Transurethral Vaporization Research Articles

Transurethral Vaporization of Bladder Neck Using Holmium Laser: First Experience in Manado

Abstract: Bladder neck contracture (BNC) is a potential complication after radical prostatectomy (RP). This may be a result of inadequate approximation at the time of surgery, urinary extravasation, or distraction of the bladder neck from a hematoma. Patients commonly complains of a poor urinary stream or prolonged unexplained incontinence. Treatment of BNC requires a tailored approach and can range from simple, office-based procedures to complex surgical reconstruction. We reported a case of 81-year-old male complaining urine retention for one month. The patient had previous open prostate procedure a year prior. On examination, neurogenic causes were excluded. Retrograde ureterocystography revealed bladder neck contracture. Patient was diagnosed as bladder neck contracture post open prostatectomy surgery. Transurethral holmium laser vaporization with 800 micrometre, 20 Hz frequency and 4,5 Joule of power. through a ureteroscope was performed. Two-way Folley catheter 18Fr was inserted without irrigation. Patient was discharged post-surgery two days after catheter removal and spontaneous micturition. Endoscopic balloon dilatation with incision appears to offers promising result in the management of BNC. The consideration of using transurethral vaporization with holmium laser modality was the first procedure ever done in Manado. In conclusion, TUVP is one of the alternatives, minimally invasive procedures to treat BNC. The use of holmium laser for the incision of bladder neck is another alternative to treat BNC with great outome proven by the length of stay (LOS) of two days after the procedure was done. Keywords: bladder neck contracture; transurethral vaporization; holmium laser; post prostatectomy

Therapeutic efficacy of the combination of two surgical procedures with tamsulosin in treatment of benign prostatic hyperplasia complicated with bladder stones

Purpose: To compare the efficacies of two surgical methods combined with tamsulosin in treating benign prostatic hyperplasia (BPH) complicated with bladder stones.
 Methods: A total of 86 patients with BPH complicated with bladder stones and admitted to The People’s Hospital of Dingzhou, Hebei, from October 2021 to October 2022 were selected as subjects. The patients were equally divided into groups A and B (n = 43). Patients in group A were treated with transurethral vaporization and electro-resection of the prostate (TURP) + percutaneous nephroscopic lithotripsy (PCNL), while patients in group B were treated with TURP + holmium laser lithotripsy (HLL). Baseline clinical information, curative effect, surgery-related indicators, clinical symptoms, and recurrence were compared between the two groups of patients.
 Results: At 4 weeks post-surgery, Qmax was significantly higher in group B than in group A, while IPSS score, RUV, and prostate volume were significantly lower in group B than in group A (p ˂ 0.05). The levels of physiological state, psychological state, social functionality and level of subjective judgment were higher in group B than in group A (p ˂ 0.05). The incidence of complications in group A was 11.63 %, with a recurrence rate of 6.98 %, while the corresponding values for group B were 13.95 and 4.65 %, respectively (p > 0.05).
 Conclusion: The effect of TURP + HLL surgery on patients with BPH complicated with bladder stones is significantly better than that of TURP + PCNL surgery. The former also reduces clinical symptoms while improving the quality of life of patients.

OUTCOMES ANALYSIS OF TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) AND TRANSURETHRAL VAPORIZATION OF THE PROSTATE (TUVP) IN PATIENT WITH BENIGN PROSTATE HYPERPLASIA: SYSTEMATIC REVIEW

