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Understanding patient interest among surgical options is challenging. We used Google Trends to analyze interest in benign prostatic hyperplasia (BPH) surgeries recommended for prostate volumes

Objectives: This study aims to evaluate the impact of anterior fibromuscular stroma preserved enucleation (AFSPE) of the prostate on serum testosterone levels in patients with benign prostatic obstruction (BPO) and to explore age‐related differences in postoperative testosterone elevation. Methods: In a retrospective analysis, 304 patients from a pool of 560 who underwent AFSPE at Linkou Chang Gung Memorial Hospital between January 2018 and December 2021 were evaluated. Patients were stratified based on preoperative testosterone levels into low (<3.5 ng/mL) and normal (≥3.5 ng/mL) groups. Serum testosterone levels were measured preoperatively, at 1.5 and 3–6 months postoperatively. Age and other demographic data were analyzed as potential factors influencing testosterone changes. Results: The low‐testosterone group (n = 90) showed significant testosterone increases, from an average of 2.61 ng/mL preoperatively to 3.3 ng/mL at 1.5 months and 3.59 ng/mL at 3–6 months postoperatively (p < 0.0001). The normal‐testosterone group (n = 214) maintained stable testosterone levels at 1.5 months but exhibited a significant rise to 6.06 ng/mL by 3–6 months (p = 0.0079). Older age was inversely associated with postoperative testosterone elevation in both groups. Improvements in nocturia were notable in both groups. Conclusions: AFSPE of the prostate significantly elevates serum testosterone levels in men with BPO, particularly benefiting those initially with low levels. Age is a crucial factor influencing postoperative testosterone changes, indicating that younger patients may benefit more from this intervention. AFSPE offers a promising approach for improving hormonal health in BPO patients, alongside alleviating urinary symptoms. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model. Materials and methods: Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into Spasm group (n=65) and non-spasm group (n=177) according to whether they had bladder spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors. Results: Postoperative serum PGI2 and 5-HT levels were higher in patients in the Spasm group compared with the Non-spasm group (P

Purpose We aimed to evaluate the effect of self-training using a virtual reality head-mounted display simulator on the acquisition of surgical skills for holmium laser enucleation surgery. Methods Thirteen medical students without surgical skills for holmium laser enucleation of the prostate were trained using multimedia to learn the technique via simulator manipulation. Thereafter, participants performed the technique on a virtual benign prostatic hyperplasia model A (test A). After a 1-week wash-out period, they underwent self-training using a simulator and performed the technique on model B (test B). Subsequently, participants were asked to respond to Training Satisfaction Questions. Video footage of hand movements and endoscope view were recorded during tests A and B for later review by 2 expert surgeons. A 20-step Assessment Checklist, 6-domain Global Rating Scale, and a Pass Rating were used to compare performance on tests A and B. Results Thirteen participants completed both tests A and B. The 20-step Assessment Checklist and 6-domain Global Rating Scale evaluation results showed significantly improved scores in test B than in test A (P

Objective: To assess the quality and readability of online information on holmium laser enucleation of the prostate in managing benign prostate hyperplasia using the most-used search engine worldwide, Google. Methods: Google search terms “Holmium laser surgery” and “enlarged prostate” were used to generate 150 search results. Two independent authors (i) excluded any paywall, scientific literature, or advertisement and (ii) conducted an independent assessment on information quality, which was based on DISCERN, QUEST, and JAMA criteria, and readability, which was based on the FKG, GFI, SMOG, and FRE scores on qualified webpages. A third author was involved if there were any discrepancies between the assessments. Results: 107 qualified webpages were included in the data analysis. The median DISCERN score was 42 out of 80 (IQR 35–49). The median JAMA score was 0 out of 4 (IQR 0–1). The median QUEST score was 9 out of 28 (IQR 9–12). Using the non-parametric ANOVA and post hoc Games–Howell test, significant differences were identified between rankings of webpages. Sponsorship had no influence on the quality of webpages. The overall readability level required a minimum reading level of grade 11. Linear regression analysis showed that a higher ranked webpage is a positive predictor for all three quality assessment tools. Conclusions: The overall quality of online information on HoLEP is poor. We identify that the top-ranked google searches have a higher DISCERN score and are a positive predictor for DISCERN/QUEST/JAMA. Quality online information can benefit patients but should be used in conjunction with professional medical consultation.

