1
|
Ito H, Takanashi M, Fukazawa T, Takizawa H, Hioki M, Shinoki R, Kawahara T, Makiyama K, Kobayashi K. Predictors of postoperative storage symptoms in male patients with lower urinary tract symptoms: A retrospective analysis of prostate surgery for benign prostatic enlargement. Low Urin Tract Symptoms 2024; 16:e12512. [PMID: 38602061 DOI: 10.1111/luts.12512] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/20/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES This study investigated the effects of prostate surgery on storage symptoms in male patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargement (BPE). This study aimed to identify patient characteristics associated with improved, unchanged, and deteriorated post-surgical storage symptoms and to identify the risk factors for non-improvement or deterioration. METHODS A retrospective analysis of 586 prostate surgeries performed between 2016 and 2022 at Yokosuka Kyosai Hospital was conducted on patients with LUTS and at least one storage symptom preoperatively. Patients with active urinary tract infection, prostate/bladder cancer, urethral strictures, or dementia were excluded. The study enrolled 230 patients and assessed storage symptoms using the International Prostate Symptom Score (IPSS). RESULTS Overall, storage symptoms improved, remained unchanged, and deteriorated in 87.0%, 5.7%, and 7.4% of patients, respectively. The patients in the deteriorated group were significantly older, whereas those in the no-change group had smaller prostate volumes. Patient-reported outcome scores (IPSS, IPSS-QoL, and BII) were significantly higher in the improved group. The predictors of non-improvement included low IPSS storage score, cardiovascular disease, and diabetes mellitus. Predictors of deterioration included advanced age and low IPSS storage score. CONCLUSIONS Patients with severe LUTS showed greater postoperative improvement in storage symptoms. A low IPSS storage score predicted non-improvement and deterioration. Advanced age, low IPSS storage score, and a history of cardiovascular disease and diabetes mellitus were identified as key predictors. Awareness of these factors may guide preoperative counseling and improve decision-making in prostate surgery, ensuring more personalized and effective treatment strategies.
Collapse
Affiliation(s)
- Hiroki Ito
- Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
- Department of Urology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Masato Takanashi
- Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Takeshi Fukazawa
- Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Hiroki Takizawa
- Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Mari Hioki
- Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Risa Shinoki
- Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Takashi Kawahara
- Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| |
Collapse
|
2
|
Sandhu JS, Bixler BR, Dahm P, Goueli R, Kirkby E, Stoffel JT, Wilt TJ. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023. J Urol 2024; 211:11-19. [PMID: 37706750 DOI: 10.1097/ju.0000000000003698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE The purpose of this American Urological Association (AUA) Guideline amendment is to provide a useful reference on the effective evidence-based management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH). MATERIALS AND METHODS The Minnesota Evidence Review Team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies relevant to the management of BPH. The guideline was updated in 2023 to capture eligible literature published between September 2020 and October 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS The BPH amendment resulted in changes to statements/supporting text on combination therapy, photoselective vaporization of the prostate (PVP), water vapor thermal therapy (WVTT), laser enucleation, and prostate artery embolization (PAE). A new statement on temporary implanted prostatic devices (TIPD) was added. In addition, statements on transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT) were removed and information regarding these legacy technologies was added to the background section. References and the accompanying treatment algorithms were updated to align with the updated text. CONCLUSION This guideline seeks to improve clinicians' ability to evaluate and treat patients with BPH/LUTS based on currently available evidence. Future studies will be essential to further support these statements to improve patient care.
Collapse
Affiliation(s)
| | | | - Philipp Dahm
- Research and Education for Surgical Services at the Minneapolis Veterans Administration Medical Center, Minneapolis, Minnesota
| | | | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | - Timothy J Wilt
- Research and Education for Surgical Services at the Minneapolis Veterans Administration Medical Center, Minneapolis, Minnesota
| |
Collapse
|
3
|
Sathianathen NJ, Furrer MA, Mulholland CJ, Katsios A, Soliman C, Lawrentschuk N, Peters JS, Zargar H, Costello AJ, Hovens CM, Bishop C, Rao R, Tong R, Steiner D, Moon D, Thomas BC, Dundee P, Calero JAR, Thalmann GN, Corcoran NM. Lymphovascular Invasion at the Time of Radical Prostatectomy Adversely Impacts Oncological Outcomes. Cancers (Basel) 2023; 16:123. [PMID: 38201549 PMCID: PMC10778356 DOI: 10.3390/cancers16010123] [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: 10/07/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan-Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% (n = 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease (p < 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7-23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6-2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6-3.0). The same relationship was seen across D'Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis.
Collapse
Affiliation(s)
- Niranjan J. Sathianathen
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
| | - Marc A. Furrer
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Department of Urology, University of Bern, 3010 Bern, Switzerland; (A.K.); (G.N.T.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten, 4600 Olten, Switzerland
- Department of Urology, Solothurner Spitäler AG, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
| | - Clancy J. Mulholland
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
| | - Andreas Katsios
- Department of Urology, University of Bern, 3010 Bern, Switzerland; (A.K.); (G.N.T.)
