Uroflowmetry Research Articles

The clinical study of urinary flow parameters after drag-and-bond anastomosis for ileal orthotopic neobladder reconstruction.

To assess the viability of this procedure in laparoscopic radical cystectomy with ileal orthotopic neobladder reconstruction, the objective of this study is to examine the relationship between urinary flow parameters of urethral drag-and-bond anastomosis in the reconstruction of the ileal orthotopic neobladder. 36 patients with bladder cancer underwent laparoscopic radical cystectomy with ileal orthotopic neobladder reconstruction at Jiangxi provincial people's hospital between June 2016 and January 2021,16 patients underwent intermittent urethral anastomosis, while 20 patients underwent neobladder-urethral drag-and-bond anastomosis. The maximum bladder capacity, residual urine output, maximum urinary flow rate, and outlet morphology of the new bladder neck were all monitored throughout postoperative follow-up regularly. There was no significant difference between the urethral drag-and-bond anastomosis group (group A) and the conventional anastomosis group (group B) at 3months and 12months after surgery, and the maximum bladder capacity (3months, 488.35 ± 51.56ml vs 481.06 ± 40.61ml, t = -0.462, P = 0.647; 12months, 496.35 ± 51.09ml vs 476.56 ± 56.33ml, t = -1.103, P = 0.278), residual urine output (3months, 44.15 ± 24.12ml vs 38.69 ± 21.82ml, t = -0.704, P = 0.486;12months, 49.65 ± 26.95ml vs 36.75 ± 21.96ml, t = -1.546, P = 0.131) and maximum urine flow rate (3months, 12.36 ± 2.63ml/s vs 13.60 ± 2.82ml/s, t = 1.361, P = 0.182;12months, 12.18 ± 3.14ml/s vs 11.13 ± 3.01ml/s, t = -1.004, P = 0.322) of the two groups were not significant (P > 0.05). The new bladder outlet morphology was not distorted in group A patients, the continuity was good, and there were fewer associated complications. There was no significant difference in postoperative urodynamic parameters between the urethral drag-and-bond anastomosis group and the conventional anastomosis group, and the postoperative new bladder outlet was in good shape, with clinical significance.

Comparison of maximum voided volume and maximum bladder capacity in voiding diary, uroflowmetry and cystometrography in children with non-neurogenic lower urinary tract dysfunction

BackgroundMaximum voided volumes (MVV) and maximum bladder capacities (MBC) are important parameters in the evaluation of lower urinary tract functions in children. However, consistency of MVV and MBC measurements between voiding diary (VD), uroflowmetry (UF) and cystometrography (CMG) in children with non-neurogenic lower urinary tract dysfunction (LUTD) has not been addressed specifically. ObjectiveWe aimed to compare the MVV in VD and UF and MBC in CMG in children with non-neurogenic LUT dysfunction and investigate for possible factors for discrepancies. Materials and MethodsChildren with non-neurogenic LUTD were retrospectively evaluated with a focus on VD, UF, and CMG. VD applied for 2 days and MVV recorded except for first urine in morning. UF repeated in children with < 50% of expected bladder capacity (EBC) for age. Highest value and post voiding residual urine (PVR) was recorded. CMG was performed if these conditions were present: High PVR or LUT dysfunction resistant to standard urotherapy (conservative management with biofeedback) and medical therapy (oral anticholinergics) or LUT dysfunction accompanied by VUR or recurrent UTI. MBC in CMG was recorded according to International Children Continence Society (ICCS) standards. MVV and MBC in VD, UF, CMG were compared and possible factors for discrepancy were investigated. Results54 children (median age: 10 (4-17) years) were included in the study. 39 (72.2%) were girls, 15 (27.8%) were boys. Median MVV was 232.50 (20-600) ml in VD, 257.50 (69-683) ml in UF and MBC was 184 (31-666) ml in CMG (p= 0.012) (Summary Table). In the subgroup analysis, it was shown that the bladder capacities obtained from all three tests were not compatible with each other in children younger than 10 years of age, in girls, in those with recurrent urinary tract infection, detrusor overactivity, high PVR and normal flow pattern (p=0.003, p=0.016, p=0.029, p<0.001, p=0.045, p=0.03, respectively). DiscussionThere is a discrepancy between bladder capacities obtained from VD, UF and CMG In children with non-neurogenic LUT dysfunction. In particular, the lower capacity obtained from invasive urodynamic tests may be related to the poor compliance of children during the procedure. Therefore, when invasive urodynamics is required in these cases, we recommend that maximum cystometric capacity to be evaluated by comparing with voided volumes at UF, VD and other clinical signs and symptoms, and urodynamic parameters in more detail. ConclusionMVV in VD and UF are comparable, but MBC in CMG is lower in children with non-neurogenic LUTD selected for invasive urodynamic studies. More attention should be paid to bladder capacity obtained from urodynamic studies in children exhibiting the characteristics identified in the subgroup analysis. We believe that evaluating bladder capacity values, especially obtained from invasive studies, in conjunction with clinical findings can prevent misdiagnosis, over investigation and overtreatment in children with non-neurogenic LUTD.

