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Samir M, Elaal AAA, Gad KAS, Basyony MW. Two-year follow-up comparing Rezūm therapy versus bipolar transurethral resection of the prostate for treating benign prostatic hyperplasia. A prospective randomized study. Int J Urol 2024; 31:545-550. [PMID: 38291876 DOI: 10.1111/iju.15410] [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: 10/31/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Çakıroğlu B. Minimally invasive connective water vapor energy method for benign prostatic hyperplasia. Urologia 2024; 91:298-305. [PMID: 38069654 DOI: 10.1177/03915603231216191] [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] [Indexed: 05/31/2024]
Abstract
The Rezūm system has emerged as a promising treatment option for benign prostatic hyperplasia (BPH) by employing endoscopic removal of prostate tissue. This meta-analysis aimed to evaluate the benefits and drawbacks of Rezūm therapy in recent studies. A systematic literature search was conducted in EMBASE, PubMed, and the Cochrane Library databases until December 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search utilized keywords such as water vapor thermal therapy, Rezūm, convective water vapor thermal therapy, and convective radiofrequency water vapor thermal therapy. A total of 21 studies were included in the analysis, comprising 5 prospective randomized studies, 2 case series, 2 randomized controlled trials, 1 crossover study, and 11 retrospective studies. The collective sample involved 2090 patients with a mean follow-up period of 14.42 ± 18.08 (1-72) months and a mean age of 68.12 ± 4.79 years. Significant improvements were reported in the International Prostate Symptom Score (IPSS), quality of life (QoL), maximal flow rate (Qmax), postvoid residual urine volume (PVR), prostate volume (PV), and International Erectile Index Function (IIEF) values. Unlike other BPH treatments that often require general or regional anesthesia, the connective water vapor energy system can be administered with sedo-analgesia and local anesthesia, potentially leading to improved sexual function scores. Considering the relief of symptoms, Rezūm therapy may serve as a viable alternative to transurethral surgery for patients with prostate volumes ranging from <30 to >80 cc.
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Affiliation(s)
- Basri Çakıroğlu
- Urology Department, Hisar Intercontinental Hospital, Istanbul, Turkey
- Istanbul Galata University, Istanbul, Turkey
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Feiertag JH, Kane JA, Clark JY. Incidence of Surgical Reintervention for Benign Prostatic Hyperplasia Following Prostatic Urethral Lift, Transurethral Resection of the Prostate, and Photoselective Vaporization of the Prostate: A TriNetX Analysis. EUR UROL SUPPL 2024; 59:63-70. [PMID: 38298771 PMCID: PMC10829608 DOI: 10.1016/j.euros.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 02/02/2024] Open
Abstract
Background Prostatic urethral lift, or UroLift, has gained popularity as a treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Surgical reintervention rates are a reliable indicator for treatment durability. Objective The objective of this study was to utilize TriNetX, a third-party database, to investigate the incidence of surgical reintervention following UroLift, transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) procedures for BPH from 2015 to 2018. Design setting and participants Male patients aged 18-100 yr diagnosed with BPH were identified in the TriNetX Diamond Network database between January 2015 and December 2018. Cohorts of individuals undergoing their first UroLift procedure were built using Current Procedural Terminology and International Classification of Diseases 10th Revision codes. TURP and PVP cohorts were built as comparison groups. The cohorts were then queried for subsequent BPH-related procedures. Outcome measurements and statistical analysis Reprocedure rates were assessed and descriptive statistics were used. Results and limitations The mean age at first-time UroLift was 70.1 ± 9.4 yr (n = 14 343). Cumulative reprocedure rates collected after first-time UroLift included 1 yr after UroLift (5.1%, n = 14 343) and 4 yr after UroLift (16.1%, n = 710), with an average annual increase of +3.6% per year following 1 yr after the procedure. Comparatively, TURP (n = 22 071) and PVP (n = 14 110) had 4-yr reprocedure rates of 7.5% and 7.8%, respectively, during the same timeframe. Limitations include a lack of clinical data and loss of follow-up data outside the Diamond Network. Conclusions The reprocedure rate of UroLift at 4 yr is double the rate of TURP and PVP. In appropriately selected patients, UroLift might be a suitable option for those who desire symptomatic relief from BPH with minimal erectile and ejaculatory side effects. However, the risk of secondary surgical intervention should be considered when considering BPH treatments. Patient summary We compared the reintervention rates of prostatic urethral lift (PUL), transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) using the TriNetX database, and have found that the highest reintervention rates were for PUL of 16% at 4 yr of follow-up, compared with about 8% for those who had TURP and PVP. Interestingly, the most common reintervention was the same operation at 1 yr. This has important implications when counseling patients about the durability of these various outlet procedures for BPH.
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Affiliation(s)
| | - Jennifer A. Kane
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joseph Y. Clark
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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van Kollenburg R, van Riel L, Bloemen P, de Reijke T, Beerlage H, de Bruin D, Oddens J. Transperineal laser ablation as treatment for benign prostatic obstruction: Safety, feasibility and functional outcomes-A pilot study. BJUI COMPASS 2024; 5:52-59. [PMID: 38179027 PMCID: PMC10764162 DOI: 10.1002/bco2.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 01/06/2024] Open
Abstract
Background Standard surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) requires anaesthesia and hospitalization. Transperineal laser ablation (TPLA) is a novel minimally invasive treatment for BPO, which has been performed using local anaesthetics and conscious sedation. Objectives The aim of this study is to assess safety, feasibility and functional outcomes of TPLA for the treatment of LUTS in men fit also for standard surgery. Methods This prospective, multicentre, interventional pilot study included 20 patients. Eligible patients were men ≥40 years of age, with urodynamically proven bladder outlet obstruction, a peak urinary flow of 5-15 mL/s and a prostate volume of 30-120 cc. All subjects underwent Soractelite™ TPLA using the Echolaser® X4 system. Two to four fibres were placed in the prostate, whereafter laser light induced coagulative necrosis. Twelve months of follow-up included uroflowmetry, an ultrasound of the prostate and PROMs (IPSS and IIEF). Results Twenty patients were treated with TPLA using local anaesthetics and optional sedation. Sixteen patients were treated in an outpatient setting, using only local anaesthetics in 12 of them; four were treated in the operating room, whereof two under general anaesthesia. No device related adverse events occurred, nor did any grade ≥3 adverse events during follow-up. Post-TPLA, 10 men continued spontaneous voiding, and 10 men developed a urinary retention treated by a temporary indwelling catheter for 15.2 ± 3.5 days. At 12 months, Qmax improved from 9.7 ± 3.5 to 14.9 ± 6.0 (p = 0.015), IPSS improved from 21.3 ± 5.2 to 10.9 ± 5.5 (p < 0.0001), QoL improved from 4.9 ± 0.9 to 1.9 ± 1.1 (p < 0.0001), IIEF-15 total score remained stable and 11/13 patients (85%) preserved antegrade ejaculation. Conclusions TPLA is a safe and feasible treatment for men with LUTS due to BPO. TPLA can be performed in an outpatient setting under only local anaesthetics. Functional and quality of life outcomes improved significantly at 12 months, and erectile function remained stable.
