Volume Benign Prostatic Hyperplasia Research Articles

Trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy: A case series.

To detail a novel technique of robotic-assisted simple prostatectomy that makes handling the gland protruding into the bladder neck easier and can preserve the urethra and retain ejaculation function as much as possible. This is a prospective case series. Clinical data of 17 male patients who had large volume (>80 mL) benign prostatic hyperplasia (BPH) were enrolled to undergo trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy (usRASP). We adopted the approach through the space between the bladder neck and seminal vesicle to perform a usRASP that can avoid the detrusor skirt and fibrous matrix area of the retropubic prostate. Between the transitional zone and the peripheral zone of the large prostate, the hyperplastic prostatic gland tissue can be enucleated under direct vision while preserving the prostatic urethra and retaining the ejaculatory duct and bladder neck intact. All preoperative, perioperative and postoperative clinical data were collected, and descriptive analysis was performed. The median intravesical prostatic protrusion was 19.3 mm (8.5-32.2). The median operative time was 100 min (75-140), and the median estimated blood loss was 100 mL (10-500). The median time to catheter removal was 7 days (5-7), with a median postoperative hospital stay of 2 days (2-4). After at least 6-month follow-up, the median maximum urine flow rate and postvoid residual volume were 40.1 mL/s (12.7-52.4) and 15 mL (5-23), respectively; the median International Prostate Symptom Score and Quality of Life score were 0 (0-6.3) and 1 (0-3), respectively; and the median total prostate-specific antigen was 0.84 ng/mL (0.15-1.01). All patients successfully underwent usRASP. Fifty-eight percent of patients with normal ejaculation function before surgery can still retain normal ejaculation function. We described a new approach to performing usRASP. This new method remarkably improved the voiding function, maintained antegrade ejaculation and did not increase the post-operative complications.

Comparative analysis of the safety and efficacy of 1470-nm diode laser enucleation of the prostate and plasmakinetic resection of prostate in the treatment of large volume benign prostatic hyperplasia (>80 ml)

Objective To compare the efficacy and safety of 1470-nm diode laser enucleation of the prostate (DiLEP) with that of plasmakinetic resection of the prostate (PKRP) in treating patients with large benign prostatic hyperplasia (BPH > 80ml). Methods The clinical data from 211 cases of BPH (>80 ml) were collected for analysis. The patients were divided into two groups: the PKRP group (n = 118) and the DiLEP group (n = 93), based on the surgical method used. Result The DiLEP group demonstrated significantly lower surgical time (p < 0.001), intraoperative bleeding (p < 0.001), bladder flushing time (p = 0.003), indwelling catheter time (p < 0.005), and length of hospital stay (p = 0.018) compared to the PKRP group. However, the quality of the prostatectomy was significantly higher in the DiLEP group (p = 0.005). The Qmax for the DiLEP group was significantly higher than that of the PKRP group (p < 0.05). Compared to the PKRP group, the incidence of urinary incontinence in the DiLEP group increased significantly 4 weeks post-surgery (p = 0.026), although the need for blood transfusion during surgery was significantly reduced (p = 0.037). Conclusion Both DiLEP and PKRP are safe and effective methods for treating large-volume BPH. However, DiLEP offers advantages such as more thorough glandular resection, shorter surgical time, reduced bleeding, quicker recovery, and fewer complications.

(294) Trends and Clinical Practice Patterns of Prostatic Urethral Lift (PUL): An Analysis of the American Board of Urology Case Logs