| | - Christopher Soliman
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Nathan Lawrentschuk
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Justin S. Peters
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Homi Zargar
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Anthony J. Costello
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Australian Prostate Centre, North Melbourne, VIC 3051, Australia
| | - Christopher M. Hovens
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Australian Prostate Centre, North Melbourne, VIC 3051, Australia
| | - Conrad Bishop
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Department of Urology, Footscray Hospital Western Health, Melbourne, VIC 3011, Australia
| | - Ranjit Rao
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Raymond Tong
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Daniel Steiner
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Daniel Moon
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3050, Australia
| | - Benjamin C. Thomas
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Department of Urology, Solothurner Spitäler AG, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
| | - Philip Dundee
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Department of Urology, Solothurner Spitäler AG, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
| | | | - George N. Thalmann
- Department of Urology, University of Bern, 3010 Bern, Switzerland; (A.K.); (G.N.T.)
| | - Niall M. Corcoran
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Department of Urology, Solothurner Spitäler AG, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
- Australian Prostate Centre, North Melbourne, VIC 3051, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, VIC 3050, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC 3050, Australia
| |
Collapse
|
4
|
Ten E. Comparative analysis of conventional penile clamps and Uriclak device in managing male incontinence following radical, turp, or laser prostate surgery. Front Surg 2023; 10:1301353. [PMID: 38192489 PMCID: PMC10773612 DOI: 10.3389/fsurg.2023.1301353] [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: 09/24/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024] Open
Abstract
This article examines the impact of various prostate surgery techniques on male urinary incontinence, evaluating the feasibility, efficacy, and safety of penile clamps as a post-prostate surgery treatment. The study compares the characteristics and applications of conventional penile clamps and the Uriclak urethral compression device, highlighting their differences and potential for managing male incontinence.
Collapse
Affiliation(s)
- Eva Ten
- Department of Urology, Franziskus Hospital, Berlin, Germany
| |
Collapse
|
5
|
Yanaral F, Gültekin MH, Halis A, Akbulut F, Sarilar O, Ozgor F. Adjustable Male Sling for The Treatment of Postprostatectomy Stress Urinary Incontinence: Intermediate-Term Follow-Up Results. Cureus 2023; 15:e43280. [PMID: 37692721 PMCID: PMC10492627 DOI: 10.7759/cureus.43280] [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] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Objective To evaluate the outcomes of adjustable male sling (Argus®) implantation in the management of post-prostatectomy incontinence (PPI) with intermediate-term follow-up results. Materials and methods The data on adjustable male sling surgery between September 2015 and September 2020 were retrospectively analyzed. Patients were preoperatively evaluated with a voiding diary, 24-hour pad test, and validated questionnaire. Functional outcomes were also evaluated using 24-hour pad requirement and pad weight, and the International Consultation on Incontinence (ICIQ-SF) score. Results A total of 16 patients (eight having undergone the transurethral resection of the prostate [TUR-P] and eight radical prostatectomy [RP]) were enrolled in the study. Thirteen patients had moderate (81.25%) PPI, and three patients (18.75%) had severe PPI. With the mean follow-up of 36.9±14.3 months, nine patients (56.2%) were noted as cured and four (25%) as improved, with an overall success rate of 81.2%. At the last follow-up visit, the median number of pads used per day decreased from 3.5 to 1, and the 24-hour pad test result decreased from 300 to 50 gr (p < 0.001 and p < 0.001, respectively). The ICIQ-SF score decreased from the initial mean of 15.8 ± 2.3 to 7.1 ± 6.6 (p < 0.001). When the outcomes were compared according to the etiology, there was no statistically significant difference (p = 0.522). Conclusions Male sling surgery can be performed safely in patients with moderate and severe stress urinary incontinence with low complication and high success rates. The results of TUR-P-related PPI are similar to those of surgery performed due to the etiology of RP.
Collapse
Affiliation(s)
- Fatih Yanaral
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | | | - Ahmet Halis
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | - Fatih Akbulut
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | - Omer Sarilar
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | - Faruk Ozgor
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| |
Collapse
|
6
|
Thakur PS, Gharde P, Prasad R, Wanjari MB, Sharma R. Restoring Quality of Life: A Comprehensive Review of Penile Rehabilitation Techniques Following Prostate Surgery. Cureus 2023; 15:e38186. [PMID: 37261151 PMCID: PMC10226834 DOI: 10.7759/cureus.38186] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
Prostate cancer is the most common type of cancer in men, and its treatment options include surgery, radiation therapy, and chemotherapy. Prostate surgery can often result in erectile dysfunction (ED), significantly impacting patients' quality of life. Penile rehabilitation techniques have been developed to restore erectile function following prostate surgery. This review discusses the different penile rehabilitation techniques available, their effectiveness, and the factors affecting their success. This paper also addresses the importance of addressing the psychological aspects of ED in these patients and the need for personalized and tailored rehabilitation plans. By providing a comprehensive understanding of penile rehabilitation techniques, this paper can assist clinicians in restoring the quality of life of patients who have undergone prostate surgery.
