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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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Cheng Y, Li T, Wu X, Ling Q, Rao K, Yuan X, Chen Z, Du G, Xu S. The diagnostic value of non-invasive methods for diagnosing bladder outlet obstruction in men with lower urinary tract symptoms: A meta-analysis. Front Surg 2022; 9:986679. [PMID: 36338622 PMCID: PMC9632994 DOI: 10.3389/fsurg.2022.986679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose We conducted the first meta-analysis to determine the diagnostic value of non-invasive methods for diagnosing bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS). Methods We searched a range of databases for relevant publications up to June 2022, including PubMed, Embase, Web of Science, and the Cochrane Library. Retrieved studies were then reviewed for eligibility and data were extracted. The risk of bias (RoB) was assessed using the QUADAS-2 tool. We then performed a formal meta-analysis to evaluate the accuracy of various non-invasive methods for diagnosing BOO in men. Results We identified 51 eligible studies including 7,897 patients for meta-analysis. The majority of the studies had a low overall RoB. Detrusor wall thickness (DWT) (pooled sensitivity (SSY): 71%; specificity (SPY): 88%; diagnostic odds ratio (DOR): 17.15; area under curve (AUC) 0.87) and the penile cuff test (PCT) (pooled SSY: 87%; SPY: 78%; DOR: 23.54; AUC: 0.88) showed high accuracy for diagnosing BOO. Furthermore, data suggested that DWT had the highest pooled SPY (0.89), DOR (32.58), and AUC (0.90), when using 2 mm as the cut-off. Conclusion Of the non-invasive tests tested, DWT and PCT had the highest levels of diagnostic accuracy for diagnosing BOO in men with LUTS. DWT, with a 2 mm cut-off, had the highest level of accuracy. These two methods represent good options as non-invasive tools for evaluating BOO in males.
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Semi-Automatic MRI Feature Assessment in Small- and Medium-Volume Benign Prostatic Hyperplasia after Prostatic Artery Embolization. Diagnostics (Basel) 2022; 12:diagnostics12030585. [PMID: 35328138 PMCID: PMC8946889 DOI: 10.3390/diagnostics12030585] [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] [Received: 01/26/2022] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: To assess the treatment response of benign prostatic syndrome (BPS) following prostatic artery embolization (PAE) using a semi-automatic software analysis of magnetic resonance imaging (MRI) features and clinical indexes. (2) Methods: Prospective, monocenter study of MRI and clinical data of n = 27 patients with symptomatic BPS before and (1, 6, 12 months) after PAE. MRI analysis was performed using a dedicated semi-automatic software for segmentation of the central and the total gland (CG, TG), respectively; signal intensities (SIs) of T1-weighted (T1w), T2-weighted (T2w), and diffusion-weighted images (DWI), as well as intravesical prostatic protrusion (IPP) and prostatic volumes (CGV, TGV), were evaluated at each time point. The semi-automatic assessed TGV was compared to conventional TGV by an ellipse formula. International prostate symptom score (IPSS) and international consultation on incontinence questionnaire−urinary incontinence short form (ICIQ-UI SF) questionnaires were used as clinical indexes. Statistical testing in the form of ANOVA, pairwise comparisons using Bonferroni correction, and multiple linear correlations, were conducted using SPSS. (3) Results: TGV was significantly reduced one, six, and 12 months after PAE as assessed by the semi-automatic approach and conventional ellipse formula (p = 0.005; p = 0.025). CGV significantly decreased after one month (p = 0.038), but showed no significant differences six and 12 months after PAE (p = 0.191; p = 0.283). IPP at baseline was demonstrated by 25/27 patients (92.6%) with a significant decrease one, six, and 12 months after treatment (p = 0.028; p = 0.010; p = 0.008). Significant improvement in IPSS and ICIQ-UI SF (p = 0.002; p = 0.016) after one month correlated moderately with TGV reduction (p = 0.031; p = 0.05, correlation coefficients 0.52; 0.69). Apparent diffusion coefficient (ADC) values of CG significantly decreased one month after embolization (p < 0.001), while there were no significant differences in T1w and T2w SIs before and after treatment at each time point. (4) Conclusions: The semi-automatic approach is appropriate for the assessment of volumetric and morphological changes in prostate MRI following PAE, able to identify significantly different ADC values post-treatment without the need for manual identification of infarct areas. Semi-automatic measured TGV reduction is significant and comparable to the TGV calculated by the conventional ellipse formula, confirming the clinical response after PAE.
