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Background Different treatment options are available for the management of BPH. Our study aimed to compare the surgical outcomes of a holmium laser enucleation of the prostate (HoLEP) and a bipolar transurethral resection of the prostate (Bipolar-TURP) after 2 years. Methods Our prospective randomized study included 114 patients: 55 patients underwent HoLEP procedure and 59 patients underwent bipolar TURP procedure. All patients underwent a complete preoperative assessment and a physical examination. The postoperative follow-up data included Q max and IPSS recordings at 1, 3, 6, 12, and 24 months and PVR urinary volume recordings at 6 and 12 months. Any postoperative complications were also recorded. Results There were no statistically significant differences between both groups regarding IPSS and Q max scores at one and 24 months postoperative. Also, there were no statistically significant differences between both groups regarding postoperative PVR at 6 and 12 months. One patient in the HoLEP group developed total incontinence after surgery. Conclusion Our study did not show a significant difference between HoLEP and bipolar TURP regarding postoperative Q max and IPSS scores at 24 months of follow-up.

Author(s): Fedrigon, Donald; Alshara, Luay; Monga, Manoj | Abstract: INTRODUCTION:Two automated irrigation systems have been released for use during endoscopic procedures such as ureteroscopy: the Cogentix RocaFlow® (CRF) and Thermedx FluidSmart® (TFS). Accurate pressure control using automated systems may help providers maintain irrigation pressures within a safe range while also providing clear visualization. Our objective was to directly compare these systems based on their pressure accuracy, pressure-flow relationships, and fluid heating capabilities in order to help providers better utilize the temperature and pressure settings of each system. MATERIALS AND METHODS:An in vitro ureteroscopy model was used for testing, consisting of a short semirigid ureteroscope (6/7, 5F, 31cm Wolf 425612) connected to a continuous digital pressure transducer (Meriam m1550). Each system pressure output and flow-rate, via 100mL beaker filling time, was measured using multiple trials at pressure settings between 30 and 300mmHg. Output fluid temperature was monitored using a digital thermometer (Omega DP25-TH). RESULTS:The pressure output of both systems exceeded the desired setting across the entire tested range, a difference of 15.7±2.4mmHg for the TFS compared to 5.2±1.5mmHg for the CRF (p l 0.0001). Related to this finding, the TFS also had slightly higher flow rates across all trials (7±2mL/min). Temperature testing revealed a similar maximum temperature of 34.0⁰C with both systems, however, the TFS peaked after only 8 minutes and started to plateau as early as 4-5 minutes into the test, while the CRF took over 18 minutes to reach a similar peak. CONCLUSIONS:Our in vitro ureteroscopy testing found that the CRF system had better pressure accuracy than the TFS system but with noticeably slower fluid heating capabilities. Each system provided steady irrigation at safe pressures within their expected operating parameters with small differences in performance that should not limit their ability to provide steady irrigation at safe pressures.

Introduction: Benign prostatic hyperplasia (BPH) is a common disease affecting men 50 years and older. Treatment options consist of observation, pharmacological treatment, minimally invasive surgery and traditional surgery. Alpha-blockers and 5-alpha-reductase inhibitors are the primary medications used to treat BPH. Transurethral resection of the prostate (TURP) is the gold standard of surgical management of BPH. Objective: To evaluate the effect of six weeks finasteride therapy before TURP on overall surgical outcomes and early postoperative quality of life (QoL). Patients and methods: Between June 2014 and August 2016, patients with BPH at our department were randomly assigned to one of two groups: group (A) receiving 5 mg of finasteride daily for six weeks and group (B) did not receiving finasteride before TURP. All patients were assessed using a modified validated Arabic version of the International Prostate Symptom Score (IPSS). Intra operative serum hemoglobin concentration and hemoglobin concentration in irrigating fluid were recorded. One month post-surgery, IPSS, storage, voiding subscores and QoL scores were measured. Results: Out of a total of 115 patients, 98 patients completed the study. Before surgery, there was no significant difference between the two groups in prostate size (Prostate size was 54.52 ± 7.3 g in group A and 50.19 ± 6.8 g in group B, p value = 0.72), IPSS (19.86 ± 4.68 in group A vs. 21.14 ± 4.33 in group B, p value = 0.17), maximum urinary flow rate and post-void residual urine test results. No significant difference between Qol score in both groups before surgery (p value = 0.96). Group A patients had significantly less intraoperative blood loss than group B patients (308.29 ± 48.1 ml vs. 431.11 ± 96.4 ml, p = 0.001). One month postoperatively, group A patients showed greater improvement in QoL than group B patients (p = 0.03). Conclusions: Finasteride therapy for 6 weeks before TURP reduced intraoperative blood loss and statistically improved quality of life in the early postoperative period. However, larger number of patients and longer duration of follow up is recommended to confirm its clinical significance. Keywords: Finasteride, TURP, Quality of life