Transrectal Ultrasound Volume Research Articles

Transurethral Bipolar Enucleation of the Prostate Is an Effective Treatment Option for Men With Urinary Retention

To evaluate outcomes of transurethral bipolar enucleation (TuBE) of the prostate in patients with refractory lower urinary tract symptoms. A retrospective analysis was performed on patients who underwent TuBE from July 2014 to March 2015. Perioperative factors evaluated included International Prostate Symptom Score, Sexual Health Inventory for Men score, prostate-specific antigen, postvoid residual volume, transrectal ultrasound volume measurement, estimated blood loss, operative time, pathologic weight, and complications. Postoperative evaluation was performed at 6 weeks and 3 months. Forty-nine patients were identified. Mean age was 67 years and mean follow-up was 4.4 months. Twenty-eight patients (57%) were in retention. Preoperative, 6-week, and 3-month mean postvoid residual volumes were 278 mL, 66 mL, and 87 mL (P < .01); mean International Prostate Symptom Scores were 22, 9, and 8 (P < .01); mean quality of life scores were 5.0, 1.9, and 1.9; and Sexual Health Inventory for Men scores were 7.1, 8.4, and 7.0 (P = .35), respectively. Twenty-eight patients (57%) were able to have erections preoperatively and were still able to postoperatively. All (100%) of the patients in retention were able to void postoperatively. Mean operative time was 93 minutes, estimated blood loss was 49 mL, and pathologic weight was 18 g. Urinary tract infection occurred in 3 patients (6%), urethral stricture in 1 (2%), and bladder neck contracture in 2 (4%). Mean prostate-specific antigen decreased from 3.2 ng/dL to 0.9 ng/dL at 3 months (P < .01). TuBE is an effective operation for refractory urinary tract symptoms including those who are in urinary retention.

Evaluation of the Learning Curve for Holmium Laser Enucleation of the Prostate Using Multiple Outcome Measures

To assess and quantify the surgical learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon. A retrospective analysis of 253 consecutive cases performed by the same surgeon from 2006 to 2013 was conducted. Primary outcomes included enucleation ratio and morcellation efficiencies and complication rates. Three-month postoperative prostate-specific antigen values were used as secondary measures. Cases were divided into cohorts of 20 cases to assess changes in means analyzed through Analysis of Variance (ANOVA) tests. Scatter plots of cases with a best-fit line were drawn to analyze the learning curve. The mean age of patients across the cases was 69.21 years with an average transrectal ultrasound prostate volume of 95.84 cc. Enucleation ratio efficiency was significantly different between cohorts (P = .02) plateau after 50-60 cases conducted. Similarly, a significant difference is shown for morcellation efficiency (P = .01) with stabilization in performance after 60 cases. Complication rates decreased through the caseload but did not show a statistical difference (P = .62) or plateauing on the graph. Finally, no difference between 3-month postoperative prostate-specific antigen values was seen (P = .083); however, a learning curve of 50 cases was observed graphically. Within our single-surgeon cohort, we experienced a learning curve of 40-60 cases for the HoLEP procedure. Large variability in performance late into the caseload demonstrates the technical difficulty of HoLEP. Owing to this, adjuncts to training such as simulation-based training may be of use for the new surgeon to shorten the initial phase of learning.

Predicting Acute Urinary Retention in Patients with Elevated Post-Void Residuals

Objectives: To perform a retrospective analysis evaluating factors that may predict which men with elevated post-void residuals (PVRs) that were at increased risk to develop acute urinary retention (AUR). Methods: We retrospectively analyzed the records of 44 male patients who had 2 consecutive PVRs greater than 100 ml over a 6-month period. Using regression analysis, we evaluated patient's age, PVR volume, prostate specific antigen (PSA) and transrectal ultrasound prostate volume with respect to development of AUR over 24 months. Results: Of the 44 patients, 4 developed AUR. When all factors were considered, prostate volume was determined to be the only that was statistically significant (p = 0.003). A 1-SD increase in prostate volume (12 ml) led to a 19.6% increased risk of developing AUR. There was a strong correlation between PSA and prostate volume (0.787). A regression analysis was then repeated excluding prostate volume. PSA then became a statistically significant predictor of AUR (p = 0.007). A 1-SD increase in PSA (1.377 ng/ml) increased the patients' risk of developing AUR by 12.3%. Conclusion: In men with an elevated PVR, increased transrectal ultrasound prostate volume or PSA may help predict which patients have an elevated risk of developing AUR within the next 24 months. This information may influence which patients need early surgical intervention versus medical therapy.