Collapse
Affiliation(s)
- Prathvi S Thakur
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Department of Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Department of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjana Sharma
- Department of Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
7
|
Anil H, Ünal U, Karamik K, Ortoglu F, Erçil H. Bladder calculi concomitant with benign prostatic enlargement: is prostate surgery mandatory in patients who have never received medical therapy? Asian J Androl 2023; 25:368554. [PMID: 36722579 PMCID: PMC10521950 DOI: 10.4103/aja2022107] [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: 09/28/2022] [Accepted: 12/15/2022] [Indexed: 01/27/2023] Open
Abstract
The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned. In this study, we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors. One hundred and seventeen men with bladder stones and concomitant benign prostate enlargement (BPE) who had not received medical treatment before were included in the study. In the first step, only the bladder calculi of patients were removed and medical treatment was given for BPE. The patients who benefited from medical treatment during the follow-up were defined as Group 1 and the patients who required prostate surgery for any indication comprised Group 2. Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a cox regression model. In the follow-up of 117 patients with bladder stones removed and medical treatment initiated, 49 (41.9%) patients had prostate surgery indications. The indication for 33 (67.3%) of 49 patients was medical treatment failure. The presence of intravesical prostatic protrusion (IPP; hazard ratio: 2.071, 95% confidence interval [CI]: 1.05-4.05, P = 0.034), and high postvoiding residual urine volume (hazard ratio: 1.013, 95% CI: 1.007-1.019, P < 0.001) were found to be preoperative risk factors for needing future prostate surgery. In patients who have not received medical treatment for BPE before, bladder calculi developing secondary to BPE do not always constitute an indication for prostate surgery.
Collapse
Affiliation(s)
- Hakan Anil
- Department of Urology, Adana City Training and Research Hospital, Adana 01000, Türkiye
| | - Umut Ünal
- Department of Urology, Adana City Training and Research Hospital, Adana 01000, Türkiye
| | - Kaan Karamik
- Department of Urology, Korkuteli State Hospital, Antalya 07000, Türkiye
| | - Ferhat Ortoglu
- Department of Urology, Adana City Training and Research Hospital, Adana 01000, Türkiye
| | - Hakan Erçil
- Department of Urology, Adana City Training and Research Hospital, Adana 01000, Türkiye
| |
Collapse
|
8
|
Turgut Ö, Erbagcı A, Bayrak O, Seckiner I, Erturhan S, Sen H, Ozturk M. Correlation of Postoperative Outcomes According to the Amount of Prostatic Tissue Removed in Patients Undergoing Transurethral Resection of the Prostate. Cureus 2023; 15:e34451. [PMID: 36874733 PMCID: PMC9980425 DOI: 10.7759/cureus.34451] [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] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The present study assesses the effect of the proportion of tissue resected during transurethral resections of the prostate (TUR-P) on lower urinary tract symptoms (LUTS) and other parameters in patients with a benign prostatic obstruction (BPO). MATERIALS AND METHODS Forty-three patients who underwent TUR-P between 2018 and 2021 were assessed prospectively. The patients were divided into two groups according to the percentage of tissue removed (group 1 <30%, group 2 >30% resection). Age, prostate volume, amount of resected tissue, operative time, length of hospital stay, duration of catheterization, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), and serum prostate-specific antigen (PSA) (ng/dl) at preoperative and postoperative three months were recorded. RESULTS The percentage of tissue removed was 22.2% vs. 48.4% (p = 0.001), IPSS reduction was 77.7% vs. 83.3% (p = 0.048), QoL improvement was 77.2% vs. 84.8% (p = 0.133), Qmax increase was 171.3% vs. 193.5% (p = 0.032), and serum PSA decrease was 56.4% vs. 69.2% (p = 0.049) in groups 1 and 2, respectively. In addition, the operative time was 38.5 vs. 53.6 min (p = 0.001), the length of hospital stay was 2.0 vs. 2.4 days (p = 0.001), and the duration of catheterization average was 4.1 vs. 4.9 days (p = 0.002). CONCLUSION Resections of at least 30% of prostatic tissue can provide a significant improvement in the symptoms and parameters related to benign prostatic obstruction, while resections of less than 30% of prostatic tissue can effectively reduce urinary symptoms and improve the quality of life in older adult patients with comorbidities who require shorter operating times.
Collapse
Affiliation(s)
- Ömer Turgut
- Urology, Besni State Hospital, Adıyaman, TUR
| | - Ahmet Erbagcı
- Urology, Gaziantep University Medical Faculty, Gaziantep, TUR
| | - Omer Bayrak
- Urology, Gaziantep University Medical Faculty, Gaziantep, TUR
| | - Ilker Seckiner
- Urology, Gaziantep University Medical Faculty, Gaziantep, TUR
| | - Sakıp Erturhan
- Urology, Gaziantep University Medical Faculty, Gaziantep, TUR
| | - Haluk Sen
- Urology, Gaziantep University Medical Faculty, Gaziantep, TUR
| | - Mehmet Ozturk
- Urology, Gaziantep University Medical Faculty, Gaziantep, TUR
| |
Collapse
|
9
|
Helfand BT, Kasraeian A, Sterious S, Glaser AP, Talaty P, Alcantara M, Alcantara KM, Higgins A, Ghiraldi E, Elterman DS. How I do it: Aquablation in very large prostates (> 150 mL). Can J Urol 2022; 29:11111-11115. [PMID: 35429430] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aquablation has been well-studied in prostates sizes up to 150 mL. Recently, American Urological Association guidelines distinguish surgical interventions for men with large prostates (80 mL-150 mL) and now very large prostates (> 150 mL). Readers will gain an understanding of how to use Aquablation in the very large prostate size category.
