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Lee J, Lee S, Nguyen-Oghalai TU. Water vapor therapy and polymyalgia rheumatica: Coincidental? J Family Med Prim Care 2023; 12:2976-2978. [PMID: 38186798 PMCID: PMC10771206 DOI: 10.4103/jfmpc.jfmpc_676_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 01/09/2024] Open
Abstract
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by pain and stiffness around the shoulders and hip girdles, an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) and a dramatic response to corticosteroids. It is usually seen in adults aged over 50 years; about 30% also have giant cell arteritis. Its etiology is unknown. A 72-year-old male received water vapor therapy, a novel, minimally invasive therapy for benign prostate hypertrophy (BPH). On postoperative day 1, he developed severe shoulder pain and weakness, with difficulty with lifting his arms above his head, and hip pain and weakness, with difficulty getting out of a bed or chair. Laboratory results showed elevated ESR and CRP, but a normal creatine kinase level. The patient received low-dose prednisone and had prompt symptom relief. This case illustrates that a diagnosis of PMR after water vapor therapy can be easily overlooked.
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Affiliation(s)
- Joshua Lee
- Division of Rheumatology, Department of Medicine, Keck Medicine of USC, Los Angeles, California, United States
| | - Sandy Lee
- Division of Rheumatology, Department of Medicine, Keck Medicine of USC, Los Angeles, California, United States
| | - Tracy U. Nguyen-Oghalai
- Division of Rheumatology, Department of Medicine, Keck Medicine of USC, Los Angeles, California, United States
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Yang J, Wu W, Amier Y, Li X, Wan W, Liu C, Zhang Y, Yu X. Efficacy and safety of Water Vapor Thermal Therapy in the treatment of benign prostate hyperplasia: a systematic review and single-arm Meta-analysis. BMC Urol 2023; 23:72. [PMID: 37118692 PMCID: PMC10147364 DOI: 10.1186/s12894-023-01237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/05/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a common chronic condition among men aged 50 or older, causing voiding and obstructive lower urinary tract symptoms. Water vapor thermal therapy (WVTT) using the Rezūm® system is a new minimally invasive surgical technique that is increasingly reported as a treatment for BPH. METHODS The protocol was submitted to the PROSPERO registry. We searched PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov up to July 29, 2022. Quality assessment was carried out by a 20-item checklist form prepared by the Institute of Health Economics (IHE). Double arcsine transformation was performed to stabilize the variance of the original ratio. When I2 > 50%, the random effect model was used to calculate the pooled parameters. Otherwise, the fixed effect model was used. 95% confidence intervals (CIs) were calculated. A leave-one-out sensitivity analysis was performed to evaluate the impact of each study on the pooled outcomes, and finally, Egger's test was used to assess publication bias. RESULTS A total of seven single-arm observational studies and one random controlled trial, including 1015 patients, were included. One year after WVTT, the International Prostate Symptom Score decreased by 11.37 (95% CI: -12.53, -10.21), the IPSS Quality of Life scale decreased by 2.59 (95% CI: -2.92, -2.26), the maximum urine flow rate increased by 5.26 ml/s (95% CI: 4.53, 5.99), and the postvoid residual decreased by 13.18 ml (95% CI: -24.32, -2.03). The most common complication was dysuria, with a pooled incidence of 21% (95% CI: 14%, 29%), and the second most common complication was hematuria, with a pooled incidence of 14% (95% CI: 10%, 18%). The pooled incidence of retreatment was 3% (95% CI: 2%, 5%). CONCLUSIONS WVTT is an attractive alternative to medication or more invasive surgical procedures and can serve as first-line therapy for men with BPH.
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Affiliation(s)
- Junyi Yang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weisong Wu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yirixiatijiang Amier
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xianmiao Li
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wenlong Wan
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chang Liu
- Department of Geriatrics, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yucong Zhang
- Department of Geriatrics, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Xiao Yu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Cindolo L, Campobasso D, Conti E, Uricchio F, Franzoso F, Maruzzi D, Viola L, Varvello F, Balsamo R, Ferrari G, Morselli S, Siena G. Do Patients Treated with Water Vapor Therapy and Meeting Randomized Clinical Trial Criteria Have Better Urinary and Sexual Outcomes Than an Unselected Cohort? J Endourol 2023; 37:323-329. [PMID: 36453237 DOI: 10.1089/end.2022.0637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Water vapor intraprostatic injection (Rezum procedure) for benign prostatic hyperplasia (BPH) is one of the most promising minimally invasive surgical treatments. Five-year outcomes from the multicenter randomized controlled trial (RCT) demonstrated significant and durable urinary and sexual function results in selected patients. We compared the sexual and urinary outcomes of this procedure in patients satisfying inclusion criteria of the RCT with unselected patients. Materials and Methods: We prospectively followed all patients with symptomatic BPH who underwent Rezum therapy at eight institutions and analyzed the functional results. Patients were divided into two groups: patients who matched the 5-year RCT inclusion criteria (Group A) and patients who did not (Group B). The pre- and postoperative data, complications, presence of antegrade ejaculation, and urinary and sexual outcomes were periodically recorded. Results: A total of 426 patients were eligible for the study (232 in Group A and 194 in Group B). Patients in Group B had a higher American Society of Anesthesiologists score, prostate volume, and postvoid residual measurement. No difference was found in terms of preoperative International Prostate Symptom Score, International Index of Erectile Function, maximum urinary flow, and prostate-specific antigen. Longer operative time and higher number of vapor injections were required in Group B, with no differences in hospital stay, injection density, and complication rates. All the urinary and sexual outcomes improved with no differences between the two groups. The reintervention rate at the latest follow-up visit was 2.6% in Group A and 3.1% in Group B. Conclusions: In our large multicenter series, water vapor intraprostatic injections showed a safe and effective profile regardless of the prostate size, presence of indwelling catheter, antiplatelet/anticoagulant medications, and patients' comorbidities.