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Affiliation(s)
- Rob van Kollenburg
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
- Biomedical Engineering and PhysicsAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Luigi van Riel
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
- Biomedical Engineering and PhysicsAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Paul Bloemen
- Biomedical Engineering and PhysicsAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Theo de Reijke
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Harrie Beerlage
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Daniel de Bruin
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
- Biomedical Engineering and PhysicsAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Jorg Oddens
- UrologyAmsterdam University Medical CentresAmsterdamThe Netherlands
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5
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Ornaghi PI, Porreca A, Sandri M, Sciarra A, Falsaperla M, Ludovico GM, Cerruto MA, Antonelli A. Features of patients referring to the outpatient office due to benign prostatic hyperplasia: analysis of a national prospective cohort of 5815 cases. Prostate Cancer Prostatic Dis 2023; 26:730-735. [PMID: 35869394 DOI: 10.1038/s41391-022-00575-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/10/2022] [Accepted: 07/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evidence on clinical presentation of benign prostatic hyperplasia (BPH) is scarce, and studies involving outpatients are lacking. We aimed to provide an insight into the contemporary Italian scenario of BPH-affected outpatients using symptom scores (International Prostate Symptom Score [IPSS], BPH Impact Index [BII]), and to compare characteristics of patients with known BPH and those first-diagnosed at the visit. METHODS "IMPROVING THE PATH" project working group designed a questionary prospectively administered to BPH-affected outpatients by urologists. A cross-sectional study was performed. Data were adjusted for patient age as a potential confounding factor. RESULTS Of 5815 patients enrolled, BPH was already diagnosed in 4144 (71.3%), and not in 1671 (28.7%). Patients with known BPH, compared to newly diagnosed, were older (median 68 versus [vs] 55), had more frequent smoking (smoker 27.2 vs 22.6%, and ex-smoker 16.4 vs 12.5%) and drinking habits (55.4 vs 45.1%), were more frequently affected by hypertension (60.0 vs 42.4%), obesity (15.3 vs 9.6%), diabetes (17.9 vs 12.5%), and cardiovascular diseases (14.2 vs 9.5%), p < 0.001. At IPSS, moderate and severe symptoms correlated with already known BPH (56.1 vs 47.3% and 24.8 vs 7.8%), whereas newly diagnosed patients showed milder symptoms (44.9 vs 19.1%), all p < 0.001. At BII, concern for one's health and time lost due to urinary problems were higher in patients with known BPH (p < 0.001). For these patients, the urologist changes at least one of the ongoing medications in 63.5%. For patients newly diagnosed, supplements/phytotherapeutics, alpha-blockers, and 5-alfa reductase inhibitors were prescribed in 54.6%, 21.6%, and 7.1%, respectively. CONCLUSIONS Despite medical treatment, natural history of BPH leads to a progressive deterioration of symptoms. This may reflect the difference between newly diagnosed patients and those with known BPH in lifestyle and associated comorbidities. A healthy lifestyle and treatments including local anti-inflammatory agents may delay worsening of symptoms and improve quality of life.
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Affiliation(s)
- Paola Irene Ornaghi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, VR, Italy
| | - Angelo Porreca
- Department of Urology, Polyclinic of Abano Terme, Piazza Cristoforo Colombo, 1, 35031, Abano Terme, PD, Italy
| | - Marco Sandri
- Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Via S. Faustino 74/B, 25122, Brescia, BS, Italy
| | - Alessandro Sciarra
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Viale Regina Elena, 328, 00161, Roma, RM, Italy
| | - Mario Falsaperla
- Department of Urology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, piazza Santa Maria di Gesù, 5, 95124, Catania, CT, Italy
| | - Giuseppe Mario Ludovico
- Department of Urology, Regional General Hospital Francesco Miulli, Strada Prov. 127 Acquaviva - Santeramo Km. 4, 70021, Acquaviva delle Fonti, BA, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, VR, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, VR, Italy.
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6
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Woo H, Levin R, Cantrill C, Zhou S, Neff D, Sutton M, Bailen J, Darson M, Horgan J, Zantek P, Marty-Roix R. Prospective Trial of Water Vapor Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia in Subjects with a Large Prostate: 6- and 12-month Outcomes. EUR UROL SUPPL 2023; 58:64-72. [PMID: 38152482 PMCID: PMC10751540 DOI: 10.1016/j.euros.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/29/2023] Open
Abstract
Background Current guidelines recommend Rezūm water vapor thermal therapy for the treatment of benign prostatic hyperplasia (BPH) for prostate glands ranging in volume from 30 to 80 cm3. Few prospective studies have specifically evaluated the use of Rezūm for larger prostates. Objective To evaluate the safety and efficacy of water vapor thermal therapy in patients with a prostate gland >80 cm3 and ≤150 cm3. Design setting and participants In this prospective, single-arm study at seven centers in the USA, subjects were males aged >50 yr with symptomatic BPH and prostate volume of >80 cm3 and ≤150 cm3. Intervention Rezūm was used to deliver sterile water vapor via a transurethral approach to ablate targeted areas of prostate tissue. Outcome measurements and statistical analysis The primary efficacy outcome was response to therapy, defined on a per-patient basis as a ≥30% improvement in International Prostate Symptom Score (IPSS) from baseline to 6 mo. The primary safety outcome was a composite of serious device-related safety events. Secondary outcomes included catheterization for device-related retention. IPSS outcomes over time were analyzed via generalized estimating equations. Results and limitations Among 47 eligible patients, prostate volume ranged from 80.8 to 148.1 cm3. All patients completed 6-mo follow-up, and 40/47completed 12-mo follow-up. At 6 mo, 83% were treatment responders according to the primary efficacy endpoint. The mean IPSS improvement at 6 mo was 11.9 ± 7.5 points, reflecting significant improvement. The primary safety outcome was met, with no occurrence of device-related composite safety events. The study is limited by the nonrandomized design and early termination, unrelated to safety or effectiveness. Conclusions Our results are consistent with previous findings for prostate glands of up to 80 cm3, and indicate the safety and efficacy of Rezūm for BPH in patients with a larger prostate. Patient summary Rezūm therapy, in which water vapor is used to treat targeted areas of the prostate, is currently recommended for patients with benign enlargement of the prostate and a prostate size of up to 80 cm3. We found that this treatment was also effective and safe in patients with a larger prostate of 80-150 cm3.
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Affiliation(s)
- Henry Woo
- College of Health and Medicine, Australian National University and SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, Australia
| | | | | | - Shaw Zhou
- Pinellas Urology, South Pasadena, FL, USA
| | - Donald Neff
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | | - Paul Zantek
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | - Rezūm Clinical Trials Group
- College of Health and Medicine, Australian National University and SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, Australia
- Chesapeake Urology, Baltimore, MD, USA
- Urology of San Antonio, San Antonio, TX, USA
- Pinellas Urology, South Pasadena, FL, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Houston Metro Urology, Houston, TX, USA
- First Urology, Louisville, KY, USA
- Arizona Urology Specialists, Scottsdale, AZ, USA
- Adult & Pediatric Urology, Omaha, NE, USA
- Boston Scientific Corporation, Marlborough, MA, USA
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Busetto GM, Checchia A, Recchia M, Tocci E, Falagario UG, Annunziata G, Annese P, d’Altilia N, Mancini V, Ferro M, Crocetto F, Tataru OS, Gianfrancesco LD, Porreca A, Giudice FD, Berardinis ED, Bettocchi C, Cormio L, Carrieri G. Minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS): promise or panacea? Asian J Androl 2023; 26:00129336-990000000-00138. [PMID: 37921510 PMCID: PMC10919430 DOI: 10.4103/aja202357] [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: 06/29/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
ABSTRACT The increasing importance of treatment of lower urinary tract symptoms (LUTS), while avoiding side effects and maintaining sexual function, has allowed for the development of minimally invasive surgical therapies (MISTs). Recently, the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia (BPH) to the management of nonneurogenic male LUTS. The aim of the present review was to evaluate the efficacy and safety of the most commonly used MISTs: ablative techniques such as aquablation, prostatic artery embolization, water vapor energy, and transperineal prostate laser ablation, and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device (iTIND). MISTs are becoming a new promise, even if clinical trials with longer follow-up are still lacking. Most of them are still under investigation and, to date, only a few options have been given as a recommendation for use. They cannot be considered as standard of care and are not suitable for all patients. Advantages and disadvantages should be underlined, without forgetting our objective: treatment of LUTS and re-treatment avoidance.