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Lee J, Choo MS, Yoo S, Cho MC, Son H, Jeong H. Intravesical Prostatic Protrusion and Prognosis of Non-Muscle Invasive Bladder Cancer: Analysis of Long-Term Data over 5 Years with Machine-Learning Algorithms. J Clin Med 2021; 10:jcm10184263. [PMID: 34575374 PMCID: PMC8468209 DOI: 10.3390/jcm10184263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/28/2022] Open
Abstract
We aim to investigate the significance of intravesical prostate protrusion (IPP) on the prognosis of non-muscle invasive bladder cancer (NMIBC) after the transurethral resection of bladder tumors (TURBT). For newly diagnosed NMIBC, we retrospectively analyzed the association between prognosis and IPP for at least a 5-year follow-up. A degree of IPP over 5 mm in a preoperative CT scan was classified as severe. The primary endpoint was recurrence-free survival, and the secondary endpoint was progression-free survival. The machine learning (ML) algorithm of a support vector machine was used for predictive model development. Of a total of 122 patients, ultimately, severe IPP was observed in 33 patients (27.0%). IPP correlated positively with age, BPH, recurrence, and prognosis. Severe IPP was significantly higher in the recurrence group and reduced in the recurrence-free survival group (p = 0.038, p = 0.032). Severe IPP independently increased the risk of intravesical recurrence by 2.6 times. The addition of IPP to the known oncological risk factors in the prediction model using the ML algorithm improved the predictability of cancer recurrence by approximately 6%, to 0.803. IPP was analyzed as a potential independent risk factor for NMIBC recurrence and progression after TURBT. This anatomical feature of the prostate could affect the recurrence of bladder tumors.
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Tanuma Y, Tanaka Y, Okamoto T. Cutoff level of prostate volume to predict the efficacy of α1-D/A adrenoceptor antagonist, naftopidil. Urol Ann 2021; 13:296-300. [PMID: 34421268 PMCID: PMC8343274 DOI: 10.4103/ua.ua_93_20] [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] [Received: 06/11/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: In lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) patients, prostate volume (PV) at baseline affects the improvement of International Prostate Symptom Score voiding symptoms (IPSS-VS) by naftopidil (NAF), but not total IPSS (IPSS-TS). To predict the efficacy of NAF, the PV cutoff point was examined using IPSS-VS. Materials and Methods: Seventy-seven patients with LUTS/BPH were administrated with NAF 50 mg/day for 4 weeks. Age, PV, IPSS, IPSS quality-of-life (IPSS-QoL), and maximum flow rate (MFR) were evaluated at baseline, and IPSS, IPSS-QoL, and MFR were evaluated after the treatment (at 4 weeks). Responders and nonresponders were divided by IPSS-VS at 4 weeks, and the PV cutoff point was calculated. Results: At baseline, the mean age and PV were 70.7 ± 8.2 years (range, 54–88 years) and 43.3 ± 24.5 mL (range, 20.6–141.7 mL), respectively. After 4 weeks, area under the receiver operating characteristic curve was largest in the patients with <4 points of IPSS-VS. The best standard value to evaluate the efficacy IPSS-VS at 4 weeks was 4 points for the NAF treatment, and the best PV cutoff point was 37.3 mL (sensitivity 60.5%, specificity 71.9%). Conclusions: PV at baseline was one of the predictive factors which affected the efficacy of NAF for IPSS-VS, and LUTS/BPH patients who had PV more than 37.3 mL indicated poor improvement of IPSS-VS, even if IPSS-TS was improved.
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Affiliation(s)
- Yasushi Tanuma
- Department of Urology, Hokkaido Social Welfare Association Hakodate Hospital, Hokkaido, Japan
| | - Yoshinori Tanaka
- Department of Urology, Hokkaido Prefectural Esashi Hospital, Hokkaido, Japan
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Eze BU, Ani CO, Mbaeri TU. Is intravesical prostatic protrusion associated with more complications in benign prostatic hyperplasia patients? Low Urin Tract Symptoms 2021; 13:468-474. [PMID: 34080315 DOI: 10.1111/luts.12394] [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: 01/13/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Intravesical prostatic protrusion (IPP) is a noninvasive parameter that can predict disease progression and development of complications in benign prostatic hyperplasia (BPH). This study was to determine the relationship between IPP and the presence of complications in BPH patients. METHODS This was a cross-sectional study of BPH patients at Enugu State University of Science and Technology Teaching Hospital, Enugu. Patients were assessed for acute urinary retention (AUR), chronic urinary retention (CUR), epididymoorchitis, hematuria, hernia, urinary tract infection (UTI), serum creatinine, and prostate-specific antigen (PSA). They also had abdominal ultrasonography assessments for IPP, total prostate volume, bladder wall thickness (BWT), postvoid residual (PVR), hydronephrosis, bladder diverticulum, and urolithiasis using Sonoscape S11 with an abdominal-probe frequency of 3.5 MHz. IPP was measured in millimeter and divided into <10 mm and ≥10 mm. Data were analyzed using SPSS version 21 and were subjected to 1-way analysis of variance, chi-square test, and Pearson correlation. The odds ratios of development of complications at an IPP cutoff of 10 mm were calculated. P < .05 was considered significant. RESULTS A total of 118 patients with a mean age of 64.18 ± 10.96 years and a mean IPP of 14.29 ± 10.20 mm were included. Forty-eight patients had IPP < 10 mm and seventy patients ≥10 mm. Patients with IPP ≥10 mm had significantly higher mean BWT, International Prostate Symptom Score (IPSS), PSA, and PVR (P ≤ .05) and significantly more AUR, CUR, hematuria, hydronephrosis, and UTI (P ≤ .01). CONCLUSION Patients with IPP ≥ 10 mm have a significantly higher incidence of some complications.