Collapse
Affiliation(s)
- Brian T Helfand
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA
| | | | - Steve Sterious
- Department of Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Alexander P Glaser
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA
| | - Pooja Talaty
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA
| | | | | | - Andrew Higgins
- Department of Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Eric Ghiraldi
- Department of Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Dean S Elterman
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Helfand BT, Glaser AP, Kasraeian A, Sterious S, Talaty P, Alcantara M, Alcantara KM, Higgins A, Ghiraldi E, Elterman D. Men with lower urinary tract symptoms secondary to BPH undergoing Aquablation with very large prostates (> 150 mL). Can J Urol 2021; 28:10884-10888. [PMID: 34895392] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The AUA guidelines for benign prostatic hyperplasia distinguish treatments based upon prostate volume (PV), particularly for very large prostates (> 150 mL). While the clinical outcomes and benefits of Aquablation have been studied for men with average and large prostates, it is unknown whether this technology can be used for very large prostates. MATERIALS AND METHODS Men with PV > 150 mL undergoing Aquablation were identified retrospectively from four North American hospitals. The surgical times and clinical outcomes of men with very large prostates (> 150 mL) were compared to data from men with average PV ≤ 80 mL (WATER study) and large PV 80 mL-150 mL (WATER II study). RESULTS The average PV of men who underwent Aquablation with very large prostates was 209 mL ± 56 (n = 34, range 151-362 mL), large PV 107 mL ± 20 (n = 101, range 80-150 mL) and average PV 54 mL ± 16 (n = 116, range 30-80 mL). For men with PV > 150 mL, baseline IPSS was 19 ± 6. With a mean follow up of 7 ± 9 months, the IPSS improved to 7 ± 5 (p < 0.001). Peak urinary flow rate, Qmax, improved from 7 ± 4 mL/s to 19 ± 5 mL/s (p<0.001). Compared to the two other PV groups, there were no differences in terms of improvements in IPSS, quality of life, or uroflowmetry. There were no reports of transfusions (0%) in the cohort of men with very large prostates. CONCLUSIONS In the present study, we demonstrate that Aquablation is effective and safe in prostates greater than 150 mL while showing consistent outcomes compared to average and large prostates sizes.
Collapse
Affiliation(s)
- Brian T Helfand
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA
| | - Alexander P Glaser
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA
| | | | - Steve Sterious
- Department of Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Pooja Talaty
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA 2Kasraeian Urology, Jacksonville, Florida, USA
| | | | | | - Andrew Higgins
- Department of Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Eric Ghiraldi
- Department of Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Dean Elterman
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Shatalova O, Filist S, Korenevskiy N, Taha Al-Kasasbeh R, Shaqadan A, Protasova Z, Ilyash M, Rybochkin A. Application of fuzzy neural network model and current-voltage analysis of biologically active points for prediction post-surgery risks. Comput Methods Biomech Biomed Engin 2021; 24:1504-1516. [PMID: 34176395 DOI: 10.1080/10255842.2021.1895128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/21/2022]
Abstract
The work investigates neural network model for prediction of post-surgical treatment risks. The descriptors of the risk classifiers are formed on the basis of the analysis of the current-voltage characteristics of one, two and three biologically active points. The training and verification samples were formed by examining 120 patients with a diagnosis of benign prostatic hyperplasia. Of these, 62 patients were successfully operated on (class C1), 30 had various complications after surgery (class C2), 28 patients required additional treatment (class C3). The constructed classifiers showed a high quality of predicting critical conditions during surgical treatment.
Collapse
Affiliation(s)
- Olga Shatalova
- Department of Biomedical Engineering, Southwest State University, Kursk, Russian Federation
| | - Sergey Filist
- Department of Biomedical Engineering, Southwest State University, Kursk, Russian Federation
| | - Nikolay Korenevskiy
- Department of Biomedical Engineering, Southwest State University, Kursk, Russian Federation
| | | | | | - Zeinab Protasova
- Department of Biomedical Engineering, Southwest State University, Kursk, Russian Federation
| | - Maksim Ilyash
- Mechanics and Optics, Saint-Petersburg National Research University of Information Technologies, Russian Federation
| | - Anatoly Rybochkin
- Department of Space Instrumentation Tel, Southwestern State University, Kursk, Russian Federation
| |
Collapse
|
12
|
Johnston SS, Jamous N, Mistry S, Jain S, Gangoli G, Danker W, Ammann E, Hampton K. Association of In-Hospital Surgical Bleeding Events with Prolonged Hospital Length of Stay, Days Spent in Critical Care, Complications, and Mortality: A Retrospective Cohort Study Among Patients Undergoing Neoplasm-Directed Surgeries in English Hospitals. Clinicoecon Outcomes Res 2021; 13:19-29. [PMID: 33447063 PMCID: PMC7802902 DOI: 10.2147/ceor.s287970] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the association of in-hospital surgical bleeding events with the outcomes of hospital length of stay (LOS), days spent in critical care, complications, and mortality among patients undergoing neoplasm-directed surgeries in English hospitals. Patients and Methods This is a retrospective cohort study using English hospital discharge data (Hospital Episode Statistics [HES]) linked to electronic health records (Clinical Practice Research Datalink [CPRD]). HES includes information on patient demographics, admission and discharge dates, diagnoses and procedures, days spent in critical care, and discharge status. CPRD includes information on patient demographics, diagnoses and symptoms, drug exposures, vaccination history, and laboratory tests. Patients aged ≥18 years who underwent selected neoplasm-directed surgeries between 1-Jan-2010 and 29-February-2016: hysterectomy, low anterior resection (LAR), lung resection, mastectomy, and prostate surgery were included. The primary independent variable was in-hospital surgical bleeding events identified by diagnosis of haemorrhage and haematoma complicating a procedure or reopening/re-exploration and surgical arrest of postoperative bleeding. Outcomes included LOS, days spent in critical care, in-hospital complications (diagnoses of infections, acute renal failure, vascular events), and in-hospital mortality, identified during surgery through discharge. Multivariable regression was used to examine the adjusted association of bleeding events with outcomes. Results The study included 26,437 neoplasm-directed surgeries (hysterectomy=6092; LAR=2957; lung=1538; mastectomy=12,806; prostate=3044). Incidence proportions of bleeding events were: hysterectomy=1.9% (95% confidence interval=1.1–2.5%); LAR=3.0% (CI=2.3–3.6%); lung=1.8% (CI=1.1–2.5%); mastectomy=1.6% (CI=1.3–1.8%); prostate=1.0% (CI=0.6–1.3%). In adjusted analyses, bleeding events were associated with: prolonged LOS: 3.1 (CI=1.1–6.3) mastectomy to 5.7 (CI=3.6–8.2) LAR days longer; more days spent in critical care: 0.4 (CI=0.03–0.27) mastectomy to 6.5 (CI=2.5–13.6) hysterectomy days more; and higher incidence proportions of all examined complications; all P<0.05. Conclusion This study quantifies a substantial clinical and healthcare resource utilization burden associated with surgical bleeding among patients undergoing neoplasm-directed surgery in England hospitals.