Abstract Introduction Prior studies have shown that among benign prostatic hyperplasia (BPH) surgical treatments, PUL has a higher likelihood of preserving sexual function. As a result, the 2021 AUA guidelines on management of BPH note that PUL may be offered as a treatment option to those eligible patients who desire preservation of erectile and ejaculatory function. Objective We investigated practice trends associated with PUL utilization and hypothesized that PUL would be performed more frequently for younger patients and by urologists subspecializing in andrology (infertility and/or sexual medicine). Methods We obtained de-identified, self-reported American Board of Urology (ABU) case logs from 2015-2021. We identified 4,131 urologists who performed 48,610 surgeries with an indication for BPH per ICD codes. CPT codes distinguished PUL from transurethral incision, electrosurgical resection, laser coagulation/vaporization, laser enucleation, and thermotherapy. We identified 786 urologists who performed 7,895 PUL procedures representing 19.2% of all BPH surgeries. Additionally, 24 urologists only performed PUL, and 3,345 urologists did not perform any PUL. A logistic regression model assessed factors independently associated with performing PUL. Results The number of annual PUL performed has ranged from 101 to 2,852, comprising an increasing proportion of BPH surgeries from an initial 1.6% in 2015 to 32.5% of all BPH surgeries performed in 2020. In adjusted analyses, factors associated with higher odds of performing PUL included subspecialization in andrology (odds ratio [OR] 4.01, 95% CI 1.94-8.29); practice area population &amp;gt;1,000,000 (OR 1.55, 95% CI 1.01-2.38); and government (OR 4.22, 95% CI 1.83-9.74), private practice group (OR 2.68, 95% CI 1.53-4.68), and salaried hospital employment (OR 1.94, 95% CI 1.00-3.96). The operative year (OR 1.66 per year, 95% CI 1.54-1.80) and surgeon BPH surgical volume (OR 1.02 per case increase, 95% CI 1.01-1.02) were associated with increased odds of performing PUL. Endourology subspecialization was associated with lower odds of PUL (OR 0.40, 95% CI 0.2-0.8). Geographic region, surgeon age, surgeon gender, certification vs recertification status, and patient age were not associated with use of PUL. Conclusions Based on 7 years of ABU case log data, PUL is more likely to be performed by andrologists, urologists practicing in large metropolitan areas, higher volume BPH surgeons, and urologists in private practice group, government, or hospital salaried employment. Contrary to our hypothesis, lower patient age was not associated with a higher odds of undergoing PUL. The use of PUL has increased significantly and currently comprises one third of all BPH surgeries. More study is needed to determine the extent to which patient demand for ejaculation preservation is driving the rapid adoption of PUL reflected in the ABU case logs. Disclosure No

Evaluating the demographic profile and mapping the prevalence of overactive bladder in benign prostrate hypertrophy patients: a retrospective, observational study

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objectives of the study was to evaluate the demographic profile of benign prostatic hyperplasia (BPH) patients and prevalence of overactive bladder (OAB) among these patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A real-world, retrospective, observational study (DEMO-2) on BPH patients was conducted across India from April-2021 to March-2022. Demographics, BPH characteristics, status of OAB, and their management were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 5881 BPH patients were included with a mean age of 65.3 years and mean BPH duration of 3.2 years. Majority (80.98%) of the patients had associated comorbidity; hypertension (50.2%), diabetes (26.9%) and dyslipidemia (13%) were the most common. Majority (63%) of the patients complained of incomplete bladder emptying. In BPH patients, 29.9% had OAB. These patients had a higher mean prostate volume (44.96 vs. 42.17 cc) and prostate specific antigen (PSA) levels (4.11 vs. 3.79 ng/ml) versus BPH patients without OAB. For BPH, tamsulosin was the most prescribed drug (85.90%) followed by dutasteride (66.90%); tamsulosin + dutasteride was most common combination therapy (32.6%). In BPH patients with OAB, 82% received OAB medications and solifenacin (63.9%) was the most common medication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: Majority of the BPH patients were between the ages of 50-75 years. Tamsulosin was the most commonly prescribed medication in BPH patients. Combination of tamsulosin and dutasteride was the mainstay of treatment. OAB was seen in 29.9% of the BPH patients, and solifenacin was the most commonly utilized (63.1%) medication in BPH patients with OAB. About 18% of these patients did not receive any specific medication for OAB. Adequate treatment strategies need to be adopted for BPH patients with OAB.&lt;/p&gt;

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

A Retrospective Multi-Center Study of the Clinical Effects of Transurethral Columnar Balloon Dilation of the Prostate in the Treatment of Elderly Patients with Benign Prostatic Hyperplasia.