ABSTRACT Purpose: CT-guided MWA is a safe and effective tool that should be utilized in the treatment of small renal masses (SRMs). We aim to clarify the utility of CT-guided MWA by examining patient outcomes such as recurrence, treatment success, changes in renal function, and complications. Methods: A retrospective review of consecutive patients with SRMs who underwent same day renal mass biopsy (RMB) and CT-guided MWA between 2015 and 2022 was performed. Treatment safety was assessed by 30-day complications according to the Clavien-Dindo system and change in eGFR >30 days post-procedure. Treatment efficacy was defined by local recurrence and incomplete treatment rates and calculated using the Kaplan-Meier method. Results: A total of 108 renal masses were found in 104 patients. The overall complication rate was 7.4% (8/108), of which 4 were major complications (3.7%). For those with renal function available >30 days post ablation, the median eGFR was 47.2 (IQR: 36.0, 57), compared to 52.3 (IQR: 43.7, 61.5) pre-ablation, p

Objectives: This study aimed to evaluate the efficacy and safety of Vibegron for the treatment of residual overactive bladder (OAB) symptoms after laser vaporization of the prostate (photo‐selective vaporization of the prostate, contact laser vaporization of the prostate, and thulium laser vaporization). Methods: This randomized, open‐label, parallel‐group, single‐center superiority trial with a 12‐week observation (jRCTs071190040) enrolled male patients with OAB aged 40 years or older who had undergone laser vaporization of the prostate for not less than 12 weeks and not more than 1 year earlier. Patients were allocated to receive Vibegron 50 mg once daily or follow‐up without treatment for 12 weeks. Results: Forty‐seven patients were enrolled between January 2020 and March 2023. The median age (interquartile range) was 75.5 (72.5–78.5) years for the Vibegron group and 76.5 (71.0–81.0) years for the control group. The intergroup difference in the mean change (95% confidence interval) in the 24‐hour urinary frequency at 12 weeks after randomization was −3.66 (−4.99, −2.33), with a significant decrease for the Vibegron group. The Overactive Bladder Symptom Score, International Prostate Symptom Score, IPSS storage score, and Overactive Bladder Questionnaire score significantly improved for the Vibegron group. Voided volume per micturition also increased for the Vibegron group. Conclusions: The administration of 50 mg of Vibegron once daily for 12 weeks showed significant improvement compared with follow‐up without treatment in bladder storage (OAB) symptoms after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to evaluate the effect of self-training using a virtual reality head-mounted display simulator on the acquisition of surgical skills for holmium laser enucleation surgery. Methods: Thirteen medical students without surgical skills for holmium laser enucleation of the prostate were trained using multimedia to learn the technique via simulator manipulation. Thereafter, participants performed the technique on a virtual benign prostatic hyperplasia model A (test A). After a 1-week wash-out period, they underwent self-training using a simulator and performed the technique on model B (test B). Subsequently, participants were asked to respond to Training Satisfaction Questions. Video footage of hand movements and endoscope view were recorded during tests A and B for later review by 2 expert surgeons. A 20-step Assessment Checklist, 6-domain Global Rating Scale, and a Pass Rating were used to compare performance on tests A and B. Results: Thirteen participants completed both tests A and B. The 20-step Assessment Checklist and 6-domain Global Rating Scale evaluation results showed significantly improved scores in test B than in test A (P<0.05). No evaluator rated participants as passed after test A, but 11 participants (84.6%) passed after test B. Ten participants (76.9%) indicated that the simulator was helpful in acquiring surgical skills for holmium laser enucleation of the prostate. Conclusions: The virtual reality head-mounted display holmium laser enucleation of the prostate simulator was effective for surgical skill training. This simulator may help to shorten the learning curve of this technique in real clinical practice in the future. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review to assess the incidence of reoperation rate for residual/regrowth adenoma after transurethral surgeries for benign prostatic enlargement. Materials and Methods: A systematic literature search was performed on November 12, 2023, using Cochrane Central Register of Controlled Trials, PubMed, and Scopus. We only included randomized studies comparing monopolar (M)/bipolar (B) transurethral resection of the prostate (TURP) vs ablation vs enucleation procedures. Incidence of reoperation was assessed using the Cochran-Mantel-Haenszel Method and reported as risk ratio (RR), 95% confidence interval (CI), and p-values. Statistical significance was set at p < 0.05. Evidence synthesis: Forty-eight studies were included. Six studies compared enucleation vs TURP, 41 ablation vs TURP, and 1 study enucleation vs ablation vs TURP, encompassing 457 patients in enucleation, 2259 in ablation, and 2517 in the TURP group. The pooled incidence of reoperation was 6.2%, 0.7%, 2.3%, and 4.3% after ablation, enucleation, M-TURP, and B-TURP, respectively. Meta-analysis showed that the incidence of reoperation was significantly lower in the enucleation group (RR 0.28, 95% CI 0.10–0.81, p = 0.02), but the difference accounted only in studies with follow-up between 1 and 3 years (RR 0.18, 95% CI 0.04–0.85, p = 0.03). The incidence of reoperation was significantly lower in the enucleation compared with the B-TURP group (RR 0.14, 95% CI 0.03–0.77, p = 0.02). Meta-analysis showed that the incidence of reoperation was significantly higher in the ablation group (RR 1.81, 95% CI 1.33–2.47, p = 0.0002), but there was no difference in studies with follow-up up to 1 year (odds ratio 1.78 95% CI 0.97–3.29, p = 0.06) longer than 5 years (RR 2.02, 95% CI 0.71–5.79, p = 0.19). The incidence of reoperation was significantly higher in the ablation compared with the M-TURP group (RR 1.91, 95% CI 1.44–2.54, p < 0.0001). Conclusions: In mid-term follow-up, reoperation rate for residual/regrowth adenoma was significantly lower after enucleation, although was significantly higher after ablation compared with TURP. [ABSTRACT FROM AUTHOR]

