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World Journal of Urology Jun 2023This study assessed the efficacy, safety and durability outcomes of water vapor thermal therapy with Rezum in a real-world cohort of patients with lower urinary tract... (Observational Study)
Observational Study
PURPOSE
This study assessed the efficacy, safety and durability outcomes of water vapor thermal therapy with Rezum in a real-world cohort of patients with lower urinary tract symptoms due to benign prostate obstruction.
METHODS
Consecutive, unselected patients undergoing Rezum treatment between January 2014 and August 2022 were candidates for this pragmatic, observational, longitudinal, single-center cohort study. Pre- and perioperative data were descriptively summarized. The primary outcome was surgical efficacy, determined by International Prostate Symptom Score (IPSS), Quality of Life (QoL) Score, maximum urinary flow rate (Qmax), post-void residual (PVR) volume and prostate volume (PV) at baseline, 2 months, 6 months, 1 year, 2 years, and > 2 years.
RESULTS
A total of 211 patients were enrolled for analysis. Overall, catheter removal was successful in 92.4% of patients after a median of 5 days. A preoperative catheter and the presence of a median lobe increased the risk of unsuccessful catheter removal. In total, 5.7% of patients were reoperated after a median of 407 days. Comparing baseline to the longest median follow-up, the postoperative IPSS decreased significantly by 65.7%, the QoL Score declined by 66.7% (both until a maximum median of 4.5 years) and Qmax improved by 66.7% (until 3.9 years). Post-void residual volume and PV were reduced by 85.7% (3.7 years) and 47% (4.0 years), respectively. Clavien-Dindo complication ≤ II occurred in 11.8%.
CONCLUSION
Rezum is a safe minimally invasive treatment option in a real-world patient cohort with a beneficial improvement of micturition symptoms and voiding function during follow-up.
Topics: Male; Humans; Steam; Quality of Life; Treatment Outcome; Cohort Studies; Lower Urinary Tract Symptoms; Prostatic Hyperplasia
PubMed: 37140664
DOI: 10.1007/s00345-023-04395-y -
Asian Journal of Andrology 2022Benign prostatic hyperplasia (BPH) is a common disease in elderly men, and transurethral laser prostatectomy (TULP) has been widely used in the clinic to remove bladder...
Benign prostatic hyperplasia (BPH) is a common disease in elderly men, and transurethral laser prostatectomy (TULP) has been widely used in the clinic to remove bladder outlet obstruction caused by BPH. Previous animal models for wound repair after prostatectomy have many limitations, and there have been no previous reports of a mouse model of TULP. Therefore, this study aimed to establish a novel mouse model of TULP. Twelve healthy adult Kunming (KM) mice received transurethral laser vaporization prostatectomy with a 200-μm thulium laser. The mice were sacrificed, and wound specimens from the prostatic urethra and bladder neck were harvested at 1 day, 3 days, 5 days, and 7 days after surgery. Hematoxylin-eosin (HE) and immunohistochemistry were applied to confirm the establishment of the mouse TULP model. One day after the surgery, urothelium expressing uroplakin (UPK) was absent in the urethral wound site, and a large number of necrotic tissues were found in the wound site. There was no UPK-positive urothelium in the wound 3 days after surgery. At 5 days after surgery, monolayer urothelium expressing UPK was found in the wound site, indicating that the re-epithelization of the wound had been completed. On the 7 day after surgery, there were multiple layers of urothelium with UPK expression, indicating that the repair was completed. It is feasible to establish a mouse TULP model by using a microcystoscope system and a 200-μm thulium laser.
Topics: Aged; Animals; Humans; Laser Therapy; Male; Mice; Prostatectomy; Prostatic Hyperplasia; Thulium; Transurethral Resection of Prostate
PubMed: 34259200
DOI: 10.4103/aja.aja_59_21 -
Archivio Italiano Di Urologia,... Sep 2022Surgery is the treatment for male lower urinary tract symptoms (LUTS) relat-ed to benign prostatic obstruction (BPO) refractory to pharma-cological treatment or with...
OBJECTIVE
Surgery is the treatment for male lower urinary tract symptoms (LUTS) relat-ed to benign prostatic obstruction (BPO) refractory to pharma-cological treatment or with complications. This study aimed to assess factors associated with the need for surgical reinterven-tion and/or continuation of pharmacological treatment.
MATERIALS AND METHODS
A retrospective analysis of patients who underwent prostatic surgery for male LUTS associated with BPO between 1 May 2015 and 1 May 2016, with a minimum follow-up of five years, in an academic tertiary hospital. The type of surgery, preoperative, postoperative and follow-up analysis were collected in a database.