The aim of this study was to explore the clinical effect of transurethral columnar balloon dilation of the prostate (TUCBDP), in the treatment of benign prostatic hyperplasia in men over the age of 60 years old. This was a retrospective multi-center study follow-up of patients with benign prostatic hyperplasia (BPH) who underwent TUCBDP. The international prostate symptom score (IPSS), quality of life score (QoL), residual urine volume (PVR), and maximum urine flow rate (Qmax) were evaluated one and six months after the procedure. All 68 patients had the operation from January 2019 to December 2021. Their postoperative IPSS, QoL, PVR, and Qmax of the patients significantly improved, in comparison to before procedure (p < 0.05). The improvement rate of IPSS and QoL in the small volume BPH group was significantly higher than that in the non-small volume BPH group (p < 0.05), but had little effect on the improvement rate of PVR and Qmax. TUCBDP can significantly improve IPSS, QoL, PVR, and Qmax in elderly men with BPH up to six months after the procedure, with the advantages of shorter operation time and less blood loss. The postoperative improvement effect of patients with small volume BPH was more obvious than that of patients with non-small volume BPH.

Предикторы развития склероза шейки мочевого пузыря после трансуретральных вмешательств на предстательной железе

The development and widespread implementation of modern endourological procedures for the treatment of benign prostatic hyperplasia (BPH) has led to a significant reduction in postoperative complications, but these interventions are associated to an increase of bladder neck contracture (BNC) rate. Various data on the frequency, pathogenesis, and risk factors for the development of BNC after endourological interventions are presented in the literature review. The prevalence of BNC after transurethral procedures depending on the type of energy used reaches up to 10%. Risk factors of BNC included the presence of chronic prostatitis and urinary tract infections, as well as small volume BPH. The age, cardiovascular diseases, type 2 diabetes, obesity, and a long-term smoking are considered as additional risk factors. A detailed study of the risk factors for BNC will further minimize BNC rate after transurethral procedures, thus improving the quality of life of patients.

Prostatic Artery Embolization Allows to Maintain Full Sexual Activity in Patients Suffering from Bothersome Lower Urinary Tracts Symptoms related to Benign Prostatic Hyperplasia.

The effect of prostate artery embolization (PAE) on male sexual function is currently the subject of debate in the literature. The main purpose of this study was to define changes in all domains of sexual activity after PAE, using the international index of erectile function score (IIEF-15). A single-center retrospective study was conducted on 129 patients (mean age of 65.5 ± 7years), who underwent PAE from February 2014 to January 2017 for symptomatic benign prostatic hyperplasia (BPH). Fifty consecutive patients fulfilling the inclusion criteria were evaluated before and after PAE follow-up using the IIEF-15, IPSS, prostate volume (PV) and cardiovascular risk factor and BPH drugs. The IIEF-15 domains analyzed were: erectile function (EF) ejaculation and orgasm (Ej/O), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). A paired sample t test or Wilcoxon signed-rank test was used to compare IIEF-15 between baseline and follow-up. The study showed nonsignificant change in IIEF-15 total score (58.0 ± 13.8 SD;p = 0.71) and the five domains (EF 24.5 ± 7.0 SD, p = 0.82; EJ/O 8.2 ± 2.3 SD, p = 0.50; SD 7.2 ± 2.7 SD, p = 0.57; IS 10.3 ± 3.0 SD, p = 0.77; OS 8.2 ± 2.7 SD; p = 0.11) after PAE. We also found a significant improvement in IPSS score after PAE. Based on the IIEF-15 questionnaire, PAE was showed to allow good urinary symptoms results and no deterioration in sexual function.