Background: Ondansetron and Dexmedetomidine are recently used effectively to prevent shivering following spinal anesthesia. Objectives: This study compares the effects of weight-adjusted doses of Ondansetron and Dexmedetomidine in preventing post-spinal shivering and its subsequent hazards in cases who underwent elective transurethral resection of the prostate (TURP). Methods: In this prospective randomized double-blind controlled trial, 132 ASA (I, II) patients who were scheduled to undergo TURP were divided into 3 equal groups (44 each): Control group: received 5 ml of normal saline (0.9%) intravenously after SA; Group D: received 1 ug/kg. Dexmedetomidine was intravenously diluted in 5 mL of normal saline after SA. Group O received (0.1 mg/kg) Ondansetron intravenously diluted in 5 mL of normal saline after SA. Shivering occurrences, intensity, and duration (primary outcome), hemodynamics and core temperature changes, sedation level, total consumed rescue pethidine, and intraoperative complications were evaluated. Results: There was a statistically non-significant difference between Ondansetron and Dexmedetomidine as regard to shivering occurrences, intensity, and duration, while it was significant when compared to the control group. Hemodynamics showed a significant decrease in heart rate in Dexmedetomidine while compared to the Ondansetron and Control groups. Additionally, sedation levels were significantly higher in the dexmedetomidine group compared to other groups. However, there was a significant increase in total consumed rescue pethidine in the control group when compared to other groups. When compared to both the Dexmedetomidine and control groups, the Ondansetron group had a significantly lower risk of hypotension. Conclusions: The prophylactic IV weight-adjusted dose of Ondansetron is as effective as IV Dexmedetomidine in reducing the shivering occurrences, intensity, duration, and total of rescue pethidine doses in patients undergoing TURP. The IV weight-adjusted dose of Ondansetron is associated with more hemodynamic stability compared to IV Dexmedetomidine, with fewer incidences of bradycardia and hypotension. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to compare the efficacy and functional outcomes of monopolar transurethral resection of the prostate (m-TURP) without and with the preservation of urethral mucosa at the prostatic apex. Materials and methods: In a retrospective study from June 2018 to June 2020, 53 patients with benign prostatic hyperplasia who undertook m-TURP were included in the study. The patients who underwent conventional m-TURP were considered group A (n = 26) and those who were operated by m-TURP with preserved prostate apex were considered group B (n = 27). Preoperative and operative parameters, postoperative complications, urinary incontinence (UI), postoperative 6-month functional outcomes including International Prostate Symptom Score, International Index of Erectile Function score, and peak flow rates (Q max) were assessed and compared between groups. Results: All preoperative parameters were similar in both groups without significant differences (P > 0.05). In group A, the mean operative time was significantly longer (40.59 ± 5.20 versus 33.84 ± 4.44 minutes), and intraoperative blood loss was significantly more (305 ± 63.4 versus 212.5 ± 65 mL) than in group B and both were statistically significant (P < 0.001 and P < 0.0001, respectively). Group B had significantly lower urge UI compared with group A (0% versus 23%; P = 0.008). Six-month follow-up data showed that the International Prostate Symptom Score, International Index of Erectile Function score, and Q max were improved in both groups with no statistically significant differences between the 2 groups (P > 0.05). Conclusion: Our results indicate that preservation of urethral mucosa at the prostatic apex can be associated with a lower incidence of early postoperative urge UI, less operative blood loss, and shorter operative length, thus improving surgical efficiency. [ABSTRACT FROM AUTHOR]

Objective: To evaluate predictors of reoperation after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) in a diverse patient population. Materials and methods: A retrospective chart review was performed on men who underwent TURP between 2013 and 2016 at our institution with follow-up data post-operatively. Variables collected included patient demographics and clinical characteristics. Primary outcomes included whether the patient underwent repeat TURP and months elapsed since initial TURP. Results: A total of 304 men underwent TURP during the study period. Thirty men (10%) underwent repeat TURP at a mean interval of 26 months. Reoperation after TURP was not associated with race, body mass index (BMI), 5-alpha-reductase inhibitor (5-ARI) use, or pre-operative prostate volume. An elevated pre-operative haemoglobin A1c (HbA1c) was associated with both reoperation (odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.03–1.69), 30 day readmission (OR = 1.96, 95% CI: 1.17–3.28) and 30-day hematuria (OR: 2.37, 95% CI: 1.29–4.38). Pre-operative prostate specific antigen (PSA) levels > 4 and hydronephrosis on imaging were also associated with a higher risk of reoperation. Conclusions: Reoperation after TURP occurred in 10% of our study cohort at a median of 26 months after surgery. Elevated HbA1c prior to surgery was associated with reoperation, 30-day readmission and 30-day hematuria. Higher risk of post-operative complications in patients with poorly controlled diabetes should be communicated at the time of decision for surgery. Future studies should evaluate whether optimising diabetes control prior to TURP reduces risk of reoperation or whether this risk is non-modifiable due to permanent changes in the lower urinary tract due to chronic hyperglycaemia. Level of evidence: III [ABSTRACT FROM AUTHOR]

