with no serious intraoperative adverse events. Postoperatively, 3 cases of transient urinary retention (<3 days), 1 case of urinary retention (8 days in duration, defined as serious), a minor anal abrasion, and microscopic hematuria were considered device-related adverse events. Debulking of targeted prostate tissue was not observed with transrectal ultrasound imaging or with endoscopic visualization, and clinically meaningful improvement in uroflow or postvoid residual urine (PVR) did not occur. However, International Prostate Symptom Score improvement at 1 month was 12.5 (52.4%) ± 6.6 points (n = 25), at 3 months was 11.9 (50.8%) ± 7.6 points (n = 24), and at 6 months was 10.4 (44.0%) ± 7.6 points (n = 24) (P <.001). Prostate histotripsy was safe and well tolerated in this pilot human trial with improvement in lower urinary tract symptoms.

Endovascular Management in a Case of Recurrent Bleed Following Transurethral Resection of the Prostate

Transurethral resection of prostate (TURP) remains the gold standard surgical therapy for symptomatic benign prostatic enlargement, with reported International Prostate Symptom Score reduction of up to 70%. However, as many as 20% of patients can have significant complications including sexual dysfunction, perioperative bleeding requiring blood transfusion, and incontinence. Intractable hematuria from the prostate can be life-threatening, and its management remains a difficult clinical problem. Prostate artery embolization (PAE) is occasionally indicated in such patients when all other measures have failed. PAE has been used to treat benign prostatic hyperplasia; however, literature related to its use for bleeding following TURP remains limited. We report a case of an elderly male who presented with recurrent episodes of hematuria following TURP and was successfully treated by endovascular management.

Long-term Patient-reported Clinical Outcomes and Reoperation Rate after Photovaporization with the XPS-180W GreenLight Laser

ObjectiveTo evaluate the long-term reported clinical outcomes after photovaporization of the prostate (PVP) with the XPS-GreenLight laser in patients with symptomatic benign prostatic enlargement (BPE). Design, setting, and participantsA prospective longitudinal study was performed for all consecutive patients with BPE who underwent PVP at our institution between 2010 and 2012. Patient-reported clinical outcomes were assessed at 1 mo, 3 mo, 12 mo, and 57 mo using International Prostate Symptoms Score, International Continence Society, and International Index of Erectile Function short-form questionnaires. Maximum flow rate (Qmax), postvoid residual urine measurements were assessed at 3 mo and 12 mo. Long-term satisfaction, complications, and reoperation rates were assessed by questionnaires. Prostate-specific antigen was measured at 3 mo, 12 mo, and 57 mo. InterventionA single surgeon (GF) has practiced photovaporization with a Moxy fiber, under transrectal ultrasonography monitoring. Long-term clinical outcomes were evaluated using questionnaires. Outcome measurements and statistical analysisThe primary measurement was the reoperation. Results and limitationsEighty-four patients of 102 answered the long-term questionnaire. The mean age was 68±7.2 yr. The mean follow-up was 57.4±6.8 mo. The mean prostate volume was 73±38ml. After treatment, the mean International Prostate Symptoms Score decreased significantly from 19.9±6.4 to 6.1±5.6, 3.9±3.4, and 5.9±5.8, respectively, at 3 mo, 12 mo, and 57 mo. The mean prostate-specific antigen level decreased significantly (−56%) from 4.5±4.3ng/ml preoperatively to 2.0±2.0ng/ml and 2.6±2.2ng/ml, respectively, at 12 mo and 57 mo. The mean Qmax increased from 9.6±3.8ml/s preoperatively to 23.9±11.5ml/s and 25.2±9.2ml/s, respectively, at 3 mo and 12 mo. Overall reoperation rate was 4.8%(4/84). Limitations include the single surgeon single center design study and the lack of long-term objectives data such as urodynamic parameters (postvoid residual urine and Qmax). ConclusionsPhotovaporization of the prostate with the XPS-GreenLight laser is an effective technique able to durably improve reported clinical outcomes in patients with BPE. Patient summaryIn this study we looked at the long-term outcomes after laser therapy with XPS-GreenLight laser for benign prostatic enlargement. We found a few reoperation rates and good stable reported clinical outcomes after a mean follow-up of 57 mo. We conclude that this laser technique can offer durably good reported clinical outcomes.

Influence of dutasteride treatment on serum hormone levels and aging male symptoms in patients with benign prostatic enlargement.