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Affiliation(s)
- Gian Maria Busetto
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Andrea Checchia
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Marco Recchia
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Edoardo Tocci
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | | | | | - Pasquale Annese
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Nicola d’Altilia
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Matteo Ferro
- Urology Unit, European Institute of Oncology (IEO) IRCCS, Milan 20141, Italy
| | | | - Octavian Sabin Tataru
- G. E. Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures 540142, Romania
| | - Luca Di Gianfrancesco
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35128, Italy
| | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35128, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Roma 00161, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Roma 00161, Italy
| | - Carlo Bettocchi
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Luigi Cormio
- University of Foggia, Foggia 71122, Italy
- Urology Unit, “L. Bonomo” Hospital, Andria 76123, Italy
| | - Giuseppe Carrieri
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
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Dey A, Mamoulakis C, Hasan N, Yuan Y, Shakil A, Omar MI. Emerging Technologies for the Surgical Management of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Obstruction. A Systematic Review. Eur Urol Focus 2023:S2405-4569(23)00201-8. [PMID: 37741783 DOI: 10.1016/j.euf.2023.09.003] [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: 06/13/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
CONTEXT Surgical management of lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) aims at ablating prostate adenoma by resection, enucleation, or vaporisation. Apart from established ablation modes according to the European Association of Urology guidelines, various technologies have emerged as safe/effective alternatives but remain under investigation. OBJECTIVE To explore short-term benefits/harms of emerging technologies for surgical management of LUTS/BPO. EVIDENCE ACQUISITION A systematic literature search was conducted using MEDLINE, EMBASE, and CENTRAL via Ovid up to June 18, 2022. We included randomised controlled trials (RCTs) exploring aquablation, prostatic arterial embolisation (PAE), Rezum, prostatic urethral lift (PUL), and temporary implantable nitinol device (iTIND) versus sham/transurethral resection of the prostate (TURP). EVIDENCE SYNTHESIS We included ten RCTs (1108 men). Aquablation versus TURP: insignificant change in International Prostate Symptoms Score (IPSS; mean difference [MD] 0.0, 95% confidence interval [CI] -2.44 to 2.44), quality of life (QoL; MD 0.30, 95% CI -0.81 to 0.21), maximum urinary flow rate (Qmax; MD -0.30, 95% CI -3.71 to 3.11), retreatment (risk ratio [RR] 0.18, 95% CI 0.02-1.66), and urinary incontinence (UI; RR 0.71, 95% CI 0.26-1.95). PAE versus monopolar TURP (M-TURP): insignificant change in IPSS (MD 3.33, 95% CI -28.39 to 35.05), QoL (MD 0.12, 95% CI -0.30 to 0.54), International Index of Erectile Function (IIEF-5; MD 3.07, 95% CI -1.78 to 7.92), and UI (RR 0.15, 95% CI 0.01-2.86), and significant change in Qmax (MD -9.52, 95% CI -14.04 to -5.0), favouring M-TURP. PAE versus bipolar TURP: insignificant change in IPSS (MD -2.80, 95% CI -6.61 to 1.01), QoL (MD -0.69, 95% CI -1.46 to 0.08), Qmax (MD -3.51, 95% CI -8.08 to 1.06), UI (RR 0.14, 95% CI 0.01-2.51), and retreatment (RR 1.91, 95% CI 0.19-19.63). PUL versus TURP: insignificant change in QoL (MD 0.40, 95% CI -0.29 to 1.09), UI (RR 0.13, 95% CI 0.02-1.05), and retreatment (RR 0.48, 95% CI 0.12-1.86), and significant change in IPSS (MD 3.40, 95% CI 0.22-6.58), and IIEF-5 (MD 3.00, 95% CI 0.41-5.59) and Qmax (MD -9.60, 95% CI -13.44 to -5.76), favouring PUL and TURP, respectively. Rezum and iTIND have not been evaluated in RCTs against TURP to date. CONCLUSIONS Supporting evidence for clinical use of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits/harms should be investigated further in high-quality RCTs. PATIENT SUMMARY This review summarises the evidence for the clinical use of aquablation, prostatic arterial embolisation (PAE), prostatic urethral lift (PUL), Rezum, and temporary implantable nitinol device (iTIND) to manage lower urinary tract symptoms secondary to benign prostatic obstruction. The supporting evidence for the clinical usage of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits and harms should be investigated further in high-quality randomised controlled trials.
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Affiliation(s)
- Anirban Dey
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | | | - Yuhong Yuan
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ambreen Shakil
- Institute of Education in Healthcare and Medical Sciences, University of Aberdeen, UK
| | - Muhammad Imran Omar
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Guidelines Office, European Association of Urology, Arnhem, The Netherlands.
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9
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Alnazari M, Bakhsh A, Rajih ES. Emphysematous sloughed floating ball after prostate water vaporization Rezum: A case report. World J Clin Cases 2023; 11:5525-5529. [PMID: 37637678 PMCID: PMC10450385 DOI: 10.12998/wjcc.v11.i23.5525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/23/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Rezūm™ water vapor therapy is a new minimally invasive endoscopic technology for the management and treatment of benign prostatic hyperplasia. CASE SUMMARY A 63-year-old male presented to our department with severe dysuria, frequency, urgency, and interrupted stream 2 mo after receiving Rezūm™ therapy. The symptoms were caused by a retained floating emphysematous necrotic sloughed tissue. We also discovered a persistent bacterial infection that was resistant to parenteral antimicrobial therapy. The treatment of the patient included surgical removal of the necrotic tissue. CONCLUSION Despite the good safety profile and minimal adverse events related to Rezūm™ therapy, major complications can still occur.