Urological procedures vary from minor ambulatory operations to ultra-major surgeries, and many are in elderly patients. This article highlights the preoperative assessment, intraoperative management, specific complications, and postoperative management of selected common procedures, namely transurethral resection of the prostate (TURP), percutaneous nephrolithotomy (PCNL), nephrectomy, robotic assisted laparoscopic prostatectomy and radical cystectomy. Paediatric procedures are not covered. [ABSTRACT FROM AUTHOR]

Objectives Urinary incontinence (UI) is one of the major complications of benign prostate hyperplasia (BPH), which reduces the concept of male identity, and self-esteem and increases frailty syndrome. The present study aims to determine the effect of Kegel’s exercises on UI, frailty syndrome, and self-esteem of the elderly with BPH after transurethral resection of prostate (TURP). Methods & Materials In this randomized clinical trial, 76 older men with BPH who had underwent TURP surgery were randomly assigned to the control and intervention groups. The intervention group performed 60 Kegel’s exercises daily for 12 weeks, but the control group did not perform any exercises. The Edmonton frailty scale, international consultation on incontinence questionnaire – UI short form (ICIQ-UI-SF), Rosenberg self-esteem scale, mini mental status examination, questionnaire of urinary incontinence diagnosis, and a demographic form were completed before training, eight weeks after training, and four weeks after the end of training. Statistical analysis was conducted using descriptive and inferential tests in SPSS software, version 26. Results The mean scores of frailty syndrome, self-esteem and UI improved in the intervention group, but worsened in the control group (P

Prostate sarcoma is extremely rare, comprising less than 0.1 % of prostate cancers.A 61-year-old male presented to the emergency department with urinary retention and hematuria. Upon resolution of urinary retention, abdominal computed tomography showed a giant prostatic tumor, of approximately 1700 cubic centimeters, causing bilateral ureteric obstruction, and invasion of rectum and sigmoid colon. Laparotomy due to bowel obstruction showed peritoneal carcinomatosis. Palliative chemotherapy was initiated; however, he died due to hematological toxicity related to doxorubicin.Radical surgery is the ideal treatment; in cases of advanced or metastatic disease, adjuvant or palliative chemotherapy or radiotherapy withholds little or no benefit.

Objectives Urinary incontinence (UI) is one of the major complications of benign prostate hyperplasia (BPH), which reduces the concept of male identity, and self-esteem and increases frailty syndrome. The present study aims to determine the effect of Kegel’s exercises on UI, frailty syndrome, and self-esteem of the elderly with BPH after transurethral resection of prostate (TURP). Methods & Materials In this randomized clinical trial, 76 older men with BPH who had underwent TURP surgery were randomly assigned to the control and intervention groups. The intervention group performed 60 Kegel’s exercises daily for 12 weeks, but the control group did not perform any exercises. The Edmonton frailty scale, international consultation on incontinence questionnaire – UI short form (ICIQ-UISF), Rosenberg self-esteem scale, mini mental status examination, questionnaire of urinary incontinence diagnosis, and a demographic form were completed before training, eight weeks after training, and four weeks after the end of training. Statistical analysis was conducted using descriptive and inferential tests in SPSS software, version 26. Results The mean scores of frailty syndrome, self-esteem and UI improved in the intervention group, but worsened in the control group (P<0.001). There were no significant differences between groups before training but significant differences were reported eight weeks after training and four weeks after end of training (P<0.05). Conclusion Implementing 60 Kegel’s exercises daily for 12 weeks after TURP can reduce UI and frailty syndrome and increase self-esteem in older men. [ABSTRACT FROM AUTHOR]

