Evaluation of Storage Symptoms Improvement and Factors Affecting, After Relief of Obstruction in Patients With Benign Prostatic Enlargement

Urodynamics in the Evaluation and Management of Bothersome Lower Urinary Tract Symptoms in Men With a Prostate

INTRODUCTION

Despite their utility, urodynamics (UDS) are associated with medical risks and patient discomfort. Therefore, it is crucial to select patients for UDS where the results are likely to change clinical decision-making or solidify diagnostic confidence. This narrative review aims to assess the indications, benefits and limitations of UDS in men with a prostate who have refractory lower urinary tract symptoms.

METHODS

A comprehensive review of the literature was conducted, focusing on studies evaluating the utility, patient perspectives, and clinical guidelines related to the use of UDS.

RESULTS

UDS are beneficial in specific clinical scenarios, such as in patients with neurogenic lower urinary tract dysfunction (NLUTD) or when the likelihood of successful intervention is uncertain. For men with suspected BPH, routine UDS before surgical intervention may not be necessary unless there are comorbid conditions such as frailty or a history of radiation that exacerbate risk of surgery or in the presence of significant diagnostic uncertainty, such as in men with suspected neurogenic lower urinary tract dysfunction.

CONCLUSIONS

UDS should be selectively utilized in clinical practice to maximize their diagnostic and therapeutic benefits while minimizing patient discomfort and risks. In men with suspected BPH, UDS should be considered in cases with diagnostic uncertainty or in the presence of significant comorbidities. Further research is needed to refine the indications for UDS and to develop noninvasive alternatives that can provide similar diagnostic insights.

Water Vapor Energy Therapy Safely Reduces Urinary Medication Use: A Multicenter Retrospective Real-World Study in Japan (SCCOP Study 24-01)

OBJECTIVE

The Japanese guidelines for male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) recommend the water vapor energy therapy (WAVE) procedure only for patients in whom conventional BPH surgery is unsuitable due to advanced age or comorbidities. This study aims to evaluate the efficacy and safety of the WAVE procedure using the Rezum system in Japan.

METHODS

This multicenter retrospective study included patients who underwent the WAVE procedure between August 2022 and December 2023. A total of 311 patients from 13 institutions were registered. The number of medications for LUTS was determined before surgery and 6 months after surgery. Additionally, voiding function and perioperative complications were analyzed.

RESULTS

Of the 311 patients, 291 were eligible for analysis. The mean number of LUTS medications significantly decreased from 1.4 to 0.6 (p < 0.001). The mean maximum urinary flow rate significantly improved from 9.8 mL/s preoperatively to 12.2 mL/s at 6 months postoperatively (p < 0.001). The mean post-void residual volume also significantly decreased from 124 to 78 mL (p < 0.001). Furthermore, the mean total International Prostate Symptom Score significantly improved from 17.8 to 8.9 (p < 0.001). Complications classified as Clavien-Dindo Grade III or higher occurred in four cases (1.2%).

CONCLUSION

This large-scale, multicenter study demonstrates that the WAVE procedure improves LUTS, reduces the number of LUTS medications, and is both effective and safe for elderly patients with multiple comorbidities in Japan.

Review of simultaneous treatment with intradetrusor onabotulinumtoxinA injections during transurethral prostate surgery for men with bladder outlet obstruction and overactive bladder

Bladder outlet obstruction (BOO) is common in males with benign prostate enlargement (BPE) and often presents with different lower urinary tract symptoms. Overactive bladder (OAB) has been reported to be related to BOO, although it can also be idiopathic. The storage symptoms of BOO are often similar to those of OAB. The etiology and pathophysiology of both BPE and OAB are multifactorial with metabolic syndrome known as one of the factors. As of today, transurethral prostate surgery remains the gold standard for treating BOO associated with BPE. Intradetrusor onabotulinumtoxinA (BoNT-A) injections have been shown to be effective in treating OAB. However, they are usually administered after transurethral prostate surgery. In view of the strong therapeutic effects of both surgery and injections, the feasibility of combining them in one setting to increase patient comfort, convenience, and possibly results while decreasing costs is appealing to physicians. However, patient safety and possible complications have to be considered. In this article, we review available studies of concurrent intradetrusor BoNT-A injections during transurethral prostate surgery. Although there is no definitive evidence supporting the concurrent use of intradetrusor BoNT-A during transurethral prostate surgery, there are no reports of increased complications too. Further large-scale randomized controlled trials would be necessary to validate the feasibility of combining the treatments in one setting and observe for possible complications.

Predictors of postoperative storage symptoms in male patients with lower urinary tract symptoms: A retrospective analysis of prostate surgery for benign prostatic enlargement

OBJECTIVES

This study investigated the effects of prostate surgery on storage symptoms in male patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargement (BPE). This study aimed to identify patient characteristics associated with improved, unchanged, and deteriorated post-surgical storage symptoms and to identify the risk factors for non-improvement or deterioration.

METHODS

A retrospective analysis of 586 prostate surgeries performed between 2016 and 2022 at Yokosuka Kyosai Hospital was conducted on patients with LUTS and at least one storage symptom preoperatively. Patients with active urinary tract infection, prostate/bladder cancer, urethral strictures, or dementia were excluded. The study enrolled 230 patients and assessed storage symptoms using the International Prostate Symptom Score (IPSS).

RESULTS

Overall, storage symptoms improved, remained unchanged, and deteriorated in 87.0%, 5.7%, and 7.4% of patients, respectively. The patients in the deteriorated group were significantly older, whereas those in the no-change group had smaller prostate volumes. Patient-reported outcome scores (IPSS, IPSS-QoL, and BII) were significantly higher in the improved group. The predictors of non-improvement included low IPSS storage score, cardiovascular disease, and diabetes mellitus. Predictors of deterioration included advanced age and low IPSS storage score.

CONCLUSIONS

Patients with severe LUTS showed greater postoperative improvement in storage symptoms. A low IPSS storage score predicted non-improvement and deterioration. Advanced age, low IPSS storage score, and a history of cardiovascular disease and diabetes mellitus were identified as key predictors. Awareness of these factors may guide preoperative counseling and improve decision-making in prostate surgery, ensuring more personalized and effective treatment strategies.