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- The symptoms of 128 consecutive patients (mean age 65 years) with benign prostatic hypertrophy were assessed and compared with flowmetry recordings. The 84 patients (65%) with peak flow rates ≥2 standard deviations from the mean were considered to have abnormal flowmetry and their symptoms were compared with those of the 44 men with normal peak flows. No significant correlation between peak flow rate and age was found within this group. Symptoms of poor stream, nocturia, post-micturition dribble and nocturnal or full-bladder hesitancy were present in over two-thirds of the whole series. Poor stream, hesitancy and nocturnal or full-bladder hesitancy were found to have significant associations with abnormal flowmetry recordings but also to have a high incidence within the normal flowmetry group. Discriminant analysis was unable to define a symptom complex which would accurately predict those within our group with abnormal peak flows. It was concluded that symptomatology and flowmetry evidence of lower urinary tract obstruction are not associated and subjective and objective evidence must be considered independently in selecting candidates for prostatectomy. [ABSTRACT FROM AUTHOR]

Transperineal prostate biopsy (TPPB) is proven to be an effective diagnostic tool for prostate cancer detection. It allows satisfactory sampling of apical and anterior areas which is not well achieved with the transrectal route, without the associated risks of urinary tract infection or sepsis. The main objective of this paper is to describe the technique utilized in our institution to perform transperineal prostate biopsy under local anesthetic in the outpatient clinic setting.

Robotics and autonomous systems are reshaping the world, changing healthcare, food production and biodiversity management. While they will play a fundamental role in delivering the UN Sustainable Development Goals, associated opportunities and threats are yet to be considered systematically. We report on a horizon scan evaluating robotics and autonomous systems impact on all Sustainable Development Goals, involving 102 experts from around the world. Robotics and autonomous systems are likely to transform how the Sustainable Development Goals are achieved, through replacing and supporting human activities, fostering innovation, enhancing remote access and improving monitoring. Emerging threats relate to reinforcing inequalities, exacerbating environmental change, diverting resources from tried-and-tested solutions and reducing freedom and privacy through inadequate governance. Although predicting future impacts of robotics and autonomous systems on the Sustainable Development Goals is difficult, thoroughly examining technological developments early is essential to prevent unintended detrimental consequences. Additionally, robotics and autonomous systems should be considered explicitly when developing future iterations of the Sustainable Development Goals to avoid reversing progress or exacerbating inequalities., (© 2022. The Author(s).)

The response to the Covid-19 pandemic in 2020-21 was dominated by the Westphalian primacy of national territory and sovereignty, significantly worsening and prolonging this crisis. Global platforms for cross-border coordination and cooperation were constrained by national self-interest. Arguably, the lack of a worldwide supranational (or post-Westphalian) authority in health governance is one important structural reason for the fragmented, chaotic, and ineffective response to Covid-19. The failure of Westphalian governance responses to the pandemic provides a unique opportunity for post-Westphalian governance structures to be established and contribute to reforming international pandemic preparedness. While this is unlikely to happen soon at the global level, a comprehensive framework is emerging at the European Union level in the form of a European Health Union. Through a combined conceptualisation of supranational governance and the securitisation process of international health crises, Covid-19 has opened the door to post-Westphalian health governance coordinated by the European Commission., (© 2021 The Authors Disasters © 2021 Overseas Development Institute.)

Objective: To assess the safety and feasibility of aquablation in a first-in-man study. Aquablation is a novel minimally invasive water ablation therapy combining image guidance and robotics (AquaBeam(®) ) for the targeted and heat-free removal of prostatic tissue in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH)., Patients and Methods: A prospective, non-randomised, single-centre trial in men aged 50-80 years with moderate-to-severe LUTS was conducted. Under real-time image-based ultrasonic guidance, AquaBeam technology enables surgical planning and mapping, and leads to a controlled heat-free resection of the prostate using a high-velocity saline stream. Patients were evaluated at 1, 3, and 6 months after aquablation., Results: In all, 15 patients were treated with aquablation under general anaesthesia. The mean (range) age was 73 (59-86) years and prostate size was 54 (27-85) mL. A substantial median lobe was present in six of the 15 patients. The mean International Prostate Symptom Score (IPSS) was 23 and the maximum urinary flow rate (Qmax ) was 8.4 mL/s at baseline. The mean procedural time was 48 min with a mean aquablation treatment time of 8 min. All procedures were technically successful with no serious or unexpected adverse events (AEs). All but one patient had removal of catheter on day 1, and most of the patients were discharged on the first postoperative day. No patient required a blood transfusion, and postoperative sodium changes were negligible. There were no serious 30-day AEs. One patient underwent a second aquablation treatment within 90 days of the first procedure. The mean IPSS score statistically improved from 23.1 at baseline to 8.6 at 6 months (P < 0.001) and the Qmax increased from 8.6 mL/s at baseline to 18.6 mL/s at the 6-month follow-up (P < 0.001). At 6 months, the mean detrusor pressure at Qmax decreased to 45 cmH2 0 from 66 cmH2 0 at baseline (P < 0.05), and the mean prostate size was reduced to 36 mL, a 31% reduction in size vs baseline (P < 0.001). No cases of urinary incontinence or erectile dysfunction were reported., Conclusions: These preliminary results from this initial study show aquablation of the prostate is technically feasible with a safety profile comparable to other BPH technologies. The combination of surgical mapping by the operating surgeon and the high-velocity saline provides a promising technique delivering a conformal, quantifiable, and standardised heat-free ablation of the prostate. Advantages of this technique include reduction in resection time compared with other endoscopic methods, as well as the potential to preserve sexual function., (© 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.)