Predicting the risk of failed trial without catheter following Rezum™ therapy.

Convective water vapor thermal therapy or "Rezum™" treatment for lower urinary tract symptoms in men with benign prostate hypertrophy require postoperative catheterization to avoid acute urinary retention. Unsuccessful catheter removal is still unpredictable. We, therefore, aimed to identify the risk factors of failed initial trial without catheter (TWOC) after Rezum™ therapy inside a large cohort of patients. A retrospective study was conducted on patients who underwent Rezum™ therapy by three referent urologists across two academic hospitals between January 2022 and January 2023. A Foley catheter was systematically placed after therapy for 7days in all patients before TWOC. Patients characteristics [age, imagery, maximum urinary flow rate (Qmax), postvoid residual (PVR)], and treatment outcomes (International Prostate Symptom Score (IPSS), quality of life (QoL), adverse events) were analyzed at baseline and 3months from procedure. Failed initial TWOC was defined as the incapacity to pass urine or measured PVR > 300mL. After univariate selection, the risk factors for TWOC failure were identified using multivariate logistic regression analysis. 216 patients qualified for analysis with 23 (10.6%) failing the first TWOC after 7days of catheterization. After multivariate logistic regression, only preoperative PVR predicted TWOC failure (OR 1.01; p = 0.007). The cut-off of preoperative PVR increasing this risk was 120mL (p = 0, 02). Over 10% of men undergoing Rezum™ therapy for LUTS/BPH will experience TWOC failure and AUR after 7days of catheterization. Preoperative PVR seems to be the only independent risk factor of unsuccessful catheter removal.

Comparative Study of the Outcome of Buccal Mucosa Graft Urethroplasty and Preputial Flap Urethroplasty for Anterior Urethral Stricture: A Prospective Randomized Study.

Urethroplasty using a buccal mucosa graft (BMG) and a preputial skin flap (PSF) are two common techniques used for the treatment of anterior urethral stricture. The present study compared the efficacy of these two techniques on the basis of success rate, preservation of sexual function, and complications. This prospective, randomized, interventional study was conducted on adult male patients diagnosed with non-obliterative anterior urethral strictures of length >2 cm from August 2021 to December 2022. Pre-operative and post-operative work-up done included assessment of the International Prostate Symptom Score (IPSS), Quality of Life (QOL), International Index of Erectile Function (IIEF) Score, Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EJD), Bother score, Urethral Stricture Surgery-Patient-Related Outcome Measure (USS-PROM), and peak urinary flow rate (Qmax) for each patient. Post-operative values for each score were compared with pre-operative values. Out of 31 patients, 16 underwent BMG urethroplasty, and 15 underwent PSF urethroplasty. The most common cause of stricture in both groups was idiopathic (35.5% and 53.3%). A statistically significant increase in IIEF score was observed in the BMG group in comparison to the PSF group (P<0.0001). The mean IPPS score in USS-PROM has shown a significant drop in BMG (19.6 vs. 17.3; P = 0.020). Hemoglobin drop was significantly higher in PSF than in BMG (2.6 vs. 1.9; P = 0.011). A higher incidence of surgical site infection was reported in the PSF group than in the BMG group (46.7% vs. 12.5%). The average operative time for surgery was higher in PSF than in BMG (154.8 min vs. 145.0 min), respectively. Each group had one patient with a recurrence. Both techniques are equally good for urethral reconstruction (UR); however, improvement of sexual function is more in favor of the BMG urethroplasty group.

The efficacy and safety of prostatic urethral lift as a minimally invasive therapeutic modality to treat lower urinary tract symptoms while maintaining sexual function in patients with benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials.

