Symptoms Of Bladder Outlet Obstruction Research Articles

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Histologic inflammation and collagen content are not positively correlated in human BPH.

Recent clinical studies have implicated prostate inflammation and fibrosis in the development of bladder outlet obstruction and lower urinary tract symptoms (LUTS). Studies utilizing rodent models, including work in our laboratory, have shown prostate fibrosis to occur as a consequence of inflammation. However, the relationship between collagen content and inflammation in human tissue samples obtained from surgical treatment of benign prostatic hypererplasia(BPH)/LUTS has not to our knowledge been previously examined. Prostate tissue specimens from 53 patients (ages 47-88, mean 65.1) treated by open simple prostatectomy or transurethral resection of the prostatefor BPH/LUTS were stained to quantitatively assess prostate inflammation and collagen content. Patients with prostate cancer present in greater than 5% of the surgical specimen were excluded. Prostate volume was determined from pelvic CT scan obtained within 2years of surgery. Analysis of the data showed that inflammation was inversely correlated with collagen content (r = -0.28, p = 0.04). In men with prostates less than 75 cm3 inflammation increases and collagen content decreases with prostate volume (p = 0.002 and p = 0.03, respectively) while in men with prostate volume over 75 cm3 inflammation decreases and collagen content increases with prostate volume (p = 0.30 and p = 0.005, respectively). Our data do not support the assumed positive association of prostate inflammation with collagen content. Coordinated analysis of scatter plots of inflammation and collagen content with prostate volume revealed a subset of prostates with volumes >50 cm3 prostate characterized by intense inflammation and low collagen content and it is this subgroup that appears most responsible for the inverse correlation of inflammation and collagen.

Choice Of treatment method for symptomatic Bladder outlet obstruction in patients with benign prostatic hyperplasia after kidney transplantation

St. Petersburg, Russian Federation The paper presents a comparative assessment of different methods of treating symptomatic bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) who underwent kidney transplantation (KT).

18F-FDG PET/CT of Alveolar Rhabdomyosarcoma of Prostate in a 17-Year-Old Boy.

Rhabdomyosarcoma of the prostate is a rare malignancy that usually presents in childhood and adolescence with symptoms of bladder outlet obstruction. Serum prostate-specific antigen is usually normal, and 18F-FDG PET/CT has a crucial role to rule out distant metastases. We present a case of alveolar rhabdomyosarcoma of the prostate in a 17-year-old boy.

Intradetrusor OnabotulinumtoxinA Injections at the Time of Holmium Laser Enucleation of the Prostate for Men with Severe Storage Symptoms.

Introduction: Intradetrusor onabotulinumtoxinA (OTA) injection is a well-established treatment option for refractory overactive bladder; however, its use at the time of holmium laser enucleation of the prostate (HoLEP) for men with bladder outlet obstruction (BOO) and severe storage symptoms has not been previously reported. Materials and Methods: We retrospectively identified men with BOO and severe storage symptoms who underwent treatment with 200 U of intradetrusor OTA (Botox®) at the time of HoLEP. Patients were propensity score matched to a cohort of HoLEP-only patients based on age, Michigan Incontinence Symptom Index (M-ISI) score, preoperative urinary retention, urge incontinence, and prostate size. Perioperative, postoperative, and patient-reported outcomes were examined between groups. Results: We identified 82 men who underwent HoLEP, including 41 patients in the OTA group and 41 patients in the control group. There was no difference in operative times (59 minutes OTA vs 55 minutes control, p = 0.2), rates of same-day trial of void (TOV) (92% OTA vs 94% control, p = 0.7), or rates of same-day discharge (88% OTA vs 85% control, p = 0.6) between groups. There was no difference in temporary postoperative urinary retention (7% OTA vs 2% control, p = 0.3) between groups. Patients who received OTA injections had a significant reduction in their incontinence scores at 3-month follow-up (M-ISI -8, interquartile range [IQR]: -13 to 0, p < 0.001), whereas control patients did not (M-ISI -5, IQR: -8 to -1, p = 0.2). There was no difference in rates of 90-day complications between groups (OTA 10% vs control 5%, p = 0.7). Conclusions: Intradetrusor OTA at the time of HoLEP is safe and is associated with improved urinary incontinence scores and AUA Symptom Score. Rates of same-day discharge and same-day TOV after HoLEP were not affected by OTA. These findings support the role of OTA as an adjunct to surgical intervention in men with incontinence in the presence of BOO.