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Affiliation(s)
- Mansour Alnazari
- Department of Urology, Taibah University, Madinah 16655, Al Madinah, Saudi Arabia
| | - Abdulaziz Bakhsh
- Department of Urology, Taibah University, Madinah 16655, Al Madinah, Saudi Arabia
| | - Emad Sabri Rajih
- Department of Urology, Taibah University, Madinah 16655, Al Madinah, Saudi Arabia
- Urology Section, Department of Surgery, King Faisal Specialist Hospital & Research Center, Madinah, Saudi Arabia
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10
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van Kollenburg RAA, van Riel LAMJG, de Bruin DM, de Reijke TM, Oddens JR. Novel minimally invasive treatments for lower urinary tract symptoms: a systematic review and network meta-analysis. Int Braz J Urol 2023; 49:411-427. [PMID: 37267609 PMCID: PMC10482440 DOI: 10.1590/s1677-5538.ibju.2023.0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/19/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE To review and compare the effectivity of novel minimally invasive treatments (MITs) to transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) in men. METHODS Medline, Embase, and Cochrane databases were searched from January 2010 to December 2022 for randomized controlled trials (RCTs) evaluating MITs, compared to TURP or sham, in men with LUTS. Studies were assessed by risk of bias tool, and evidence by GRADE. Functional outcomes by means of uroflowmetry and IPSS were the primary outcomes, safety and sexual function were secondary outcomes. As part of this review, a network meta-analysis (NMA) was conducted. MITs were ranked based on functional outcome improvement probability. RESULTS In total, 10 RCTs were included, evaluating aquablation, prostatic urethral lift, prostatic artery embolization (PAE), convective water vapor thermal treatment or temporary implantable nitinol device. All MITs showed a better safety profile compared to TURP. Functional outcome improvement following aquablation were comparable to TURP. In the NMA, aquablation was ranked highest, PAE followed with the second highest probability to improve functional outcomes. Other novel MITs resulted in worse functional outcomes compared to TURP. Level of evidence was low to very low. CONCLUSIONS Five MITs for treatment of LUTS were identified. Aquablation is likely to result in functional outcomes most comparable to TURP. Second in ranking was PAE, a technique that does not require general or spinal anesthesia. MITs have a better safety profile compared to TURP. However, due to high study heterogeneity, results should be interpreted with caution.
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Affiliation(s)
- Robertus Arnoldus Antonius van Kollenburg
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
| | - Luigi Antonio Maria Johannes Gerardus van Riel
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
| | - Daniel Martijn de Bruin
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
| | - Theodorus Maria de Reijke
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
| | - Jorg Reinier Oddens
- University of Amsterdam, Biomedical Engineering and PhysicsAmsterdam UMCDepartment of UrologyNetherlandsDepartment of Urology, Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Netherlands
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11
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Cornu JN, Zantek P, Burtt G, Martin C, Martin A, Springate C, Chughtai B. Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol 2023; 83:534-547. [PMID: 36964042 DOI: 10.1016/j.eururo.2023.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
CONTEXT Minimally invasive surgical therapies for male lower urinary tract symptoms secondary to benign prostatic obstruction were developed to be safer and more tolerable than standard ablative techniques. These treatments have not been compared with each other in a randomised fashion, and for some treatments, there are no trials against a reference technique. OBJECTIVE To compare the efficacy, safety, and tolerability of water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device (iTIND), transurethral microwave thermotherapy (TUMT), and transurethral resection of the prostate (TURP). EVIDENCE ACQUISITION A systematic search of MEDLINE/PubMed, Embase, Cochrane Library, and grey literature for randomised controlled trials was performed. Trials meeting the selection criteria were assessed for the risk of bias using the Cochrane RoB2 tool. Treatments were compared, using a network meta-analysis, in terms of outcomes including symptom score, quality of life, maximum urinary flow rate, postvoid residual urine, International Index of Erectile Function (IIEF-5), and scales from the Male Sexual Health Questionnaire. EVIDENCE SYNTHESIS The search identified 63 trials. Symptoms and quality of life for PAE, PUL, and WVTT appeared similar to those for TURP, whereas TURP was found to have the most clinically significant improvement in flow rate. TUMT was less efficacious than TURP but provided similar results on quality of life. Comparisons of ejaculatory function favoured WVTT and PUL compared with TURP. The relative efficacy of iTIND was less clear because of the risk of bias in the respective trial. CONCLUSIONS PAE, PUL, and WVTT appear favourable from a risk-benefit perspective despite probably having less efficacy than TURP for objective outcomes. These findings warrant confirmation through long-term randomised controlled trials. PATIENT SUMMARY This paper has summarised the evidence from 63 clinical trials on minimally invasive surgical therapies for men with symptoms of an enlarged prostate, including water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device, and transurethral microwave thermotherapy (TUMT). Improvement in symptoms for each of PAE, PUL, TUMT, and WVTT in short-term follow-up was similar to that for the standard surgical treatment, although standard surgery appeared to provide the greatest increase in urine flow. Men who had WVTT or PUL were less likely to have problems with sexual function than those who had standard surgery.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France.
| | | | | | | | | | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
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12
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Sahakyan Y, Erman A, Bhojani N, Chughtai B, Zorn KC, Sander B, Elterman DS. Pharmacotherapy vs. minimally invasive therapies as initial therapy for moderate-to-severe benign prostatic hyperplasia: a cost-effectiveness study. Prostate Cancer Prostatic Dis 2023; 26:113-118. [PMID: 35689083 DOI: 10.1038/s41391-022-00561-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/13/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recently, minimally invasive therapies (MITs), such as water vapor thermal therapy (WVTT) and prostatic urethral lift (PUL) have become an alternative to surgery or pharmacotherapy to manage benign prostatic hyperplasia (BPH), offering symptom relief with a favorable safety profile. The objective of this study was to evaluate the cost-utility of MITs (WVTT and PUL) compared to pharmacotherapy as initial treatment for patients with moderate-to-severe BPH. METHODS In this model-based economic evaluation we simulated BPH progression in men (mean age 65 years, average International Prostate Symptom Score 16.6) over their lifetime and estimated healthcare costs (from the US public payer perspective) per quality-adjusted life year (QALY), discounted at 3% annually. Various clinical scenarios were evaluated given that most men undergo several lifelong therapies up to surgical intervention and potentially thereafter. As such, in the study model men could receive up to three lines of therapy: (1) initial pharmacotherapy with MIT as second-line, and transurethral resection of the prostate (TURP) or pharmacotherapy as third-line; (2) initial MIT (WVTT or PUL) with MIT again, TURP or pharmacotherapy as second-line, and TURP as third-line. Model was populated using data from the published literature. Probabilistic analyses were performed. RESULTS Initial treatment with WVTT led to the highest QALYs (13.05) and the lowest cost ($15,461). The cumulative QALYs and lifetime costs were 12.92 QALYs and $20,280 for pharmacotherapy followed by WVTT, 12.87 QALYs and $22,424 for pharmacotherapy followed by PUL, 12.86 QALYs and $20,930 for initial treatment with PUL. In the cost-utility analysis, WVTT as initial treatment dominated all three strategies, i.e., generated more QALYs at a lower cost. CONCLUSION WVTT is an effective and cost-saving procedure, and may be an appropriate first-line alternative to pharmacotherapy for moderate-to-severe BPH patients who seek faster improvement and no lifelong commitment to daily medications.
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Affiliation(s)
- Yeva Sahakyan
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Aysegul Erman
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Naeem Bhojani
- University of Montreal Hospital Center, Montreal, QC, Canada
| | | | - Kevin C Zorn
- University of Montreal Hospital Center, Montreal, QC, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Dean S Elterman
- Division of Urology Krembil Research Institute, University Health Network, Toronto, ON, Canada.