Benign prostatic hyperplasia (BPH) is prevalent among elderly men, necessitating focused attention. The Prostatic Urethral Lift (PUL) procedure, a minimally invasive intervention, has emerged as a promising option for BPH management. It has shown remarkable results in ameliorating lower urinary tract symptoms (LUTS), enhancing quality of life, and preserving sexual function. This study aims to evaluate the effectiveness and safety of PUL in BPH patients. Key databases (MEDLINE, Cochrane CENTRAL, ScienceDirect, EBSCO, Google Scholar) were systematically searched using pertinent terms related to PUL and BPH. Following the PRISMA checklist, we considered only randomized controlled trials (RCTs) from 2013 to 2023. The assessment focused on LUTS, quality of life, sexual function, and adverse events within three months. Follow-up post-treatment mean values compared with controls (Sham) and the improvement from baseline to post-treatment follow-up duration were considered. Statistical analysis and risk of bias evaluation were conducted using Review Manager 5.4.1, presenting results as difference of mean values (MD) and risk ratios (RR). A meta-analysis with a Random Effects Model of 7 RCTs involving 378 confirmed BPH patients demonstrated significant improvements in the PUL arm including International Prostate Symptom Score (IPSS) (MD 5.51, p<0.0001), maximum urinary flow rate (Qmax) (MD 2.13, p=0.0001), BPH Impact Index (BPHII) (MD 2.14, p=0.0001), and IPSS-QoL (MD 1.50, p<0.0001), without significant increase of adverse events (RR 1.51; p=0.50). Positive outcomes were observed in sexual function variables and post-void residual measurements when post-treatment values were compared to baseline. PUL holds advantages over control interventions, providing encouraging prospects for BPH management. This study underscores the need for further exploration of PUL's efficacy and safety in BPH patients.

Surgical treatment of large-volume benign prostate hyperplasia: a comparative analysis of the outcomes of using standard and modified laparoscopic retropubic simple prostatectomy combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis

Introduction. The optimal approaches to the surgical treatment of large-volume benign prostatic hyperplasia (BPH) have not yet been determined, but laparoscopic retropubic simple prostatectomy (LSP) is one of the preferred methods of surgical treatment for large-volume BPH. There are limitations to standard approaches to LSP, which necessitate the development of improved techniques.Objective. To provide comparative analysis of the efficacy and safety of standard LSP and modified LSP combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis.Materials &amp; methods. The present multicenter study included 300 patients (mean age 67.0 ± 5.2 years) who were randomly assigned to standard and modified LSP groups. The main efficacy criteria of the intervention during 6 months of observation were: the severity of symptoms of urinary disorders (IPSS score), quality of life, peak urine flow rate and residual urine volume. All complications developed during the postoperative follow-up were recorded.Results. Of the 300 patients, 149 underwent standard LSP, and 151 underwent a modified LSP. Significant differences were detected in the hospital stay (p = 0.032), the rate of decrease in hemoglobin (p = 0.020) and the irrigation time (p = 0.001). In addition, the use of the modified technique was associated with a lower incidence of short-term urinary incontinence (p = 0.031), urinary retention due to urethral catheter occlusion (p = 0.002), and incidence of bladder tamponade (p = 0.001). After 6 months of postoperative follow-up, the groups were comparable in most of outcomes, except for peak urine flow (23.9 ± 2.3 and 20.3 ± 1.9 ml/s in the modified and standard LSP groups, respectively, p = 0.001). After 6 months of postoperative follow-up, the modified LSP group had a lower incidence of bladder tamponade (p = 0.010), urge urinary incontinence (p = 0.002) and bladder neck contracture (p = 0.031).Conclusion. The effectiveness of the modified LSP as a method of surgical treatment of large-volume BPH is not inferior to those in the standard LSP group, and the safety profile suggests the feasibility of wider testing of the technique in practice.

Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Obstruction: 5-year Outcomes of a Randomised, Open-label, Noninferiority Trial