Purpose: It has previously been shown that holmium laser resection of the prostate (HoLRP) is superior to transurethral resection of the prostate (TURP) with regard to perioperative morbidity and is equivalent to TURP in the short term. We present the long-term results of a randomized, prospective trial comparing HoLRP to TURP since information regarding the durability of holmium prostatectomy is lacking in the literature to date., Materials and Methods: A total of 120 patients with urodynamic obstruction were randomized (April 1996 to August 1997) into 2 comparable groups and assigned to HoLRP or TURP. All patients were assessed preoperatively and followed prospectively at 3 weeks, 3, 6, 12, 24 and 48 months postoperatively with an American Urological Association symptom score, quality of life score, peak urinary flow rate, and questionnaires concerning sexual function and continence. Preoperative pressure flow studies, ultrasound prostatic volume assessment and post-void residual volume measurement were repeated at the 6-month visit. All adverse events were noted., Results: Of 120 patients 73 completed the 48-month assessment. HoLRP and TURP resulted in significant improvements in all parameters. There was no difference between the 2 techniques in terms of urodynamic parameters, potency, continence and symptom scores at the 48-month assessment. HoLRP took significantly longer to perform but perioperative morbidity, catheter time, nursing contact time and hospital stay were significantly less for HoLRP compared to TURP., Conclusions: HoLRP and TURP give equivalent and satisfactory long-term results, with no differences noted in major morbidity. This confirms the durability of these 2 treatments. Peri-operative morbidity is less with HoLRP.

Purpose: Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment for bladder outlet obstruction secondary to benign prostatic hyperplasia. HoLEP is a transurethral procedure that uses the holmium laser fiber (wavelength 2,140 nm) to dissect whole prostatic lobes off of the surgical capsule in retrograde fashion, while maintaining excellent hemostasis. The lobes are removed from the bladder by a purpose built transurethral morcellator, which means that large volume prostates can be enucleated endoscopically. We compared this procedure with transurethral prostate resection (TURP) in a randomized trial by evaluating outcomes in patients with a prostate volume of 40 to 200 ml on transrectal ultrasound., Materials and Methods: A total of 61 patients with urodynamically proved bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized to TURP or HoLEP. Perioperative parameters recorded included resectoscope, laser, electrocautery, morcellation and catheter time, hospital stay, bladder irrigation, volume blood transfusion the rate and resected tissue weight. Patients were followed 1, 3, 6 and 12 months postoperatively with peak urinary flow rate measurement and quality of life and American Urological Association symptom scores. Patients also underwent urodynamic assessment at 6 months with measurement of peak detrusor pressure at maximal flow, post-void residual volume and prostate volume by transrectal ultrasound. Continence, potency and all adverse events were recorded at each visit., Results: HoLEP was superior to TURP in terms of mean catheter time (17.7 +/- 0.7 vs 44.9 +/- 10 hours) and hospital stay (27.6 +/- 2.7 vs 49.9 +/- 5.6 hours) but it required more time to perform (62.1 +/- 5.9 vs 33.1 +/- 3.7 minutes). More prostate tissue was removed in the HoLEP group (40.4 +/- 5.7 vs 24.7 +/- 3.4 gm). HoLEP was also superior to TURP in terms of relieving urodynamic obstruction at 6 months of followup (postoperative detrusor pressure at maximum flow 20.8 +/- 2.8 vs 40.7 +/- 2.7 cm H2O). HoLEP and TURP led to significant improvements in peak flow rates, symptom scores and quality of life scores compared with baseline and there was no significant difference between the 2 procedures with respect to these parameters at 12 months. Fewer adverse events were recorded in the HoLEP group., Conclusions: HoLEP is superior to TURP for relieving bladder outlet obstruction in men with benign prostatic hyperplasia. It allows more rapid catheter removal and hospital discharge. It requires more time to perform than TURP but more prostate tissue is removed, resulting in similar efficiency in tissue retrieval. HoLEP is equivalent to TURP in relieving men of lower urinary tract symptoms and in improving peak urinary flow rates at 12 months of followup.