1
|
Kumar N, Somani B. Monopolar Transurethral Enucleoresection of Prostate: Feasibility of Modified Nesbit's Enucleoresection with Apical Release. J Clin Med 2024; 13:1455. [PMID: 38592292 PMCID: PMC10932116 DOI: 10.3390/jcm13051455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Transurethral resection of the prostate (TURP) has been the standard surgical treatment for Benign Hyperplasia of the Prostate (BPH) for decades. Our objective was to evaluate the outcome of our new technique: Monopolar Transurethral Enucleoresection of the Prostate (TUERP) with apical release (bring it all to centre). Methods: A prospective study of all cases undergoing TUERP at a tertiary centre from January 2020 to October 2022 was performed. Patient demographics, intraoperative variables and postoperative results along with follow-up data were collected. Data of all the cases who had completed a one-year follow-up post-surgery were included and analysed. Results: A total of 240 patients with complete data including a one-year follow-up were included. Mean prostatic volume was 55.3 ± 11.6 gm, and 28 (11.67%) cases were >100 gm. The mean operative time was 31.7 ± 7.6, and mean haemoglobin drop at 24 h was 0.73 ± 1.21 gm/dL. The overall complication rate was 16.67%, with only two (0.83%) Clavien-Dindo III complications (haematuria and clots needing evacuation) and the other complications being Clavien-Dindo I/II complications. Sustained improvement at 1 year of follow-up was noted: Qmax: 25.2 ± 5.6 mL/s, IPSS: 4.7 ± 2.5 and PVR: 22.5 ± 9.6 mL. Conclusions: Monopolar TUERP with a modified Nesbit's enucleoresection with apical release can be considered a promising technique, which needs further studies to be validated with appropriate comparisons.
Collapse
Affiliation(s)
- Nitesh Kumar
- Ford Hospital and Research Centre, Patna 800027, India;
| | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| |
Collapse
|
2
|
Huck C, Achard V, Maitre P, Murthy V, Zilli T. Stereotactic body radiation therapy for prostate cancer after surgical treatment of prostatic obstruction: Impact on urinary morbidity and mitigation strategies. Clin Transl Radiat Oncol 2024; 45:100709. [PMID: 38179576 PMCID: PMC10765005 DOI: 10.1016/j.ctro.2023.100709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
In the past decade, stereotactic body radiation therapy (SBRT) has emerged as a valid treatment option for patients with localized prostate cancer. Despite the promising results of ultra-hypofractionation in terms of tolerance and disease control, the toxicity profile of SBRT for prostate cancer patients with a history of surgical treatment of benign prostate hyperplasia is still underreported. Here we present an overview of the available data on urinary morbidity for prostate cancer patients treated with SBRT after prior surgical treatments for benign prostate hyperplasia. Technical improvements useful to minimize toxicity and possible treatments for radiation-induced urethritis are discussed.
Collapse
Affiliation(s)
- Constance Huck
- Division of Radiation Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Vérane Achard
- Division of Radiation Oncology, Fribourg Cantonal Hospital, Fribourg, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Priyamvada Maitre
- Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vedang Murthy
- Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Thomas Zilli
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| |
Collapse
|
3
|
Daniels JP, Patel DN, Galvan GC, Friedrich NA, Das S, Akhavein A, Daskivich T, Josephson D, Desai P, De Nunzio C, Freedland SJ. Investigating trends in interest for benign prostatic hyperplasia surgery options using Google Trends. Prostate Cancer Prostatic Dis 2024; 27:150-152. [PMID: 37422525 PMCID: PMC10876473 DOI: 10.1038/s41391-023-00692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/07/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
Understanding patient interest among surgical options is challenging. We used Google Trends to analyze interest in benign prostatic hyperplasia (BPH) surgeries recommended for prostate volumes <80 cc. Google Trends was queried with five BPH surgeries. Final rank of search terms was TURP, UroLift, Rezum, Aquablation, and Greenlight. Google Trends can be an effective tool for evaluating public interest trends in BPH surgery.