A Band from the “Blue”

Several lesions of the bladder are incidental findings and a few of them are seen against a background of bladder outlet obstruction. Tuberculosis of the bladder is associated with characteristic lesions and changes. Presented here is a never-seen-before bladder lesion in a patient presenting with symptoms of Bladder Outlet Obstruction due to an enlarged tuberculous prostate, and no evidence of tuberculous cystitis.

Low- vs. High-Power Laser for Holmium Laser Enucleation of Prostate.

Holmium laser enucleation of the prostate (HoLEP) constitutes an established technique for treating patients with symptomatic bladder outlet obstruction. Most surgeons perform surgeries using high-power (HP) settings. Nevertheless, HP laser machines are costly, require high-power sockets, and may be linked with increased postoperative dysuria. Low-power (LP) lasers could overcome these drawbacks without compromising postoperative outcomes. Nevertheless, there is a paucity of data regarding LP laser settings during HoLEP, as most endourologists are hesitant to apply them in their clinical practice. We aimed to provide an up-to-date narrative looking at the impact of LP settings in HoLEP and comparing LP with HP HoLEP. According to current evidence, intra- and post-operative outcomes as well as complication rates are independent of the laser power level. LP HoLEP is feasible, safe, and effective and may improve postoperative irritative and storage symptoms.

Does histological prostatic inflammation during transurethral resection of the prostate for bladder outlet obstruction affect post‐operative urinary outcomes?

Benign prostate hyperplasia (BPH) is a common cause for bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS) in men. The pathophysiology of BPH is multifactorial and inflammation has been linked with progression of BPH and LUTS. The association between histological prostatitis found at transurethral resection of the prostate (TURP) and adverse post-operative urinary outcomes is not clearly defined. Our aim was to evaluate the association between histological prostatitis and adverse post-operative urinary outcomes following TURP procedure. Patients who had undergone TURP for BPH at a single institution between 2014 and 2018 were included. The study population was divided into three cohorts: those with no histological inflammation, those with any form of inflammation and those specifically with prostatic stromal inflammation. Functional outcomes were assessed by defining a series of measurable post-operative "LUTS events" and comparing these to time-to-event profile using a Kaplan-Meier estimator. A total 198 patients were included (no inflammation n=101; any inflammation n=97, prostatic stromal inflammation n=81). All three groups were comparable in terms of baseline characteristics. The any inflammation group had significantly more adverse post-operative outcomes after TURP compared to the no inflammation group, P=0.0065. The stromal inflammation group had more LUTS events after surgery compared to the no inflammation groups in the first year of follow-up n=0.011; over a 5-year follow-up period the results were not statistically significant, P=0.244. Histological prostatitis is associated with worse urinary outcomes after TURP compared to no inflammation. These results are useful in improving prognostic discussions with patients after TURP.

The patient burden of nocturnal polyuria in the United States: Results from the epidemiology of nocturnal polyuria (EpiNP) study.

To explore the impact of nocturnal polyuria (NP) on health-related quality of life (HRQoL), work productivity, mental health, fatigue, bother, and daytime sleepiness. This large-scale, US population-representative epidemiologic study was conducted in two parts: a web-based survey and 3-day bladder diary. Consenting participants completed the baseline Epidemiology of NP (EpiNP) survey online (Lower Urinary Tract Symptoms [LUTS] Tool, comorbidities, burden, and multiple HRQoL measures). Participants who reported ≥2 voids/night, and a random sample of 100 respondents each reporting 0 or 1 void/night, were sent urine measurement containers and asked to complete the 3-day bladder diary. NP was defined as Nocturnal Polyuria Index >0.33 (NPI33) or nocturnal urine production >90 ml/h (NUP90). Five subgroups were created: Idiopathic NP (NP with no underlying cause), NP associated with symptoms of overactive bladder (NPOAB) or bladder outlet obstruction (NPBOO; men only), NP associated with other comorbidities (NPCOM; e.g., diabetes, hypertension, heart disease, sleep apnea), and no NP (did not meet NP criteria). A total of 4893 men and 5297 women completed the EpiNP survey; mean age was 54.4 (SD = 14.7). Significantly greater patient burden (p < 0.0001) was evidenced in the nocturia group (≥2 voids/night) versus no nocturia group (0-1 void/night) on daily impact of nocturia, LUTS Bother, prostate symptoms (men only), work productivity, physical and mental health component scores, depression, fatigue, and daytime sleepiness. NP subgroup analyses showed men in the NPBOO group and women in the NPOAB group reported the greatest impact on LUTS bother, fatigue, physical health, work productivity impairment, daytime sleepiness, and depression (women only). This was the first large-scale, epidemiologic study to explore the impact of different forms of NP on patients' HRQoL. Findings demonstrate that NP associated with other urologic or comorbid conditions appears to have greater patient burden than idiopathic NP, in particular for women.