MONOPOLAR VERSUS BIPOLAR TRANSURETHRAL ENUCLEATION OF THE PROSTATE FOR LARGE VOLUME BENIGN PROSTATIC HYPERPLASIA

Background: The choice of treatment modality in patients with Benign Prostatic Hyperplasia (BPH) is one of the most discussed issues in urology. In recent years, the surgical treatment of prostates of large sizes by means of enucleation has become increasingly popular. The emergence of special loops to perform bipolar and monopolar enucleation using standard equipment for TURP has opened up new possibilities for the treatment of patients by transurethral monopolar enucleation.Aim of the Work: To evaluate the efficacy and safety of Monopolar versus Bipolar Transurethral Enucleation of the Prostatefor Large volume Benign Prostatic Hyperplasia. Patients and Methods: 40 patients with BPH were randomly divided into two groups: Group 1 underwent Monopolar Transurethral Enucleation of the Prostate (M-TUEP) (n=20), and Group 2 underwent Bipolar Transurethral Enucleation of the Prostate (B-TUEP) (n=20). Operation time, incidence of hyponatremia,estimated blood loss by drop of haemoglobin, improvement of International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score, Uroflowmetry (Qmax and Qave), Post Voiding Residual Urine (PVR) and Prostate volume and other complications ( as reintervention for clots and bleeding control, recatheterization, UTI, incidence of TUR syndrome, incidence of infarction, incontinence, bladder neck contracture and urethral stricture) were compared. Results: Operation was successfully performed in all 40 cases, and no open surgery was converted in any case or blood transfusion was needed. There was no statistically significant difference between both groups in operative time, postoperative haemoglobin and serum sodium levels decline, or improvement in postoperative IPSS, QoL score, Qmax, Qave, Prostate volume and PVR. All patients were followed up to 6 months postoperatively, and no complications occurred except one patient in Group 1 (5% of Group 1 and 2.5 % of the whole study) developed Urethral stricture. Conclusion: M-TUEP was shown to be a safe and highly effective technique for relief of Bladder Outlet Obstruction (BOO). The clinical efficacy of M-TUEP is sustainable for up to 6 months of follow-up. Our single-center results show that M-TUEP has the same efficacy as B-TUEP for the surgical treatment of symptomatic BPH, so M-TUEP can replace B-TUEP with the same efficacy and comparable safety.

MP25-16 HOLMIUM ENUCLEATION OF THE PROSTATE WITH A GLAND VOLUME OVER 200CC

INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is recommended as a treatment option for bladder outlet obstruction for large volume benign prostatic hyperplasia in AUA, UK and European guidelines. It is unclear whether prostate volume (PV) limits HoLEP in terms of safety, efficacy or outcomes. The objectives of this study are to assess the feasibility, outcomes and techniques for HoLEP of prostates with a specimen weight over 150g (equivalent to a preoperative PV >200cc). METHODS: A retrospective review of a prospectively maintained database was conducted at a tertiary HoLEP center in the UK. All HoLEP procedures on glands with a specimen weight >150g were identified and reviewed. Outcomes measured included laser and morcellation times, use of cystotomy, change in serum hemoglobin (Hb), blood transfusion rates, and changes in IPSS, Qmax and PVR at 3 months. RESULTS: 127 patients were identified as having undergone HoLEP with a specimen weight 150g or above over a 14 year period. These were subdivided into three groups by specimen weight of 150-189g or 200-250cc (n= 70), 190-225g or 250-300cc (n=34) and >225g or >300cc (n=23). The median specimen weight was 185g (equivalent to pre-op PV = 250cc). Median enucleation and morcellation time was 70 minutes (range 40-150) and 45 minutes (range 12-240) respectively. Six patients underwent a concomitant cystotomy to remove lobes, four of whom had a specimen weight >225g. The mean length of stay was 1 day (range 0-14). The median change in Hb was 18g/L. The transfusion rate was 1.6%. The median preoperative IPSS in patients without an indwelling catheter was 19 versus 6 at 3 months postoperatively. 85% had a successful initial trial without catheter rising to 95% by second trial. The median preoperative Qmax in patients (without a catheter) was 8mL/s versus 22mL/s postoperatively. Outcomes stratified by specimen weight/equivalent preoperative PV are detailed in Table 1. CONCLUSIONS: HoLEP is feasible and safe for a PV >200cc. PV need not be a barrier to HoLEP in specialist centers. Most HoLEP outcomes are independent of PV, although the use of cystotomy is more common in men with prostates > 300cc. For a PV from 200-300cc and >300cc, we propose the terms mega- and ultra-HoLEP respectively.Source of Funding: No funding received

Endoscopic transvesical adenomectomy of the prostate, a new minimally invasive approach for large benign prostatic hyperplasia. What has our experience taught us?