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13
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Khalil IA, Aldeeb M, Mohammed A, Awad K, Ibrahim T, Al-Zoubi RM, Aboumarzouk OM, Al-Rumaihi K. The role of Rezum in the management of refractory urinary retention due to benign prostate hyperplasia: A literature review. Arab J Urol 2023; 21:185-189. [PMID: 37521455 PMCID: PMC10373601 DOI: 10.1080/2090598x.2023.2178104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/04/2023] [Indexed: 02/26/2023] Open
Abstract
Background Benign prostatic hyperplasia is the most common cause of urinary retention in men (BPH). The gold standard surgical treatment is transurethral resection of the prostate (TURP). However, due to the morbidity and mortality associated with TURP, more minimally invasive treatments, such as vaporizing the prostate with the Rezum system, have been introduced. We investigated the efficacy of Rezum in the treatment of refractory urinary retention due to BPH in this review. Methodology and materials To conduct this review, the Cochrane methodology for systematic reviews was used. All studies that used Rezum to treat catheter-dependent patients with enlarged prostates were included. The literature search showed 111 studies, 84 of which were excluded due to non-relevance based on titles and 18 due to lack of relevance based on abstract review. Full manuscripts were reviewed in nine studies, three of which were excluded because they did not meet the inclusion criteria. Results This review included 301 patients in total. The rate of a successful trial of voiding post Rezum therapy was 85%. The complication rated between 3.8 and 4.3% all of which were mild and self-limited. As there was no major complication of Rezum (clavien dindo >2), the procedure-related morbidity is negligible. Conclusion In this review, Rezum was found to be an efficacious and safe alternative in the treatment of refractory retention with mild complications and minimal morbidity.
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Affiliation(s)
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mohammed
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Awad
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Tarek Ibrahim
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Raed M. Al-Zoubi
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar M Aboumarzouk
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Veterinary and Life Science, The University of Medicine, University of Glasgow, Scotland, UK
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14
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Yang CY, Chen GM, Wu YX, Zhang WJ, Wang J, Chen PP, Lou ZY. Clinical efficacy and complications of transurethral resection of the prostate versus plasmakinetic enucleation of the prostate. Eur J Med Res 2023; 28:83. [PMID: 36805825 PMCID: PMC9938974 DOI: 10.1186/s40001-023-00989-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/03/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a common disease in elderly males, and many kinds of minimally invasive procedures can be used for the treatment of BPH. However, various procedures have caused some controversies regarding clinical outcomes, so more studies are needed to validate these controversial topics. AIMS This study aimed to explore differences of clinical efficacy, surgical features, and complications between transurethral resection of the prostate (TURP) and plasmakinetic enucleation of the prostate (PKEP) for BPH. METHODS A total of eligible 850 cases of BPH underwent TURP (the TURP group, 320 cases) or PKEP (the PKEP group, 530 cases) in the urology department of our hospital from March 2015 to 2018 were involved in this study. Then, the baseline data, surgical characteristics, IPSS, QoL, PVR, Qmax, IIEF-5, and documented complications were compared between the two groups. RESULTS The operative time, intraoperative irrigation volume, postoperative hemoglobin, decrease in hemoglobin, postoperative irrigation time and volume, catheterization time, and hospital stay of the PKEP group were significantly less than those of the TURP group (all P < 0.05). At 3 months, 1, 2, and 3 years after operation, no significant differences were observed in IPSS, QoL, PVR, but the results of Qmax and IIEF-5 in the PKEP group were significantly higher than those parameters in the TURP group (all P < 0.05). The incidences of massive blood loss, postoperative secondary bleeding, blood transfusion, capsular perforation, urinary tract irritation, bladder spasm, clot retention, urinary tract infection, transient incontinence, erectile dysfunction, and the incidences of II, III grade of Clavien-Dindo classification in the PKEP group were significantly lower than those of the TURP group (all P < 0.05). CONCLUSION The clinical efficacy of PKEP is compared favorably with TURP during midterm follow-up. Given the merits such as less blood loss and hospital stay, lower complications, PKEP should be given a priority for BPH.
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Affiliation(s)
- Chong-Yi Yang
- grid.507990.2Department of Urology, Ninghai First Hospital, Ningbo, 315600 Zhejiang China
| | - Ge-Ming Chen
- grid.452661.20000 0004 1803 6319Department of Urology, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310000 Zhejiang China
| | - Yue-Xiang Wu
- Community Health Service Center of Yuehu, Ningbo, 315000 Zhejiang China
| | - Wei-Jie Zhang
- grid.507990.2Department of Urology, Ninghai First Hospital, Ningbo, 315600 Zhejiang China
| | - Jie Wang
- grid.507990.2Department of Urology, Ninghai First Hospital, Ningbo, 315600 Zhejiang China
| | - Peng-Peng Chen
- grid.507990.2Department of Urology, Ninghai First Hospital, Ningbo, 315600 Zhejiang China
| | - Zhen-Yuan Lou
- Department of Urology, Ninghai First Hospital, Ningbo, 315600, Zhejiang, China.
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15
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Lucas-Cava V, Sánchez-Margallo FM, Insausti-Gorbea I, Sun F. Comparative efficacy and safety of prostatic urethral lift vs prostatic artery embolization for benign prostatic hyperplasia: a systematic review and network meta-analysis. BJU Int 2023; 131:139-152. [PMID: 35417622 DOI: 10.1111/bju.15748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/31/2022] [Accepted: 04/10/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess and compare the clinical efficacy and safety of prostatic urethral lift (PUL) and prostatic artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) by means of a systematic review and network meta-analysis. METHODS A systematic literature search was performed using PubMed and Web of Science from inception to March 2021 to identify randomized controlled trials (RCTs) that compared PUL or PAE with either transurethral resection of the prostate (TURP) or sham procedures as control interventions. Qualitative and quantitative analyses were performed to pool the data on direct and indirect comparisons between interventions using STATA 14. RESULTS Eight RCTs with 675 participants were included in our network meta-analysis. Quantitative synthesis revealed that TURP was the most efficacious intervention for clinical (International Prostate Symptoms Score and quality of life) and functional outcomes (maximum urinary flow rate and post-void residual urine volume), and was associated with a lower reintervention rate compared with PAE (risk ratio [RR] 2.08 with 95% confidence interval [CI] 0.96 to 4.51) and PUL (RR 2.33 with 95% CI 0.50 to 10.86), although the difference were not statistically significant. Indirect comparison indicated that PUL and PAE resulted in similar outcomes. PAE was associated with fewer minor adverse events (AEs; RR 0.75 with 95% CI 0.48 to 1.18) and PUL with fewer major AEs (RR 0.72 with 95% CI 0.17 to 3.13) when compared with TURP. Whilst PAE had a better ranking with regard to improvement of most clinical and functional outcomes, PUL was the best ranked procedure regarding erectile function, as measured by the International Index of Erectile Function 5, but no significant difference was observed. CONCLUSION Current evidence suggests that PUL and PAE have similar clinical efficacy and safety profiles in the management of LUTS associated with BPH. However, the quality of evidence is relatively low because of the paucity of RCTs available, and results should be interpreted with caution.