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Purpose: Benign prostatic obstruction (BPO) is the most common cause of lower urinary tract symptoms among men. GreenLight photoselective vaporization of the prostate (GL‐PVP) using a 180‐W Xcelerated performance system (XPS) laser is a well‐established method for treating BPO‐induced voiding symptoms. However, its therapeutic effects on storage symptoms remain unclear. This study aimed to analyze the storage outcomes in patients who underwent 180‐W XPS GL‐PVP for BPO and to identify outcome predictors. Materials and Methods: Patients who underwent 180‐W XPS GL‐PVP for BPO between May 2018 and May 2021 were retrospectively reviewed. Data on clinical characteristics, prostate volume, preoperative and postoperative International Prostate Symptom Scores (IPSS), and preoperative urodynamic parameters were collected. A favorable storage outcome was defined as ≥50% reduction in the IPSS storage subscore. Results: Ninety‐nine male patients were included, with a mean age of 69.4 ± 9.6 years and a baseline prostatic volume of 75.9 ± 33.1 mL. The IPSS total, storage, and voiding subscores significantly decreased after GL‐PVP (all p < 0.001). Seventy‐two patients achieved favorable storage outcome at 6 months. Multivariate analysis revealed that detrusor underactivity was predictive of unfavorable storage outcomes (p = 0.022), while IPSS voiding‐to‐storage subscore ratio >1.25 and the presence of detrusor overactivity were predictive of favorable storage outcomes (p = 0.008 and 0.033, respectively). Conclusion: 180‐W XPS GL‐PVP provided excellent outcomes in both voiding and storage lower urinary tract symptoms concomitant with BPO. Preoperative IPSS and multichannel urodynamic parameters including detrusor overactivity and underactivity are valuable predictors of postoperative storage outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of benign surgical hyperplasia includes transurethral resection of the prostate (TURP) and open prostatectomy, which have distinct indications. Diagnosis Related Groups (DRG) is a classification system of patients with similar standards for predicting hospital products and services. However, some DRG codes include several treatment regimens, such as 707 and 708, which include TURP and open prostatectomy. Objective: To compare hospital stay and adverse events for TURP and open prostatectomy. Methods: Crosssectional, retrospective, quantitative study, in which 279 urology patients submitted to TURP or open prostatectomy were selected between 2017 and 2021, classified as code DRG 707 or 708, which refer to major male surgeries of the pelvic region with comorbidities and major male surgeries of the pelvic region without comorbidities, respectively, Patients were divided into two groups, 220 selected for TURP and 59 for open prostatectomy. Results: There was a significant difference in hospital stay (p

Background: Transurethral resection of the prostate (TURP) is increasingly performed in Nigeria. The irrigation fluid commonly used is 5% dextrose water, which is second only to water in terms of availability and affordability. Although it has the advantage of lower incidence of intravascular hemolysis, there are concerns regarding its potential deleterious effects when absorbed into the bloodstream, especially for diabetic or glucose-intolerant individuals. Objective: This study aims to determine the effect of the use of 5% dextrose water as irrigation fluid for TURP on the blood sugar level. Materials and Methods: This was a case-controlled study of 108 patients who underwent TURP for benign prostatic hypertrophy at the 82 Division Hospital of the Nigeria Army, Enugu, Nigeria, between 2016 and 2022. The case group (n = 80) had TURP with 5% dextrose water as irrigation fluid, while the control group (n = 28) underwent the traditional transvesical prostatectomy (TVP). In both groups, an equal volume of normal saline was used for preloading for spinal anesthesia and for maintenance during surgery. Results: After 2 h from the onset of surgery, the mean preoperative blood sugar levels and the mean 2 h blood sugar levels were 95.61 and 112.99 mg/dL, respectively, for the TURP group and 100.43 and 106.61 mg/dL, respectively, for the TVP group (P = 0.122 and 0.308, respectively). Conclusion: TURP utilizing 5% dextrose water as “irrigant” did not show a significant increase in blood sugar levels. Therefore, it is considered a safe irrigation fluid in the study population.

Background: Prostatic urethral lift, or UroLift, has gained popularity as a treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Surgical reintervention rates are a reliable indicator for treatment durability. Objective: The objective of this study was to utilize TriNetX, a third-party database, to investigate the incidence of surgical reintervention following UroLift, transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) procedures for BPH from 2015 to 2018. Design, setting, and participants: Male patients aged 18–100 yr diagnosed with BPH were identified in the TriNetX Diamond Network database between January 2015 and December 2018. Cohorts of individuals undergoing their first UroLift procedure were built using Current Procedural Terminology and International Classification of Diseases 10th Revision codes. TURP and PVP cohorts were built as comparison groups. The cohorts were then queried for subsequent BPH-related procedures. Outcome measurements and statistical analysis: Reprocedure rates were assessed and descriptive statistics were used. Results and limitations: The mean age at first-time UroLift was 70.1 ± 9.4 yr (n = 14 343). Cumulative reprocedure rates collected after first-time UroLift included 1 yr after UroLift (5.1%, n = 14 343) and 4 yr after UroLift (16.1%, n = 710), with an average annual increase of +3.6% per year following 1 yr after the procedure. Comparatively, TURP (n = 22 071) and PVP (n = 14 110) had 4-yr reprocedure rates of 7.5% and 7.8%, respectively, during the same timeframe. Limitations include a lack of clinical data and loss of follow-up data outside the Diamond Network. Conclusions: The reprocedure rate of UroLift at 4 yr is double the rate of TURP and PVP. In appropriately selected patients, UroLift might be a suitable option for those who desire symptomatic relief from BPH with minimal erectile and ejaculatory side effects. However, the risk of secondary surgical intervention should be considered when considering BPH treatments. Patient summary: We compared the reintervention rates of prostatic urethral lift (PUL), transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) using the TriNetX database, and have found that the highest reintervention rates were for PUL of 16% at 4 yr of follow-up, compared with about 8% for those who had TURP and PVP. Interestingly, the most common reintervention was the same operation at 1 yr. This has important implications when counseling patients about the durability of these various outlet procedures for BPH.