IntroductionRecent technical advances have made new minimally invasive techniques possible to treat large volume (>80 ml) benign prostatic hyperplasia (BPH). The endoscopic transperitoneal adenomectomy of the prostate (ETAP) is a new minimally invasive technique developed in our centre. The aim of this study was to describe the safety, efficacy and to evaluate our learning curve in ETAP.Material and methodsThis was a single-centre study that enrolled eighty-eight consecutive patients with large BPH who underwent ETAP. Pre-, per- and postoperative data were prospectively collected. Statistical analysis compared the first 40 patients submitted to ETAP (Group A) with the subsequent 48 patients (Group B).ResultsThere were no significant differences in the surgical procedure between groups. The median operating time was 94 (80–110) minutes and the estimated blood loss 150 (100–300) ml. There were no perioperative blood transfusions nor any conversions to open approach needed. Median hospital stay was 3 (3–5) days and catheter was removed mainly at day 9 (5–11). The median Qmax improved from 8.0 (6.2–9.9) ml/s to 15.0 (11.5–23.0) ml/s postoperatively and the median International Prostate Symptom Score (IPSS) score decreased from 20 (15–24) to 6 (4–11) after the procedure.ConclusionsETAP is a secure and feasible minimally invasive technique for treatment of large BPH. The functional outcomes of this technique are consistent and promising.

The clinical application of combination suprapubic prostatectomy with transurethral resection of the prostate (TURP) in patients with large volume benign prostatic hyperplasia (BPH)

To investigate the safety and efficacy of the combination of suprapubic prostatectomy with transurethral resection of the prostate (TURP) for the treatment of large volume benign prostatic hyperplasia (BPH). We retrospectively analyzed the clinical data of two methods of treatment with 60 cases of a large volume BPH (>100 g) from January 2011 to 2017; the methods were suprapubic prostatectomy and suprapubic prostatectomy combination with TURP, in which the single open group comprised 30 cases, treated using the former method, and the combined open group comprised the other 30 cases, treated using the latter method. In the combined open group, the residual prostate gland was removed by TURP. We compared both the groups of patients using age, prostate volume, international prostate symptom score (IPSS), prostate-specific antigen (PSA), maximum flow rate, residual urine, operation time, hospitalization time, postoperative washing time, blood transfusion rate, and decreased amount of intraoperative hemoglobin in operation, and compared the preoperative and postoperative IPSS, maximum flow rate, and residual urine volume. There was no significant difference between the two groups in age, prostate volume, IPSS, PSA, maximum flow rate, residual urine, and other clinical data (P > 0.05); the single group operation time, postoperative bladder irrigation time, hospitalization time, blood transfusion rate, and decreased amount of intraoperative hemoglobin were significantly greater in the single open group than in the combined open group, and statistically significant differences were observed between both the groups (P < 0.05). Postoperative voiding function improved significantly compared with the preoperative, and a statistically significant difference was observed (P < 0.05). The combination of suprapubic prostatectomy with TURP is an effective and a safe surgical method for the treatment of patients with large volume BPH. It is certainly worthy of clinical application.

The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature

ObjectiveOur objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia (BPH). MethodsA retrospective analysis was performed for all patients who underwent 180 W XPS-laser photoselective vaporization of the prostate (PVP) vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers. Data collection included baseline comorbidities, disease-specific quality of life scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), complications, prostate volume and prostate-specific antigen (PSA). The secondary endpoints were the incidence of intraoperative and postoperative adverse events. Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery. ResultsMean age of men was 67.8 years old, with a mean body mass index of 29.7 kg/m2. Mean prostate volume as measured by transrectal ultrasound was 29 mL. Anticoagulation use was 47% and urinary retention with catheter at time of surgery was 17%. Mean hospital stay and catheter time were 0.5 days. Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months (interquartile range, 3–22.5 months). The International Prostate Symptom Score improved from 22.8 ± 7.0 at baseline to 10.7 ± 7.4 (p < 0.01) and 6.3 ± 4.4 (p < 0.01) at 1 and 6 months, respectively. The Qmax improved from 7.70 ± 4.46 mL/s at baseline to 17.25 ± 9.30 mL/s (p < 0.01) and 19.14 ± 7.19 mL/s (p < 0.001) at 1 and 6 months, respectively, while the PVR improved from 216.0 ± 271.0 mL preoperatively to 32.8 ± 45.3 mL (p < 0.01) and 26.2 ± 46.0 mL (p < 0.01) at 1 and 6 months, respectively. The PSA dropped from 1.97 ± 1.76 ng/mL preoperatively to 0.71 ± 0.61 ng/mL (p < 0.01) and 0.74 ± 0.63 ng/mL at 1 and 6 months, respectively. No patient had a bladder neck contracture postoperatively and no capsular perforations were noted intraoperatively. ConclusionThe 180 W GreenLight XPS system is safe and effective for men with small volume BPH. PVP produced improvements in symptomatic and clinical parameters without any safety concern. It represents a safe surgical option in this under studied population.