Objective: This systematic review aims to compare IPSS score and Uroflowmetry (Qmax) results between Transurethral Resection of The Prostate (monopolar and bipolar TURP) and Transurethral Vaporization of The Prostate (PVP, ThuVARP, Biolitec, TUEVP, BPV). Material & Methods: Articles were obtained through online searches using Medline, Google Scholar, and Cochrane Library using keywords Transurethral Resection of The Prostate (TURP) dan Transurethral Vaporization of The Prostate (TUVP) and IPSS or Qmax. Results: A total of 6 RCTs and 3 Cohort consisted of 1212 BPH patients treated with TURP (B-TURP and B-TURP) or TUVP (TUVP, BPV, Biolitec, ThuVARP, GLVP(PVP)). There is a significant difference result of IPSS score and Qmax at the third month of follow-up after both therapies. Conclusion: The post-operative IPSS score and Qmax results at the third month of follow-up in BPH patients treated with TURP or TUVP presents varied results. TURP has a better post-operative IPSS score compared to Biolitec Laser, but not superior when compared with TUEVP, BPV, ThuVARP, and PVP. Notably, TURP has better post-operative Qmax results than BPV, TUEVP, and ThuVARP, but not when compared with PVP.

Comparison of the short-term efficacy and safety of bipolar transurethral electro vaporization and holmium laser enucleation of the prostate for moderate and large benign prostatic enlargement

BackgroundTo compare the efficacy and safety of bipolar transurethral vaporization of the prostate (B-TUVP) with holmium laser enucleation of the prostate (HoLEP) for moderate [prostate volume (PV) 30–80 ml] and large (≥ 80 ml) benign prostatic enlargement (BPE).Materials and methodsMale patients with lower urinary tract symptom (LUTS) or urinary retention who underwent B-TUVP or HoLEP treatment in two regional centers were respectively enrolled. Patient characteristics and treatment outcomes were retrospectively compared between B-TUVP and HoLEP.ResultsIn patients with moderate and large prostate volume,B-TUVP showed shorter operative time (P < 0.001) and less hemoglobin decrease (P < 0.001) than in HoLEP. In uncatheterised patients, voiding symptoms and patients’ quality of life improved after B-TUVP and HoLEP, but these improvement rates were consistently bigger in HoLEP than in B-TUVP. In catheterised patients, the rate of achieving catheter-free status after surgery was higher in HoLEP than in B-TUVP for patients with PV > 80 ml.(P < 0.001) The incidence of postoperative fever was higher in B-TUVP than in HoLEP for patients with PV 30–80 ml (P < 0.001) but not for those with PV > 80 ml.(P=0.08) The Incidence of postoperative stress incontinence(SUI) was higher in HoLEP than in B-TUVP for patients with moderate and large prostate volume.ConclusionsThere are few studies that investigated the short-term efficacy and safety of second-generation B-TUVP in comparison with HoLEP for moderate and large BPE. Improvement in LUTS and achievement of catheter-free status were predominant in HoLEP, and these outcomes were more prominent in patients with large BPE of PV > 80 ml. However, B-TUVP resulted in less blood loss, shorter operative duration, and less SUI suggesting that B-TUVP is also well-tolerated surgical modality.

Comparison of PKRP and TUVP in the treatment of high-risk BPH and analysis of postoperative influencing factors.

ObjectiveThis study aims to compare the efficacy of plasma kinetic loop resection of the prostate (PKRP) and transurethral vaporization of the prostate (TUVP) for the treatment of high-risk benign prostatic hyperplasia (BPH), and analyze the influence of the related factors on the operation of BPH.MethodsA total of 108 high-risk BPH patients diagnosed in our hospital from March 2018 to September 2021 were selected and randomly divided into an observation group and a control group, with 54 cases in each group. The control group was treated with TUVP, and the observation group was treated with PKRP. The international prostate symptom score (IPSS), quality of life (QOL) index, maximum urine flow rate (Qmax), and residual urine volume (RU) were observed before and after treatment. The general information such as age, educational level, residence, and residence status of the patient, as well as clinical information such as surgical method, nocturia frequency, preoperative IPSS score, RU, medical history, and prostate texture, were also recorded. All patients were followed up for 1 month, and complications were recorded.ResultsThe IPSS score, QOL score, and RU of patients in the two groups were lower after treatment than those before treatment, and the Qmax was higher than that before treatment (P < 0.05). The IPSS score, QOL score, and RU of the observation group were lower than those of the control group, and the Qmax was higher than that of the control group (P < 0.05). The incidence of postoperative complications in the observation group was lower than in the control group (P < 0.05). Univariate analysis showed that the patient's age, surgical method, nocturia frequency, preoperative IPSS score, RU, medical history, and prostatic texture all could affect the postoperative condition of patients with BPH (P < 0.05). Multivariate logistic analysis showed that the patient's age, surgical method, nocturia frequency, preoperative IPSS score, RU, and medical history were the independent influencing factors of the postoperative condition of patients with BPH (P < 0.05).ConclusionPKRP in the treatment of high-risk BPH patients can effectively reduce the IPSS score, QOL score, and RU and significantly increase Qmax, with fewer complications and a good prognosis. Patients’ postoperative recovery was related to their age, surgical method, nocturia frequency, preoperative IPSS score, RU, and medical history. Therefore, choosing PKRP to treat high-risk BPH patients can effectively improve the postoperative urethral functional recovery of patients and reduce the occurrence of complications.