Background and objectiveProstatic artery embolisation (PAE) and transurethral resection of the prostate (TURP) are two of the surgical options for treatment of lower urinary tract symptoms/benign prostatic obstruction (LUTS/BPO). Our aim was to compare the efficacy and safety of PAE and TURP for LUTS/BPO treatment at long-term follow-up. MethodsWe conducted a randomised, open-label, single-centre trial at a Swiss tertiary care centre. The main outcome was the change in International Prostate Symptom Score (IPSS) after PAE versus TURP. Secondary outcomes included patient-reported outcomes, functional measures, and adverse events assessed at baseline and at 3, 6, 12, 24, and 60 mo. Between-group differences in the change from baseline to 5 yr were tested using two-sided Mann-Whitney and t tests. Key findings and limitationsOf the 103 patients with refractory LUTS/BPO who were randomised between 2014 and 2017, 18/48 who underwent PAE and 38/51 who underwent TURP reached the 60-mo follow-up visit. The mean reduction in IPSS from baseline to 5 yr was −7.78 points after PAE and −11.57 points after TURP (difference 3.79 points, 95% confidence interval [CI] −0.66 to 8.24; p = 0.092). TURP was superior for most patient-reported secondary outcomes except for erectile function. At 5 yr, PAE was less effective than TURP regarding objective parameters, such as the improvement in maximum urinary flow rate (3.59 vs 9.30 ml/s, difference −5.71, 95% CI −10.72 to −0.70; p = 0. 027) and reduction in postvoid residual volume (27.81 vs 219.97 ml; difference 192.15, 95% CI 83.79–300.51; p = 0.001). Conclusions and clinical implicationsThe improvement in LUTS/BPO at 5 yr after PAE was inferior to that achieved with TURP. The limitations of PAE should be considered during patient selection and counselling. Patient summaryIn this study, we show the long-term results of prostate artery embolisation (PAE) in comparison to transurethral resection of the prostate (TURP) for the treatment of benign prostate enlargement causing urinary symptoms. PAE shows good long-term results in properly selected patients, although the improvements are less pronounced than with TURP.This trial is registered on ClinicalTrials.gov as NCT02054013.

Efficacy and safety of electroacupuncture for benign prostatic hyperplasia: A systematic review and meta-analysis.

This study aimed to evaluate the efficacy and safety of electroacupuncture (EA) in the treatment of benign prostatic hyperplasia. Seven databases were searched from the inception of each database to March 31, 2023, including PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure, Wanfang, and China Biology Medicine. The modified Jadad scale was used to assess literature quality, and literature inclusion and exclusion were conducted in strict accordance with the criteria of a score of ≥4. The risk of bias was evaluated using the Cochrane risk of bias tool. The pooled effect size of the binary data was measured by odds ratio (OR) and 95% confidence interval (CI), and the pooled effect size of the continuous data was presented as weighted mean difference (WMD) and 95% CI. If I² was larger than 50%, a random effects model was adopted, and otherwise, a fixed effects model was used. Additionally, publication bias assessment and sensitivity analysis were conducted. A total of 325 records were retrieved, and finally 9 randomized controlled trial studies were included, involving 1045 patients. Meta-analysis revealed that the EA group had better improvement than the control group in terms of clinical effective rate (odds ratio = 3.92, 95% CI = 2.38 to 6.47, I² = 0%, P < .001), International Prostate Symptom Score (WMD = -4.99, 95% CI = -6.15 to -3.84, I² = 76.9%, P < .001), maximum urinary flow rate (WMD = -4.99, 95% CI = -6.15 to -3.84, I² = 87.4%, P < .001), and post-void residual volume (WMD = -17.12, 95% CI = -29.49 to -4.75, I² = 89.1%, P < .01). There was no statistical significance in prostate volume and adverse events between the EA group and the control group (P > .05). EA is effective in the treatment of benign prostatic hyperplasia with acceptable overall safety.

Clinical effect of phytosterol-enriched saw palmetto extract on urinary function in healthy middle-aged and older males: a double-blind, placebo-controlled randomized comparative study

Background: Saw palmetto extract (SPE) is one of the most widely used supplements for benign prostatic hyperplasia (BPH) due to its pharmacological effects. β-sitosterol-enriched saw palmetto oil (VISPO™) contains more than 3% β-sitosterol and 85% total fatty acids and has been shown to improve symptoms in patients with BPH. Lower urinary tract symptoms (LUTS) require primary preventive measures in countries with accelerated population aging, including Japan. VISPO™ is expected to be effective against the early symptoms of LUTS. However, the effect of VISPO™ on urinary function in healthy individuals has not been elucidated. Objective: This clinical study evaluated the efficacy and tolerability of VISPO™ in the management of urinary complaints among healthy middle-aged and older men who did not require treatment. Methods: We conducted a randomized, double-blind, placebo-controlled trial that included 54 male participants who were assigned to consume VISPO™ or placebo (olive oil) capsules for 12 weeks. Biometric data, uroflowmetry results, and salivary hormone levels were assessed at weeks 1 and 12. Urinary function and quality of life were assessed at weeks 1, 4, 8, and 12 using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Core Lower Urinary Tract Symptom Score (CLSS), and WHOQOL-26. Results: Two-way analysis of variance revealed that IPSS and OABSS were significantly lower in the VISPO™ group that in the placebo group. However, there were no significant differences in urine volume, urinary flow rate, or salivary hormone levels. In addition, no participants reported adverse effects (diarrhea, abdominal pain, etc.). Conclusion: The results of the present study, which is the first randomized controlled trial of VISPO™ conducted among healthy participants, demonstrate the effectiveness of VISPO™ in the management of lower urinary tract complaints that do not require treatment. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000046386). Keywords: saw palmetto, VISPO™, β-sitosterol, fatty acids, healthy subjects, primary preventive, IPSS, OABSS, lower urinary tract symptoms (LUTS)