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Affiliation(s)
- Balantine Ugochukwu Eze
- Department of Surgery, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Chinenye Obiageli Ani
- Department of Radiology, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Timothy Uzoma Mbaeri
- Department of Surgery, Faculty of Medical Sciences, Nnamdi Azikiwe University, Awka, Nigeria
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Manov JJ, Mohan PP, Kava B, Bhatia S. Benign Prostatic Hyperplasia: A Brief Overview of Pathogenesis, Diagnosis, and Current State of Therapy. Tech Vasc Interv Radiol 2020; 23:100687. [PMID: 33308528 DOI: 10.1016/j.tvir.2020.100687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As prostatic artery embolization is assuming an increasingly important role in the management of benign prostatic hyperplasia, it is important for the practicing interventional radiologist to have a deep understanding of all aspects of the disease process and the available treatment options. This paper provides a comprehensive overview of the pathophysiology, diagnosis and management options for benign prostatic hyperplasia with an emphasis on the surgical and medical treatments.
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Affiliation(s)
- John J Manov
- Department of Radiology, University of Miami, Miller School of Medicine, FL.
| | - Prasoon P Mohan
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, FL
| | - Bruce Kava
- Department of Urology, University of Miami, Miller School of Medicine, FL
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, FL
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Measurement of Prostate Volume with MRI (A Guide for the Perplexed): Biproximate Method with Analysis of Precision and Accuracy. Sci Rep 2020; 10:575. [PMID: 31953425 PMCID: PMC6969030 DOI: 10.1038/s41598-019-57046-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
To review the anatomic basis of prostate boundary selection on T2-weighted magnetic resonance imaging (MRI). To introduce an alternative 3D ellipsoid measuring technique that maximizes precision, report the intra- and inter-observer reliability, and to advocate it's use for research involving multiple observers. We demonstrate prostate boundary anatomy using gross pathology and MRI examples. This provides background for selecting key boundary marks when measuring prostate volume. An alternative ellipsoid volume method is then proposed using these boundaries in an attempt to improve inter-observer precision. An IRB approved retrospective study of 140 patients with elevated serum prostate specific antigen levels and/or abnormal digital rectal examinations was done with T2-weighted MRI applying a new (Biproximate) technique. Measurements were made by 2 examiners, correlated with each other for inter-observer precision and correlated with an expert observer for accuracy. Correlation statistics, linear regression analysis, and tests of means were applied using p ≤ 0.05 as the threshold for significance. Inter-observer correlation (precision) was 0.95 between observers. Correlation between these observers and the expert (accuracy) was 0.94 and 0.97 respectively. Intra-observer correlation for the expert was 0.98. Means for inter-rater reliability and accuracy were all the same (p = 0.001). We conclude that using more precise reproducible landmarks with biproximate technique, precision and accuracy of total prostate volume is found to be demonstrated.
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Maron SZ, Sher A, Kim J, Lookstein RA, Rastinehad AR, Fischman A. Effect of Median Lobe Enlargement on Early Prostatic Artery Embolization Outcomes. J Vasc Interv Radiol 2020; 31:370-377. [PMID: 31956004 DOI: 10.1016/j.jvir.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To evaluate outcomes after prostatic artery embolization (PAE) in patients with severe intravesical prostatic protrusion (IPP). MATERIALS AND METHODS This was a retrospective, single health system, 2-hospital study from April 2015 to December 2018 of 54 patients who underwent elective PAE procedures (age mean 67.5 years; standard deviation [SD] 8.5). The cohort had a mean ellipsoid prostate volume of 100.1 cm3 (SD 56.7), a mean baseline International Prostate Symptom Score (IPSS) of 18.7 (SD 8.2), a mean baseline quality of life (QOL) score of 4.1 (SD 1.4), and a median follow-up of 38 days (range 10-656 days). Outcomes including IPSS and QOL score reduction (where a lower QOL score indicates an improvement in QOL), and clinical success were compared between severe (≥10 mm) and nonsevere (<10 mm) IPP patients. A linear regression model was used to examine the impact of IPP on these outcomes. RESULTS No significant differences in patient characteristics were found between nonsevere (n = 17) and severe (n = 37) IPP patients. Both cohorts showed IPSS reduction (nonsevere 6.0, P = .0397; severe 8.2, P < .0001) and QOL score reduction (nonsevere 1.0, P = .102; severe 2.0, P < .0001). No significant differences in IPSS or QOL score reduction were found between the cohorts (P = .431 and P = .127). Linear regression found that baseline IPP was not a significant contributor to the outcomes (IPSS: R2 = .5, P < .0001; IPP: P = .702; QOL: R2 = .5, P = .0003; IPP: P = .108). CONCLUSIONS There were no significant differences in early outcomes in PAE between patients with severe and nonsevere IPP.