An Evaluation of the Immunohistochemical Expression of Mismatch Repair Proteins (MSH2, MSH6, MLH1, and PMS2) in Prostate Adenocarcinoma.

Background and objectiveMismatch repair (MMR) proteins are an integral part of the cell cycle, and they play an important role in the genomic stability of the microsatellite complex. Microsatellite instability (MSI) is associated with Lynch and multi-tumor syndromes. Identifying patients with Lynch syndrome is essential for screening, early detection, and surveillance of other Lynch syndrome-associated tumors. The role of MMR deficiency is well known in colorectal and endometrial adenocarcinoma. However, the role of MMR deficiency in prostatic adenocarcinoma is a matter of controversy. A few studies have been published to analyze the association between MMR deficiency and prostatic adenocarcinoma. In this study, we used immunohistochemistry to look into the expression of four MMR proteins in prostatic adenocarcinoma: MSH2, MSH6, MLH1, and PMS2.MethodologyThis was a cross-sectional descriptive study involving 74 cases of acinar prostatic adenocarcinoma, diagnosed with hematoxylin & eosin (H&E), over a period of six months between December 2021 and May 2022 at the Chughtai Institute of Pathology in Lahore, Pakistan. We performed the immunohistochemical (IHC) analysis and interpretation of four antibodies, i.e., MSH2, MSH6, MLH1, and PMS2.ResultsIn our study, the age of the patients ranged from 50 to 98 years, with a mean age of 67.99 ± 9.59 years. The specimens were collected through transurethral resection of the prostate (TURP), transurethral vaporization of the prostate (TVP), core biopsy, and radical prostatectomy. Isolated loss of each MSH2 and PMS2 was noted in nine cases (12.20%) and MSH6 in two cases (2.70%). There was no loss noted for MLH1. Furthermore, simultaneous loss of MSH2/MSH6 was observed in one case (1.35%).ConclusionOur study findings revealed a low frequency of IHC expression of MMR proteins, especially the concurrent loss of paired MMR proteins. However, prostatic adenocarcinoma is associated with the isolated loss of MMR proteins. Thus, the present study does not warrant reflex testing/screening in every case of prostatic adenocarcinoma, because of its low frequency, which is probably suggestive of its sporadic pattern.

Cluster Analysis Assessment in Proposing a Surgical Technique for Benign Prostatic Enlargement.

Benign prostatic enlargement (BPE) is a common disease in men over 50 years old. The phenotype of patients with BPE is heterogenous, regarding both baseline patient characteristics and disease-related parameters. Treatment can be either medical-conservative or surgical. A great variety of surgical techniques are available for surgical management, with three of the most common being monopolar transurethral resection of the prostate (mTUR-P), bipolar transurethral resection of the prostate (bTUR-P), and bipolar transurethral vaporization of the prostate (bTUVis). The selection of each one of these depends on surgeon reasoning, equipment availability, patient characteristics, and preferences. Since all of these techniques are available in our Urology Department, and surgeons are skilled to perform each one of them, we performed a clustering analysis according to patient pre-operative characteristics, using the k-means algorithm, to compare clustering-related technique assignment with the real-life technique used.