Rotationally resliced 3D prostate TRUS segmentation using convex optimization with shape priors.

Efficient and accurate segmentations of 3D end-firing transrectal ultrasound (TRUS) images play an important role in planning of 3D TRUS guided prostate biopsy. However, poor image quality of the input 3D TRUS images, such as strong imaging artifacts and speckles, often makes it a challenging task to extract the prostate boundaries accurately and efficiently. In this paper, the authors propose a novel convex optimization-based approach to delineate the prostate surface from a given 3D TRUS image, which reduces the original 3D segmentation problem to a sequence of simple 2D segmentation subproblems over the rotational reslices of the 3D TRUS volume. Essentially, the authors introduce a novel convex relaxation-based contour evolution approach to each 2D slicewise image segmentation with the joint optimization of shape information, where the learned 2D nonlinear statistical shape prior is incorporated to segment the initial slice, its result is propagated as a shape constraint to the segmentation of the following slices. In practice, the proposed segmentation algorithm is implemented on a GPU to achieve the high computational performance. Experimental results using 30 patient 3D TRUS images show that the proposed method can achieve a mean Dice similarity coefficient of 93.4% ± 2.2% in 20 s for one 3D image, outperforming the existing local-optimization-based methods, e.g., level-set and active-contour, in terms of accuracy and efficiency. In addition, inter- and intraobserver variability experiments show its good reproducibility. A semiautomatic segmentation approach is proposed and evaluated to extract the prostate boundary from 3D TRUS images acquired by a 3D end-firing TRUS guided prostate biopsy system. Experimental results suggest that it may be suitable for the clinical use involving the image guided prostate biopsy procedures.

A prospective, randomized comparative study of monopolar transurethral resection of the prostate versus photoselective vaporization of the prostate with GreenLight 120-W laser, in prostates less than 80 cc.

In this study we aimed to compare photoselective vaporization (PVP) with the GreenLight 120-W Laser and monopolar transurethral resection as surgical treatments of prostates less than 80 cc in men with obstructive benign prostatic hyperplasia. From February 2009 to March 2012 we allocated 101 patients with a prostate glands of less than 80 cc; patients were randomly assigned for surgical treatment with monopolar transurethral resection of the prostate (TURP) (n = 62) or PVP (n = 39). Serum prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax) postmicturition residual (PMR), transrectal ultrasound volumes (TRUS), postvoid urine residual (PVR), complications, re-operations and hospitalization time were collected. The patients were seen in the follow up at 6, 12 and 24 months. Median age was 69 (56-87) years old in the TURP group and 67 (51-87) years old in the PVP group. Mean preoperative prostate volume was 55 cc (40-72) and 60 cc (41-75) cc in the TURP group versus the PVP group. There was no statistically difference in subjectively (IPSS, SHIM) and objectively (Qmax-PMR) parameters and postoperatively complication rates between the two groups (p > 0.05). A significant difference was observed in the PVP group with a 2 (1-4) days hospital stay compared with 5 (3-9) days for the TURP group (p < 0.001). Prostate PVP and TURP are effective surgical treatments for benign prostatic hyperplasia. Postoperative functional improvements were durable and equivalent in the two groups. The two techniques have a similar complication rate.

Is determination of transition zone volume by transrectal ultrasound in patients with clinically benign prostatic enlargement sufficiently reliable in the clinical setting?