To clarify the effects of dutasteride on serum hormone levels and aging male symptoms in patients with benign prostatic enlargement. The present prospective study was carried out in 110 symptomatic benign prostatic enlargement patients treated with daily administration of 0.5mg dutasteride. We analyzed serum hormonal levels and aging related symptoms using a validated Aging Male Symptom questionnaire at baseline and after 3months of dutasteride treatment. The mean total testosterone, free testosterone and luteinizing hormone levels after dutasteride treatment were approximately 20% higher than those at baseline. The percentage increases in total and free testosterone levels were negatively correlated with these baseline levels. Baseline age, levels of total testosterone and free testosterone, and the changes in the rate of luteinizing hormone after dutasteride treatment tended to be correlated with an increase in the rate of total testosterone and free testosterone after dutasteride treatment. In a subgroup of 26 patients with moderate-to-severe aging male symptoms, poor morning erection and free testosterone levels <8.5pg/mL, total aging male symptoms, and somatic symptoms scores significantly decreased after dutasteride treatment with an increase of total and free testosterone. The increase of endogenous free testosterone and total testosterone by dutasteride might bring additional benefits of improvement of aging male-related symptoms, especially in patients with lower free testosterone baseline levels and moderate-to-poor aging-related symptoms.

PD27-07 PREOPERATIVE TRANSRECTAL ULTRASONOGRAPHIC FINDINGS CAN PREDICT THE IMPROVEMENT OF THE PEAK URINARY FLOW RATE AFTER SURGICAL TREATMENT OF BENIGN PROSTATIC ENLARGEMENT IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV1 Apr 2017PD27-07 PREOPERATIVE TRANSRECTAL ULTRASONOGRAPHIC FINDINGS CAN PREDICT THE IMPROVEMENT OF THE PEAK URINARY FLOW RATE AFTER SURGICAL TREATMENT OF BENIGN PROSTATIC ENLARGEMENT IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS Juhyun Park, Chu Hong Park, Inyoung Sun, Sung Yong Cho, Min Chul Cho, Hyeon Jeong, and Hwancheol Son Juhyun ParkJuhyun Park More articles by this author , Chu Hong ParkChu Hong Park More articles by this author , Inyoung SunInyoung Sun More articles by this author , Sung Yong ChoSung Yong Cho More articles by this author , Min Chul ChoMin Chul Cho More articles by this author , Hyeon JeongHyeon Jeong More articles by this author , and Hwancheol SonHwancheol Son More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1228AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We investigated whether preoperative prostatic urethral angle (PUA) and intravesical prostatic protrusion (IPP) on transrectal ultrasonography (TRUS) were associated with the improvement of peak urinary flow rate after surgical treatment of benign prostatic enlargement (BPE) in patients with lower urinary tract symptoms. METHODS A total of 173 men who underwent photoselective vaporization of prostate (PVP) for symptomatic BPE from August 2012 to March 2016 were retrospectively reviewed. Preoperative TRUS was performed and total prostatic volume, transitional zone volume were measured. According to the PUA, the patients were divided into two groups and comparatively analyzed. Surgical outcomes were assessed by the ratio of the international prostate symptom score (IPSS) / quality of life (QoL), the difference in the peak urinary flow rate (Qmax) / post-voided residual urine (PVR) before and at 1, 3, 6, 12, 24, 36 months postoperatively. Sucessful surgical outcome was defined to achievement of increase by = 30% of Qmax after surgery compared to baseline. RESULTS The 90 patients were in Group A (PUA < 48°) and 83 patients were in Group B (PUA (≥ 48°). The age, body mass index, prostatic specific antigen, total prostate volume, PVR, IPSS voiding symptom scores, storage symptom scores and QoL scores were comparable between two groups. However, the rate of IPP and Qmax showed significantly difference (P < 0.05). The successful improvement of Qmax was observed in 107 (61.8%) patients. Multivariate analysis revealed that preoperative IPP (OR 3.921(1.244-12.353), P = 0.020) and higher PUA (≥ 48°, OR 2.353(1.177-4.703), P = 0.015) were independent predictors of successful surgical outcome after PVP. CONCLUSIONS Preoperative higher PUA and IPP were the independent risk factors to the improvement of the peak urinary flow rate after surgical treatment of patients with symptomatic BPE. Larger scale prospective study is needed. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e513-e514 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Juhyun Park More articles by this author Chu Hong Park More articles by this author Inyoung Sun More articles by this author Sung Yong Cho More articles by this author Min Chul Cho More articles by this author Hyeon Jeong More articles by this author Hwancheol Son More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Thulium Vapoenucleation of the Prostate: Surgical Technique from Vaporization to Vapoenucleation

Abstract Introduction: Thulium vapoenucleation of the prostate (ThuVEP) is a minimally invasive size-independent transurethral procedure for symptomatic benign prostatic enlargement (BPE). We have shown that ThuVEP may be safely applied to almost all patients and provides results similar to open prostatectomy and transurethral resection of the prostate.1–6 The aim of this video is to teach the steps necessary to execute ThuVEP safely. Materials and Methods: In this educational video, we detail our surgical technique for ThuVEP and include advice on how to avoid complications. We emphasize a tested systematic surgical learning algorithm beginning with vaporization, advancing to vaporesection, and ultimately progressing to vapoenulceation. Results: Our previous work has shown that by following the presented learning algorithm, proficiency at ThuVEP is attainable after 15 mentored-assisted cases and even applies to urology residents with limited previous transurethral experience. In a review of 1080 patients...