Melanosis, the aberrant deposition of melanin pigment in the absence of melanocytes, is very rare in the genitourinary tract. We report a case of a 74-year-old male with symptomatic benign prostatic hyperplasia. Diagnostic cystourethroscopy demonstrated bladder mucosa remarkable for numerous flat, velvety, and brown–black lesions. The patient underwent cystolitholapaxy, transurethral resection of the prostate, and bladder biopsy. Microscopic examination of the bladder biopsy demonstrated urothelium with granular, black pigmentation within the mucosa and histiocytes in the lamina propria; a Fontana Masson stain was positive for melanin. Microscopic examination of the transurethral resection of the prostate demonstrated nodular hyperplasia with focal, black pigmentation of the stroma. The rarity of bladder and prostate melanosis highlights the need for further investigation to elucidate its clinical significance and provide assurance of its benignity. Despite its rarity, melanosis should be kept in the differential diagnosis when melanotic lesions are encountered during cystoscopy. [ABSTRACT FROM AUTHOR]

Introduction: Ropivacaine is a newer local anaesthetic proven to have a lower systemic toxicity profile, particularly in terms of cardiac and Central Nervous System (CNS) toxicity, than the racemic and levorotatory isomers of bupivacaine, especially in elderly patients. Fentanyl, as an adjuvant, enhances analgesia and promotes early postoperative mobility. Aim: To assess and compare the efficacy and safety of isobaric levobupivacaine and fentanyl versus isobaric ropivacaine and fentanyl in patients undergoing Transurethral Resection of the Prostate (TURP) under Spinal Anaesthesia (SA). Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesia at SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India, from March 2021 to January 2023. A total of 60 patients ranging in age from 40 to 80 years, scheduled for elective TURP, were enrolled in the present study. The selected patients were randomly assigned into two groups, each consisting of 30 patients. Group A received a dosage of 2.6 cc of 0.75% isobaric ropivacaine (equivalent to 19.5 mg) along with 0.4 cc of fentanyl (equivalent to 20 micrograms). In contrast, group B received a dosage of 2.6 cc of 0.5% isobaric levobupivacaine (equivalent to 13 mg) and 0.4 cc of fentanyl (20 micrograms). The primary outcome measures were the onset of action, duration of sensory-motor block, and postoperative analgesia. Data were analysed using Epi Info version 7.2.1.0 statistical software. The quantitative data collected were summarised using the mean and Standard Deviation (SD). A p-value of less than or equal to 0.05 was considered statistically significant. Results: The majority of patients in the present study were elderly males in both groups. The mean age distribution in group A was 64.27±8.17, and in group B, it was 65.13±7.1. Both groups were comparable and not statistically significant (p=0.634). The mean weight of the two groups was similar, with group A at 64.9±7.49 kg and group B at 63.1±6.96 kg. Both groups were comparable and not statistically significant (p=0.334). The mean height of the patients was 165±4.85 cm in group A and 164±3.83 cm in group B, and it was comparable between the two groups without statistical significance (p=0.145). The duration of sensory block was 241.03±18.88 minutes in group A and 181.5±33.42 minutes in group B. The duration of motor block was 210.7±17.93 minutes in group A and 160±14.82 minutes in group B. Group A demonstrated a significant prolongation of sensory (p

Introduction: Laparoscopic radical prostatectomy (LRP) has become a common option for the treatment of prostate cancer. The aim of our study was to examine whether LRP performed within 12 weeks of transurethral resection of the prostate (TURP) is associated with surgical difficulty or outcomes. Material and methods: A single-institutional retrospective analysis was performed on patients who underwent LRP for incidental prostate cancer after TURP between July 2009 and December 2017. The interval between TURP and LRP was determined and patients with intervals of = 12 weeks were compared to those with intervals of > 12 weeks. Patient characteristics, perioperative, pathological, and postoperative functional outcomes were analyzed to determine statistically significant differences between the 2 groups. Multivariable analyses were performed to determine whether the interval between TURP and LRP was a significant independent predictor of these outcomes. Results: A total of 56 incidental prostate cancer patients detected by TURP were included in this study. No significant differences were detected in estimated blood loss, operative duration, postoperative length of stay, and rate of positive margin, Gleason score upgrading, major complications, incontinence and prostate-specific antigen (PSA) recurrence in patients with a TURP to LRP interval above and below 12 weeks. The TURP to LRP interval was not an independent predictor of outcomes during or after LRP. Conclusions: Our results showed that performing LRP within 12 weeks after TURP does not adversely influence surgical difficulty or outcomes. [ABSTRACT FROM AUTHOR]