IntroductionControversies exist regarding the accuracy of transrectal ultrasound (TRUS) determination of transition zone volume (TZV) when compared with enucleated adenoma weight.AimTo determine the accuracy and reliability of measurements of the TZV by TRUS, by comparing preoperative radiological findings with the enucleated prostate adenoma volume, measured by fluid displacement volumetry (FDV), after retropubic prostatectomy performed by the Millin method, and, moreover, to evaluate changes in the surgical capsule size in the intermediate postoperative period.Material and methodsWe measured TZV preoperatively using TRUS and postoperatively with FDV in 112 patients who underwent retroperitoneal prostatectomy for benign prostatic hyperplasia (BPH).ResultsThe TRUS volume correlated well with specimen volumes (r = 0.945, p < 0.0001). The median (quartile 1, quartile 3) absolute error was 7.35 ml (4.15 ml, 9.28 ml) and the median percent error was 9.12% (4.75%, 14.98%). Percent error, but not absolute error, was significantly related to TRUS TZV (p < 0.001 and 0.217, respectively). Adenomas > 80 cc were associated with lower percent error. The median volume of the residual prostate tissue measured 3.5 years after prostatectomy was 92.65 cc (65.75 cc, 109.58 cc), whereas the median volume of the surgical capsule, depending on the equation used for its calculation, was 24.80 cc (16.25 cc, 37.37 cc) and 31.43 cc (23.14 cc, 43.32 cc).ConclusionsThe TRUS TZV correlated well with values determined by FDV. It can be reliably used in clinical management of BPH.

Concordance between transrectal ultrasound guided biopsy results and radical prostatectomy final pathology: Are we getting better at predicting final pathology?

Inaccuracy in biopsy Gleason scoring poses a risk to men who may then receive inappropriate treatment. We assess whether there was a change in discordance rates between biopsy and radical prostatectomy at our institution in recent years, while considering the implementation of active surveillance and the shift in biopsy scores caused by the 2005 International Society of Urologic Pathology update to the Gleason scoring protocol. We reviewed patients who underwent radical prostatectomy at our institution between May 2004 and April 2011. We analyzed clinical and pathological correlates of upgrading in 3 subgroups: Gleason sum (GS) 6/6, GS6/7 and GS7/7, where the sum preceding the dash was determined from biopsy and the subsequent sum was determined from the radical prostatectomy specimen. We applied the log-rank test and Cox model to a Kaplan Meier analysis of biochemical recurrence in the subgroups, and also mapped GS6/7 discordance over time. In total, 1717 patients met our inclusion criteria. The 3 subgroups had significantly different mean prostate-specific antigen, patient age, tumour volume, margin status, pathologic stage, prostate weight, transrectal ultrasound volume and rate of progression (p < 0.05). We noted a multiphasic trend with a fall in discordance after 2005. However, there was no sustained trend over the study period taken as a whole (p = 0.06). Although no sustained trend was observed, the falling discordance after 2005 may reflect the accommodation to the Gleason scoring update, while the gradual adoption of active surveillance may have led to the otherwise increasing trends. However, our observations may also be spurious biopsy sampling errors.

Prostate Volume in Patients Undergoing Primary Surgical or Radiotherapeutic Management of Localized Adenocarcinoma: Implications for Design of Minimally Invasive Imaging and Treatment Devices for the Prostate