Retrospective analysis of second-generation bipolar transurethral vaporization of the prostate in older patients aged [formula omitted]80 years with benign prostate enlargement

Background:To investigate the treatment outcomes and postoperative complications of second-generation bipolar transurethral vaporization of the prostate (B-TUVP) using an oval-shaped electrode in older patients aged ≥80 years with benign prostatic enlargement (BPE). Materials and Methods:Second-generation B-TUVP was performed in male patients with lower urinary tract symptoms (LUTS) or urinary retention between July 2018 and August 2021. Patient characteristics and surgical outcomes were retrospectively compared between patients aged <80 and ≥80 years. Results:A total of 178 patients with BPE who underwent B-TUVP at Yokosuka Kyosai Hospital were enrolled in this study with six months follow-up. For catheterized patients, improvement in uroflowmetric outcomes and patient reported outcomes (PROs) were almost equivalent between those <80 and ≥80 years of age. Achievement of a catheter-free status after B-TUVP was higher in patients aged <80 years (87.2%) than those aged ≥80 years (69.2%); however, there was no statistical significance (P= 0.061). Postoperative prolonged hematuria and fever were significantly more frequent in patients aged ≥80 years than in those <80 years. Age (≥80 years) and operative duration (≥100 min) were independent and significant predictors of postoperative complications of B-TUVP. Conclusion:This study is the first to demonstrate that B-TUVP showed almost equivalent uroflowmetric outcomes and PROs in patients aged <80 and ≥80 years with BPE. Age of ≥80 years was associated with higher postoperative complications after B-TUVP, which suggests that B-TUVP should be performed within 100 min to minimize postoperative complications, such as prolonged hematuria and fever.

A0315 - Transurethral Vapor Ablation (TUVA) of intermediate risk localized Prostate Cancer (PCa)

A0315 - Transurethral Vapor Ablation (TUVA) of intermediate risk localized Prostate Cancer (PCa)

Surgical treatment options for benign prostatic obstruction: beyond prostate volume.

Many surgical treatment options are available for patients who present with benign prostatic obstruction (BPO). This article reviews the current treatment options available and distinguishes them based on five clinical considerations: antithrombotic therapy, sexual function preservation, ambulatory procedures, anesthesia-related risks and duration of catheterization. A comprehensive review of the literature was performed on 10 BPO procedures. Laser enucleation of the prostate (LEP), bipolar plasma transurethral vaporization of the prostate and photoselective vaporization (PVP) of the prostate reduces the risk of bleeding, which is recommended for anticoagulated men. Ejaculatory function is more likely to be preserved following transurethral incision of the prostate, Rezūm, Aquablation, UroLift and iTind. Same-day discharge is possible for LEP, PVP and prostatic arterial embolization (PAE). For patients with high anesthesia-related risks, procedures compatible with local anesthesia (UroLift, Rezūm, iTind and PAE) should be favored. Catheterization duration is shorter with UroLift, PVP and LEP. BPO treatment options are growing rapidly. The optimal procedure for a given patient is based on factors such as associated risks, recovery and expected outcomes. Besides prostate volume, the clinical considerations in the present article can help elucidate the best surgical BPO treatment option for each patient based on their values, preferences, and risk tolerance.

Short-term efficacy and safety of second generation bipolar transurethral vaporization of the prostate (B-TUVP) for large benign prostate enlargement: Results from a retrospective feasibility study.

BackgroundTo investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml.Materials and methods100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients’ characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml.Results17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients’ QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed.ConclusionsThis is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE.