Objective To explore the correlation of membranous urethral length (MUL) in benign prostatic hyperplasia (BPH) patients with urinary incontinence after transurethral vaporization of the prostate. Methods Total of 413 patients with BPH admitted to our hospital from February 2020 to February 2023 were selected as the research objects, and they were randomly divided into the training set (n =328) and the validation set (n = 85). According to whether the patients had urinary incontinence 30 d after surgery, the patients were divided into the urinary incontinence group and the favorable prognosis group, and the clinical data of the two groups were compared. Multivariate Logistic analysis was conducted to analyze the relationship between MUL and the occurrence of urinary incontinence in postoperative patients, and the risk factors of urinary incontinence were screened. R software was used to build a prediction model, and Bootstrap method was used to verify the model internally, and verification set was used to verify the model externally. Results In the training set and the verification set, the number of patients with urinary incontinence 30 d after surgery was 60 and 14, accounting for 18.29% and 16.47%, respectively, with no significant difference between groups (P>0.05), and urinary incontinence gradually disappeared 6 months after surgery. There were no significant differences in the clinical data of the patients in the training set (P >0.05). After treatment, there were statistically significant differences in operative time, indwelling catheter time, PV, MUL, IPSS-V score, MCC, LH and T indexes between the two groups (P<0.05). After treatment, MUL in the group with favorable prognosis was significantly higher than that in the urinary incontinence group. Logistic model regression showed that there was a stable association between MUL and urinary incontinence before and after surgery, and the difference in trend test was statistically significant (P <0.05). Restricted cubic spline model showed that there was no non-linear relationship between the risk of urinary incontinence and age (P<0. 05). Operation time ≥60 min, indurating catheter time 5=7 d, PV ≥50 mL, preoperative MUL <14 mm and postoperative MUL <13 mm were risk factors for urinary incontinence in patients. The area under ROC curve ( AUC) of the training set and validation set were 0.879 (95% CI- 0.864 ~ 0.901) and 0.872 (95% CI-.0.828 -0.911), the sensitivity was 90.43% and 89.85%, and the specificity was 88.54% and 89.13%, respectively. The calibration curve showed a good fit between the prediction probability and the reference probability of the model before and after verification, and there was no statistical significance between the Hosmer-Lemeshow test results (P > 0.05). It had good prediction accuracy and high net benefit value. Conclusion Preoperative MUL≤14 mm and postoperative MUL≤ 13 mm are risk factors for postoperative urinary incontinence. Longer MUL can reduce the risk of postoperative complications and accelerate the recovery of urinary control in patients. [ABSTRACT FROM AUTHOR]

Introduction: Men with detrusor underactivity (DUA) and concomitant bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC). Materials and Methods: This review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short‐ and long‐term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta‐analysis was performed using Review Manager (RevMan) software. Results: There were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eight TURP (transurethral resection of the prostate) studies, four GreenLight PVP (photoselective vaporization of the prostate) studies, two HoLEP (Holmium laser enucleation of the prostate) studies, one GreenLight PVP/HoLEP study, one Holmium laser incision of the prostate study, and one study did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long‐term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS), lower quality‐of‐life (QoL) score, better maximum flow rate (Qmax), and lower post‐voiding residual (PVR) of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow‐up. Conclusion: In this meta‐analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow‐up period after surgery. [ABSTRACT FROM AUTHOR]

Background: Endoscopic prostate surgery is an established treatment for male lower urinary tract symptoms (LUTS) and is recognized to have low mortality rates. We aimed to describe factors that may have contributed to death following endoscopic prostate surgery using data from the Australia and New Zealand Audits of Surgical Mortality (ANZASM). Methods: All urological related deaths reported to ANZASM from January 1 2012 to December 31 2019 were reviewed. Deaths related to endoscopic prostate resection (transurethral resection of prostate – TURP, laser procedures) were included. Peer reviewers identified up to three clinical management issues (CMIs), and these were analysed. CMIs were classified in order of least to most concerning: area of consideration, area of concern and adverse events. Results: Of 1127 total urological deaths, 77 deaths were related to endoscopic prostate surgery (7.0%). Most procedures were monopolar TURP. The mean age of patients was 80.9 years (range 57.0–96.2). Leading causes of death were cardiovascular events 23/77 (29.9%) and respiratory failure 14/77 (18.2%). Assessors identified 39 CMIs in 26/77 (33.8%) patients. Twenty‐three were areas of consideration, nine were areas of concern and seven identified adverse events. The most common CMIs were regarding post‐operative care (14/39) and the decision to operate (13/39). Conclusion: Most deaths did not elicit concerns from the ANZASM peer assessors. However, the main concerns identified were surrounding decision making and rationale for operating. This highlights the importance of clear counselling and documentation during the treatment decision process. [ABSTRACT FROM AUTHOR]