Robotic-assisted simple prostatectomy: long-term, trifecta- and pentafecta-based analysis of functional outcomes

Background: Robotic-assisted simple prostatectomy (RASP) proved to be a sound and effective procedure for bladder outlet obstructive symptoms relief. Routinely, the transvesical (Freyer) or transcapsular (Millin) techniques are performed. A novel approach of near-infrared fluorescence imaging (NIFI)-guided urethra-sparing robot-assisted prostatectomy (Madigan) was recently introduced. Objectives: The aim of our study was to evaluate the long-term functional outcomes between the Millin, Freyer, and Madigan RASP. Design: This is a single-center, retrospective evaluation of a prospectively maintained Institutional Review Board–approved database. Methods: Data from patients who have undergone RASP in our center were prospectively collected. Demographics, prostate size, and preoperative flowmetry parameters were assessed. Questionnaires such as International Index of Erectile Function (IIEF), and International Consultation on Incontinence Questionnaire (ICIQ), International prostatic symptoms score (IPSS) with its quality of life (QoL) score, Male Sexual Health Questionnaire (MSHQ), Overactive bladder questionnaire (OABQ) were administered to every patient preoperatively and during follow-up. We tested composite outcomes (trifecta) defined as a combination of postoperative Q-max &gt;15 ml/s, IPSS score &lt; 8, and absence of complications. We also tested a pentafecta which keeps in account the persistence of antegrade ejaculation (MSHQ &gt; 0) and the erectile function maintenance (∆IEEF &lt; 6). Results: Median follow-up was 36 months. Millin, Madigan, and Freyer procedures were performed in 37 (51%), 18 (25%), and 17 (24%) cases, respectively. Trifecta was achieved in 43 (60%) patients. Preoperative ICIQ, postoperative IPSS, postoperative OABQ, and QoL were significantly different between groups (all p &lt; 0.02). Pentafecta was achieved by 14 (20%) patients. The pentafecta group showed a statistically significant advantage in terms of postoperative IPSS and MSHQ ( p &lt; 0.01). Conclusion: RASP provides an effective and durable relief of obstructive symptoms at long-term follow-up, regardless of the technique, achieving the trifecta in the majority of the patients. The Madigan technique is significantly related to the pentafecta achievement.

Efficacy and Safety of Transurethral Enucleation of Prostate

Background: Benign Prostatic Hyperplasia (BPH) is one of the most common urological diseases seen in aging men. Surgical treatment is recommended for patients unresponsive to medical therapy or those who have developed BPH-related complications. Enucleation procedure distinguished itself as a successful treatment option in large BPH patients, mimics open prostate enucleation, characterized by good surgical efficiency, reduced complications, faster postoperative recovery, similar prostatic tissue ablation capabilities and satisfactory follow-up results compared with the open technique. Objectives: To assess the safety and efficacy of transurethral enucleation of prostate. Methods: Patients aged above 45 years with symptoms of bladder outlet obstruction due to BPH, with maximal urinary flow rate (Qmax) of &lt;15 ml/s, failure to relieve symptoms by medications or acute urinary retention failing at least one trial without catheter or recurrent gross hematuria due to prostatomegaly or upper urinary tract changes due to bladder outlet obstruction due to BPH and patient willing to undergo Transurethral Resection of the Prostate (TUEP) were included in this study. Results: In our study patients aged between 55-90 years were enrolled. Most common presenting complaints were frequency and acute urinary retention. Mean preoperative prostate size was 102.9 ± 10.90g with a range of 84-126 g. Mean operative time was 86.71 ± 5.24 minutes. The mean postoperative ID catheter was 2.1+1.63 days. Postoperative uroflowmetry and International Prostate Symptom Score (IPSS) improved significantly. Conclusion: TUEP represents a promising endoscopic approach in large Benign Prostate Enlargement (BPE) cases, mimics conventional open method of enucleation of the prostate while having all the advantages of a minimally invasive surgery.