Collapse
Affiliation(s)
| | | | | | | | - Sanjay Das
- University of California- Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Premal Desai
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Stephen J Freedland
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Durham VA Medical Center, Durham, NC, USA.
| |
Collapse
|
4
|
Wroclawski ML, Takemura LS, Santos HOD, Heldwein FL, Gauhar V, Lim EJ, Law YXT, Teoh JYC, Herrmann TRW, Castellani D. Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta-analysis. Neurourol Urodyn 2024; 43:126-143. [PMID: 38010924 DOI: 10.1002/nau.25336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/22/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Men with detrusor underactivity (DUA) and concomitant bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC). MATERIALS AND METHODS This review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short- and long-term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta-analysis was performed using Review Manager (RevMan) software. RESULTS There were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eight TURP (transurethral resection of the prostate) studies, four GreenLight PVP (photoselective vaporization of the prostate) studies, two HoLEP (Holmium laser enucleation of the prostate) studies, one GreenLight PVP/HoLEP study, one Holmium laser incision of the prostate study, and one study did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long-term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS), lower quality-of-life (QoL) score, better maximum flow rate (Qmax), and lower post-voiding residual (PVR) of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow-up. CONCLUSION In this meta-analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow-up period after surgery.
Collapse
Affiliation(s)
- Marcelo Langer Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Urology, Hospital Beneficencia Portuguesa de Sao Paulo, São Paulo, Brazil
- Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | - Flavio Lobo Heldwein
- Department of Urology, Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
- Department of Urology, National University Hospital, Singapore
| | - Ee Jean Lim
- Department of Urology, National University Hospital, Singapore
| | | | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliera-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
5
|
Sakai A, Borza T, Antar A, Richmond E, Allen GO, Knoedler M, Manakas C, Huang W, Gralnek D, Grimes MD. Incidental Prostate Cancer Diagnosis Is Common After Holmium Laser Enucleation of the Prostate. Urology 2024; 183:170-175. [PMID: 38043905 PMCID: PMC10872358 DOI: 10.1016/j.urology.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/30/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To determine the incidence of incidental prostate cancer detection (iPCa) after holmium laser enucleation of the prostate (HoLEP). The published rate of iPCa after HoLEP is widely variable from 7% to 23% and we aim to define preoperative risk factors for iPCa to inform risk-adjusted preoperative evaluation for PCa. METHODS Consecutive patients undergoing HoLEP from 2018 to 2022 were included and comprehensive clinical data abstracted from a prospectively maintained database. iPCa was defined as a diagnosis of PCa on pathologic examination of the HoLEP specimen. Patients with and without iPCa were compared with respect to preoperative clinical variables. RESULTS Of 913 HoLEP patients, 183 (20%) were diagnosed with iPCa. Most patients (95%) had a preoperative prostate-specific antigen (PSA), 9% had negative MRI, and 30% had negative prostate biopsy. On multivariable analysis, PSA density (OR 1.06; 95% CI 1.03, 1.10; P < .001), preoperative biopsy status (OR 0.47, CI 0.30, 0.75; P = .002), and current 5-alpha reductase inhibitor use (OR 0.64, CI 0.43, 0.97; P = .034), were associated with iPCa diagnosis. CONCLUSION In a significantly prescreened population, we identified a 20% rate of iPCa after HoLEP. Preoperative characteristics associated with iPCa diagnosis included increasing age, increasing PSA density, and current 5-alpha reductase inhibitor use. However, these factors alone may be of limited clinical utility to prospectively identify patients at high risk of iPCa diagnosis. We suggest and advocate for development of a standardized, risk-adapted evaluation focused on expanded use of imaging and selective biopsy to prioritize identification of clinically significant PCa prior to nononcologic surgery.
Collapse
Affiliation(s)
- Akihisa Sakai
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Tudor Borza
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Ali Antar
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Ethan Richmond
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Glenn O Allen
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Margaret Knoedler
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Christopher Manakas
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Wei Huang
- Department of Pathology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Daniel Gralnek
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Matthew D Grimes
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI.
| |
Collapse
|