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Affiliation(s)
- Vanesa Lucas-Cava
- Endoluminal Therapy and Diagnosis Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Francisco Miguel Sánchez-Margallo
- Scientific Director, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.,CIBER de enfermedades cardiovasculares, Madrid, Spain
| | - Iñigo Insausti-Gorbea
- Department of Interventional Radiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Fei Sun
- Endoluminal Therapy and Diagnosis Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.,CIBER de enfermedades cardiovasculares, Madrid, Spain
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16
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Eure G, Rukstalis D, Roehrborn C. Prostatic Urethral Lift for Obstructive Median Lobes: Consistent Results Across Controlled Trial and Real-World Settings. J Endourol 2023; 37:50-59. [PMID: 35876440 PMCID: PMC9810349 DOI: 10.1089/end.2022.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: The evidence for prostatic urethral lift (PUL), in treating lower urinary tract symptoms/benign prostatic hyperplasia (BPH) in men with obstructive median lobes (OMLs), has grown. In this study, we present the first detailed comparison of outcomes between OML patients treated with PUL in controlled and real-world settings to relevant comparators (subjects treated with transurethral resection of the prostate [TURP] and sham in randomized controlled trials [RCTs]) to demonstrate similar symptom, safety, and patient experience outcomes. Materials and Methods: Symptom and safety outcomes and patient satisfaction were compared through 12 months among controlled PUL studies: BPH6 RCT (35 men randomized to TURP); L.I.F.T. pivotal RCT in subjects with lateral lobe obstruction (66 subjects randomized to sham) and MedLift, an U.S. Food and Drug Administration-approved Investigational Device Exemption (IDE) extension of the L.I.F.T. trial (45 men with OML). Symptom improvement, catheterization, and adverse event rates were compared between MedLift subjects and OML patients (n = 187) from the large real-world retrospective (RWR) study of PUL filtered on baseline characteristics to approximate the MedLift population. Results: Posttreatment, International Prostate Symptoms Score (IPSS) improvement for MedLift subjects was 170% greater compared with sham at 3 months with significantly better quality of life (QoL), Qmax, and benign prostatic hyperplasia impact index (BPHII). Compared with TURP, MedLift IPSS and QoL improved significantly better at 1 and 3 months and with superior ejaculatory function scores at all time points after PUL. IPSS, QoL, postvoid residual (PVR), and Qmax outcomes were equivalent between MedLift and RWR OML groups at 3, 6, and 12 months. RWR OML patients did not experience higher rates of overall adverse events compared with MedLift. Conclusion: Controlled and real-world outcomes confirm PUL is a safe and effective treatment for BPH patients with and without OML.
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Affiliation(s)
- Gregg Eure
- Department of Urology, Urology of Virginia, Virginia Beach, Virginia, USA.,Address correspondence to: Gregg Eure, MS, Department of Urology, Urology of Virginia, Virginia Beach, VA, USA
| | - Daniel Rukstalis
- Prisma Health USC Medical Group, Division of Urology, 300 Palmetto Health Pkwy, Columbia
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17
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Manfredi C, García-Gómez B, Arcaniolo D, García-Rojo E, Crocerossa F, Autorino R, Gratzke C, De Sio M, Romero-Otero J. Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 2022; 8:1711-1732. [PMID: 35803852 DOI: 10.1016/j.euf.2022.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO). OBJECTIVE To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907). EVIDENCE SYNTHESIS A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006). CONCLUSIONS Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk. PATIENT SUMMARY Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.
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Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Borja García-Gómez
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Esther García-Rojo
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Javier Romero-Otero
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain.
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CHECCUCCI E, VOLPI G, DE CILLIS S, PIRAMIDE F, PIANA A, VECCIA A, FALAGARIO U, LOIZZO D, PANDOLFO SD, AUTORINO R, AMPARORE D. Comment on: "Emerging minimally invasive transurethral treatments for benign prostatic hyperplasia: a systematic review with meta-analysis of functional outcomes and description of complications". Minerva Urol Nephrol 2022; 74:475-478. [DOI: 10.23736/s2724-6051.22.04946-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Factors Predicting Successful Same-Day Trial of Void (TOV) after Laser Vaporization of the. Urology 2022; 165:280-284. [DOI: 10.1016/j.urology.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/20/2022]
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20
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Deyirmendjian C, Elterman D, Chughtai B, Zorn KC, Bhojani N. Surgical treatment options for benign prostatic obstruction: beyond prostate volume. Curr Opin Urol 2022; 32:102-108. [PMID: 34669611 DOI: 10.1097/mou.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Many surgical treatment options are available for patients who present with benign prostatic obstruction (BPO). This article reviews the current treatment options available and distinguishes them based on five clinical considerations: antithrombotic therapy, sexual function preservation, ambulatory procedures, anesthesia-related risks and duration of catheterization. RECENT FINDINGS A comprehensive review of the literature was performed on 10 BPO procedures. Laser enucleation of the prostate (LEP), bipolar plasma transurethral vaporization of the prostate and photoselective vaporization (PVP) of the prostate reduces the risk of bleeding, which is recommended for anticoagulated men. Ejaculatory function is more likely to be preserved following transurethral incision of the prostate, Rezūm, Aquablation, UroLift and iTind. Same-day discharge is possible for LEP, PVP and prostatic arterial embolization (PAE). For patients with high anesthesia-related risks, procedures compatible with local anesthesia (UroLift, Rezūm, iTind and PAE) should be favored. Catheterization duration is shorter with UroLift, PVP and LEP. SUMMARY BPO treatment options are growing rapidly. The optimal procedure for a given patient is based on factors such as associated risks, recovery and expected outcomes. Besides prostate volume, the clinical considerations in the present article can help elucidate the best surgical BPO treatment option for each patient based on their values, preferences, and risk tolerance.
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Affiliation(s)
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
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21
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Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis. J Vasc Interv Radiol 2021; 33:359-367.e8. [PMID: 34968671 DOI: 10.1016/j.jvir.2021.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/30/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To review and indirectly compare the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS A literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostate artery embolization (PAE). Data on the following variables were included: international Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and post-void residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect. RESULTS No significant difference in outcomes between therapies were noted for IPSS at the 3-, 6-, and 12-month follow-ups. Although outcomes for rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation vs PAE vs Rezum. TURP PVR was significantly better than Urolift at 3-, 6-, and 12 months. No significant differences in minor or major AEs were noted. CONCLUSION Although significant differences in outcomes were limited, aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while aquablation has limited high quality data and has been associated with bleeding-related complications.
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22
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Zorn KC, Bidair M, Trainer A, Arther A, Kramolowsky E, Desai M, Doumanian L, Elterman D, Kaufman RP, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Uchio E, Gin G, Goldenberg SL, Paterson R, So A, Humphreys M, Roehrborn C, Kaplan S, Motola J, Bhojani N. Aquablation therapy in large prostates (80–150 cc) for lower urinary tract symptoms due to benign prostatic hyperplasia: WATER II 3‐year trial results. BJUI COMPASS 2021; 3:130-138. [PMID: 35474721 PMCID: PMC8988689 DOI: 10.1002/bco2.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 01/09/2023] Open
Abstract
Objective The objective of this study is to determine if Aquablation therapy can maintain its effectiveness in treating men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with large‐volume (80–150 cc) prostates at 3 years. Subjects and Methods One hundred one men with moderate‐to‐severe BPH symptoms and prostate volumes between 80 and 150 cc were enrolled in a prospective, nonrandomized, multicenter, international clinical trial in late 2017. Baseline, procedural, and follow‐up parameters were recorded at baseline and scheduled postoperative visits. IPSS, Qmax, and treatment failure are reported at 3 years. Results The mean prostate volume was 107 cc (range 80–150). Mean IPSS improved from 23.2 at baseline to 6.5 at 3 years (16.3‐point improvement, p < 0.0001). Mean IPSS quality of life improved from 4.6 at baseline to 1.1 at 3 years (improvement of 3.4 points, p < 0.0001). Maximum urinary flow increased from 8.7 to 18.5 cc/s. At 3 year follow‐up, 6% of treated patients needed BPH medication and an additional 3% required surgical retreatment for LUTS. Conclusions Three‐year follow‐up demonstrates a sustained symptom reduction response along with low irreversible complications to Aquablation in men with LUTS due to BPH and prostates of 80–150 cc. Current treatment options available for men with prostates of this size have similar efficacy outcomes but are burdened with high rates of irreversible complications. There are now numerous clinical studies with Aquablation used in various prostates sizes, and it should be offered as an option to men with LUTS due to BPH.