Peroxinitrite and Malondialdehyde as Biomarkers for Overactive Bladder.

To measure urine malondialdehyde (MDA) and urine peroxynitrite (ONOO) levels in patients with overactive bladder (OAB), and compare them with healthy individuals; to determine the change of those markers in OAB patients prescribed antimuscarinic drugs. An observational study. The Department of Urology, School of Medicine, University of Gaziantep, Gaziantep, Turkey, between August 2021 and February 2022. Patients diagnosed with OAB (Group 1), and healthy controls (Group 2) were compared. Urinary MDA (µmol/L) and ONOO (µmol/L) levels were measured in all participants. The patients diagnosed with OAB were underwent antimuscarinic therapy with propiverine 30 mg. The levels of MDA (µmol/L) and ONOO (µmol/L) were reanalysed during the third month of antimuscarinic therapy. Patients with stress urinary incontinence, neurogenic bladder, pelvic organ prolapse stage ≥3 (POP-Q ≥3), interstitial cystitis (bladder pain syndrome), history of pelvic radiotherapy, symptoms of bladder outlet obstruction, Qmax <10 ml/sec for men and <15 ml/sec for women measured by uroflowmetry, and history of pelvic and incontinence surgery were excluded from the study. There was no difference in the mean age and or gender distribution of the two groups (p=0.166 and p=0.774, respectively). While the mean MDA levels were significantly higher in patients with OAB, (3.34 ± 1.06µmol/L vs. 2.62 ± 1.45µmol/L, p=0.036), no significant change was detected in ONOO levels between the groups (1.03 ± 0.75 µmol/L vs. 0.71 ± 022 µmol/L, p >0.05). Although no significant change was detected in MDA levels after antimuscarinic therapy (3.50 ± 1.19 µmol/L, p=0.529), there was a statistically significant increase in ONOO levels (1.49 ± 1.45 µmol/L, p=0.013). MDA might be used in the diagnosis of OAB, as a biomarker, similar to recent studies. ONOO was evaluated for the first time in the literature for the diagnosis of OAB, unfortunately, no significant outcomes were obtained. In addition, both MDA and ONOO had no role in monitoring antimuscarinic therapy. Overactive bladder, Peroxynitrite, Malondialdehyde.

V-047 LAPAROSCOPIC TEP- RECURRENT MASSIVE REDUCICLE COMPLETE SCROTAL HERNIA

Abstract The patient was 67 yrs old gentlemen. Swelling over the Left groin for the last one and half year with recent onset discomfort. He was operated on same side 2 years back with open suregry. On clinical examination - large scrotal reducile hernia was observed, another reducible herinia primary was obseved on right side. He was also having symptoms of bladder outlet obstruction for which tablet. silodosin was started. A complete workup was done and patiemt was told about need for folys post operative. He underwent surgery for same under general anesthesia. (video enclosed). The post operative period was eneventful and on follow up of 8 months there is no recurrence. Why laparoscopy - Hernia was reducible, recurrence was on medial aspect. Less tone of abdominal was musculature. Challaanges in laparoscopy - Hernia sac reduction. Opening of sac may happen loss of TEP space, Management of sac, Large mesh covering all defects, post operative seroma, Mesh fixation mutiple places and surggical mangement of contrallaetral hernia in same setting.

Systematic review of urinary biomarkers of female bladder outlet obstruction (fBOO).

Diagnosis of bladder outlet obstruction (BOO) in females is often challenging, not only because of the overlap in storage and voiding symptoms in women with various etiologies of lower urinary tract (LUT) dysfunction but also due to the lack of standardized urodynamic criteria to define the condition. There is an unmet need of biologic markers to evaluate BOO in females as an adjunct to other clinical criteria. We sought to elucidate the role of urinary biomarkers in female BOO. We performed a systematic review of studies involving urinary biomarkers in female BOO. The search was performed in PubMed. A total of 58 papers were retrieved and 2 were included for final analysis. Currently, there are no validated biologic markers for female BOO available. Having a biomarker that can be obtained through a urine sample will be an invaluable tool to evaluate and counsel patients with LUT symptoms and possible BOO. The use of NGF as an indicator of BOO in female patients seems to be promising: NGF levels are elevated in women with BOO when compared with normal controls. We found that NGF levels may be applied as a useful biomarker in the diagnosis and evaluation of female patients with BOO symptoms. It will not completely replace other clinical diagnostic tools such as formal urodynamic testing but play a role as a supplement to it. Nevertheless, further studies should be conducted to establish NGF levels as a female BOO biomarker and a routine testing modality.