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Affiliation(s)
- Samuel Z Maron
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029. https://twitter.com/MaronSamuel
| | - Alex Sher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029
| | - Jeremy Kim
- Charlotte Radiology, Charlotte, North Carolina
| | - Robert A Lookstein
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029
| | - Ardeshir R Rastinehad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029
| | - Aaron Fischman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029.
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Alexander LF, Oto A, Allen BC, Akin O, Chong J, Froemming AT, Fulgham PF, Goldfarb S, Maranchie JK, Mody RN, Patel BN, Schieda N, Schuster DM, Turkbey IB, Venkatesan AM, Wang CL, Lockhart ME. ACR Appropriateness Criteria® Lower Urinary Tract Symptoms-Suspicion of Benign Prostatic Hyperplasia. J Am Coll Radiol 2019; 16:S378-S383. [DOI: 10.1016/j.jacr.2019.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 01/31/2023]
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Bilhim T. Prostatic Artery Embolization and the Median Lobe: Stuck in the Middle with You? J Vasc Interv Radiol 2019; 30:1817-1819. [DOI: 10.1016/j.jvir.2019.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 02/04/2023] Open
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Mishra K, Baeza C, Bukavina L, Gómez RG. Modified transurethral resection of the prostate for the management of BPH-related refractory lower urinary tract symptoms in patients with a history of pelvic fracture urethral injury reconstruction. Int Urol Nephrol 2019; 51:2137-2141. [PMID: 31493103 DOI: 10.1007/s11255-019-02276-1] [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: 06/17/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To evaluate the impact of a modified transurethral resection of prostate (mTURP) in patients with a history of pelvic fracture urethral injury (PFUI) status post-urethroplasty, and subsequent lower urinary tract symptoms (LUTS) refractory to medical therapy caused by benign prostatic hyperplasia (BPH). METHODS Five patients were identified with a history of PFUI and a successful reconstruction of the urethra, who developed severe LUTS. After maximal medical therapy failed, these patients underwent a mTURP. Their continence status and voiding parameters were recorded before and after surgery. RESULTS Significant improvements in both post-void residual (172 ± 137.36 mL vs. 26.6 ± 24.44 mL), p = 0.026, and International Prostatic Symptom Score (23.6 ± 4.82 vs. 7.6 ± 4.30), p = 0.002 were observed in the study. Although maximum flow rate was not statistically significant, there was an overall improvement in Qmax in all patients (8.92 ± 3.71 vs. 16.78 ± 6.44 mL/sec). Furthermore, all patients remained continent after this modified intervention. CONCLUSION Our modified TURP provides an adjunctive option in the management of severe LUTS secondary to BPH in patients with a history of PFUI urethroplasty who are refractory to medical management. In our experience, the patients experienced a lasting response with no incontinence.
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Affiliation(s)
- Kirtishri Mishra
- Urology Institute, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Cristina Baeza
- Urology Service, Hospital del Trabajador, Ramón Carnicer 185, Providencia, Santiago, Región Metropolitana Chile, Chile.,Universidad Andres Bello School of Medicine, Santiago, Chile
| | - Laura Bukavina
- Urology Institute, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Reynaldo G Gómez
- Urology Service, Hospital del Trabajador, Ramón Carnicer 185, Providencia, Santiago, Región Metropolitana Chile, Chile. .,Universidad Andres Bello School of Medicine, Santiago, Chile.
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Rukstalis D, Grier D, Stroup SP, Tutrone R, deSouza E, Freedman S, David R, Kamientsky J, Eure G. Prostatic Urethral Lift (PUL) for obstructive median lobes: 12 month results of the MedLift Study. Prostate Cancer Prostatic Dis 2019; 22:411-419. [PMID: 30542055 PMCID: PMC6760566 DOI: 10.1038/s41391-018-0118-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022]
Abstract
Evidence indicating Prostatic Urethral Lift (PUL) delivers significant improvement in symptomatic BPH with low morbidity is based on subjects with lateral lobe (LL) enlargement only. MedLift was an FDA IDE extension of the L.I.F.T. randomized study designed to examine safety and efficacy of PUL for treatment of obstructive middle lobes (OML). Inclusion criteria for this non-randomized cohort were identical to the L.I.F.T. randomized study, except for requiring an OML: ≥ 50 years of age, IPSS ≥ 13, and Qmax ≤ 12 ml/s. Primary endpoint analysis quantified improvement in IPSS over baseline and rate of post-procedure serious complications. Quantification of symptom relief, quality of life, flow rate, and sexual function occurred through 12 months. Outcomes were compared to historical L.I.F.T LL results and were combined to demonstrate the full effectiveness of PUL. Of the 71 screened subjects, 45 were enrolled. At 1, 3, 6, and 12 months, mean IPSS improved from baseline at least 13.5 points (p < 0.0001). Quality of life and BPHII were similarly improved (>60% and >70%, respectively at 3, 6, and 12 months, p < 0.0001). Mean Qmax improvement ranged from 90 to 129% (p < 0.0001). At 1 month, 86% (CI 73-94%) reported ≥70 on the Quality of Recovery scale, 80% (CI 66-89%) reported being "much" or "very much better," and 89% (CI 76-95%) would recommend the procedure. Compared to LL subjects, OML subjects' symptoms improved at least as much at every time point (OML range 13.5-15.9, LL range 9.9-11.1, p ≤ 0.01). On combining OML with LL data, >70% (range CI 63-81%) of subjects demonstrated ≥ 8 point improvement in IPSS through 12 months. Analysis of the combined dataset indicates ≥ 40% (CI 30-51%) of sexually active men improved the minimal clinically important difference in erectile function through 12 months. Prostates, including those with middle lobe obstruction, can be treated with the PUL procedure safely and effectively.