RESULTS
A total of 212 patients were included with a mean age of 70 ± 8.66 years at five years follow-up. At 5 years, a total of 86.9% of patients do not need pharmacological treatment and 12% required surgical reintervention. Of the preoperative parameters, it was found a relationship between prior prostatitis and the need for second surgery with an odds ratio of 4.6.
CONCLUSIONS
Patients should be informed of the potential need for pharmacological treatment following surgery, or even of the need for reintervention. History of prostatitis seems to be a risk factor for reintervention.
Topics: Aged; Humans; Lower Urinary Tract Symptoms; Male; Middle Aged; Prostatic Hyperplasia; Prostatitis; Retrospective Studies; Urethral Obstruction
PubMed: 36165472
DOI: 10.4081/aiua.2022.3.295 -
Cureus Apr 2024A 72-year-old male with a history of systemic hypertension, asthma, chronic obstructive pulmonary disease (COPD), and hyperlipidemia presents with diffuse patches of...
A 72-year-old male with a history of systemic hypertension, asthma, chronic obstructive pulmonary disease (COPD), and hyperlipidemia presents with diffuse patches of cutaneous depigmentation. A shave biopsy of different regions of depigmented skin indicated vitiligo. The patient was prescribed Opzelura (ruxolitinib) 1.5% topical cream as well as tacrolimus 0.1% topical ointment for vitiligo. He also had a history of prostate cancer. A prostate biopsy revealed three sites of prostatic adenocarcinoma with a Gleason score of 6 and a Prostate Imaging-Reporting and Data System (PI-RADS) score of 2. The patient remained in active surveillance for prostate cancer without treatment, due to its low severity. A subsequent biopsy five years later revealed a decrease in prostate cancer prevalence, with cancer present in only one core and at a lower severity. The purpose of this case presentation is to discuss possible links between vitiligo and prostate cancer, as well as their shared mechanisms and pathways.
PubMed: 38817459
DOI: 10.7759/cureus.59349 -
Asian Journal of Urology Jan 2022To evaluate the efficacy and safety of simultaneous administration of dutasteride, tadalafil and solifenacin in the treatment of benign prostatic hyperplasia (BPH) with...
OBJECTIVE
To evaluate the efficacy and safety of simultaneous administration of dutasteride, tadalafil and solifenacin in the treatment of benign prostatic hyperplasia (BPH) with overactive bladder symptoms and lower urinary tract obstruction in previously unsuccessfully treated men.
METHODS
Patients in Group A (=97) received dutasteride 0.5 mg/day, tadalafil 2.5 mg/day, and solifenacin 2.5 mg/day; Group B (=95) received dutasteride 0.5 mg/day, tadalafil 5 mg/day, and solifenacin 5 mg/day; Group C (=103) received dutasteride 0.5 mg/day, tadalafil 20 mg/day, and solifenacin 10 mg/day. The functional status of the lower urinary tract was assessed using the International Prostate Symptom Score (I-PSS), Overactive Bladder Questionnaire (OABq), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD) as well as uroflowmetry.
RESULTS
The total score of the sexual function remained unchanged in Group B of patients 81.3 points 80.2 points (>0.05) according to MSHQ-EjD, 61.4 points 51.2 points (>0.05) according to IIEF data. The total assessment of symptoms of hyperactivity significantly decreased in Group C according to OABq data after the 4th week of the study (17.5 points 26.1 points, <0.05) and remained below the baseline until the end of the study (15.2 points).
CONCLUSIONS
The simultaneous administration of standard doses of dutasteride, solifenacin, and tadalafil for 3 months is safe, effective, and can be recommended for patients with BPH to reduce symptoms of obstruction and hyperactivity of the bladder and maintain sexual function.
PubMed: 35198395
DOI: 10.1016/j.ajur.2021.04.002 -
International Neurourology Journal Sep 2022Lower urinary tract symptoms (LUTS) associated with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) can negatively impact quality of life. We...
PURPOSE
Lower urinary tract symptoms (LUTS) associated with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) can negatively impact quality of life. We evaluated the structural connectivity of the brain in men with BPH with chronic BOO using diffusion tensor imaging (DTI).