Introduction: The objective of this study was to collect and analyze prostate volumetric data from different patient cohorts treated for localized prostate cancer. These data were examined with respect to the design of minimally invasive treatment devices for localized prostate cancer. Methods: Among 700 patients with prostate cancer (stages T1a-T3c), 342 had radical retropubic prostatectomy (RRP) specimens submitted for whole mounting; 308 received permanent prostate brachytherapy and underwent transrectal ultrasonography (TRUS); and 50 received external beam radiotherapy with computed tomographic (CT)- based 3-dimensional treatment planning. Analysis included cumulative histograms, descriptive statistics, and statistical comparisons of median height, width, length, and volume. Results: Median prostate dimensions (in millimeters) and volumes (in cubic centimeters) were as follows: Height by RRP was 30; TRUS prolate, 33; TRUS planimetry, 35; and CT, 42. Width by RRP was 47; TRUS prolate, 50; TRUS planimetry, 51; and CT, 51. Length by RRP was 42; TRUS prolate, 49; TRUS planimetry, 45; and CT, 41. Volume by RRP was 32; TRUS prolate, 41; TRUS planimetry, 43; and CT, 45. Conclusions: Although median TRUS and CT volumes were similar (41-45 cm3), median RRP volume was 9 to 13 cm3 less. Of the cases examined, 75% would be encompassed by an imaging device with an azimuthal field of view of 48 to 55 mm and 95% by a device with a length of 54 to 63 mm.

Automatic Localization of the da Vinci Surgical Instrument Tips in 3-D Transrectal Ultrasound

Robot-assisted laparoscopic radical prostatectomy (RALRP) using the da Vinci surgical system is the current state-of-the-art treatment option for clinically confined prostate cancer. Given the limited field of view of the surgical site in RALRP, several groups have proposed the integration of transrectal ultrasound (TRUS) imaging in the surgical workflow to assist with accurate resection of the prostate and the sparing of the neurovascular bundles (NVBs). We previously introduced a robotic TRUS manipulator and a method for automatically tracking da Vinci surgical instruments with the TRUS imaging plane, in order to facilitate the integration of intraoperative TRUS in RALRP. Rapid and automatic registration of the kinematic frames of the da Vinci surgical system and the robotic TRUS probe manipulator is a critical component of the instrument tracking system. In this paper, we propose a fully automatic registration technique based on automatic 3-D TRUS localization of robot instrument tips pressed against the air-tissue boundary anterior to the prostate. The detection approach uses a multiscale filtering technique to identify and localize surgical instrument tips in the TRUS volume, and could also be used to detect other surface fiducials in 3-D ultrasound. Experiments have been performed using a tissue phantom and two ex vivo tissue samples to show the feasibility of the proposed methods. Also, an initial in vivo evaluation of the system has been carried out on a live anaesthetized dog with a da Vinci Si surgical system and a target registration error (defined as the root mean square distance of corresponding points after registration) of 2.68 mm has been achieved. Results show this method's accuracy and consistency for automatic registration of TRUS images to the da Vinci surgical system.

Comparison of 3 Dimensional vs. 2 Dimensional Transrectal Ultrasound Prostate Volume Model Measurement

Comparison of 3 Dimensional vs. 2 Dimensional Transrectal Ultrasound Prostate Volume Model Measurement

2182 IMPACT OF THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP) ON SEXUAL FUNCTION: A PROSPECTIVE SINGLE CENTER STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (III)1 Apr 20132182 IMPACT OF THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP) ON SEXUAL FUNCTION: A PROSPECTIVE SINGLE CENTER STUDY Christian Tiburtius, Sophie Knipper, Thorsten Bach, and Christopher Netsch Christian TiburtiusChristian Tiburtius Hamburg, Germany More articles by this author , Sophie KnipperSophie Knipper Hamburg, Germany More articles by this author , Thorsten BachThorsten Bach Hamburg, Germany More articles by this author , and Christopher NetschChristopher Netsch Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2091AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate changes in sexual function after ThuVEP for the treatment of benign prostatic obstruction (BPO) in men at 12-month follow-up. METHODS A prospective analysis of seventy-two patients who underwent ThuVEP between January and July 2011. Preoperative evaluation included transrectal ultrasound gland volume measurement, maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life (QoL), post-voiding residual urine (PVR), and the International Index of Erectile Function (IIEF-5). Patients were subdivided into two groups: group A: IIEF-5 > 19 and group B: IIEF-5 < 19. Intra-, peri-, and postoperative parameters were evaluated. All patients were reassessed at 12-month follow-up by Qmax, IPSS, QoL, PVR, and IIEF-5. Patient data were expressed as median (interquartile range). RESULTS Median patient age was 70 (65-73) years and the median prostate volume was 52.5 (39.75-72) ml, respectively. At 12-month follow-up, IPSS (20 vs. 4), QoL (4 vs. 1), Qmax (9.7 vs. 22.15 ml/s), and PVR (100 vs. 15 ml) improved significantly in comparison to preoperative assessment (p < 0.001) with no statistical differences between group A and B. A slight but no significant increase in the IIEF-EF domain score was reported at 12-month follow-up (19.5 vs. 20), which could also be shown in group A (25 vs. 26) and group B (6 vs. 8), respectively. CONCLUSIONS ThuVEP is an efficacious procedure for the treatment of BPO. ThuVEP did not impact erectile function in patients with normal preoperative erectile function (IIEF-EF > 19) and those with preoperative existing erectile dysfunction (IIEF-EF < 19). © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e894-e895 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Tiburtius Hamburg, Germany More articles by this author Sophie Knipper Hamburg, Germany More articles by this author Thorsten Bach Hamburg, Germany More articles by this author Christopher Netsch Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of Two Commercial Treatment Planning Systems Variseed and Mim for Low-Dose-Rate Prostate Brachytherapy