V14-03 TRANSURETHRAL WATER VAPOR ABLATION (STEAM) TO TREAT LOCALIZED PROSTATE CANCER (INVESTIGATIONAL USE ONLY)

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-03 TRANSURETHRAL WATER VAPOR ABLATION (STEAM) TO TREAT LOCALIZED PROSTATE CANCER (INVESTIGATIONAL USE ONLY) Christopher Dixon, and Christopher Warlick Christopher DixonChristopher Dixon More articles by this author , and Christopher WarlickChristopher Warlick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Convective water vapor is a unique technology that uses the thermal energy of water vapor (steam) to ablate tissue. The objective was in vivo validation of Transurethral Vapor Ablation (TUVA) in men with clinically significant localized prostate cancer by; Group 1 - TUVA/RRP assessed by immediate whole mount sectioning, Group 2 - TUVA assessed by pre/post treatment MRI in an early feasibility trial and Both Groups by intraoperative real-time ultrasound and AE assessment. METHODS: A tabletop generator and a transurethral endoscopic delivery device, along with real-time TRUS, were used to direct water vapor into any anatomic zone of the prostate to ablate malignant prostate tissue. The procedure technique currently used, including the endoscopic and real-time ultrasound monitoring of needle deployment, advancement and vapor delivery is demonstrated. To evaluate the convective principles of TUVA, real-time ultrasound patterns of vapor delivery and 7-day post treatment gadolinium MRI images were studied. Ablation effectiveness was assessed in two independent groups. In Group 1 by whole mount sectioning immediately following TUVA / radical prostatectomy. In Group 2 by assessing pre- and 7-day post TUVA MRI nonenhancement patterns as well as PIRADSv2 resolution. Immediate safety was assessed by intraoperative inspection, gross examination of the prostate (Group 1) and immediate post op adverse events along with 7-day MRI’s (Group 2). RESULTS: Real-time ultrasound vapor patterns confirmed convective spread within the zonal anatomy and boundaries of the prostate. Real-time ultrasound during treatment demonstrated the convective principles and the ability to “see” the treatment. Collectively, whole mount sectioning along with the non-enhancing areas seen on MRI’s at 7-days demonstrated ablation to ALL anatomic zones and boundaries consistent with the unique ablation capabilities of convection. In Group 2, after one treatment session, 14/17 PIRADSv2 lesions ≥3 were no longer visible within the ablation zone on 7-day MRI. There were no serious adverse events intraoperatively or within one week of the treatment. CONCLUSIONS: Transurethral delivery of water vapor thermal energy can effectively ablate any zone of the prostate from apex to base, anterior to posterior, and laterally to the prostatic “capsule”. Early feasibility data using this investigational device are favorable. Source of Funding: Francis Medical, Maple Grove, MN © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1165-e1166 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Dixon More articles by this author Christopher Warlick More articles by this author Expand All Advertisement Loading ...

Surgical treatment of benign prostatic obstruction (BPO) in patients under anticoagulation: areview of the bleeding risks of established techniques

HintergrundBei einer alternden Gesellschaft ist mit einer Zunahme der therapiebedürftigen benignen Prostataobstruktion (BPO) zu rechnen, auch der Anteil an Patienten mit kardiovaskulären Komorbiditäten unter Antikoagulation steigt an. Hier kann die operative Therapie der BPO problematisch sein. Die blutstillende Wirkung der Techniken ist von besonderer Bedeutung.FragestellungDie folgende Übersichtsarbeit diskutiert die Datenlage zum Blutungsrisiko etablierter operativer Techniken und die Stellungnahme der EAU-Leitlinie „EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract symptoms (LUTS) incl. Benign Prostatic Obstruction (BPO)“ zu diesem Thema.Material und MethodenEs wurde eine Datenanalyse aus PubMed erstellt.ErgebnisseDie EAU-Leitlinie gibt der transurethralen Vaporisation der Prostata mittels Greenlight‑, Thulium- oder Diodenlaser und der Enukleation mittels Holmium- oder Thuliumlaser bei diesem Patientengut den Vorzug. Die bipolare ist der monopolaren transurethralen Resektion der Prostata (TURP) bei der Blutstillung überlegen. Die bipolare Enukleation der Prostata (BipoLEP) kann bei guter Hämostase zukünftig eine Alternative darstellen. Neuere minimal-invasive Techniken wie Urolift® (NeoTract, Pleasanton, USA), I‑TIND© (MediTate, Or-Akiva, Israel) und Rezūm™ (Boston Scientific, Boston, USA) zeigen ein geringes Blutungsrisiko, dies gilt auch für die Prostataarterienembolisation. Nicht geeignet erscheint die Aquaablation/AquaBeam® bei häufigen Nachblutungen. Die chirurgische Adenomektomie kann mit hoher Blutungsgefahr verbunden sein.SchlussfolgerungTransurethrale Laservaporisation und -enukleation der Prostata sind die Therapie der Wahl beim antikoagulierten Patienten, jedoch haben auch andere transurethrale Techniken, wie die BipoLEP, ein akzeptables Blutungsrisiko und können je nach lokalen Ressourcen eine Alternative darstellen. Neuere minimal-invasive Ansätze können zukünftig mehr an Bedeutung gewinnen.