METHODS
Ambulatory male patients aged ≥45 years with BPH and BOO were recruited. LUTS was defined as an International Prostate Symptom Score (IPSS) ≥12 and a maximum urinary flow rate ≤15 mL/sec. Upon recruitment, uroflowmetry and validated questionnaires regarding bladder status were collected. DTI images from each subject were aligned with the ICBM-DTI-81 atlas, defining 50 white matter tracts (WMTs). The mean values of DTI parameters-fractional anisotropy and mean diffusivity-for each WMT were extracted. These measures were then utilized to compute Pearson correlation coefficients with clinical parameters. Objective clinical parameters included uroflowmetry parameters, postvoid residual (PVR) volume, and bladder capacity. Subjective clinical parameters were assessed using validated questionnaires: the IPSS, Incontinence Symptom Index, and Sexual Health Inventory for Men.
RESULTS
The correlation analysis revealed 15 WMTs that showed statistically significant associations (P<0.05) with objective and subjective clinical parameters. Eight tracts were associated with uroflowmetry parameters: maximum flow rate (Qmax), mean flow rate (Qmean), and PVR. Among these tracts, the middle cerebellar peduncles and left medial lemniscus were associated with Qmax; the genu of the corpus callosum, left superior corona radiata, corticospinal tract, right medial lemniscus, posterior corona radiata with Qmean; and the left posterior corona radiata with PVR. Seven tracts also demonstrated significant associations with the IPSS.
CONCLUSION
Our results suggest correlations between the preserved white matter integrity of specific WMTs and the severity of LUTS based on objective and subjective clinical parameters, leading us to believe that a distinct pathology of the central nervous system might exist.
PubMed: 36203254
DOI: 10.5213/inj.2244018.009 -
Journal of Clinical Medicine Oct 2021Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1-8% of patients. The high incidence of prostate cancer... (Review)
Review
Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1-8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased oncological cure rates, these adverse events do occur, compromising patients' quality of life. Non-traumatic obstruction of the posterior urethra and bladder neck include membranous and prostatic urethral stenosis and bladder neck stenosis (also known as contracture). The devastated bladder outlet can result from benign conditions, such as neurogenic dysfunction, trauma, iatrogenic causes, or more frequently from complications of oncologic treatment, such as prostate, bladder and rectum. Most posterior urethral stenoses may respond to endoluminal treatments such as dilatation, direct vision internal urethrotomy, and occasionally urethral stents. Although surgical reconstruction offers the best chance of durable success, these reconstructive options are fraught with severe complications and, therefore, are far from being ideal. In patients with prior RT, failed reconstruction, densely fibrotic and/or necrotic and calcified posterior urethra, refractory incontinence or severe comorbidities, reconstruction may not be either feasible or recommended. In these cases, urinary diversion with or without cystectomy is usually required. This review aims to discuss the diagnostic evaluation and treatment options for patients with bladder outlet obstruction with a special emphasis on patients unsuitable for reconstruction of the posterior urethra and requiring urinary diversion.
PubMed: 34768438
DOI: 10.3390/jcm10214920 -
International Braz J Urol : Official... 2022This study aimed to assess the possible healing effect of combination treatment with a hydrogen sulfide (H2S) donor, sodium hydrosulfide (NaHS) plus tadalafil on partial...
PURPOSE
This study aimed to assess the possible healing effect of combination treatment with a hydrogen sulfide (H2S) donor, sodium hydrosulfide (NaHS) plus tadalafil on partial bladder outlet obstruction (PBOO)-induced bladder dysfunction.
MATERIALS AND METHODS
A total of 75 male Sprague-Dawley rats aged 10-wk and 300-350g were divided into five groups; control; PBOO; PBOO+NaHS (5.6mg/kg/day, i.p., 6-wk); PBOO+tadalafil (2mg/kg/day, oral, 6-wk) and PBOO+NaHS+tadalafil. PBOO was created by partial urethral ligation. 6 weeks after obstruction, the in vitro contractile responses of the detrusor muscle and Western blotting, H2S and malondialdehyde assay were performed in bladder tissues.
RESULTS
There was an increase in bladder weight(p<0.001) and a decrease in contractile responses to KCL(p<0.001), carbachol(p<0.01), electrical field stimulation(p<0.05) and ATP (p<0.001) in the detrusor smooth muscle of obstructed rats which was normalized after the combination treatment. Cystathionine γ-lyase and cystathionine β-synthase, and nuclear factor kappa B protein levels did not significantly differ among groups. The obstruction induced decrement in 3-mercaptopyruvate sulfur transferase protein expression(p<0.001) and H2S levels(p<0.01) as well as increment in protein expressions of neuronal nitric oxide synthase (NO, p<0.001), endothelial NOS (p<0.05), inducible NOS(p<0.001), hypoxia-inducible factor 1-alpha (p<0.01), and malondialdehyde levels (p<0.01), when combined treatment entirely normalized.
