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Arroyave JS, Larenas F, Massouh R, Gonzalez D, Brown PV, Concha SA, Zaliasnik TA, Giménez B, Palese M, Fulla J. Predictors of symptomatic relief in water vapor thermal therapy for prostatic hyperplasia: 36-month prospective study. World J Urol 2024; 42:576. [PMID: 39412583 DOI: 10.1007/s00345-024-05295-5] [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: 08/08/2024] [Accepted: 09/26/2024] [Indexed: 01/04/2025] Open
Abstract
PURPOSE Existing literature lacks an analysis of factors predicting the achievement of minimum clinically important differences (MCID) after water vapor thermal therapy (WVTT) for prostatic hyperplasia. This study aims to identify these predictors over a 36-month post-WVTT period. METHODS This prospective single surgeon case series assessed male patients receiving WVTT. Eligibility criteria included being at least 45 years old, having an estimated prostate volume (EPV) of 30-80 cc, an International Prostate Symptom Score (IPSS) of 12 points or more, and a maximum urinary flow rate (Qmax) under 16 mL/sec. MCID, representing the smallest symptomatic improvement perceived by patients, was calculated using the distribution-based method, considering half a standard deviation of baseline IPSS scores. Correlation and linear regression analyses assessed MCID attainment. Multivariable logistic regression evaluated MCID achievement, considering multicollinearity, heteroskedasticity, and normality. RESULTS Of 206 men with a median 29.1-month follow-up (Range: 24-36), 13.6% didn't achieve MCID for IPSS, and 7.2% for QoL scores. Significant hindrances to MCID attainment for IPSS were a large median lobe (> 10 mm protrusion) (OR = 3.01, 95% CI: 2.3-3.72), increased median lobe treatments (OR = 1.73, 95% CI: 1.23-2.35), and high preoperative irritative IPSS scores (OR = 1.25, 95% CI: 1.13-1.38). Factors for QoL MCID non-achievement included age over 75 (OR = 1.25, 95% CI: 1.13-1.38), a large median lobe (OR = 1.87, 95% CI: 1.62-2.01), and EPV over 60 cc (OR = 1.55, 95% CI: 1.16-1.97). A 6.3% surgical re-intervention rate was noted. CONCLUSIONS The characteristics of the median lobe as well as the severity of lower urinary tract symptoms are crucial for treatment success. These should be integral to preoperative assessments and patient discussions on treatment options.
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Affiliation(s)
| | - Francisca Larenas
- Department of Urology, Hospital Clínico San Borja Arriarán, Avenida Santa Rosa 1234, Santiago, Chile
- Department of Urology, University of Chile, Santiago, Chile
| | - Ragheb Massouh
- Department of Urology, University of Chile, Santiago, Chile
| | - Diego Gonzalez
- Department of Urology, University of Chile, Santiago, Chile
| | | | | | | | - Belén Giménez
- Department of Urology, Hospital Clínico San Borja Arriarán, Avenida Santa Rosa 1234, Santiago, Chile
- Department of Urology, University of Chile, Santiago, Chile
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan Fulla
- Department of Urology, Hospital Clínico San Borja Arriarán, Avenida Santa Rosa 1234, Santiago, Chile.
- Department of Urology, University of Chile, Santiago, Chile.
- Clínica MEDS, Santiago, Chile.