Use and Outcomes of Amplatz Renal Dilator for Treatment of Urethral Strictures

Background: Urethral strictures pose a significant challenge in urological practice, with traditional treatments often associated with considerable morbidity. The quest for less invasive yet effective interventions has led to innovative approaches, among which the Amplatz Renal Dilator has emerged as a promising tool. Objective: This study aimed to evaluate the efficacy and safety of the Amplatz Renal Dilator in the treatment of urethral strictures, focusing on urinary flow rates, stricture severity, patient symptom relief, and the incidence of complications. Methods: A prospective, observational cohort study was conducted at multiple centers including Gajju Khan Medical College Swabi Naseer Teaching Hospital Peshawar in the duration from January, 2023 to June, 2023. Total Thirty-five participants diagnosed with urethral strictures were enrolled and treated with the Amplatz Renal Dilator. The study spanned two years, with an initial six-month recruitment phase followed by an eighteen-month follow-up. Efficacy was assessed through improvements in urinary flow rates and stricture severity, while safety was evaluated by monitoring procedural complications and recurrences. Quality of life and patient satisfaction were also measured using validated questionnaires. Results: Post-treatment, urinary flow rates significantly improved from a mean of 10 mL/s (SD ± 2) to 15 mL/s (SD ± 3) (p&lt;0.001). Stricture severity decreased from Grade 3 (SD ± 1) to Grade 1 (SD ± 1) (p&lt;0.001). International Prostate Symptom Score (IPSS) from 22 (SD ± 4) to 10 (SD ± 3) (p&lt;0.001). The incidence of immediate complications was 5%, with no significant long-term complications reported. The recurrence rate of strictures was observed at 10%. Conclusion: The Amplatz Renal Dilator demonstrates significant efficacy in improving urinary flow rates and reducing stricture severity, with minimal complications and a low recurrence rate. These findings suggest that the Amplatz Renal Dilator is a safe and effective option for the treatment of urethral strictures, warranting further investigation in larger, randomized controlled trials.

Effect of Low-Frequency Renal Nerve Stimulation on Renal Glucose Release during Normoglycemia and a Hypoglycemic Clamp in Pigs.

Previously, we demonstrated that renal denervation in pigs reduces renal glucose release during a hypoglycemic episode. In this study we set out to examine changes in side-dependent renal net glucose release (SGN) through unilateral low-frequency stimulation (LFS) of the renal plexus with a pulse generator (2-5 Hz) during normoglycemia (60 min) and insulin-induced hypoglycemia ≤3.5 mmol/L (75 min) in seven pigs. The jugular vein, carotid artery, renal artery and vein, and both ureters were catheterized for measurement purposes, blood pressure management, and drug and fluid infusions. Para-aminohippurate (PAH) and inulin infusions were used to determine side-dependent renal plasma flow (SRP) and glomerular filtration rate (GFR). In a linear mixed model, LFS caused no change in SRP but decreased sodium excretion (p < 0.0001), as well as decreasing GFR during hypoglycemia (p = 0.0176). In a linear mixed model, only hypoglycemic conditions exerted significant effects on SGN (p = 0.001), whereas LFS did not. In a Wilcoxon signed rank exact test, LFS significantly increased SGN (p = 0.03125) and decreased sodium excretion (p = 0.0017) and urinary flow rate (p = 0.0129) when only considering the first instance LFS followed a preceding period of non-stimulation during normoglycemia. To conclude, this study represents, to our knowledge, the first description of an induction of renal gluconeogenesis by LFS.