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Affiliation(s)
- Luca Cindolo
- Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy.,Department of Urology, "Hesperia Hospital," and CURE Group, Modena, Italy
| | - Davide Campobasso
- Department of Urology, University Hospital of Parma/Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Enrico Conti
- Department of Urology, Levante Ligure Hospital, La Spezia, Italy
| | - Francesco Uricchio
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | | | - Daniele Maruzzi
- Department of Urology, S. Maria Degli Angeli Hospital, Pordenone, Italy
| | - Lorenzo Viola
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence
| | - Francesco Varvello
- Department of Urology, Michele e Pietro Ferrero Hospital, Alba-Bra, Italy
| | - Raffaele Balsamo
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Giovanni Ferrari
- Department of Urology, "Hesperia Hospital," and CURE Group, Modena, Italy
| | - Simone Morselli
- Department of Urology, "Hesperia Hospital," and CURE Group, Modena, Italy
| | - Giampaolo Siena
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence
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Sessa F, Polverino P, Siena G, Bisegna C, Lo Re M, Spatafora P, Pecoraro A, Rivetti A, Moscardi L, Saladino M, Cocci A, Gacci M, Li Marzi V, Carini M, Minervini A, Campi R, Serni S. Transperineal Laser Ablation of the Prostate (TPLA) for Lower Urinary Tract Symptoms Due to Benign Prostatic Obstruction. J Clin Med 2023; 12:jcm12030793. [PMID: 36769454 PMCID: PMC9918261 DOI: 10.3390/jcm12030793] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
We aimed to review the current evidence on surgical and functional outcomes of Transperineal Laser Ablation for LUTS due to BPH. A comprehensive review of the English-language literature was performed using the MEDLINE and Web of Science databases until 1 August 2022, aiming to select studies evaluating TPLA for the treatment of LUTS due to BPH. Additional records were found from Google Scholar. Data were extracted and summarized in Tables. An appropriate form was used for qualitative data synthesis. Seven studies were included in the review, with all being single arm, non-comparative studies. In all studies, functional outcomes were evaluated with uroflowmetry parameters and validated questionnaires, showing a promising effectiveness at short- and mid-term follow-up. There is a lack of standardized pathways for preoperative assessment of patients suitable for TPLA, and even the technique itself has been reported with a few nuances. A good safety profile has been reported by all the authors. Although promising results have been reported by different groups, selection criteria for TPLA and few technical nuances regarding the procedure were found to be heterogeneous across the published series that should be standardized in the future. Further research is needed to confirm these findings.
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Affiliation(s)
- Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
- Correspondence: ; Tel.: +39-055-275-8020 or +39-055-794-9209; Fax: +39-055-275-8014
| | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Giampaolo Siena
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Claudio Bisegna
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Mattia Lo Re
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Luisa Moscardi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Marco Saladino
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Marco Carini
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
- Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, 50100 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy
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Campobasso D, Siena G, Chiodini P, Conti E, Franzoso F, Maruzzi D, Martinelli E, Varvello F, De Nunzio C, Autorino R, Somani BK, Ferrari G, Cindolo L. Composite urinary and sexual outcomes after Rezum: an analysis of predictive factors from an Italian multi-centric study. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00587-6. [PMID: 36042295 DOI: 10.1038/s41391-022-00587-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/03/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Rezum system is one of the latest minimally invasive surgical treatments for benign prostatic hyperplasia. METHODS We retrospectively reviewed all patients who underwent the Rezum treatment in seven different Italian institutions. A successful urinary outcome was defined as: ≥50% improvement in the IPSS <7, improvement in peak flow ≥50% and/or more than 15 ml/s, ≥1-point improvement in the QoL questionnaire and in the absence of perioperative major complications (AUR, transfusion) or postoperative incontinence. A successful sexual outcome was defined as postoperative (latest follow up consultation) antegrade ejaculation or no variation in ejaculatory function and an increase, or stability or max 1 class reduction, in IIEF-5. RESULTS 262 patients were enrolled with a follow-up period of 11 months (IQR 5-15). No early or late serious adverse events (Clavien III-IV) occurred. Early complications occurred in 39.3% of cases, with 4 cases of clot retention and one case of blood transfusion. Urge incontinence was reported by 6 patients (2.2%). A treatment failure requiring re-intervention occurred in 4 cases (1.5%). The preoperative antegrade ejaculation rate was 56.5%, and after the procedure it increased to 78.2%. The increase of ≥1-point in the QoL was achieved in 92.7% of the cases. Optimal urinary and sexual outcomes were achieved in 52.9% and 87.8%, respectively. CONCLUSIONS In our series, water vapor intraprostatic injections seem to be an effective and safe procedure.
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Affiliation(s)
- Davide Campobasso
- Department of Urology, University Hospital of Parma/Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Giampaolo Siena
- Department of Urology, Careggi Hospital, University of Florence, "San Luca Nuovo", Florence, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrico Conti
- Department of Urology, Levante Ligure Hospital, La Spezia, Italy
| | | | - Daniele Maruzzi
- Department of Urology, "S. Maria Degli Angeli" Hospital, Pordenone, Italy
| | | | - Francesco Varvello
- Department of Urology, "Michele e Pietro Ferrero" Hospital, Alba-Bra, Italy
| | - Cosimo De Nunzio
- Department of Urology, "Sant'Andrea" Hospital, Sapienza University, Roma, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University (VCU) Health, Richmond, VA, USA
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Giovanni Ferrari
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | - Luca Cindolo
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy.,Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy
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