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Affiliation(s)
- Daniel Rukstalis
- Wake Forest University Health Sciences Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Douglas Grier
- Sound Urological Associates, 21822 76th Avenue West Edmonds, Edmonds, WA, 98026, USA
| | - Sean P Stroup
- Department of Urology, Naval Medical Center San Diego, 34800 Bob Wilson Drive San Diego, San Diego, CA, 92134, USA
| | - Ronald Tutrone
- Chesapeake Urology Research Associates, 6535 N, Charles St., Suite 625, Towson, MD, 21204, USA
| | - Euclid deSouza
- Adult & Pediatric Urology, PC 10707 Pacific Street Suite 101, Omaha, NE, 68114, USA
| | - Sheldon Freedman
- Sheldon J. Freedman, M.D., LTD 653 N Town Center Drive, Suite 308, Las Vegas, NV, 89144, USA
| | - Richard David
- Skyline Urology, 5522 Sepulveda Blvd Sherman Oaks, Oaks, CA, 91411, USA
| | - Jed Kamientsky
- Manhattan Medical Research Practice, PLLC 215 Lexington Avenue 21th Floor, New York, 10016, USA
| | - Gregg Eure
- Urology of Virginia, PLLC 225 Clearfield Ave, Virginia Beach, VA, 23462, USA.
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14
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Wasserman NF, Niendorf E, Spilseth B. Precision and accuracy of magnetic resonance imaging for lobar classification of benign prostatic hyperplasia. Abdom Radiol (NY) 2019; 44:2535-2544. [PMID: 30929050 DOI: 10.1007/s00261-019-01970-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To validate the application of a magnetic resonance imaging (MRI)-based lobar classification of benign prostatic hyperplasia (BPH) for use in research and clinical management. METHODS Two radiologists with 5 and 11 years post-fellowship experience were trained in the lobar classification of BPH using an internally developed atlas of prostate anatomy with example MRI images edited by a third senior radiologist designated as the "administrator" of the study. A study population of 140 patients referred to a tertiary academic medical center with known or suspected prostate cancer was selected by the administrator to test the interrater reliability (IRR; precision) of the classification as well as accuracy of the two readers compared to the administrator as the "gold" standard. The intrarater reliability of repeat readings of the administrator was also examined. Percentage of agreement, proportion of agreement, and Cohen's κ were applied. This was a retrospective IRB-approved study. RESULTS IRR (precision) between the two interpreting radiologists was 64% agreement, corresponding to unweighted κ of 0.52. Composite proportion of agreement across all BPH types (categories) for interpreting radiologists was 0.67. Observer accuracy was 62% agreement, unweighted κ 0.49, for observer 1 and 67%, unweighted κ 0.58, for observer 2. Intrarater reliability for the administrator was 87% agreement, unweighted κ 0.81 with composite proportion of agreement across all categories of 0.87. CONCLUSIONS MRI lobar classification of BPH is a reproducible and reliable tool for research and clinical applications.
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Affiliation(s)
- Neil F Wasserman
- Department of Radiology, University of Minnesota Medical School, Mayo Mail Code 292, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
- , Minneapolis, USA.
| | - Eric Niendorf
- Department of Radiology, University of Minnesota Medical School, Mayo Mail Code 292, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Benjamin Spilseth
- Department of Radiology, University of Minnesota Medical School, Mayo Mail Code 292, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA
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Ali R, Gabr A, Mouli SK, Kallini JR, Riaz A, Mora R, Lewandowski RJ, Hohlastos E, Casalino DD, Hofer MD, Hamoui N, Miller FH, Hairston J, Salem R. MR imaging findings of the prostate gland following prostate artery embolization: results from a prospective phase 2 study. Abdom Radiol (NY) 2019; 44:713-722. [PMID: 30196364 DOI: 10.1007/s00261-018-1757-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess changes in imaging and volume characteristics of the prostate gland by magnetic resonance (MR) following prostatic artery embolization (PAE) for benign prostate hyperplasia. METHODS With IRB approval, we analyzed prospectively acquired MR data of PAE patients at baseline and 6-month following treatment from 2015 to 2017. We reviewed prostate MRs looking for sequelae of embolization [changes in signal intensity and/or enhancement, infection/inflammation, infarction, edema, and change in intravesical prostatic protrusion (IPP)]. We calculated the total volume (TV) and central gland volumes (CGV) using DynaCAD® and measured change in volumes. Analyses were performed using SPSS with p < 0.05 considered significant. RESULTS Forty-three patients (n = 43) met our inclusion criteria. 93% (30/43) and 100% (43/43) showed a decrease in TV and CGV at 6-months respectively. At baseline, median TV was 86 cc (range 29.4-232) and median CGV was 54.4 cc (range 12.9-165.5). Median decrease in TV was 18.2% (CI 13.3-27.2) (p = 0.0001) and median decrease in CGV was 26.7% (CI 20.4-35.9) (p = 0.0001). Thirty-seven percent (16/43) of patients had IPP at baseline; 100% showed a decrease in size of median lobe at follow-up. At 6-month follow-up, 33% (14/43) showed imaging features of infarction, 79% (34/43) had decrease in T2-signal intensity, and 51% (22/43) showed a decrease in enhancement. None had edema, peri-prostatic fat changes or infection/inflammation. CONCLUSION PAE causes a statistically significant reduction in the TV and CGV. There is also a reduction of the degree of IPP. Non-specific findings of infarction, decrease in T2-signal, and enhancement were also seen.