Intravesical Prostatic Protrusion as a Predicting Factor for the Adverse Clinical Outcome in Patients With Symptomatic Benign Prostatic Enlargement Treated With Dutasteride

To evaluate the role of intravesical prostatic protrusion (IPP) as a predictive factor for adverse clinical outcomes in patients treated with dutasteride for lower urinary tract symptoms secondary to benign prostatic enlargement (BPE). In total, 111 patients treated with dutasteride for symptomatic BPE were analyzed. Stepwise multivariate logistic regression was applied to evaluate predictors for acute urinary retention (AUR) or benign prostatic hyperplasia (BPH)-related surgery. We applied an IPP cutoff value of 10 mm. The clinical variables were assessed using univariate analysis. Of 111 patients, 27 (24.3%) developed AUR or required surgical intervention. On multivariate analysis, IPP remained as the independent predictor for AUR and need for BPH-related surgery (odds ratio, 1.27; P < .001). Both international prostate symptom score and maximum urinary flow rate significantly improved in patients with low IPP (P = .03 and P < .001, respectively), but not in those with high IPP. No significant reduction was found in the degree of IPP despite the significant reduction in prostate volume after dutasteride treatment (P = .84 and P < .001, respectively). The 3-year cumulative incidence of AUR or BPH-related surgery in the low IPP group vs the high IPP group was 9.9% vs 71.5%, respectively (P < .001). High IPP is associated with a higher risk of treatment resistance, AUR, or the need for prostatic surgery in patients receiving dutasteride treatment for symptomatic BPE. Dutasteride might not be effective for IPP reduction.

EVALUATION OF THE EFFICACY OF TADALAFIL IN IMPROVING LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT

Lower urinary tract symptoms (LUTS) are common bothersome association with benign prostatic enlargement (BPE). The relationship between erectile dysfunction(ED) and LUTS/ BPE has been studied in the Multinational Survey of the Aging Male and in several epidemiologic studies, suggesting that the two diseases may share a common pathophysiology. The aim of the present study is to evaluate the efficacy and safety of use of tadalafil monotherapy in improving LUTS in patients with symptomatic BPE. Sixty patients aged more than 50 years with symptomatic BPE with LUTS more than 6 months were included from January 2013 to May 2015. These patients were assessed for their International Prostate Symptoms Score (IPSS) which was ≥7 and maximum urinary flow rate (Q max) which was >10 and < 20 ml/s. Patients were given tadalafil tablet 5 mg once daily without other therapy. The treatment was continued for three months and the patients were asked to come back for follow up each four weeks. Among the 60 patients, 50 (83.3%) showed significant improvement in their IPSS by achieving ≥3- points total IPSS improvement in symptoms. There was also significant improvement in the maximum urinary flow rate. The end point was at 12 weeks. It is concluded that, Tadalafil 5 mg once daily can be considered as an option for relieving LUTS in patients with symptomatic BPE

Plasmakinetic Vapor Enucleation of the Prostate with Button Electrode versus Plasmakinetic Resection of the Prostate for Benign Prostatic Enlargement >90 ml: Perioperative and 3-Month Follow-Up Results of a Prospective, Randomized Clinical Trial

Objective: To evaluate plasmakinetic vapor enucleation of the prostate (PVEP) with button electrode and plasmakinetic resection of the prostate (PKRP) in patients with urinary symptoms due to benign prostatic enlargement (BPE) >90 ml. Methods: A total of 112 patients with symptomatic BPE were randomly assigned to either PKRP or PVEP prospectively from August 2012 to May 2014 in our department. Perioperative and postoperative data were investigated during a 3-month follow-up. Results: PVEP was significantly superior to PKRP in terms of operation time (63.9 ± 7.7 vs. 78.1 ± 13.6 min, p < 0.001), hemoglobin loss (1.18 ± 0.30 vs. 1.63 ± 0.38 g/dl, p < 0.001), serum sodium decrease (2.9 ± 0.7 vs. 4.3 ± 0.8 mmol/l, p < 0.001), catheterization duration (49.3 ± 12.2 vs. 78.1 ± 14.8 h, p < 0.001) and hospital stay (100.2 ± 28.3 vs. 116.0 ± 29.2 h, p = 0.004). There were no statistical differences in blood transfusion between the two groups. In addition, there were no statistical differences in maximum urinary flow rate, International Prostate Symptom Score, postvoid residual urine volume, quality-of-life score, transient incontinence, and urethral stricture at 3 months postoperatively. Conclusions: PVEP with button electrode is an equally effective technique for treatment of large BPE with PKRP, with more safety and faster recovery. It may become the superior alternative to PKRP for patients with large BPE.