Relevance of intravesical pressures during transurethral procedures

Endourology has undergone fundamental changes over the last 2decades. Maintaining low intrarenal pressure (IRP) during upper urinary tract procedures is an established concept. However, researchers have not yet studied the concept of reduced intravesical pressures (IVPs) during transurethral (TUR) surgery as thoroughly. Low IVP is supposed to decrease complications as fluid retention, TUR syndrome, and incidence of fever. The study aims to give an overview of the contemporarily existing concepts and specify the term of low IVP to avoid TUR-related complications and optimize TUR-related results. A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were transurethral resection, transurethral enucleation, transurethral vaporization, pressure, fluid absorption, and TUR syndrome. Analyzed mean IVPs during TUR vary between 11 and 35 cmH2O but are mostly kept below 30 cmH2O. Mean maximum IVPs during TUR range from 20 to 55 cmH2O. Maximum IVPs seem to be lower when surgeons utilize continuous flow resection, and irrigation pressures are kept low. The results demonstrate a strong correlation between IVP levels and fluid absorption. IVP increase remains a neglected predictor of transurethral procedure complications, and endourologists should consider its intraoperative monitoring. Further research is necessary to quantify generated pressures and introduce means of controlling them.

Ejaculatory Hood-Sparing Vaporization of the Prostate and Its Impact on Erectile, Ejaculatory, and Sexual Function

To assess the impact of ejaculatory hood (EH)-sparing transurethral vaporization of the prostate (TUVP) on sexual function, with a specific focus on erectile and ejaculatory function. We studied 25 patients who underwent EH-sparing Photo Selective Vaporization of the Prostate using the Greenlight Laser or Bipolar Button Plasma Vaporization of the Prostate from August 2016 to March 2018. All patients were sexually active with anterograde ejaculation prior to treatment. Patients completed the Male Sexual Health Questionnaire (MSHQ) and AUA Symptom Score pre- and postoperatively. We compared preprocedure sexual function with postprocedure sexual function at 1- and 3-month intervals. A logistic regression model was used to identify predictors of improvement in sexual function. Twenty-five patients underwent EH-sparing TUVP from August 2016 to March 2018. At 3-months postoperatively, patients had significant improvement in erection score (12 vs 9, P=.04) and erection bother score (5 vs 3.5, P <.01) compared to baseline. They also had improvement in ejaculation score (26 vs 23, P=.03), ejaculation bother score (5 vs 4, P=.01), and total MSHQ score (87.5 vs 73, P=.01). Anterograde ejaculation was preserved in 80.0% of patients. Logistic regression identified higher AUA score severity as an independent predictor of MSHQ score improvement (1.32, CI: 1.03-1.69, P=.03). At 3 months postoperatively, the majority of men who underwent EH-sparing TUVP had preserved anterograde ejaculation and improved overall sexual function based on MSHQ survey. This validates EH-sparing TUVP in men with BPH who wish to maintain sexual function.