(210) Four-Year Surgical and Sexual Function Outcomes of Rezum Therapy Across a Broad Range of Prostate Volumes

Abstract Introduction Benign prostatic hyperplasia (BPH) often leads to the development of lower urinary tract symptoms (LUTS), which can result in significant deterioration in quality of life (QoL). Rezum therapy has demonstrated efficacy in alleviating LUTS secondary to BPH across a broad range of prostate volumes (PVs). However, there is a scarcity of long-term real-world data on Rezum outcomes across a wide range of PVs. Objective To evaluate surgical and sexual function Rezum outcomes over a 4-year period in patients with PVs &amp;lt;30cc, 30-80cc, or &amp;gt;80cc. Methods A retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were stratified into three cohorts based on PV: &amp;lt;30cc, 30-80cc, or &amp;gt;80cc. Outcome measures, including International Prostate Symptom Score (IPSS), QoL, International Index of Erectile Function (IIEF)-Erectile and Orgasmic function, maximum urinary flow rate (Qmax), BPH medication usage, adverse events (AEs), and decisional regret scores were collected and compared at baseline and 1-, 3-, 6-, 12-, and/or 48-months follow-up. Results A total of 252 patients were analyzed, with 35 (13.9%), 196 (77.8%), and 21 (8.3%) patients in the 30cc, 30-80cc, and &amp;gt;80cc cohorts, respectively. The &amp;gt;80cc cohort was significantly older (66.9 years [8.1]) than the &amp;lt;30cc cohort (63.4 years [8.5], p = 0.02). The &amp;lt;30cc cohort had a significantly higher baseline IPSS (21 [15-28]) and QoL (5 [4-6]) than the 30-80cc (IPSS 17 [10-23], p = 0.003; QoL 4 [3-5], p=0.02) and &amp;gt;80cc (IPSS 16 [6.5-22.5], p = 0.01; QoL 4 [3-5], p = 0.006) cohorts. The number of injections utilized per lateral prostatic lobe significantly increased with PV (&amp;lt;30cc: 1 injection [0-1] vs 30-80cc: 2 injections [1-2] vs &amp;gt;80cc: 3 injections [2-3.5], p &amp;lt; 0.001). When compared to baseline, the combined cohort saw significant percent changes at 48-months in IPSS (-70.6%, p &amp;lt; .001), QoL (-80%, p &amp;lt; .001), and Qmax (52%, p = 0.003). Within each PV cohort, significant improvements in IPSS and QoL were found at all follow-ups when compared to baseline. Qmax improvements were significant only in the 30-80cc cohort at all follow-ups. There were no significant differences in percent changes in IPSS, QoL, or Qmax between cohorts at 3-, 6-, 12-, or 48-months when compared to baseline. The &amp;lt;30cc and 30-80cc cohorts had significant decreases in BPH medication usage as early as 3-months that remained durable through 48-months (all p &amp;lt; 0.05). The &amp;gt;80cc cohort experienced a significant decrease in BPH medication usage at 3-months but it did not remain durable to 12- or 48-months. No significant differences in postoperative AEs or decision regret scores were observed between cohorts. There were no significant changes in erectile function and orgasmic function at 12-months within cohorts. No significant differences were found in 48-months reoperation rates between the &amp;lt;30cc, 30-80cc, and &amp;gt;80cc cohorts (0% vs 4.9% vs 5%, p = 0.49). Conclusions Rezum effectively improved LUTS secondary to BPH irrespective of PV, with improvements being durable over 4 years. However, patients with PVs &amp;gt;80cc should be counseled on the possibility of continuing their BPH medications following treatment. Disclosure No.

(064) The Optilume® Drug Coated Balloon for Recurrent Anterior Urethral Strictures: Robust III Study 3-year Interim Results

Abstract Introduction The Optilume® Drug Coated Balloon (DCB) is a dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. Outcomes after 3-year follow-up are presented here. Objective The ROBUST III study is a randomized controlled trial comparing the Optilume® Drug Coated Balloon (DCB) against direct visual internal urethrotomy (DVIU) or dilation. Methods 127 subjects were randomized in a 2:1 fashion at 23 sites. Seventy-nine were treated with the DCB and 48 were treated with DVIU or dilation. Follow-up past 1 year was limited to those treated with the DCB. Eligibility criteria included adult males with anterior strictures with ≥2 prior treatments and stricture length ≤3cm. Long-term endpoints included freedom from repeat treatment, International Prostate Symptom Score (IPSS), and peak urinary flow rate (Qmax). Results Subjects randomized to receive the DCB had an average of 3.2 prior treatments and average stricture length of 1.6cm (46% ≥2cm), with 8/79 (10.1%) having penile strictures and 9/79 (11.4%) having prior pelvic radiation. IPSS significantly improved from 22.0 at baseline to 11.3 at 3 years. Qmax significantly improved from a baseline of 7.7 mL/sec to 12.2 mL/sec at 3 years. Freedom from repeat intervention for DCB subjects was estimated to be 74%. No late-onset treatment related adverse events were observed. Conclusions The Optilume® DCB continues to achieve significant improvements in symptoms, flow, and reintervention rates through 3 years post treatment. Disclosure No.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

ObjectiveTo investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study. MethodsOne hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. ResultsA total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. ConclusionIntra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

The application of the modified Snodgrass technique in hypospadias surgery.