operative transrectal ultrasound volume (CT/TRUS ratio) was significantly less for thin seed patients than for standard seed patients (p50.0015). For the standard seed group, the volumetric difference between the preoperative TRUS and post-operative CT tended to be greater in smaller sized prostates. However, in the thin seed patients, the volume variation between the preoperative TRUS and postoperative CT was independent of prostate size. Of the factors considered a priori to be potential predictors of prostate swelling (initial prostate volume, number of needles, prior hormonal therapy, group, operative time), only group was shown to significantly impact on prostate swelling on multivariate analysis, with less swelling in thin seed patients. Conclusions: I thin seeds (ThinSeed, Oncura Pty Ltd) are associated with an initial learning curve in terms of operative time, even among experienced brachytherapists. Their ability to reduce prostate swelling, and the implications in terms of reducing timing-dependent variations in post-implant dosimetry, as well as acute urinary morbidity, deserves further exploration.

Early experience photoselective vaporisation of the prostate using the 180W lithium triborate and comparison with the 120W lithium triborate laser

Purpose:There is a paucity of information on the clinical efficacy and safety of the photoselective vaporization (PVP) of the prostate using the 180W lithium triborate (LBO) laser. We report on initial outcomes of PVP with the 180W laser, comparing the first 50 cases with the last 50 cases performed with the 120W LBO laser.Methods:All cases performed by a single surgeon (HHW) have been prospectively maintained. The last 50 cases treated with the 120W LBO laser (December 2009 to August 2010) were compared with the first 50 cases treated with the 180W LBO (July 2010 to June 2011). Patient variables were recorded preoperatively and at 3 months postoperatively. Perioperative data was also recorded.Results:The 180W cases had a larger median transrectal ultrasound prostate volume (68 mL vs. 51 mL, P<0.05). For the 180W and 120W LBO lasers, total operating time was 64.2 and 72.5 minutes (not significant [NS] at P=0.22), lasering time 49.6 and 54.6 minutes (NS, P=0.30) and energy utilisation 477.6 kJ and 377.9 kJ (P<0.05) respectively. When compared per gram of prostate tissue lasered, the 180W is quicker at 0.67 min/g vs. 1.0 min/g for the 120W laser. Complications using the Clavien-Dindo classification included 5 grade 1 complications and 3 grade 3b (bladder neck contractures) with the 180W LBO laser. The 120 W LBO laser had 4 grade 1 complications and 1 grade 2.Conclusions:There is little change in clinical outcomes with the transition from 120W to 180W LBO PVP with an already experienced PVP surgeon. The 180W LBO laser appears to have impacted upon patient selection with significantly increased prostate size and associated with increased energy utilisation. There appears to be a trend toward shorter laser times.