Collapse
Affiliation(s)
- Stephen S Johnston
- Department of Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Nadine Jamous
- Department of Health Economics and Market Access, Johnson & Johnson Medical Ltd, Edinburgh, UK
| | - Sameer Mistry
- Department of Medical Affairs, Johnson & Johnson Medical Ltd, Berkshire, UK
| | - Simran Jain
- Department of Decision Science, Mu Sigma, Bangalore, India
| | - Gaurav Gangoli
- Department of Health Economics and Market Access, Ethicon, Inc, Somerville, NJ, USA
| | - Walter Danker
- Department of Health Economics and Market Access, Ethicon, Inc, Somerville, NJ, USA
| | - Eric Ammann
- Department of Epidemiology, Janssen, Titusville, NJ, USA
| | - Kingsley Hampton
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| |
Collapse
|
13
|
Wu SY, Kuo HC. Predictive factors for recovery of voiding function after transurethral prostate surgery in men with small prostate volume and very low detrusor contractility. Low Urin Tract Symptoms 2019; 12:41-46. [PMID: 31430060 DOI: 10.1111/luts.12282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/12/2019] [Revised: 06/18/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Detrusor underactivity (DU) is a common but poorly understood clinical problem. The diagnosis and treatment are difficult and full of uncertainties. There are many overlaps between DU and bladder outlet obstruction (BOO) in men. Prostatic surgery might improve voiding efficiency (VE). This study aims to investigate effectiveness and predictors of voiding function recovery after prostate surgery in patients with DU. METHODS Male patients with DU and small total prostate volume (TPV, <40 mL) who had undergone transurethral prostate surgery were retrospectively reviewed over the past two decades. Video-urodynamic studies were performed before and after the operation. The urodynamic parameters were recorded, and change of VE was used to determine treatment outcome. A postoperative VE of ≥50% was considered successful. RESULTS A total of 48 patients were included, with a mean age of 74.4 ± 10.0 years. The mean follow-up period was 24.9 ± 30.5 months. At the most recent follow-up, 29 (60.4%) patients had positive results. Among them, 21 (72.4%) patients recovered within 1 month, and only one recovered later than 6 months after the operation. After surgery, the maximum flow rate, voided volume, postvoid residual urine, and VE all showed improvement. Patients with successful outcome had a higher baseline detrusor pressure (p = .029) and greater maximum flow rate (p = .034) than the nonrecovery group. The age and other parameters were not significantly different between recovery and nonrecovery group. CONCLUSIONS Patients with DU and small TPV might also benefit from prostatic surgery if they had a higher detrusor pressure and maximum flow rate at baseline.
Collapse
Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
14
|
Desai M, Bidair M, Zorn KC, Trainer A, Arther A, Kramolowsky E, Doumanian L, Elterman D, Kaufman RP, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Uchio E, Gin G, Goldenberg L, Paterson R, So A, Humphreys M, Roehrborn C, Kaplan S, Motola J, Bhojani N. Aquablation for benign prostatic hyperplasia in large prostates (80-150 mL): 6-month results from the WATER II trial. BJU Int 2019; 124:321-328. [PMID: 30734990 DOI: 10.1111/bju.14703] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 11/30/2022]
Abstract
OBJECTIVE To present 6-month safety and effectiveness data from a multicentre prospective study of aquablation in men with lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) with prostate volumes between 80 and 150 mL. METHODS Between September and December 2017, 101 men with LUTSattributable to BPHwere prospectively enrolled at 16 centres in Canada and the USA. RESULTS The mean prostate volume was 107 mL. The mean length of hospital stay after the aquablation procedure was 1.6 days (range: same day to 6 days). The primary safety endpoint (Clavien-Dindo grade 2 or higher or any grade 1 event resulting in persistent disability) at 3 months occurred in 45.5% of men, which met the study design goal of < 65% (P < 0.001). At 6 months, 22% of the patients had experienced a Clavien-Dindo grade 2, 14% a grade 3 and 5% a grade 4 adverse event. Bleeding complications requiring intervention and/or transfusion were recorded in eight patients prior to discharge and in six patients after discharge. The mean International Prostate Symptom Score improved from 23.2 ± 6.3 at baseline to 6.7 ± 5.1 at 3 months, meeting the study's primary efficacy endpoint goal (P < 0.001). The maximum urinary flow rate increased from 8.7 to 18.8 mL/s (P < 0.001) and post-void residual urine volume decreased from 131 at baseline to 47 at 6 months (P < 0.0001). At 6 months, prostate-specific antigen concentration reduced from 7.1 ± 5.9 ng/mL at baseline to 4.0 ± 3.9 ng/mL, a 44% reduction. CONCLUSIONS Aquablation is safe and effective in treating men with larger prostates (80-150 mL), without significant increase in procedure or resection time.