We aimed to explore the effectiveness of the modified tubularized incised plate urethroplasty (Snodgrass Technique) in hypospadias surgery. A study was conducted on 50 pediatric patients with hypospadias treated in our hospital from May 2020 to May 2023. The patients were divided into two groups based on the condition of their urethral plate; 22 patients were included in the study group and 28 patients were included in the control group. The control group underwent the traditional Snodgrass technique, while the study group received the modified Snodgrass technique. The two groups were compared in terms of treatment efficacy, preoperative and postoperative 6-month Hypospadias Objective Scoring Evaluation (HOSE) scores, surgical data, and postoperative complications. The operation time for the study group was longer than that of the control group, and the intraoperative blood loss was less, but the differences were not statistically significant (p > 0.05). The success rate of surgery in the study group was 95.45% (21/22), compared to 71.43% (20/28) in the control group, showing a statistically significant difference (p < 0.05). The maximum urinary flow rate at 3 and 6 months postoperatively was significantly higher in the study group than in the control group (p < 0.05). The time to maximum flow (TQmax) and post-void residual (PVR) at 3 and 6 months postoperatively were significantly lower in the study group (p < 0.05). A total of 3 patients in the cohort developed urethral fistulas, all between 0.10 cm x 0.10 cm and 0.15 cm x 0.15 cm in size. By instructing the patients to apply pressure to the fistula during urination, all fistulas closed between 3 and 6 months postoperatively. The incidence of postoperative complications was 4.55% in the study group and 28.57% in the control group, a difference that was statistically significant (p < 0.05). The modified Snodgrass technique shows significant therapeutic effectiveness in hypospadias surgery, substantially increasing the success rate and reducing postoperative complications in pediatric patients, making it suitable for widespread application.

Balloon dilation for the treatment of male urethral strictures: a systematic review and meta-analysis

ObjectiveThe use of minimally invasive endoluminal treatment for urethral strictures has been a subject for debate for several decades. The aim of this study was to review and discuss the...

Day surgery in the treatment of benign prostatic obstruction with photoselective vaporisation of the prostate: A single‐institution experience

AbstractAimTo assess the feasibility, efficacy and safety of performing photoselective vaporisation of the prostate (PVP) as a day‐surgery procedure for patients with benign prostatic obstruction.Patients and MethodsA prospective single‐arm observational study was performed involving patients with benign prostatic obstruction (BPO) who received PVP between 2017 and 2021. Data were collected on demographics, prostate volume by transrectal ultrasonography, mean peak flow rate (Qmax), post‐void residual urine volume, International Prostate Symptom Score (IPSS) with quality‐of‐life (QoL) index, length of stay, success in weaning off catheter on the day of operation and complications.ResultsPVP was performed successfully in all 37 men between 2017 and 2021. Their mean age was 67 years. The mean prostate volume was 54 mL. The mean duration of operation was 80 min. The mean peak urinary flow rate improved from 9.14 to 16.8, 17.3 and 15.4 mL/s at post‐operative 1, 3 and 12 months, respectively (P = .001). The mean IPSS score improved from 19.5 to 8.94, 6.40 and 5.63 at post‐operative 1, 3 and 12 months, respectively (P &lt; .001). The mean QoL index improved from 4.07 to 2.43, 2.25 and 1.81 at post‐operative 1, 3 and 12 months, respectively (P = .001). The mean duration of catheterisation after PVP was 5.81 h. Thirty‐three (89.2%) patients were discharged on the same day. Overall, the 30‐day complication rate was 27%. The most common complication was haematuria (6 patients, 16.2%). Five patients (13.5%) required readmission and inpatient care. There was one Clavien–Dindo grade III and IV complication (2.6%), respectively.ConclusionThis study demonstrated the feasibility of performing PVP as a day‐surgery procedure with good short‐ and medium‐term functional outcomes and safety profiles.