Baseline Symptom Score and Flow Rate Can Predict Failure of Medical Treatment of Lower Urinary Tract Symptoms: Prospective 12-year Follow-up Study

To assess predictors of failure of medical treatment of lower urinary tract symptoms (LUTS) and evaluate long-term outcome. Between January 1993 and September 1994, 178 men referred with LUTS were prospectively recruited. Assessments included maximum urine flow (Qmax), postvoiding residuals (PVR), transrectal ultrasound (TRUS) prostate volumes, American Urological Association symptom score, and validated quality of life (QOL) and bother scores. Treatment failure was defined as need for transurethral resection of the prostate (TURP). Data were collected at baseline, with final follow-up at 12 years. Univariate and multivariate analyses used Kaplan-Meier and the Cox proportional hazards regression model, respectively, to assess covariates on risk of failure and independent variable prognostic values. Median follow-up was 7.9 years (range, 0-12 years). The mean QOL baseline score of 7.1 improved to 3.6 at 6 years and to 3.3 at 12 years (P <.05 for all). Fifty patients (28%) underwent TURP, with 36 undergoing TURP within 3 years. By univariate analysis, Qmax, AUA and bother scores, and PVR were significantly associated with treatment failure. Independent predictors of failure by multivariate Cox regression were Qmax (>15 vs <15 mL/s; hazard ratio, 3.37; 95% confidence interval, 1.74-6.52; P <.0001) and bother score (<13 vs >13; hazard ratio, 2.37; 95% confidence interval, 1.29-4.35; P = .005). At 12 years, AUA, QOL, and bother scores statistically improved compared with baseline (13 vs 8, 10 vs 6, and 5 vs 2, respectively). Limitations included attrition bias from nonresponders. The beneficial effect of medical treatment persisted for up to 12 years. Treatment is more likely to fail within the first 3 years in patients with low baseline Qmax and high bother scores.

Urinary retention following transperineal template prostate biopsy – study of risk factors

Background: As greater numbers of transperineal template prostate biopsies (TTPBs) are being performed, we have noticed that a considerable number of patients experience urinary retention post-procedure. We wanted to quantify this, and to examine factors that might predict which patients will experience retention. Patients and methods: Data analysis was performed on a prospectively maintained database on 93 consecutive patients undergoing template prostate biopsy over a 12-month period. Results: Mean patient age was 66 years (range 46–79). Mean prostate-specific antigen (PSA) was 8.34 ng/ml (1–31), mean transrectal ultrasonography (TRUS) volume 51 cc (10–133) and mean number of cores 52 (11–84). Twenty-five patients had muscle relaxant as part of their anaesthetic (27%). Fifteen patients had haematuria immediately post-procedure (16%). Twenty-six procedures were performed by a urology trainee (28%). Sixteen patients experienced retention post-template biopsy (17%). Their mean age was 67 years, mean PSA 8.9 ng/ml, mean TRUS volume 68 cc and mean number of cores 58. Of the retention group, 10 patients had muscle relaxant (63%), one patient had haematuria (6%) and four procedures were performed by a trainee (25%). Factors that significantly correlated with retention were TRUS volume ( r = 0.36, p = 0.0004) and the use of muscle relaxant ( r = 0.37, p = 0.0003). Age, PSA, number of cores taken, haematuria post-biopsy, and intra-operative furosemide, paracetamol, diclofenac, morphine and dexamethasone were not correlated with retention ( p &gt; 0.05). Conclusion: Patients with higher TRUS volumes are at increased risk of retention post-TTPB and should be counselled accordingly. Due to anti-muscarinic effects, muscle relaxants should not be used.

Is Small Prostate Volume a Predictor of Gleason Score Upgrading after Radical Prostatectomy?