Collapse
Affiliation(s)
- Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Mo Bidair
- San Diego Clinical Trials, San Diego, CA, USA
| | - Kevin C Zorn
- University of Montreal Hospital Center, Université de Montréal, Montreal, QC, Canada
| | - Andrew Trainer
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, NE, USA
| | - Andrew Arther
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, NE, USA
| | | | - Leo Doumanian
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Dean Elterman
- University of Toronto - University Health Network, Toronto, ON, Canada
| | | | - James Lingeman
- Indiana University Health Physicians, Indianapolis, IN, USA
| | - Amy Krambeck
- Indiana University Health Physicians, Indianapolis, IN, USA
| | - Gregg Eure
- Urology of Virginia, Virginia Beach, VA, USA
| | - Gopal Badlani
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark Plante
- University of Vermont Medical Center, Burlington, VT, USA
| | - Edward Uchio
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Greg Gin
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | | | - Ryan Paterson
- University of British Columbia, Vancouver, BC, Canada
| | - Alan So
- University of British Columbia, Vancouver, BC, Canada
| | | | - Claus Roehrborn
- UT Southwestern Medical Center, Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Steven Kaplan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jay Motola
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naeem Bhojani
- University of Montreal Hospital Center, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
15
|
Aagaard MF, Khayyami Y, Hansen FB, Tofft HP, Nordling J. Implantation of the argus sling in a hard-to-treat patient group with urinary stress incontinence. Scand J Urol 2018; 52:448-452. [PMID: 30298753 DOI: 10.1080/21681805.2018.1517823] [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: 10/28/2022]
Abstract
INTRODUCTION Awareness of prostate cancer is growing in the Western population, and an increasing number of patients are being referred to prostate surgery. This is a significant contributor to male stress urinary incontinence (SUI). Implantation of an artificial sphincter (AUS) is considered the gold standard treatment of SUI. This study investigates the role of minimally invasive treatment with the Argus sling in a heterogenic hard-to-treat patient group. METHOD The study was a retrospective follow-up study with patients as their own controls. Forty-one patients were enrolled and treated with the Argus sling. Patients enrolled had persisting SUI after prostate surgery for more than 12 months, despite conservative treatment. The pre-operative daily usage of pads and the 24 hours urinary leakage were compared to the post-operative findings. The primary goal was to achieve complete continence or a reduction of more than 50% in pad usage or urinary leakage. RESULTS In total, 71% of the 41 patients enrolled met our primary objective. Complete continence was obtained in 56%, and a reduction of 50% or more was obtained in an additional 15%. CONCLUSION This study has reproduced continence rates seen in previous studies, but in the hard-to-treat patients with urgency or formerly failed surgery, the continence rate was found to be inferior. The AUS has produced similar results and must still be considered the gold standard treatment of SUI, but the Argus sling is an alternative for patients who want a passive system or for patients not suitable for AUS.
Collapse
Affiliation(s)
| | - Yasmine Khayyami
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| | - Frank Bohn Hansen
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| | - Hans Peter Tofft
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| | - Jørgen Nordling
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| |
Collapse
|
16
|
Abstract
In the population of patients with prostate cancer, survivorship has come to the forefront of continuity-of-care. In addition to urinary control, erectile function is a significant issue after radical pelvic surgery. Penile prosthesis surgery remains an excellent option for restoring erectile function to those for whom more conservative measures have failed. This review article outlines the anatomical, surgical and post-operative consideration involved in the placement of a penile prosthesis in this special patient population.
Collapse
Affiliation(s)
- Nelson Bennett
- Department of Urology, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
17
|
Mina SH, Garcia-Perdomo HA. Effectiveness of tranexamic acid for decreasing bleeding in prostate surgery: a systematic review and meta-analysis. Cent European J Urol 2017; 71:72-77. [PMID: 29732210 PMCID: PMC5926641 DOI: 10.5173/ceju.2017.1581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The objective of this study was to determine the effectiveness of tranexamic acid in decreasing bleeding in patients undergoing prostate surgery. Material and methods All clinical experiments were included without language restrictions. The inclusion criteria were as follows: men over 18 years of age who underwent prostate surgery (transurethral, prostate adenectomy, and radical prostatectomy) and received tranexamic acid prior to prostate surgery as a preventive measure for perioperative hemorrhage. Prophylactic tranexamic acid vs. no intervention or placebo were compared. The primary outcomes were as follows: 1) intraoperative blood loss and 2) the need for red blood cell transfusion. A systematic search was performed in MEDLINE, EMBASE, CENTRAL and LILACS. Other sources were used to discover published and unpublished literature sources. The statistical analysis was performed in Review Manager v.5.3. Results Four studies were included with a total of 436 patients. Three of the four studies had small sample sizes. There was a low risk of attrition bias and reporting bias. Unclear risk of selection bias, performance bias, or detection bias was presented. A mean difference (MD) of -174.49 [95% CI (-248.43 to -100.56)] was found for perioperative blood loss (the primary outcome). At the end of the procedure, the hemoglobin concentration had a MD of -1.19 [95% CI (-4.37 to 1.99)]. Conclusions Tranexamic acid is effective at preventing perioperative blood loss compared with the placebo in patients undergoing transurethral resection of the prostate (TURP). However, this treatment was not effective neither at preventing the need for transfusions nor at increasing hemoglobin values at the end of the procedure.