A Prospective, Randomized Study Comparing the Outcome After Thulium Laser Enucleation of the Prostate with Conventional Monopolar TURP for the Treatment of Symptomatic Benign Prostatic Hyperplasia.

This is a prospective randomized study with the aim of comparing (thulium laser enucleation of the prostate (ThuLEP) and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) treatment. Patients are assessed preoperatively and up to 6 months postoperatively. International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rates (Qmax), international index of erectile function-5 (IIEF-5) and post-void residual volume (PVR) are collected on each follow-up. In comparison to TURP, the ThuLEP group has significantly less need for catheter traction and less need for postoperative irrigation. The operative time is significantly higher in ThuLEP compared to TURP. ThuLEP is significantly superior to TURP in terms of early catheter removal, less drop in haemoglobin, less fall in serum sodium level, and early hospital discharge. ThuLEP and TURP resulted in a significant improvement from baseline in terms of IPSS, PVR, Qmax, and QoL, but there was no significant difference between the 2 groups. The IIEF-5 is the same as the baseline in both groups. Early and late complications are also comparable. The ThuLEP outperforms TURP in terms of blood loss, significantly less need for postoperative catheter traction, bladder irrigations, early catheter removal, and less hospital stay. Transurethral resection of the prostate takes longer operative time in the early stages of experience. The results of both surgeries are comparable in terms of PVR, Qmax, and subjective scoring systems (IPSS, QoL). Transurethral resection of the prostate is a safe and efficient BPH treatment method comparable to the monopolar TURP.

Two-year follow-up comparing Rezūm therapy versus bipolar transurethral resection of the prostate for treating benign prostatichyperplasia. A prospective randomized study.

Comparison of the efficacy and safety of Rezūm therapy and bipolar transurethral resection of prostate (B-TURP) for the management of benign prostatic hyperplasia (BPH) of 50-120 g size. One hundred patients with BPH who met the inclusion criteria were included and split into two equal groups to undergo Rezūm therapy or B-TURP. The two groups were compared for efficacy using international prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), operative time, catheter time, hospital stay, post-void residual urine (PVR), prostate-specific antigen (PSA), and residual prostate size and safety using the incidence of complications. Rezūm significantly ameliorated IPSS from the baseline score by 55.3%, QoL by 50%, Qmax by 62.5%, International Index of Erectile Function (IIEF) by 7.1%, PVR by 50%, residual prostate size by 28.1% and PSA by 42% at 2 years. Meanwhile, the improvement in B-TURP was significantly higher than Rezūm group, Rezūm therapy had a significantly shorter duration of operative time and hospital stay. Also, it had fewer complications in comparison with B-TURP. Rezūm is a minimally invasive procedure that provides significantly improved symptomatic relief of BPH and quality of life with preservation of erectile and ejaculatory functions. However, it is not as effective as B-TURP.

Evaluation of functional and oncological outcomes of localized prostate cancer after different minimally invasive therapeutic methods: A single center experience.

To study the functional and oncological results of minimally invasive treatment methods: cryoablation, brachytherapy, and high-intensity focused ultrasound (HIFU) therapy of localized prostate cancer in a single hospital. One hundred sixty patients with localized prostate cancer were treated with minimally invasive methods (53, 52, 55 patients with cryoablation, brachytherapy and HIFU therapy, respectively). Prostate-specific antigen and evaluation of post-procedure biopsies were used as an assessment. The review of functional indicators and quality of life was made with International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL) questionnaires. Patients after cryoablation showed worse results of oncological control according to positive repeat biopsies, best indicators were observed after brachytherapy. When considering the IPSS results, there were statistically significantly worse scores in the brachytherapy group in the early postoperative period, these differences do not reach statistical significance in the late period in the brachytherapy and cryoablation groups. Patients in the cryoablation group showed worse indicators of IIEF-5; in the early postoperative period; in the late follow-up period, the indicators of erectile function in patients in the cryoablation group did not statistically significantly differ from those in patients after brachytherapy. Patients after HIFU therapy showed fewer cases of de novo erectile dysfunction during the follow-up period of 3 years, higher average IIEF-5 scores, lower IPSS scores and better QoL results. The recurrence of prostate cancer was statistically significantly higher in the International Society of Urological Pathology (ISUP) 3 grade group. HIFU therapy had better urination indicators compared to other groups, that can be associated with the laser enucleation of prostatic hyperplasia. The advantage was noted in patients after HIFU therapy when comparing the parameters to the IIEF-5 thus, HIFU treatment had a better impact on patients' QoL with localized prostate cancer.