Evaluation of the super-selective prostate artery embolization combined with TURP for patients with large volume (>80 ml) benign prostatic hyperplasia

Objective To explore the safety and efficacy of super-selective prostate artery embolization (PAE) combined with TURP (transurethral resection of prostate) as an alternative method for patients with severe large BPH (>80 ml). Methods From March 2015 to June 2017, a total of 40 patients with large benign prostatic hyperplasia who failed in medical treatment were selected for PAE combined with TURP (18 cases)and TURP (22 cases). In the PAE combined with TURP group, the mean age was (75.0±8.7) years (ranging 60-88 years) and the mean prostatic volume was (111.0±23.3) ml, ranged from 83 to 145 ml). The international prostate symptom score (IPSS), quality of life (QOL), maximal urine flow rate (Qmax)and postvoid residual urine(PVR) were(25.2±3.6), (5.1±1.0), (6.4±2.3)ml/s and (107.7±32.6)ml, respectively. In the TURP group, the mean age was (76.0±6.9) years (ranging 62-85 years) and the mean prostatic volume was (107.5±27.4) ml, ranged from 80 to 150 ml). The IPSS, QOL, Qmax and PVR were(24.3±4.2), (4.9±0.9), (6.7±2.2)ml/s and (106.6±32.2)ml, respectively. Clinical data of all of patients were analyzed retrospectively, including operative time, estimate blood loss, weight and efficacy of resected tissue, time of continuous bladder irrigation and catheterization, IPSS, QOL, PVR, Qmax and postoperative complications. Results There were significant differences in the operative time [(75.8±25.1)min vs.(103.2±27.7) min], estimate blood loss [(122.8±33.9)ml vs.(447.6±36.0)ml], weight of resected tissue [(99.9±24.2)g vs.(82.9±15.5)g], efficacy of resected tissue [(76.9±20.7)g/h vs.(41.7±14.2)g/h], continuous bladder irrigation time [(1.4±0.5) d vs.(2.4±0.8) d] and catheterization time [(2.2±0.4)d vs.(3.4±0.6)d] between PAE combined TURP group and TURP group(P 0.05). Conclusions PAE combined TURP could be used a safe and effective therapy for treating patients with LUTS due to large volume (>80 ml) BPH. It has been a priority in less blood, more efficient of resected tissue and less postoperative complications. Key words: Benign prostatic hyperplasia; Prostatic artery embolization; Low urinary tract symptoms

Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial.

We compared the perioperative and postoperative characteristics of thulium vapoenucleation and holmium laser enucleation of the prostate for the treatment of large volume benign prostatic hyperplasia. A total of 94 patients with benign prostatic hyperplasia and a median prostate size of 80 (IQR 46.75-100)cc were either randomized to thulium vapoenucleation or holmium laser enucleation of the prostate. Patients were assessed preoperatively, 1 and 6months postoperatively. The median operative time was 60 (IQR 41-79)min without significant differences between the groups. There were no significant differences between the groups regarding catheter time [2 (IQR 2-2)days] and postoperative stay [2 (IQR 2-3)days]. Clavien 1 (13.8%), 2 (3.2%), 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. At 6-month follow-up, median maximum flow rate (10.7 vs. 25.9ml/s), post-void residual urine (100 vs. 6.5ml), I-PSS (20 vs. 5), quality of life (4 vs. 1), PSA (4.14 vs. 0.71µg/l), and prostate volume (80 vs. 16ml) had improved significantly (p < 0.001) compared to baseline without significant differences between the groups. Median PSA decrease was 79.7% (58.8-90.6%) and prostate volume reduction was 74.5% (68.57-87.63%) without differences between the groups. The reoperation rate was zero at 6-month follow-up. Thulium vapoenucleation and holmium laser enucleation of the prostate are safe and effective procedures for the treatment of large volume benign prostatic hyperplasia. Both procedures give satisfactory micturition improvement with low morbidity and sufficient prostate volume reduction at 6-month follow-up.

V5-10 EXTRAPERITEONAL SIMPLE PROSTATECTOMY: A SURGERY FOR BEGINNERS?