Effect of Variation of Volume of Injected Water in the Air Sacs of Urinary Catheters on Bladder Spasm After Transurethral Plasmakentic Vaporization of Prostate

Objective We aim to explore variation of the injected water volume in the air sacs of indwelling urinary catheters on bladder spasm and blood urine in patients after transurethral plasmakentic vaporization of prostate (TUPKVP). Methods We included 90 patients who had benign prostatic hyperplasia and received transurethral plasmakentic vaporization of prostate in the First Affiliated Hospital of Jinan University from July 2018 to July 2019. They were averagely randomized into three groups: control group, experimental group A and experimental group B. We injected 30 ml of water into the air sacs of urinary catheters of patients postoperatively. At the first day after operation, the water was reduced to 20 ml in experimental group A, 10 ml in experimental group B, and the water volume in control group remained unchanged. The bladder spasm, blood urine and comfort level in three groups were analyzed comparatively. Results Nursing intervention of reducing injected water volume resulted in a lower incidence of bladder spasm in experimental group B than those in other two groups with 10% on the day of surgery, 3.3% at the second day postoperatively and no bladder spasm at the third day after operation. There was a significant difference in the incidence of bladder spasm between the three groups (χ²=19.449, P=0.000; χ²=6.469, P=0.040; χ²=8.314, P=0.013). Blood urine was milder in experimental group B than that in other two groups at the third day postoperatively with significant difference (χ²=6.796, P=0.037). Patients in experimental group B felt more comfortable than those in other two groups with a rate of comfort up to 70%. There was a significant difference in it between three groups (χ²=9.600, P=0.008). Conclusions For patients who underwent transurethral plasmakentic vaporization of prostate, when continuous bladder irrigation and analgesia are withdrawn, reduction of water volume in the air sacs of indwelling urinary catheters to 10ml can relieve the constriction of the bladder outlet and rubbing bladder mucosa and prostatic fossa and thus reduce the incidence of bladder spasm and blood urine and increase comfort level.

Explore: The Value of Prostatic Calculi in Prostate Surgery

Objective To explore the significance of prostatic calculi in prostate surgery. Methods During the beginning of 2010 to the end of 2017, a retrospective analysis was made of 821 cases of benign prostatic hyperplasia (BPH) with prostatic calculi admitted to our hospital. During 2010 to 2015, transurethral resection of the prostate (TURP) was performed. And then, from 2015 to 2017, it was replaced as transurethral laser vaporization of the prostate (TULVP). There were 5 converted to open. We should remove the prostate tissue til the surgical capsule by electrocision or vaporization. If annular fibrous tissue or prostatic calculi are encountered during the operation, the calculi will be exfoliated, and then stop operation. Results All the operations were successfully completed, with an average times of 47 minutes (22-117 minutes), bleeding of 50ml (15-350 ml), indwelling catheter for 5.7 days (3-10 days), and continuous bladder irrigation for 1.3 days (1-5 days). During the follow-up period of 0.4-5 years, the urination symptoms and quality of life of the post-operation patients were significantly improved. Conclusions Prostate calculi can be used as a marker of the depth of operation for BPH.

What's New in Bipolar TURP for Surgical Management of BPH?

Transurethral resection of the prostate (TURP) is still considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), but new methods like bipolar TURP became a real treatment alternative. Bipolar resection presents many option for the effective resection of the prostate: the most similar with m-TURP is represented by the loop resection, then transurethral vaporisation of the prostate (B-TUVP) which is derived from plasmakinetic B-TURP and the enucleation, which is among open prosta tectomy or holmium laser, the first choice of surgical treatment in men with a substantially enlarged prostate and moderate-to-severe LUTS. There was no statistical difference observed between M-TURP and B-TURP in the parameters of surgery time, catheterization time, PSA drop, peak flow improvement (Qmax), occurrence of urinary retention, and IPSS and quality of life (QoL) scores. On the other hand, B-TURP proved to be superior to M-TURP in relation to hospitalization time, blood transfusion rate, post-TURP syndrome, serum sodium rate and lower occurrence of urethral stenosis. when is about the cost of the procedure, a meta-analysis on 24 from the most relevant publications in the last 20 years, revealed that the TURis system demon strates equivalent efficacy versus MTURP, In conclusion, it could be observed nowadays that bipolar-TURP represents a viable alternative to M-TURP in patients with moderate to-severe LUTS secondary to BPO, with similar efficacy but lower peri-operative morbidity.