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Affiliation(s)
- Rehan Ali
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Samdeep K Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Joseph Ralph Kallini
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ronald Mora
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
- Division of Transplantation, Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Elias Hohlastos
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - David D Casalino
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Matthias D Hofer
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Nabeel Hamoui
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Frank H Miller
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - John Hairston
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
- Division of Transplantation, Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA.
- Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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Agbo C, Ramyil V, Dakum N, Shuaibu S, Onowa V, Nabasu L, Galam Z, Ukaonu B. The value of intravesical prostatic protrusion in evaluation of bladder outlet obstruction from benign prostatic enlargement in Nigeria. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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17
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Gandhi J, Weissbart SJ, Kim AN, Joshi G, Kaplan SA, Khan SA. Clinical Considerations for Intravesical Prostatic Protrusion in the Evaluation and Management of Bladder Outlet Obstruction Secondary to Benign Prostatic Hyperplasia. Curr Urol 2018; 12:6-12. [PMID: 30374274 DOI: 10.1159/000447224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 01/23/2023] Open
Abstract
Background Intravesical prostatic protrusion (IPP) is a manifestation of benign prostatic hyperplasia marked by overgrowth of the prostatic median lobe into the bladder, producing bladder outlet obstruction and related storage and voiding symptoms. Methods A MEDLINE® database search of the current literature was guided using combination of "prostate" with the following terms: intravesical prostatic protrusion, bladder trabeculation, bladder outlet obstruction, lower urinary tract symptoms, alpha blockers, transrectal ultrasonography, and prostatectomy. Results Although IPP can be identified via a variety of imaging modalities, it is easily detected via transrectal ultrasonography (TRUS). Failing to detect IPP promptly by TRUS may result in refractory symptoms of benign prostatic hyperplasia, as the condition may not respond to typical α1-adrenoceptor antagonist therapy. In addition, depending on grade, IPP can influence outcomes and complications of prostatectomies. Conclusion Upon report of lower urinary tract symptoms, initial performance of TRUS along with digital rectal examination prevents delay in the appropriate evaluation and management of prostatic diseases.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University Medicine, Stony Brook, Southampton, New York.,Department of Medical Student Research Institute, St. George's University School of Medicine, St. George, Grenada
| | - Steven J Weissbart
- Department of Urology, Stony Brook University Medicine, Stony Brook, Southampton, New York
| | - Albert N Kim
- Department of Urology, Stony Brook University Medicine, Stony Brook, Southampton, New York
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, New York
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York.,Department of Men's Wellness Program, Mount Sinai Health System, New York, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University Medicine, Stony Brook, Southampton, New York.,Department of Urology, Stony Brook University Medicine, Stony Brook, Southampton, New York
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18
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Suzuki T, Otsuka A, Ozono S. Combination of intravesical prostatic protrusion and resistive index is useful to predict bladder outlet obstruction in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Int J Urol 2016; 23:929-933. [PMID: 27545297 DOI: 10.1111/iju.13188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/18/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine which parameters obtained from transrectal ultrasonography are accurate predictors of urodynamically-confirmed bladder outlet obstruction in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. METHODS The records of 350 patients with complaints of lower urinary tract symptoms suggestive of benign prostatic hyperplasia were reviewed. Baseline parameters were international prostate symptom score, quality of life score, postvoid residual urine volume, prostate-specific antigen, and data obtained from uroflowmetry and transrectal ultrasonography. Urodynamic studies were carried out to determine bladder outlet obstruction. Receiver operator characteristic curves were generated to compare the accuracy of the different parameters, and the area under the curve of each parameter was calculated. RESULTS Bladder outlet obstruction index positively correlated with intravesical prostatic protrusion, total prostate volume, transition zone volume, transition zone index, resistive index and prostate-specific antigen. Further, resistive index was only a significant independent variable with intravesical prostatic protrusion. Intravesical prostatic protrusion had the highest area under the curve of 0.790 among all variables, and its cut-off value was 10 mm. The positive predictive value of intravesical prostatic protrusion was 76.2%. In addition, the positive predictive value of the combined parameters intravesical prostatic protrusion and resistive index increased to 83.8%. CONCLUSIONS Intravesical prostatic protrusion and resistive index are useful parameters for predicting bladder outlet obstruction in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. In clinical practice, the combination of intravesical prostatic protrusion and resistive index on ultrasound can be diagnostic of bladder outlet obstruction.