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Lombardo R, Santarelli V, Turchi B, Santoro G, Guercio A, Franco A, Secco S, Dell’Oglio P, Galfano A, Olivero A, Pastore AL, Al Salhi Y, Fuschi A, Nacchia A, Tema G, Fegiz A, Fusco F, Cini R, Cicione A, Tubaro A, De Nunzio C. Evaluation of Peri-Operative Outcomes after Prostatic Urethral Lift with Emphasis on Urodynamic Changes, Symptom Improvement and Sexual Function. Diagnostics (Basel) 2024; 14:2110. [PMID: 39410516 PMCID: PMC11475309 DOI: 10.3390/diagnostics14192110] [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: 07/30/2024] [Revised: 08/29/2024] [Accepted: 09/20/2024] [Indexed: 10/20/2024] Open
Abstract
Background and Aims: The aim of our study is to evaluate the possible urodynamic effect of prostatic urethral lift (PUL) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Methods: A consecutive series of patients undergoing PUL placement were consecutively enrolled in two centers. Inclusion criteria: ≥50 years of age, benign prostatic obstruction (BPO), international prostate symptom score (IPSS) ≥ 13, prostate volume ≤ 60 mL, and no middle prostate lobe. All patients were evaluated using a detailed clinical history, a validated questionnaire, flexible cystoscopy, and pressure flow studies (PFS) at baseline. PFS were performed at 6 months to evaluate the urodynamic effect of PUL. Results: Overall, 20 patients with a median age of 63 were enrolled. At six months, statistically significant improvements in terms of median Qmax (11.5 vs. 8.5; p < 0.05) and median IPSS (16 vs. 10.5; p < 0.05) were recorded, and sexual function was maintained. All urodynamic parameters improved at 6 months, and significance was reached for all values except for PdetQmax. Finally, Schäfer's class improved from a median of III to a median of II. More specifically, 16/20 presented an improvement in the Schäfer class, and 12/20 patients presented a BOOI < 20 at 6 months. Conclusions: PUL represents an effective treatment in patients with LUTS due to BPH and improves bladder outlet obstruction without any effect on sexual function.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Valerio Santarelli
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Beatrice Turchi
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Giuseppe Santoro
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Alessandro Guercio
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Antonio Franco
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Silvia Secco
- Department of Urology, Ospedale Niguarda, 20162 Milan, Italy; (S.S.); (P.D.)
| | - Paolo Dell’Oglio
- Department of Urology, Ospedale Niguarda, 20162 Milan, Italy; (S.S.); (P.D.)
| | - Antonio Galfano
- Department of Urology, Ospedale Niguarda, 20162 Milan, Italy; (S.S.); (P.D.)
| | - Alberto Olivero
- Department of Urology, Ospedale Niguarda, 20162 Milan, Italy; (S.S.); (P.D.)
| | - Antonio Luigi Pastore
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Yazan Al Salhi
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Andrea Fuschi
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Antonio Nacchia
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Giorgia Tema
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Alessandra Fegiz
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Ferdinando Fusco
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Riccardo Cini
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Antonio Cicione
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Andrea Tubaro
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
| | - Cosimo De Nunzio
- Department of Urology, Sapienza Università di Roma, 00191 Rome, Italy; (V.S.); (B.T.); (G.S.); (A.G.); (A.F.); (Y.A.S.); (A.F.); (A.N.); (G.T.); (A.F.); (F.F.); (R.C.); (C.D.N.)
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Netsch C, Gross AJ, Herrmann TR, Herrmann J, Becker B. [Minimally-Invasive Surgical Techniques (MIST): Shedding Light on the Mist]. Aktuelle Urol 2024; 55:219-227. [PMID: 38547919 DOI: 10.1055/a-2269-1280] [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: 05/30/2024]
Abstract
As life expectancy increases and there is growing demand for BPH treatments, innovative technologies have been developed, allowing for swift recovery, symptom relief, low complication rates, and the possibility of performing procedures on an outpatient basis, often under local anaesthesia. This review aims to describe the outcomes of newly developed minimally-invasive surgical therapies (MIST) for BPH treatment in terms of functional voiding parameters and sexual function. These therapies are categorized into primarily ablative (Aquablation [Aquabeam]), non-ablative (Prostatic Urethral Lift (PUL, Urolift), temporary implantable devices [iTind]), and secondarily ablative procedures (convective water vapor ablation, Rezum, Prostate Artery Embolization [PAE]). All MIST technologies have advanced the medical care of patients with BPH while preserving ejaculation. However, there is a shortage of long-term data specifically addressing re-intervention rates and the preservation of functional voiding parameters. Although there is promising data from regulatory trials and randomized studies, all MIST therapies are potentially associated with severe complications. Patients considering such methods must be thoroughly informed about their inferiority compared with established transurethral procedures like TUR-P and enucleation.