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Affiliation(s)
- Kevin C. Zorn
- University of Montreal Hospital Center University of Montreal Montréal Québec Canada
| | - Mohamed Bidair
- Urology San Diego Clinical Trials San Diego California USA
| | - Andrew Trainer
- Urology Adult Pediatric Urology & Urogynecology, P.C. Omaha Nebraska USA
| | - Andrew Arther
- Urology Adult Pediatric Urology & Urogynecology, P.C. Omaha Nebraska USA
| | | | - Mihir Desai
- Institute of Urology University of Southern California Los Angeles California USA
| | - Leo Doumanian
- Institute of Urology University of Southern California Los Angeles California USA
| | - Dean Elterman
- University Health Network University of Toronto Toronto Ontario Canada
| | | | - James Lingeman
- Urology Indiana University Health Physicians Indianapolis Indiana USA
| | - Amy Krambeck
- Urology Indiana University Health Physicians Indianapolis Indiana USA
| | - Gregg Eure
- Urology Urology of Virginia Virginia Beach Virginia USA
| | - Gopal Badlani
- Urology Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Mark Plante
- Urology University of Vermont Medical Center Burlington Vermont USA
| | - Edward Uchio
- Urology VA Long Beach Healthcare System Long Beach California USA
| | - Greg Gin
- Urology VA Long Beach Healthcare System Long Beach California USA
| | | | - Ryan Paterson
- Urology University of British Columbia Vancouver British Columbia Canada
| | - Alan So
- Urology University of British Columbia Vancouver British Columbia Canada
| | | | - Claus Roehrborn
- UT Southwestern Medical Center, Department of Urology University of Texas Southwestern Dallas Texas USA
| | - Steven Kaplan
- Urology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Jay Motola
- Urology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Naeem Bhojani
- University of Montreal Hospital Center University of Montreal Montréal Québec Canada
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23
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New Ultra-minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia: A Systematic Review and Analysis of Comparative Outcomes. EUR UROL SUPPL 2021; 33:28-41. [PMID: 34604814 PMCID: PMC8473553 DOI: 10.1016/j.euros.2021.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Context Benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) is diagnosed in up to 80% of men during their lifetime. Several novel ultra-minimally invasive surgical treatments (uMISTs) for BPH/benign prostatic obstruction (BPO) have become available over the past 5 yr. Objective To evaluate the perioperative and functional outcomes of recently introduced uMISTs for BPH/BPO, including Urolift, Rezūm, temporary implantable nitinol device, prostatic artery embolization (PAE), and intraprostatic injection. Evidence acquisition A systematic literature search was conducted in December 2020 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science (registered on PROSPERO as CRD42021225014). The search strategy used PICO criteria and article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Pooled and cumulative analyses were performed to compare perioperative and functional outcomes between study groups. A random-effects model using the DerSimonian and Laird method was used to evaluate heterogeneity. Stata version 15.0 software was used for all statistical analyses. Evidence synthesis The initial electronic search identified 3978 papers, of which 48 ultimately met the inclusion criteria and were included in the analysis. Pooled analysis revealed a uMIST benefit in terms of International Prostate Symptom Score (IPSS; −9.81 points, 95% confidence interval [CI] −11.37 to −8.25 at 1 mo; −13.13 points, 95% CI −14.98 to −11.64 at 12 mo), maximum flow rate (from +3.66 ml/s, 95% CI 2.8–4.5 to +4.14 ml/s, 95% CI 0.72–7.56 at 12 mo), and postvoid residual volume (−10.10 ml, 95% CI −27.90 to 7.71 at 12 mo). No negative impact was observed on scores for the International Index of Erectile Function-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction bother and function scales (overall postintervention change in pooled median score of 1.88, 95% CI 1.34–2.42 at the start of follow-up; and 1.04, 95% CI 0.28–1.8 after 1 yr), or the IPSS-Quality of Life questionnaire. Conclusions Novel uMISTs can yield fast and effective relief of LUTS without affecting patient quality of life. Only Rezūm, UroLift, and PAE had a minimal impact on patients’ sexual function with respect to baseline, especially regarding preservation of ejaculation. Patient summary We reviewed outcomes for recently introduced ultra-minimally invasive surgical treatments for patients with lower urinary tract symptoms caused by benign prostate enlargement or obstruction. The evidence suggests that these novel techniques are beneficial in terms of controlling symptoms while preserving sexual function. Take Home Message Novel ultra-minimally invasive treatments can yield fast and effective relief of lower urinary tract symptoms without affecting a patient’s quality of life.
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24
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Manfredi C, Arcaniolo D, Spatafora P, Crocerossa F, Fusco F, Verze P, Fiori C, Damiano R, Cindolo L, DE Sio M, Otero JR. Emerging minimally invasive transurethral treatments for benign prostatic hyperplasia: a systematic review with meta-analysis of functional outcomes and description of complications. Minerva Urol Nephrol 2021; 74:389-399. [PMID: 34308611 DOI: 10.23736/s2724-6051.21.04530-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Several minimally invasive surgical procedures have been proposed as alternative therapies for benign prostatic hyperplasia (BPH). The present systematic review aimed to describe the functional outcomes and complications of emerging minimally invasive transurethral treatments for BPH. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE and Cochrane Library databases was conducted. No chronological restriction was applied. Retrospective and prospective primary studies were included. A meta-analysis of IPSS, IPSS-QoL, Qmax, and PVR was performed. Data on adverse events were presented narratively. EVIDENCE SYNTHESIS A total of 18 studies were included. Thirteen papers were eligible for the meta-analysis. iTIND, Rezūm, and Aquablation were associated with a significant improvement in IPSS (p<0.001), IPSS-QoL (p<0.001), and Qmax (p<0.001) compared to baseline. A significant reduction of PVR from baseline was found with Rezūm (p<0.001) and Aquablation (p<0.001) but not iTIND (p=0.22). A significant difference in IPSS, IPSS-QoL, and Qmax was shown in favor of Aquablation compared to Rezūm and iTIND (p<0.001). Rezūm and iTIND were mainly associated with mild to moderate adverse effects. Hematuria or bleeding was reported in all studies regarding Aquablation (0.8%-26%), the need for transfusion or intervention for bleeding varied between 1.8% and 9%. CONCLUSIONS Aquablation, Rezūm, and iTIND significantly improve urinary functional outcomes compared to baseline; however, Aquablation would seem to lead to better functional results compared to the other procedures. Rezūm and iTIND appear to have an excellent safety profile, while Aquablation would seem to expose patients to a nonnegligible risk of bleeding.
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Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy -
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pietro Spatafora
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Ferdinando Fusco
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Verze
- Department of Medicine, Surgery, Dentistry Scuola Medica Salernitana, University of, Salerno, Salerno, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Luca Cindolo
- Department of Urology, Villa Stuart Private Hospital, Rome, Italy
| | - Marco DE Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Javier R Otero
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Unit of Urology, HM Hospitales, Montepríncipe, Puerta del Sur, Sanchinarro, Madrid, Spain
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25
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Loloi J, Feiertag N, Gautam K, Maria P. An Update on the Outcomes of Patients Treated with Urolift for Benign Prostatic Hyperplasia. Res Rep Urol 2021; 13:347-355. [PMID: 34150678 PMCID: PMC8205643 DOI: 10.2147/rru.s273692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/12/2021] [Indexed: 02/05/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a ubiquitous urologic disease affecting aging men. Patients often experience bothersome lower urinary tract symptoms (LUTS) that warrant urologic evaluation and management. Routinely, patients are initially treated with medical therapies with the goal of both relaxing the bladder neck and shrinking the prostate in order to relieve obstruction secondary to prostatic enlargement. Transurethral resection of the prostate (TURP) serves as a first-line surgical intervention in those who fail medical therapy. Recently, novel minimally invasive surgical techniques for BPH management have emerged. Of these, prostatic urethral lift (PUL or Urolift) has gained attention given its presumed effectiveness and minimal risk of sexual side effects when compared to the standard TURP. The purpose of this review is to describe past and current trends in the implementation of PUL for BPH and to highlight important outcomes.