PurposeWe aimed to analyze the relationship between prostate volume and Gleason score (GS) upgrading [higher GS category in the radical prostatectomy (RP) specimen than in the prostate biopsy] in Korean men.Materials and MethodsWe retrospectively analyzed the medical records of 247 men who underwent RP between May 2006 and April 2011 at our institution. Transrectal ultrasound (TRUS) volume was categorized as 25 cm3 or less (n=61), 25 to 40 cm3 (n=121) and greater than 40 cm3 (n=65). GS was examined as a categorical variable of 6 or less, 3+4 and 4+3 or greater. The relationship between TRUS volume and upgrading of GS was analyzed using multivariate logistic regression.ResultsOverall, 87 patients (35.2%) were upgraded, 20 (8.1%) were downgraded, and 140 (56.7%) had identical biopsy and pathological Gleason sum groups. Smaller TRUS volume was significantly associated with increased likelihood of upgrading (p trend=0.022). Men with prostates 25 cm3 or less had more than 2.7 times the risk of disease being upgraded relative to men with TRUS volumes more than 40 cm3 (OR 2.718, 95% CI 1.403-8.126).ConclusionIn our study, smaller prostate volumes were at increased risk for GS upgrading after RP. This finding should be kept in mind when making treatment decisions for men with prostate cancer that appears to be of a low grade on biopsy, especially in Asian urologic fields.

Comparison of 80 W versus 120 W 532 nm Laser Prostatectomy for BPH

Purpose: Improvements to photoselective vaporization of the prostate (PVP) have been made over time, particularly with the introduction of higher power systems. Few studies however have compared the performance of these systems to their predecessors. The purpose of this study was to compare the clinical and perioperative outcomes of 80 W vs. 120 W PVP. Materials and Methods: A series of 267 and 209 consecutive patients underwent 80 W and 120 W PVP, respectively, from September 2001 to May 2009 at Weill Cornell Medical College (GreenLightTM laser system, American Medical Systems, Inc., Minnetonka, MN). Data were collected on patient demographics, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), and perioperative parameters. Maximum flow rate (Qmax), postvoid residual (PVR), and transrectal ultrasound prostate volume were recorded. Statistical analyses were carried out utilizing the Shapiro-Wilk, Mann-Whitney, Wilcoxon and unpaired t tests (SPSS 15.0, SPSS Inc., Chicago, IL, USA). Results: Baseline parameters were similar between the two groups except for greater median age (72.8 vs. 69.2 years, p = 0.01) and lower median PSA (2.0 vs. 3.3, p = 0.01) in the 80 W group. Median laser time was longer in the 80W group (85 vs. 51 minutes, p 0.001) with a higher median energy utilized (253 vs. 210 kJ, p = 0.001). Final IPSS, Qmax, PVR, and PSA were equivalent between the two groups. Conclusions: In our series, PVP was safe and effective. Durable and similar improvements in symptoms and objective parameters were achieved in patients with both 80 W and 120 W laser systems. PVP with the 120 W system, however, provided faster and more efficient vaporization compared to the 80 W system.

Comparison of 80 W versus 120 W 532 nm Laser Prostatectomy for BPH

Purpose: Improvements to photoselective vaporization of the prostate (PVP) have been made over time, particularly with the introduction of higher power systems. Few studies however have compared the performance of these systems to their predecessors. The purpose of this study was to compare the clinical and perioperative outcomes of 80 W vs. 120 W PVP. Materials and Methods: A series of 267 and 209 consecutive patients underwent 80 W and 120 W PVP, respectively, from September 2001 to May 2009 at Weill Cornell Medical College (GreenLightTM laser system, American Medical Systems, Inc., Minnetonka, MN). Data were collected on patient demographics, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), and perioperative parameters. Maximum flow rate (Qmax), postvoid residual (PVR), and transrectal ultrasound prostate volume were recorded. Statistical analyses were carried out utilizing the Shapiro-Wilk, Mann-Whitney, Wilcoxon and unpaired t tests (SPSS 15.0, SPSS Inc., Chicago, IL, USA). Results: Baseline parameters were similar between the two groups except for greater median age (72.8 vs. 69.2 years, p = 0.01) and lower median PSA (2.0 vs. 3.3, p = 0.01) in the 80 W group. Median laser time was longer in the 80W group (85 vs. 51 minutes, p 0.001) with a higher median energy utilized (253 vs. 210 kJ, p = 0.001). Final IPSS, Qmax, PVR, and PSA were equivalent between the two groups. Conclusions: In our series, PVP was safe and effective. Durable and similar improvements in symptoms and objective parameters were achieved in patients with both 80 W and 120 W laser systems. PVP with the 120 W system, however, provided faster and more efficient vaporization compared to the 80 W system.