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Affiliation(s)
| | - Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Jonas Herrmann
- Urologie und Urochirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
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Warli SM, Ikram MF, Sarumpaet RG, Tala ZZ, Putrantyo II. The efficacy and safety of prostatic urethral lift as a minimally invasive therapeutic modality to treat lower urinary tract symptoms while maintaining sexual function in patients with benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. Arch Ital Urol Androl 2024; 96:12066. [PMID: 38451253 DOI: 10.4081/aiua.2024.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is prevalent among elderly men, necessitating focused attention. The Prostatic Urethral Lift (PUL) procedure, a minimally invasive intervention, has emerged as a promising option for BPH management. It has shown remarkable results in ameliorating lower urinary tract symptoms (LUTS), enhancing quality of life, and preserving sexual function. This study aims to evaluate the effectiveness and safety of PUL in BPH patients. METHODS Key databases (MEDLINE, Cochrane CENTRAL, ScienceDirect, EBSCO, Google Scholar) were systematically searched using pertinent terms related to PUL and BPH. Following the PRISMA checklist, we considered only randomized controlled trials (RCTs) from 2013 to 2023. The assessment focused on LUTS, quality of life, sexual function, and adverse events within three months. Follow-up post-treatment mean values compared with controls (Sham) and the improvement from baseline to post-treatment follow-up duration were considered. Statistical analysis and risk of bias evaluation were conducted using Review Manager 5.4.1, presenting results as difference of mean values (MD) and risk ratios (RR). RESULTS A meta-analysis with a Random Effects Model of 7 RCTs involving 378 confirmed BPH patients demonstrated significant improvements in the PUL arm including International Prostate Symptom Score (IPSS) (MD 5.51, p<0.0001), maximum urinary flow rate (Qmax) (MD 2.13, p=0.0001), BPH Impact Index (BPHII) (MD 2.14, p=0.0001), and IPSS-QoL (MD 1.50, p<0.0001), without significant increase of adverse events (RR 1.51; p=0.50). Positive outcomes were observed in sexual function variables and post-void residual measurements when post-treatment values were compared to baseline. CONCLUSIONS PUL holds advantages over control interventions, providing encouraging prospects for BPH management. This study underscores the need for further exploration of PUL's efficacy and safety in BPH patients.
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Affiliation(s)
- Syah Mirsya Warli
- Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan; Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara-Haji Adam Malik General Hospital, Medan.
| | | | | | | | - Ignatius Ivan Putrantyo
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Haji Adam Malik General Hospital, Medan.
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Gharbieh S, Reeves F, Challacombe B. The prostatic middle lobe: clinical significance, presentation and management. Nat Rev Urol 2023; 20:645-653. [PMID: 37188789 DOI: 10.1038/s41585-023-00774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
The role of the prostatic middle lobe in the presentation and management of benign prostatic hyperplasia (BPH) is under-appreciated. Middle lobe enlargement is associated with intravesical prostatic protrusion (IPP), which causes a unique type of bladder outlet obstruction (BOO) via a 'ball-valve' mechanism. IPP is a reliable predictor of BOO and the strongest independent factor for failure of medical therapy necessitating conversion to surgical intervention. Men with middle lobe enlargement tend to exhibit mixed symptoms of both the storage and the voiding types, but symptomatology will vary depending on the degree of IPP present. Initial assessments such as uroflowmetry and post-void residual volumes are inadequate to detect IPP and could confound the clinical picture. Radiological evaluation of prostate morphology is key to assessment as it provides important prognostic information and can help with operative planning. Treatment strategies employed for BPH should consider the shape and morphology of prostate adenomata, specifically the presence of middle lobe enlargement and the degree of associated IPP.
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Hughes T, Harper P, Somani BK. Treatment Algorithm for Management of Benign Prostatic Obstruction: An Overview of Current Techniques. Life (Basel) 2023; 13:2077. [PMID: 37895457 PMCID: PMC10608556 DOI: 10.3390/life13102077] [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: 09/24/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The management of benign prostatic obstruction (BPO) should involve a treatment algorithm that takes into account prostate size, and patient's symptoms and preference with the aim of helping with urinary symptoms and enhance quality of life. The diagnostic assessment for men with lower urinary tract symptoms (LUTS) should be comprehensive to help choose the best management strategy. Strategies from lifestyle modifications to medical treatment with alpha blockers and/or 5-alpha-reductase inhibitors to surgical procedures can all be used in the management algorithm. Surgical management ranges from transurethral resection of prostate (TURP) to minimally invasive surgical therapies (MIST) including laser therapies such as Holmium laser enucleation (HoLEP) and photoselective vaporisation (PVP), aquablation, Rezūm system, prostate artery embolisation (PAE), prostatic urethral lift (PUL), temporary implantable nitinol device (iTind) and Optilume BPH catheter system. BPO is a common urological condition that has a significant impact on quality of life and economic burden globally and is likely to become increasingly prevalent with an ageing population. Selecting the most appropriate treatment modality will depend on the individual patient preferences, availability of resources, cost, anatomical factors and the goals of treatment.
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Affiliation(s)
- Thomas Hughes
- Department of Urology, South Warwickshire University Hospital NHS Foundation Trust, Warwick CV34 5BW, UK;
| | - Philip Harper
- Department of Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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