Day Case GreenLight Laser Photoselective Vaporisation of the Prostate (GL-PVP)

Background and Objective In recent years, GreenLight laser photoselective vaporisation of the prostate (GL-PVP) has emerged as the primary ablative surgical treatment option for symptomatic bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPE). Unlike the reference procedure, monopolar-transurethral resection of the prostate (M-TURP), GL-PVP can be performed as a day case. As waiting list pressures continue to burden health boards across the UK, exacerbated by the COVID-19 pandemic, enhanced access to day case surgery to optimise patient flow is now of paramount importance. We evaluated the safety and feasibility of day case GL-PVP at our high-volume UK centre and identified predictors of a postoperative overnight stay. Material and Methods We performed a retrospective observational cohort study of all patients who underwent primary GL-PVP at a single institution between October 2016 and June 2021. All procedures were performed utilising the 180W GreenLight XPS™ laser therapy system. Various clinical, operative and functional data were collated, and outcomes were compared between patients who underwent day case surgery and those admitted overnight postoperatively. Results In all, 538 patients underwent GL-PVP during the study period. Median patient age was 72 (interquartile range (IQR) 66–77), and median prostate volume was 62.5cc (IQR 45–90). Five hundred nineteen patients (96.5%) were discharged within 23 hours of admission, and 366 patients (68.0%) were managed as a true day case. Operative and functional outcomes were comparable between patients managed as a day case and those admitted overnight. There was higher patient-reported satisfaction and a lower rate of early hospital readmission in the day-case group. On univariate logistic regression analysis, patients aged ≥80 years (Odds Ratio 2.64 [95% Confidence Interval 1.65– 4.24], p = &lt; 0.001), those with American Society of Anaesthesiologists (ASA) physical status classification score ≥3 (OR 1.92 [95% CI 1.33–2.78], p = &lt; 0.001), those with prostate volume ≥80cc (OR 1.62 [95% CI 1.00–2.61], p = 0.05) and those in whom the operation time ≥60 minutes (OR 1.66 [95% CI 1.10–2.52], p = 0.02) were more likely to be admitted overnight following GL-PVP. On multivariate logistic regression analysis, age ≥80 (OR 2.64 [95% CI 1.47–4.73], p = 0.001) and ASA score ≥3 (OR 2.03 [95% CI 1.28–3.22], p = 0.003) remained predictive variables of an overnight stay. Conclusion From our observations of a large cohort of patients over a study period of almost five years, day case GLPVP is a feasible concept and does not appear to compromise perioperative outcomes. With appropriate service redesign and optimisation of postoperative patient pathways, day case GL-PVP can be established in other centres and may have a role in alleviating waiting list pressures.

Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications.

Benign prostatic hyperplasia (BPH) is a noncancerous growth of the transitional zone of the prostate, which surrounds the prostatic urethra. Consequently, it can cause lower urinary tract symptoms (LUTS) and bladder outlet obstruction symptoms that may substantially reduce a patient's quality of life. Several treatments are available for BPH, including medications such as α-blockers and 5α-reductase inhibitors and surgical options including transurethral resection of the prostate and prostatectomy. Recently, prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for selected men with BPH and moderate to severe LUTS. Adequate pre- and postprocedural evaluations with clinical examinations and questionnaires, laboratory tests, and urodynamic and imaging examinations (particularly US, MRI, and CT) are of key importance to achieve successful treatment. Considering that the use of PAE has been increasing in tertiary hospital facilities, radiologists and interventional radiologists should be aware of the main technical concepts of PAE and the key features to address in imaging reports in pre- and postprocedural settings. An invited commentary by Lopera is available online. Online supplemental material is available for this article. ©RSNA, 2021.

Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART II-Surgical Evaluation and Treatment.