Dichotomous Estimation of Prostate Volume: A Diagnostic Study of the Accuracy of the Digital Rectal Examination

PurposeTo assess the diagnostic reliability of a dichotomous digital rectal examination (DRE) tool in assessing prostate volume (PV) compared to gold-standard transrectal ultrasound (TRUS) volume measurement.Materials and MethodsMale patients presenting to a single tertiary referral centre urology practice requiring TRUS were prospectively recruited between January 2010 and August 2011. Size was estimated by DRE immediately prior to TRUS measurement. DRE measurements were classed into four groups: <30 mL , 30 to 49 mL, 50 to 99 mL and >100 mL. The primary outcomes were sensitivity, specificity, and the positive and negative likelihood ratios for a 30 mL cut-off.ResultsThree hundred and three patients were recruited to the study. The median age of the study group was 64.9 years. On TRUS analysis, 244 patients had a PV larger than 30 mL and 139 of them, larger than 50 mL. The median PV was 47 mL with a median International Prostate Symptom Score of 10 and prostatic specific antigen (PSA) of 5.7. When analysed for the ability to identify a gland larger than 30 mL, DRE had a high sensitivity and low negative likelihood ratio. The median PSA level (ng/L) for prostates measured by DRE with a 30 mL cut-off was significantly different with higher median PSA values for volumes larger than 30 mL.ConclusionsDRE is a reliable tool for dichotomous assessment of prostatic volumes above 30 mL and 50 mL. These results illustrate the value of re-examining the role of categorical DRE estimations in benign prostatic hyperplasia patients.

Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia

Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures. From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations. After receiving institutional review board approval we retrospectively reviewed the database. Reported short-term, intermediate term and long-term results are 0 to 6, 6 to 12 and greater than 12 months, respectively. Bladder stones were present in 50 patients (4.7%) and 87 of the 717 (12.1%) with laboratory studies available had renal insufficiency. Preoperative urinary retention was present in 411 cases (38.7%). Significant preoperative stress and urge incontinence was noted in 8 and 16 patients, respectively. Mean transrectal ultrasound prostate volume was 99.3 gm (range 9 to 391). Mean preoperative American Urological Association symptom score was 20.3 (range 1 to 35) and maximum urinary flow was 8.4 cc per second (range 1.1 to 39.3). Intraoperative or postoperative complications occurred in 24 cases (2.3%). Mean followup was 287 days (range 6 to 3,571). At short-term, intermediate term and long-term followup the mean symptom score was 8.7, 5.9 and 5.3, and maximum urinary flow was 17.9, 19.5 and 22.7 cc per second, respectively. At the most recent followup 3 patients (0.3%) were in urinary retention. One patient with maximum urinary flow 20 cc per second required a second procedure for bleeding prostatic regrowth. Urethral stricture was noted in 9 (0.9%), 11 (1.3%), 4 (1.3%) and 0 patients, and bladder neck contracture was found in 0, 7 (0.8%), 4 (1.3%) and 5 (6.0%) at short-term, intermediate term, long-term and greater than 5-year followup, respectively. At the most recent followup significant stress and urge incontinence was noted in 9 and 6 patients, respectively. Holmium laser prostate enucleation is safe and effective for benign prostatic hyperplasia. The complication rate is low, and incontinence and the need for ancillary procedures are rare for holmium laser prostate enucleation with durable long-term results.