V3-13 THULIUM VAPOENUCLEATION OF THE PROSTATE: SURGICAL TECHNIQUE FROM VAPORIZATION TO VAPOENUCLEATION

You have accessJournal of UrologyMale Voiding/Sexual Dysfunction/BPH/ Incontinence/Infection/Infertility1 Apr 2015V3-13 THULIUM VAPOENUCLEATION OF THE PROSTATE: SURGICAL TECHNIQUE FROM VAPORIZATION TO VAPOENUCLEATION David Leavitt, Christian Tiburtius, Christopher Netsch, Zeph Okeke, Thomas Herrmann, Arthur Smith, and Andreas Gross David LeavittDavid Leavitt More articles by this author , Christian TiburtiusChristian Tiburtius More articles by this author , Christopher NetschChristopher Netsch More articles by this author , Zeph OkekeZeph Okeke More articles by this author , Thomas HerrmannThomas Herrmann More articles by this author , Arthur SmithArthur Smith More articles by this author , and Andreas GrossAndreas Gross More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1354AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Thulium vapoenucleation of the prostate (ThuVEP) is a minimally invasive, size-independent transurethral procedure for symptomatic benign prostatic enlargement (BPE). We have shown ThuVEP may be safely applied to almost all patients, and provides results similar to open prostatectomy and transurethral resection of the prostate. The aim of this video is to teach the steps necessary to execute ThuVEP safely. METHODS In this educational video we detail our surgical technique for ThuVEP and include advice on how to avoid complications. We emphasize a tested, systematic surgical learning algorithm beginning with vaporization, advancing to vaporesection, and ultimately progressing to vapoenulceation. RESULTS Our prior work has shown that by following the presented learning algorithm, proficiency at ThuVEP is attainable after 15 mentored-assisted cases, and even applies to urology residents with limited prior transurethral experience. In a review of 1080 patients undergoing ThuVEP between 2007 and 2012, median prostate volume was 51 ml (36 – 79 ml) with 25% of the prostate volumes larger than 80 ml, median enucleation time was 32.5 minutes (22 – 50 min), median total operation time was 56 minutes (40 – 80 min), Clavien 3 or higher complications occurred in 72 (6.7%) patients, and 18 (1.7%) patients received a blood transfusion. CONCLUSIONS The learning algorithm presented for ThuVEP is safe and effective, and allows the trainee to gain surgical proficiency in a reasonable timeframe. Once surgical proficiency is achieved, ThuVEP should be considered a viable treatment option in all patients with symptomatic BPE, including those on anticoagulation and those with massive prostates. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e338-e339 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Leavitt More articles by this author Christian Tiburtius More articles by this author Christopher Netsch More articles by this author Zeph Okeke More articles by this author Thomas Herrmann More articles by this author Arthur Smith More articles by this author Andreas Gross More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prediction of Persistent Storage Symptoms after Transurethral Resection of the Prostate in Patients with Benign Prostatic Enlargement

Objective: To identify the prognostic factors causing persistent storage symptoms following transurethral resection of the prostate in patients with benign prostatic enlargement (BPE). Methods: A total of 116 men with symptomatic BPE requiring surgery were enrolled in the study between January 2011 and December 2012. The patients underwent basic clinical evaluations including transrectal ultrasound, International Prostate Symptom Score and urodynamic study. After 6 months, International Prostate Symptom Score and uroflowmetry were rechecked. The definition of persistent storage symptoms was patients with storage scores >7 points. Logistic regression analysis and receiver operating characteristic analysis were conducted. Results: The 116 patients were divided into a persistent storage symptom-positive group (n = 33) and a storage symptom-negative group (n = 83). Multivariate analysis showed that the degrees of worse initial storage symptoms (odds ratio [OR] = 8.32), small bladder capacity (OR = 4.31), impaired detrusor contractility (OR = 2.96) and age (OR = 1.05) were consistently associated with persistent storage symptoms. Conclusions: This short-term study confirms the positive and consistent correlations between the baseline degree of worse initial storage symptoms, bladder capacity, detrusor contractility and age and the improvement in storage symptoms.