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Affiliation(s)
- Takahisa Suzuki
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Seiichiro Ozono
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Lu SY, Yang CM, Fan YH, Lin ATL, Chen KK. Intravesical prostatic protrusion correlates well with storage symptoms in elderly male patients with non-neurogenic overactive bladder. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2015.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Kang M, Kim M, Choo MS, Paick JS, Oh SJ. Urodynamic Features and Significant Predictors of Bladder Outlet Obstruction in Patients With Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia and Small Prostate Volume. Urology 2015; 89:96-102. [PMID: 26683755 DOI: 10.1016/j.urology.2015.11.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the clinical and urodynamic features of patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) according to their prostate size. MATERIALS AND METHODS We analyzed 2039 LUTS/BPH patients who underwent urodynamic study between October 2004 and August 2013. We divided the patients into three groups according to their prostate size: small (≤30 mL), moderately enlarged (31-80 mL), and large prostate (≥81 mL) groups. We compared the groups regarding age, International Prostatic Symptom Score, maximal flow rate (Qmax), postvoided residual (PVR), serum prostate-specific antigen, prostate volume measured by ultrasonography, and urodynamic findings. RESULTS Patients with a small prostate had better urodynamic outcomes than those with larger prostates in overall population. Although the total prostate volume significantly correlated with the bladder outlet obstruction (BOO) index (r = 0.51), BOO patients with a small prostate had similar Qmax, higher PVR, and lower voiding efficiency, compared to those with larger prostates. Moreover, urodynamic parameters indicating bladder abnormalities, including low compliance and involuntary detrusor contraction positivity, were similar among the groups in BOO patients. A higher proportion of detrusor underactivity was also observed in the small prostate group in BOO patients. Finally, when adjusting for potential confounding variables, we identified serum prostate-specific antigen levels (odds ratio, 1.34) and Qmax (odds ratio, 0.77) as significant predictors for BOO in LUTS/BPH patients with a small prostate. CONCLUSION BOO patients with a small prostate showed higher PVR and poor voiding efficiency, as well as similar urodynamic bladder abnormalities, compared to those with moderately enlarged and large prostates.
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Affiliation(s)
- Minyong Kang
- Department of Urology, Seoul National University Bundang Hospital, Seong-nam si, Gyeonggi-do, Republic of Korea
| | - Myong Kim
- Department of Urology, Asan Medical Center, Seoul, Republic of Korea
| | - Min Soo Choo
- Department of Urology, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
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Lin YT, Amouyal G, Thiounn N, Pellerin O, Pereira H, Del Giudice C, Déan C, Sapoval M. Intra-vesical Prostatic Protrusion (IPP) Can Be Reduced by Prostatic Artery Embolization. Cardiovasc Intervent Radiol 2015; 39:690-695. [PMID: 26542027 DOI: 10.1007/s00270-015-1235-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/08/2015] [Accepted: 10/19/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prostate artery embolization (PAE) is a new approach to improve lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. PAE results in global reduction of prostate volume (PV). There are no data available on the efficacy of PAE in reducing intra-vesical prostatic protrusion (IPP), an anatomic feature that is clinically related with bladder outlet obstruction and LUTS. OBJECTIVE To assess the results of PAE in patients with significant IPP due to median lobe hyperplasia and to compare the IPSS decrease and IPP change. MATERIAL AND METHODS Prospective analysis of 18 consecutive patients with significant IPP (>5 mm) related to median lobe hyperplasia undergoing PAE using 30-500-μm-calibrated trisacryl microspheres. We measured IPP on sagittal T2-weighted images before and 3 months after PAE. IPSS and clinical results were also evaluated at 3 months. RESULTS PAE resulted in significant IPP reduction (1.57 cm ± 0.55 before PAE and 1.30 cm ± 0.46 after PAE, p = 0.0005) (Fig. 1) with no complication. IPSS, quality of life (QoL), total prostate-specific antigen (PSA) level, and PV showed significant reduction after PAE, and maximum urinary flow rate (Q max) showed significant increase after PAE. No significant change of International Index of Erectile Function (IIEF) for clinical evaluation after PAE. A significant correlation was found between the IPP change and the IPSS change (r = 0.636, p = 0.0045). CONCLUSION Patients had significant IPP reduction as well as significant symptomatic improvement after PAE, and these improvements were positively correlated.
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Affiliation(s)
- Yen-Ting Lin
- Vascular and Oncological Interventional Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France.