You have accessJournal of UrologyBPH and Voiding Dysfunction1 Apr 2017V5-10 EXTRAPERITEONAL SIMPLE PROSTATECTOMY: A SURGERY FOR BEGINNERS? Paulo Mota, Nuno Carvalho, Emanuel Carvalho-Dias, Agostinho Cordeiro, João Torres, Nuno Morais, Mário Cerqueira-Alves, Riccardo Autorino, and Estevão Lima Paulo MotaPaulo Mota More articles by this author , Nuno CarvalhoNuno Carvalho More articles by this author , Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author , Agostinho CordeiroAgostinho Cordeiro More articles by this author , João TorresJoão Torres More articles by this author , Nuno MoraisNuno Morais More articles by this author , Mário Cerqueira-AlvesMário Cerqueira-Alves More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , and Estevão LimaEstevão Lima More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1415AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic simple prostatectomy has been introduced with the purpose of reducing the morbidity associated with classical and standard open surgery. The extraperitoneal (pré-peritoneal) approach adds no technical difficulty, and additionally, allows no surgical violation of the peritoneum. The purpose of this work (video), is to show step-by-step a video-endoscopic extraperitoneal simple prostatectomy technique and present a series of cases of patients treated with this approach, with residents as first surgeons. METHODS To create an educational video that shows in a didactic way the video-endoscopic extraperitoneal simple prostatectomy procedure. Eighteen consecutive cases performed with this technique were analysed. Demographic data and main perioperative outcomes were registed and analyzed. Pre and post-operative International Prostate Symptom Score and maximum flow rate were registered as indicators of relieving of bladder outlet obstruction (BOO). A questionnaire for surgery feasibility was applied to the surgeons. RESULTS An educational video that shows in a didactic way the simple video-endoscopic extraperitoneal simple prostatectomy is presented. The results of a series of 18 consecutive cases are presented: mean prostate volume was 98 ml; mean estimated blood loss was 150 ml (no transfusions required). No intraoperative complications or conversion were recorded. Mean length of hospital stay was 3,5 days. Post-operative complications occurred in a 5,6% rate (self-limiting prolonged haematuria). A significant improvement was observed of subjective and objective indicators of BOO (p<0.05). Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis. The surgeons assessment reveals that the technique was easy to perform. CONCLUSIONS This work proves that the video-endoscopic extraperitoneal simple prostatectomy is a safe and effective procedure and certainly a good option for the surgical treatment of high volume benign prostatic hyperplasia. Additionally, in our opinion this surgery appears to be a good procedure for iniciating laparoscopic training, due to the near absence of oncologic concern, and because of its feasibility. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e602 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Paulo Mota More articles by this author Nuno Carvalho More articles by this author Emanuel Carvalho-Dias More articles by this author Agostinho Cordeiro More articles by this author João Torres More articles by this author Nuno Morais More articles by this author Mário Cerqueira-Alves More articles by this author Riccardo Autorino More articles by this author Estevão Lima More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prospective study comparing laparoscopic and open adenomectomy: Surgical and functional results

IntroductionOpen adenomectomy (OA) is the surgery of choice for large volume benign prostatic hyperplasia, and laparoscopic adenomectomy (LA) represents a minimally invasive alternative. We present a long-term, prospective study comparing both techniques. Patients and methodsThe study consecutively included 199 patients with benign prostatic hyperplasia and prostate volumes >80g who were followed for more than 12 months. The patients underwent OA (n=97) or LA (n=102). We recorded and compared demographic and perioperative data, functional results and complications using a descriptive statistical analysis. ResultsThe mean age was 69.2±7.7 years (range 42–87), and the mean prostate volume (measured by TRUS) was 112.1±32.7mL (range 78–260). There were no baseline differences among the groups in terms of age, ASA scale, prostate volume, PSA levels, Qmax, IPSS, QoL or treatments prior to the surgery. The surgical time (p<.0001) and catheter time (p<0.0002) were longer in the LA group. Operative bleeding (p<0.0001), transfusion rate (p=0.0015) and mean stay (p<0.0001) were significantly lower in the LA group. The LA group had a lower rate of complications (p=0.04), but there were no significant differences between the groups in terms of major complications (Clavien score≥3) (p=0.13) or in the rate of late complications (at one year) (p=0.66). There were also no differences between the groups in the functional postoperative results: IPSS (p=0.17), QoL (p=0.3) and Qmax (p=0.17). ConclusionsLA is a reasonable, safe and effective alternative that results in less bleeding, fewer transfusions, shorter hospital stays and lower morbidity than OA. LA has similar functional results to OA, at the expense of longer surgical times and longer catheter times.

Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis.

BackgroundProstate artery embolization (PAE) is emerging and is a promising minimally invasive therapy that improves lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). The purpose of this article was to evaluate the efficacy and safety of PAE on LUTS related to BPH.Materials and methodsA literature review was performed to identify all published articles of PAE for BPH. The sources included MEDLINE, EMBASE and Cochrane Library from 1980 to 2016. A systematic review and meta-analysis was conducted. The outcome measurements were combined by calculating the mean difference with 95% confidence interval. Statistical analysis was carried out using Review Manager 5.3.0.ResultsTwelve studies involving 840 participants were included. Compared with baseline, the International Index of Erectile Function (IIEF-5; International Prostate Symptom Score) scores, the quality of life scores, peak urinary flow rate (Qmax) and postvoid residual volume all had significant improvements during the 24-month follow-up (all P<0.00001). Both prostate volume (PV) and prostate-specific antigen had significant decrease during the 12-month follow-up (P<0.00001 and P=0.005, respectively), except postoperative 24 months (P=0.47 and P=0.32, respectively). The IIEF-5 short form scores had significant increase at postoperative 6 months (P=0.002) and 12 months (P<0.0001), except postoperative 1 month (P=0.23) and 24 months (P=0.21). For large volume (PV ≥80 mL) BPH, the results were similar. There were no life-threatening complications.ConclusionPAE is an effective, safe and well-tolerable treatment for LUTS related to BPH, including large volume (PV ≥80 mL) BPH, with a good short-term follow-up. Studies with large number of cases and longer follow-up time are needed to validate our results.

Curative effect of plasmakinetic enucleation of prostate in the treatment of large volume prostate

Objectives To evaluate the clinical effect of transurethral plasmakinetic enucleation of the prostate (PKEP) in treatment of large volume benign prostatic hyperplasia(BPH) (>80mL). Methods The clinical date of 80 patients with large volume BPH in the hospital from May 2012 to January 2015 were analyzed retrospectively. All patients were divided into PKEP group(n=37) and transurethral bipolar plasma kinetic prostatectomy (TUPKP group) (n=43) according to surgical ways. Perioperative indices, postoperative follow-up results of two groups were compared and ana- lysed. Results Bladder washing time (20.5 ± 6.7 )min, blood loss (120.5± 44.9 )mL, indwelling catheter time (4.4 ± 1.9)d, postoperative hospitalization (5.2 ±1.8)d in PKEP group were significantly lower than in TUPKP group and resection of the prostate weight (63.2± 21.5) g was significantly higher than TUPKP group (P 0.05). Qmax (22.4±4.7) mL/s in PKEP group was significantly higher than that in TUPKP group (19.5±4.0) mL/s (P 0.05), and the PSA values of the two groups were significantly decreased (P<0.05). The postoperative complication rate (62.16%) in the PKRP group was significantly lower than that in the TUPKP group (86.05%) and the difference was statistically significant (P<0.05). Conclusions PKEP has good clinical effect in the treatment of large volume BPH and TUPKP, it has the advantages of less bleeding, quick recovery and low complications. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate

Trends in Simple Prostatectomy for Benign Prostatic Hyperplasia.

The definitive treatment for symptomatic large volume (>80mL) benign prostatic hyperplasia (BPH) is simple prostatectomy (SP). This can be performed by utilizing a retropubic, suprapubic, or a combined approach. The latter two approaches allow for the management of concomitant bladder diverticulum or stones through the same incision. Each approach affords unique technical strengths and weaknesses that must be considered in light of patient characteristics and concomitant pathology. SP allows for removal of the entire prostatic adenoma while obviating some of the neurovascular and continence issues that can arise from radical prostatectomy. Concerns with SP include its relatively high perioperative morbidity, notably bleeding. Therefore, there is increasing interest in less invasive options, including enucleation procedures and minimally invasive SP. This review presents an update regarding trends and outcomes of SP, as well as the effectiveness and popularity of alternative treatments.