Collapse
Affiliation(s)
- Sergio Hernando Mina
- Universidad del Valle, Department of Urology, Santiago de Cali, Colombia.,Urology Research Group (UROGIV), Universidad del Valle, Santiago de Cali, Colombia
| | - Herney Andres Garcia-Perdomo
- Universidad del Valle, Department of Urology, Santiago de Cali, Colombia.,Urology Research Group (UROGIV), Universidad del Valle, Santiago de Cali, Colombia
| |
Collapse
|
18
|
Jeschke E, Günster C, Klauber J. [Quality assurance with administrative data (QSR): follow-up in quality measurement - an analysis of patient records]. Z Evid Fortbild Qual Gesundhwes 2015; 109:673-81. [PMID: 26699256 DOI: 10.1016/j.zefq.2015.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022]
Abstract
The present study analyses the information gain obtained by evaluating adverse events during follow-up compared to the sole analysis of events during the initial hospital stay for quality measurement purposes. The analysis is based on AOK administrative data from the years 2010 to 2012. The analyses were carried out for 10 quality indicators from the 4 QSR sectors knee replacement for osteoarthritis, appendectomy, prostate surgery for benign prostatic syndrome (BPS) and therapeutic cardiac catheterization (PCI) in patients with myocardial infarction. A total of 409,774 AOK cases were included. For almost all indicators considered, a relevant share of complications can be found to have occurred only after discharge from the initial hospitalization (7.7 %-92.6 %). Furthermore, there is only a weak connection between the findings from the first hospitalization and those from the follow-up period (0.0449 < r < 0.1935). 26-66 % of the hospitals will be classified differently based on Standardized Mortality/Morbidity Ratio (SMR) quartiles if follow-up events are included in the quality assessment (with the exception of "Other Complications after PCI" of 14 %). In summary, quality assessment is improved considerably by evaluating the follow-up period for almost all indicators considered. A quality measurement based solely on events in the initial hospital stay obscures relevant adverse events that have an impact on a comparative hospital quality assessment for these indicators.
Collapse
MESH Headings
- Appendectomy/mortality
- Appendectomy/statistics & numerical data
- Arthroplasty, Replacement, Knee/mortality
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Cardiac Catheterization/mortality
- Cardiac Catheterization/statistics & numerical data
- Data Collection/methods
- Data Collection/statistics & numerical data
- Follow-Up Studies
- Germany
- Hospital Mortality
- Hospital Records/statistics & numerical data
- Humans
- Male
- Medical Records, Problem-Oriented/statistics & numerical data
- Myocardial Infarction/mortality
- Myocardial Infarction/therapy
- Osteoarthritis, Knee/mortality
- Osteoarthritis, Knee/surgery
- Outcome Assessment, Health Care/statistics & numerical data
- Patient Readmission/statistics & numerical data
- Prostatectomy/mortality
- Prostatectomy/statistics & numerical data
- Prostatic Hyperplasia/mortality
- Prostatic Hyperplasia/surgery
- Quality Assurance, Health Care/organization & administration
- Quality Assurance, Health Care/statistics & numerical data
- Quality Indicators, Health Care/organization & administration
- Quality Indicators, Health Care/statistics & numerical data
- Reoperation/mortality
- Reoperation/statistics & numerical data
Collapse
Affiliation(s)
- Elke Jeschke
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Deutschland.
| | | | - Jürgen Klauber
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Deutschland
| |
Collapse
|
19
|
Hendrick RJ, Mitchell CR, Herrell SD, Webster RJ. Hand-held transendoscopic robotic manipulators: A transurethral laser prostate surgery case study. Int J Rob Res 2015; 34:1559-1572. [PMID: 27570361 DOI: 10.1177/0278364915585397] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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: 11/15/2022]
Abstract
Natural orifice endoscopic surgery can enable incisionless approaches, but a major challenge is the lack of small and dexterous instrumentation. Surgical robots have the potential to meet this need yet often disrupt the clinical workflow. Hand-held robots that combine thin manipulators and endoscopes have the potential to address this by integrating seamlessly into the clinical workflow and enhancing dexterity. As a case study illustrating the potential of this approach, we describe a hand-held robotic system that passes two concentric tube manipulators through a 5 mm port in a rigid endoscope for transurethral laser prostate surgery. This system is intended to catalyze the use of a clinically superior, yet rarely attempted, procedure for benign prostatic hyperplasia. This paper describes system design and experiments to evaluate the surgeon's functional workspace and accuracy using the robot. Phantom and cadaver experiments demonstrate successful completion of the target procedure via prostate lobe resection.