CONCLUSIONS
Combination therapy has beneficial effects on bladder dysfunction via regulating both H2S and nitric oxide pathways as well as downregulation of oxidative stress and hypoxia. The synergistic effect of H2S and nitric oxide is likely to modulate bladder function, which supports the combined therapy for enhancing clinical outcomes in men with BPH/LUTS.
Topics: Adenosine Triphosphate; Animals; Carbachol; Cystathionine beta-Synthase; Cystathionine gamma-Lyase; Hydrogen Sulfide; Hypoxia; Hypoxia-Inducible Factor 1; Male; Malondialdehyde; NF-kappa B; Nitric Oxide; Nitric Oxide Synthase Type I; Oxidative Stress; Rats; Rats, Sprague-Dawley; Sulfides; Sulfur; Tadalafil; Transferases; Urinary Bladder; Urinary Bladder Neck Obstruction
PubMed: 36173409
DOI: 10.1590/S1677-5538.IBJU.2022.0207 -
Urology Annals 2023Benign prostatic hyperplasia is a common benign disease occurs in older men. Some patients can be treated medically but eventually, most of them will need a surgical...
BACKGROUND
Benign prostatic hyperplasia is a common benign disease occurs in older men. Some patients can be treated medically but eventually, most of them will need a surgical intervention, and the most commonly applied procedure is transurethral resection of the prostate (TURP).
OBJECTIVES
The objective of this study is to assess the feasibility and safety of performing transurethral resection of large prostate (80 g and more).
METHODOLOGY
Out of 153 patients reviewed 48 cases included in this study. The main data collected from patients' files and patient interview. The criteria of exclusion were prostate size <80 g and previous history of TURP. The collected data were analyzed by the Statistical Package for the Social Sciences (SPSS).
RESULTS
The main results showed that 93.7% of patients did not experience major bleeding postoperatively, neither major drop in hemoglobin level. Moreover, the patient's distribution according to the presence of TUR syndrome was only 2.1% with mild symptoms. No patient had an episode of retention during the hospital stay or in the follow-up.
CONCLUSION
Surgeon experience, systematic resection approach, and strict time of resection are important factors to assure the safety of TURP in large prostate. In cases of huge prostate size >100 g, staged TURP can be offered safely or if patients' obstructive symptoms do not resolve after the first procedure.
PubMed: 37304516
DOI: 10.4103/ua.ua_192_21 -
Journal of Medical Ultrasound 2019Transrectal ultrasonography (TRUS) is the best route for examining the prostate gland because of transducer proximity, elaboration of zonal anatomical details, and...
BACKGROUND
Transrectal ultrasonography (TRUS) is the best route for examining the prostate gland because of transducer proximity, elaboration of zonal anatomical details, and Doppler assessment of prostatic arteries' hemodynamics.
MATERIALS AND METHODS
This was a cross-sectional study of 300 men with benign prostatic enlargement (BPE) and 300 healthy age-matched controls. The resistive index (RI) of the left capsular, right capsular and urethral arteries were assessed by TRUS and correlated with these parameters: maximum urine flow rate ( ), total prostatic volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), presumed circle area ratio, and the International Prostatic Symptoms Score (IPSS).
RESULTS
The RI of capsular and urethral arteries correlated significantly with , TPV, TZV, TZI, and IPSS. Of the three different RIs evaluated, the RI of UA showed the strongest correlation with (r =- 0.51; < 0.0001). The RIs were significantly higher in obstructive BOO than the non-obstructive group ( of <15 ml/sec and ≥15 ml/sec, respectively). The mean RI values were 0.73 ± 0.05 vs. 0.63 ± 0.04 for the RCA; 0.73 ± 0.05 vs. 0.62 ± 0.04 for the LCA; and 0.73 ± 0.06 vs. 0.62 ± 0.05 for the UA in the BPE and controls, respectively ( < 0.001). The TPV values were 52.36 ± 28.67 and 18.28 ± 4.26 in BPE and controls, respectively ( < 0.001).
CONCLUSION
Prostatic artery RIs are elevated in BPE. Increase in RI correlated with increase in TPV, TZV and TZI, urinary symptoms' severity, poor QOL, and the severity of BOO.
PubMed: 31867189
DOI: 10.4103/JMU.JMU_102_18