- Department of Radiology, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung City, Taiwan, ROC.
| | - Grégory Amouyal
- Vascular and Oncological Interventional Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Nicolas Thiounn
- Urology, Assistance Publique Hopitaux de Paris, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Olivier Pellerin
- Sorbonne Paris-Cité, Université Paris Descartes, Paris, France
- Inserm (Institut national de la santé et de la recherche médicale), U970, 56 rue Leblanc, 75015, Paris, France
- Vascular and Oncological Interventional Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Héléna Pereira
- Vascular and Oncological Interventional Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Costantino Del Giudice
- Vascular and Oncological Interventional Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Carole Déan
- Vascular and Oncological Interventional Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Marc Sapoval
- Sorbonne Paris-Cité, Université Paris Descartes, Paris, France
- Inserm (Institut national de la santé et de la recherche médicale), U970, 56 rue Leblanc, 75015, Paris, France
- Vascular and Oncological Interventional Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France
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22
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Lee A, Lee HJ, Lim KB, Huang HH, Ho H, Foo KT. Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow? Asian J Urol 2015; 3:39-43. [PMID: 29264161 PMCID: PMC5730749 DOI: 10.1016/j.ajur.2015.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/30/2015] [Accepted: 09/16/2015] [Indexed: 11/26/2022] Open
Abstract
Objective Men with benign prostate hyperplasia (BPH) with good urinary flow may still have bladder outlet obstruction (BOO). Intravesical prostatic protrusion (IPP) has been shown to be able to predict BOO. We aim to investigate the use of IPP to predict BOO in men with good urinary flow. Methods One hundred and fourteen consecutive men (>50 years old) presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002. They were evaluated with serum prostate specific antigen (PSA), uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume (PV). Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index > 40. Men with Qmax ≥ 12.0 mL/s were considered to have good flow. Results Among the 114 men, 61 patients had good urinary flow. Their median age, PV and Qmax were 66 years, 32.9 mm3 and 14.5 mL/s respectively. 14/61 (23.0%) patients had BOO and their distribution of IPP were as follows: Grade 1 – 0/20 (0%) obstructed, Grade 2 – 6/22 (27.3%) and Grade 3 – 8/19 (42.1%). Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%. The area-under-curve (AUC) for IPP was greater than that for PV (0.757 vs. 0.696). Conclusion Even in men with good flow, high grades of IPP were more likely to have BOO and hence, may be a useful adjunct to predict BOO.
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Affiliation(s)
- Alvin Lee
- Department of Urology, Singapore General Hospital, Singapore
| | - Han Jie Lee
- Department of Urology, Singapore General Hospital, Singapore
| | | | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore
| | - Henry Ho
- Department of Urology, Singapore General Hospital, Singapore
| | - Keong Tatt Foo
- Department of Urology, Singapore General Hospital, Singapore
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Huang T, Yu YJ, Qi J, Xu D, Duan LJ, Ding J, Zhu YP. Establishment and value assessment of efficacy prediction model about transurethral prostatectomy. Int J Urol 2015; 22:854-60. [PMID: 26059608 DOI: 10.1111/iju.12836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 05/04/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish and to evaluate discriminant models to predict the outcomes of transurethral prostatectomy. METHODS Clinical data of patients treated with transurethral prostatectomy between January and December 2013 were collected, including medical history, symptoms, biochemical tests, ultrasonography and urodynamics. Surgical efficacy was evaluated at 6-month follow up. Predictive models were constructed by logistic regression. Receiver operating characteristic curve and diagnostic tests were used to test the accuracy of models before the predictive value between models was compared. RESULTS A total of 182 patients were included, with 73.6% having an effective outcome. History of recurrent urinary tract infection (OR 1.33), score of storage phase (OR 2.58), maximum flow rate (OR 2.11) and detrusor overactivity (OR 3.13) were found to be risk factors. International Prostate Symptom Score (OR 0.13), transitional zone index (OR 0.58), resistive index of prostatic artery (OR 0.46), bladder wall thickness (OR 0.78), ultrasonic estimation of bladder weight (OR 0.28), bladder outlet obstruction index (OR 0.20) and bladder contractility index (OR 0.83) were found to be protective factors. The areas under the curve of models using factors from ultrasonography and urodynamics were 0.792 and 0.829 respectively, with no significant difference being found between them (P = 0.348). CONCLUSIONS Surgical efficacy of transurethral prostatectomy is positively correlated to severe voiding phase symptoms, outlet obstruction and better detrusor contractility, and negative correlated with urinary infection, severe storage phase symptoms and excessive detrusor contractibility. Ultrasonography might replace urodynamics in selecting patients for whom transurethral prostatectomy is more likely to be beneficial.
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Affiliation(s)
- Tao Huang
- Department of Urology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Yong Jiang Yu
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Jun Qi
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Ding Xu
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Liu Jian Duan
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Jie Ding
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu, Shanghai, China
| | - Yu Ping Zhu
- Department of Urology, Anhui Provincial Hospital, Hefei, Anhui, China
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Lebdai S, Ammi M, Bigot P, Cornu JN, Mathieu R, Descazeaud A, Azzouzi AR. Impact en pratique clinique de l’indice de protrusion prostatique intravésicale : une revue de la littérature du CTMH de l’AFU. Prog Urol 2014; 24:313-8. [DOI: 10.1016/j.purol.2013.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 09/09/2013] [Accepted: 09/15/2013] [Indexed: 11/16/2022]
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