Collapse
Affiliation(s)
- Richard J Hendrick
- Vanderbilt Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | | | - S Duke Herrell
- Vanderbilt Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA
| | - Robert J Webster
- Vanderbilt Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| |
Collapse
|
20
|
Abstract
In this paper we would like to present probably the first surgery performed on the prostate gland followed by microscopic analysis of the obtained tumor tissue sample. We based on the existing correspondence between Ludwig von Hammen and Johann N. Pechlin, and their successors in this field as well. Von Hammen seems to be a pioneer in the area of not only urological surgery but in directing this part of medical practice from "lithotomists" to physicians, much better educated than barbers in physiology but first of all in anatomy. This 17th century physician from Gdansk tried to set new standards both for surgical medical practice but histopathological examination of the excised material as well. Due to the change of the operational skills and procedures von Hammen's work got almost forgotten, but remains remembered due to the work of historians of the medicine from following centuries.
Collapse
Affiliation(s)
- Adam Szarszewski
- Department of History and Philosophy of Medical Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | | |
Collapse
|
21
|
Hermanns T, Fankhauser CD, Hefermehl LJ, Kranzbühler B, Wong LM, Capol JC, Zimmermann M, Sulser T, Müller A. Prospective evaluation of irrigation fluid absorption during pure transurethral bipolar plasma vaporisation of the prostate using expired-breath ethanol measurements. BJU Int 2013; 112:647-54. [PMID: 23773260 DOI: 10.1111/bju.12170] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 12/17/2022]
Abstract
OBJECTIVES To investigate if absorption of irrigation fluid occurs during bipolar plasma vaporisation (BPV) of the prostate. To examine the clinical predictors of increased risk of fluid absorption and to assess if changes in serum electrolytes, venous pH, haemoglobin or haematocrit are able to detect intra-operative fluid absorption. PATIENTS AND METHODS Over a 15-month period, 55 consecutive patients undergoing BPV of the prostate were investigated. The volume of intra-operative fluid absorption was measured using expired-breath ethanol measurements. Intra-operative irrigation was performed with isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min during the operation and the volume of irrigation fluid absorption was calculated from these concentrations. Data on clinical (age, prostate volume, smoking status) and surgical variables (operation time, irrigation volume, appearance of capsular perforation) as well as intra-operative changes in serum electrolytes, venous pH, haemoglobin and haematocrit were recorded. RESULTS The median (range) age of the patients was 67 (48-87) years and the median (range) prostate volume was 41 (17-111) mL. Nine patients (16%) showed a positive ethanol breath test during the procedure. The median (range) calculated fluid absorption in these patients was 346 (138-2166) mL. Three patients had a fluid absorption >500 mL. One patient with absorption of >2 L showed clinical symptoms (dyspnoea and agitation) during the operation under spinal anaesthesia. In the group of patients with fluid absorption, capsular perforation or injury to larger vessels was more often detectable. In the group of patients with fluid absorption, only venous pH showed a significant change during the operation (from median 7.41 to median 7.34, P = 0.02). The pH decrease was significantly greater in the fluid absorption group than in the group of patients without fluid absorption (0.09 vs. 0.02, P = 0.005). CONCLUSION We have demonstrated that significant intra-operative fluid absorption can occur during BPV of the prostate. Care must be taken if using this procedure in patients with significant cardiovascular comorbidities. Respecting the anatomical borders of the prostate seems to play a relevant role in preventing fluid absorption during the procedure. Venous pH could be used to detect potentially dangerous fluid absorption if intra-operative monitoring with breath ethanol measurements is not available.
Collapse
Affiliation(s)
- Thomas Hermanns
- Department of Urology, University Hospital, University of Zürich, Zürich, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Gruschkus S, Poston S, Eaddy M, Chaudhari S. Adherence to 5-alpha reductase inhibitor therapy for benign prostatic hyperplasia: clinical and economic outcomes. P T 2012; 37:464-470. [PMID: 23091339 PMCID: PMC3474422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 07/06/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Our goal was to quantify relationships between adherence to 5-alpha reductase inhibitors (5-ARIs), the risk of acute urinary retention (AUR) and prostate surgery, and medical costs related to patients with benign prostatic hyperplasia (BPH). METHODS Claims recorded over a period of 6.5 years in a nationwide managed care database were analyzed. We conducted time-to-event multivariate analysis to evaluate relationships between adherence (medication possession ratio [MPR] thresholds of 70% or higher, 75% or higher, and 80% or higher), persistence (length of therapy), and the risk of AUR and surgery. We compared mean monthly BPH-related medical costs in patients with MPRs at or above thresholds and those with MPRs below thresholds and determined changes in BPH-related costs associated with 30-day increments of therapy. RESULTS In AUR analyses (N = 17,293), meeting or exceeding MPR thresholds was associated with a reduced likelihood of AUR for 70% (hazard ratio [HR], 0.380), 75% (HR, 0.613), and 80% (HR, 0.519) (P < 0.05 for all). In prostate surgery analyses (N = 17,739), the likelihood of surgery was reduced with MPR thresholds of 70% or above (HR, 0.294), 75% or above (HR, 0.542), and 80% or above (HR, 0.436) (P < 0.05 for all). A longer duration of therapy was associated with a reduced likelihood of AUR (HR, 0.860) and surgery (HR, 0.884) (P < 0.05 for both). In both populations, adherence and persistence were also associated with significantly decreased BPH-related medical costs. CONCLUSION In patients with BPH who received 5-ARI therapy, greater adherence and persistence were associated with significantly reduced risks of AUR and prostate surgery and with significantly lower medical costs. Maximizing adherence may enable patients to realize the potential long-term benefits of 5ARIs.
Collapse
|