Surgical therapies for symptomatic bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) are many, and vary from minimally invasive office based to high-cost operative approaches. This Guideline presents effective evidence-based surgical management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH). See accompanying algorithm for a detailed summary of procedures (figure[Figure: see text]). The Minnesota Evidence Review Team searched Ovid MEDLINE, Embase, Cochrane Library, and AHRQ databases to identify eligible studies published between January 2007 and September 2020, which includes the initial publication (2018) and amendments (2019, 2020). The Team also reviewed articles identified by Guideline Panel Members. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, information is provided as Clinical Principles and Expert Opinions (table[Table: see text]). Twenty-four guideline statements pertinent to pre-operative and surgical management were developed. Appropriate levels of evidence and supporting text were created to direct urologic providers towards suitable and safe operative interventions for individual patient characteristics. A re-treatment section was created to direct attention to longevity and outcomes with individual approaches to help guide patient counselling and therapeutic decisions. Pre-operative and surgical management of BPH requires attention to individual patient characteristics and procedural risk. Clinicians should adhere to recommendations and familiarize themselves with criteria that yields the highest likelihood of surgical success when choosing a particular approach for a particular patient.

Bladder and Prostate Sonomorphology as Non Invasive Method for Assessing the Lower Urinary Tract in Patient with Symptomatic Bladder Outlet Obstruction Due to Benign Prostate Enlargement

Bladder and Prostate Sonomorphology as Non Invasive Method for Assessing the Lower Urinary Tract in Patient with Symptomatic Bladder Outlet Obstruction Due to Benign Prostate Enlargement

Combined ethanol extract of Funtumia africana and Abutilon mauritianium leaves improves the lipid profile and kidney function indices of benign prostatic hyperplasia in rats.

Benign prostate hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland as a result of an overgrowth of prostate cells and muscles found around the prostatic transition. It is age-dependent and characterized by benign prostate enlargement (BPE), bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS). The study investigated the effects of a combined extract of Funtumia africana and Abutilon mauritianum leaves (CEFA) on the lipid profile and renal indices of testosterone-induced BPH in male albino rats. Thirty (30) male albino rats (100-150 g) divided into 5 groups (n = 6) were used.BPH was induced subcutaneously with 2 ml of testosterone propionate. Groups 1-3 served as normal, BPH untreated and standard drug controls respectively, while groups 4 and 5 were BPH-induced and treated with low (200 mg/kg) and high (600 mg/kg) doses of CEFA respectively. After twenty-eight days of treatment, the rats were anaesthetized, blood was collected by cardiac puncture and the sera centrifuged to determine lipid profile and renal indices using standard analytical procedures. The acute toxicity result of CEFA indicated no mortality or adverse reactions. The results of the lipid profile and renal function studies showed a significant (p < 0.05) increase in triacylglycerol (TAG), total cholesterol (TC), urea and creatinine, and a significant (p < 0.05) decrease in high-density lipoprotein (HDL) concentrations in the BPH control group when compared to the normal control. Treatment with CEFA caused a significant (p < 0.05) decrease in TAG, urea and creatinine concentrations and a significant (p < 0.05) increase in HDL-C when compared to the untreated group. No significant (p > 0.05) difference was observed in serum concentrations of TC and low-density lipoprotein (LDL) in the treatment groups compared to the BPH control. The histopathological result indicated no toxic insult on the kidney tissues. The findings suggest that CEFA possesses antilipidaemic properties in terms of elevation and decrease in HDL and TAG concentrations respectively. Also, CEFA possesses renoprotective potential in terms of reducing urea and creatinine concentrations.

Prostatic dystrophic calcification following salvage cryotherapy for prostate cancer – an under-reported entity?

Background Salvage cryoablation (SCA) is an accepted treatment for radio-recurrent prostate cancer with well-established oncological and functional outcomes. Based on one of the longest reported prospective follow-ups in the literature (median 12 years) on 187 patients, this study reports what appears to be an under-appreciated finding in eight patients with dystrophic calcifications (DC) of the prostate following SCA, causing severe bladder outlet obstruction. Materials and methods Between 1995 and 2004, 187 patients underwent SCA, with a median follow-up of 12 years. This database was reviewed for functional and oncological outcomes and DC were evaluated. Results Functional data was available in 85 patients, amongst whom eight patients were found to develop DC (9.4%) proven when the patients presented with urinary difficulties and attempted transurethral resection was undertaken for bladder outlet obstruction. Mean time for emergence of significant symptoms of bladder outlet obstruction was 8.6 years from SCA (standard deviation (SD) = 6 years). All eightpatients required permanent drainage (seven suprapubic catheters, one nephrostomy). All patients with DC experienced biochemical recurrence (BCR), compared to 57.1% of the patients with no DC (p = 0.01). Conclusion DC following SCA appears to be an under-reported late adverse effect which may only become evident with long follow-up, and should be included in preoperative counselling.