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Affiliation(s)
- Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | | | | | - Pedro Maria
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
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26
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Light A, Jabarkhyl D, Gilling P, George G, Van Hemelrijck M, Challacombe B, Malde S, Popert R, Dasgupta P, Elhage O. Erectile Function Following Surgery for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis of Randomised Controlled Trials. Eur Urol 2021; 80:174-187. [PMID: 34127315 DOI: 10.1016/j.eururo.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Benign prostatic obstruction (BPO) is associated with sexual dysfunction. Furthermore, numerous BPO interventions may themselves impact sexual function. OBJECTIVE To perform a systematic review with network meta-analysis to evaluate how BPO interventions affect erectile function. EVIDENCE ACQUISITION Three databases were searched for randomised controlled trials (RCTs) comparing surgical interventions for BPO. The primary outcome was postoperative International Index of Erectile Function-5 (IIEF-5) score at ten time points up to 72 mo. A random-effects Bayesian network meta-analysis with meta-regression was performed. In comparison to monopolar transurethral resection (mTURP), the mean difference (MD) with 95% credible interval (CrI) and rank probability (rank p) were calculated for interventions. The mean baseline score was studied in meta-regression. τ2 values were used to quantify heterogeneity. EVIDENCE SYNTHESIS A total of 48 papers (33 RCTs, 5159 patients, 16 interventions) were included. Prostatic urethral lift (PUL) ranked highest at 1 mo (MD 3.88, 95% CrI -0.47 to 8.25; rank p = 0.742), 6 mo (MD 2.43, 95% CrI -0.72 to 5.62; rank p = 0.581), 12 mo (MD 2.94, 95% CrI -0.26 to 6.12, rank p = 0.782), and 24 mo (MD 3.63, 95% CrI 0.14 to 7.11; rank p = 0.948), at which point statistical significance was reached. At time points up to 60 mo, there were no statistically significant comparisons for other interventions. Analyses were not possible at 18, 48, or 72 mo. β did not reach statistical significance in meta-regression. τ2 was highest at 1 mo (0.56) and 60 mo (0.55). CONCLUSIONS PUL ranked highly and resulted in erectile function improvement at 24 mo compared to mTURP, but direct evidence is lacking. We did not observe significant differences in erectile function following other interventions up to 60 mo. Owing to heterogeneity, our conclusions are weakest at 1 and 60 mo. Further RCTs comparing sexual function outcomes are recommended, such as PUL versus holmium laser or bipolar enucleation. PATIENT SUMMARY Different surgical treatments can be used to treat benign enlargement of the prostate causing urinary problems. We compared the effects of various treatments on erectile function at time points up to 5 years after surgery. Compared to surgical removal of some of the prostate gland (transurethral resection of the prostate, TURP), a technique called prostatic urethral lift resulted in better erectile function scores at 24 months. However, other treatments did not differ in their effect on erectile function.
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Affiliation(s)
- Alexander Light
- Department of Surgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Dost Jabarkhyl
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Peter Gilling
- Department of Urology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Gincy George
- Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Ben Challacombe
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rick Popert
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Oussama Elhage
- Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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27
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Baboudjian M, Fourmarier M, Gondran-Tellier B, Pradere B, Userovici M, Alegorides C, Barry Delongchamps N. Head-to-head comparison of prostatic urethral lift and water vapor thermal therapy for the treatment of symptomatic benign prostatic hyperplasia: a real-life study. Int Urol Nephrol 2021; 53:1757-1763. [PMID: 34052957 DOI: 10.1007/s11255-021-02899-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed at reporting a head-to-head comparison between water vapor thermal therapy using the Rezūm™ system and prostatic urethral lift using the Urolift™ system in men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS From December 2017 to November 2019, consecutive patients who underwent Rezūm™ and Urolift™ procedures in two urology centers have been retrospectively considered. Only patients with a prostate size less than 80 mL were included. We used the PSM method to adjust baseline differences between both groups. The co-primary endpoint included the change in International Prostate Symptom Score (IPSS) and IPSS- quality of life (QoL) from baseline to 12 months. RESULTS A total of 61 (52.1%) and 56 (47.9%) patients underwent Rezum™ and Urolift™ procedures, respectively. After PSM adjustment, 24 patients were included in both groups. No serious adverse events occurred (> Clavien II) in both groups. At 12 months, higher IPSS improvement was observed in the Rezum™ group (median:4 [IQR 3-5]) than in the Urolift™ group (median:8 [IQR 7-12]), without statistical difference (p = 0.08). The improvement in term of QoL at 12 m was similar (p = 0.43). The retreatment rates were 25% (Urolift™) and 8.3% (Rezum™), p = 0.24. Erection and ejaculatory function scores did not change significantly in either treatment group. Results in the full cohort showed that Rezum™ appeared to deliver greater improvements for IPSS and IPSS-QoL (p < 0.001 and p = 0.006, respectively) and lower reintervention rate (p = 0.006) than Urolift™. CONCLUSIONS In this small retrospective study, our results indicate that both Rezum™ and Urolift™ provide a clinically significant improvement in symptoms and QoL, although some of these improvements were greater in the Rezum™ arm. Future studies are needed to definitively assess which treatment would be best suited for each patient.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, Aix-en-Provence Hospital, Aix en Provence, France. .,Department of Urology and Kidney Transplantation, La Conception Hospital, AixMarseille University, APHM, Marseille, France.
| | - Marc Fourmarier
- Department of Urology, Aix-en-Provence Hospital, Aix en Provence, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, La Conception Hospital, AixMarseille University, APHM, Marseille, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mickael Userovici
- Department of Urology, Cochin Hospital, APHP, University of Paris Descartes, Paris, France
| | - Camille Alegorides
- Department of Urology, Aix-en-Provence Hospital, Aix en Provence, France
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28
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Higazy A, Osman D, Osman T. Rezum: a novel minimally invasive treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. A review article. Int Urol Nephrol 2021; 53:1747-1756. [PMID: 33932221 DOI: 10.1007/s11255-021-02878-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022]
Abstract
Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are one of the most common morbidities in elderly men, especially in aging societies. Minimally invasive surgical treatments (MISTs) for BPH have gained an increasing interest in the current time. Rezum system is a novel MIST that uses water vapour-based convective thermal therapy to ablate prostatic tissue. According to our evaluation of the existing literature, Rezum offers a meaningful relief of LUTS with a high safety profile without compromising the sexual activity especially to those who are unfit for surgery or to those who do not desire to continue on lifelong pharmacotherapy.
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Affiliation(s)
- Ahmed Higazy
- Ain Shams University Hospitals, Cairo, 11376, Egypt.
| | - Dana Osman
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tarek Osman
- Ain Shams University Hospitals, Cairo, 11376, Egypt
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