Single-dose versus 3-day cotrimoxazole prophylaxis in transurethral resection or greenlight laser vaporisation of the prostate: study protocol for a multicentre randomised placebo controlled non-inferiority trial (CITrUS trial)

BackgroundTransurethral resection of the prostate (TURP) and Greenlight laser vaporisation (GL) of the prostate are frequently performed urological procedures. For TURP, a single-dose antimicrobial prophylaxis (AP) is recommended to reduce postoperative urinary tract infections. So far, no international recommendations for AP have been established for GL. In a survey-based study in Switzerland, Germany and Austria, urologists reported routinely extending AP primarily for 3 days after both interventions. We therefore aim to determine whether single-dose AP with cotrimoxazole is non-inferior to 3-day AP with cotrimoxazole in patients undergoing TURP or GL of the prostate.Methods/designWe will conduct an investigator-initiated, multicentre, randomised controlled trial. We plan to assess the non-inferiority of single-dose AP compared to 3-day AP. The primary outcome is the occurrence of clinically diagnosed symptomatic urinary tract infections which are treated with antimicrobial agents within 30 days after randomisation. The vast majority of collected outcomes will be assessed from routinely collected data. The sample size was estimated to be able to show the non-inferiority of single-dose AP compared to 3-day AP with at least 80% power (1 – β = 0.8) at a significance level of α = 5%, applying a 1:1 randomisation scheme. The non-inferiority margin was determined in order to preserve 70% of the effect of usual care on the primary outcome. For an assumed event rate of 9% in both treatment arms, this resulted in a non-inferiority margin of 4.4% (i.e. 13.4% to 9%). To prove non-inferiority, a total of 1574 patients should be recruited, in order to have 1416 evaluable patients. The study is supported by the Swiss National Science Foundation.DiscussionFor AP in TURP and GL, there is a large gap between usual clinical practice and evidence-based guidelines. If single-dose AP proves non-inferior to prolonged AP, our study findings may help to reduce the duration of AP in daily routine—potentially reducing the risk of emerging resistance and complications related to AP.Trial registrationClinicaltrials.gov, NCT03633643. Registered 16 August 2018.

Safety and efficacy of transurethral vaporization of the prostate using plasma kinetic energy: Long-term outcome.

Objective:The objective of this study was to assess the long-term efficacy and safety of plasma kinetic vaporization (PKVP) of the prostate for symptomatic benign prostatic hyperplasia.Patients and Methods:Twenty-one patients had been enrolled in this study at Al-Azhar University Hospitals to evaluate their long-term follow-up after PKVP. The outcome was evaluated using the International Prostate Symptom Score (IPSS), quality of life (QOL), peak urinary flow rate (Qmax), postvoiding residual (PVR) of urine, prostate volume, prostate-specific antigen (PSA) level, and long-term complications of the surgery.Results:Preoperatively, IPSS was 22.14 ± 2.22, QOL score was 4.90 ± 0.54, Qmax was 8.97 ± 2.49 ml/s, PVR was 138.5 ± 56.5 ml, prostate volume was 64.32 ± 11.16 ml, and PSA level was 4.18 ± 1.95 ng/ml. Two years’ post-PKVP, IPSS decreased to 8.57 ± 5.55, QOL score decreased to 1.90 ± 1.22, Qmax increased to 17.17 ± 7.91 ml/s, PVR decreased to 38.81 ± 59.54 ml, prostate volume decreased to 22.45 ± 7.22 ml, and PSA level decreased to 1.59 ± 0.74 ng/ml. One patient (4.8%) developed bulbar urethral stricture, 1 (4.8%) developed bladder neck contracture, and 1 (4.8%) developed meatal stenosis. Erectile dysfunction was reported by two out of 12 patients who were sexually potent before surgery, and retrograde ejaculation was reported by 10 patients (83%).Conclusion:The present study has demonstrated satisfactory good efficacy and safety of PKVP on the long term.