Purpose: We report our experience with 100 patients who underwent an innovative prostate enucleation technique that spares the complete urethral—plate from the veru montanum to the bladder neck using a low-energy thulium laser emission. The aim of our study was to evaluate the short-term effects of this procedure on ejaculation preservation and urinary obstruction. Materials and Methods: The International Prostate Symptom Index (IPSS), quality of life (QoL), and Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EJD) Short Form were used as validated instruments to quantify ejaculatory dysfunction before and 6 months after the surgery. Results: The median IPSS score pre- and postoperatively was 20 and 5, respectively (p < 0.0001); QoL dropped from a median of 4–1 (p < 0.0001); and the mean preoperative maximal flow rate improved significantly (8.5 vs 21.2 mL/min) (p < 0.0001). Furthermore, there was significant reduction in postvoid residual postoperatively (p < 0.0001). Postoperative ejaculatory function was preserved in 92/100 patients (92%). According to the MSHQ-EJD score, patients reported a slight nonsignificant decrease in frequency of ejaculation (item 1), force of expulsion (item 2) and reduction in semen volume during ejaculation (item 3), with the exception of ejaculation discomfort (item 4). Conclusion: According to our results, complete removal of the apical tissue, which has been advocated as an integral part of the so called ejaculatory hood, does not interfere with ejaculation if the ventral lissosphincter remains intact. [ABSTRACT FROM AUTHOR]

Objective: To evaluate clinicopathological features of patients with serum prostate-specific antigen (PSA) level of ≤3 ng/mL and diagnosed with prostate cancer (PCa). Materials and Methods: A total of 34 male patients diagnosed with PCa by either prostate needle biopsy (PNB) or transurethral resection of the prostate (TUR-P) were included in this study between January 2010 and June 2021. Patients whose preoperative serum PSA level was >3 ng/mL and those with missing clinical data were excluded. Preoperative clinical characteristics of the patients and pathological findings of PNB, TUR-P, and radical prostatectomy (RP) specimens were evaluated. Results: The median age of the patients was 65 (60-69) years. The median preoperative serum PSA level was 1.98 (1.45-2.64) ng/mL. PCa was detected by "systematic prostate biopsy (SBx) only", combined prostate biopsy [SBx following multiparametric magnetic resonance imaging-targeted prostate biopsy (TBx)], and "TUR-P" in 6 (17.6%), 17 (50.0%), and 11 (32.4%) patients, respectively. In combination of both biopsy, PCa was detected in "SBx specimens only", "TBx specimens only", and "both TBx and SBx specimens" in 3 (8.8%), 5 (14.7%), and 9 (26.5%) patients, respectively. Clinically significant (cs) PCa was in 52.9% of the TBx (9/17) and 60.9% of the SBx (14/23) specimen. Twenty (58.8%) patients treated with RP. csPCa in RP specimens was observed in 17/20 (85.0%) patients. Upgrading in RP specimens compared with PNB specimens was observed in 5/11 (45.5%) of the TBx and 9/17 (52.9%) of the SBx specimen. At the final RP pathology, International Society of Urologic Pathology-grade group >3 or non-organ confined disease were observed in 8 (40%) and 8 (40.0%) patients, respectively. Conclusions: Adverse pathological outcomes in RP specimens are frequent in patients with PCa with a serum PSA level of ≤3 ng/mL at the time of diagnosis, and physicians should be aware of the limitations of pre-set PSA cut-off levels. [ABSTRACT FROM AUTHOR]

Purpose of Review: Bladder outlet obstruction (BOO) encompasses the diagnosis of obstructive urinary flow accompanied by increased detrusor pressure. It can contribute to renal function deterioration, recurrent urinary tract infections, and potentially acute urine retention. While the diagnosis of BOO plays a critical role in clinical management and decision-making, a consensus on the precise evaluation remains elusive. This study aimed to comprehensively review non-invasive methods for diagnosing BOO, primarily in cases related to benign prostatic hyperplasia. Recent Findings: A systematic literature review was conducted on PubMed from January 2016 to November 2022, focusing on non-invasive tests and lower urinary tract symptoms (LUTS) or bladder outlet obstruction (BOO) in men. A total of 2520 results were included, resulting in 1620 unique findings after removing duplicates. From these, 263 abstracts were thoroughly evaluated, leading to a detailed review of 80 full-text articles and their references. The review identified numerous cutting-edge technologies, primarily ultrasound-based, such as intravesical prostatic protrusion (IPP), bladder wall thickness (BWT), and detrusor wall thickness (DWT), among others. These advancements demonstrate promising sensitivity and specificity, positioning them as valuable tools for evaluating patients with BOO. Summary: Achieving an accurate diagnosis and implementing effective management strategies for BOO patients can lead to improved patient care, optimized resource allocation for those in need, and significant reductions in unnecessary expenditures. In the near future, a plethora of additional tools will become available, poised to enhance our diagnostic and prognostic approaches for patients with BOO. [ABSTRACT FROM AUTHOR]

Introduction: Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. Methods: Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. Results: There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. Discussion: Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks. [ABSTRACT FROM AUTHOR]

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BackgroundWith the growing elderly population, there is an increasing prevalence of frail patients undergoing surgeries. A common operation in this group is the transurethral resection of prostate (TURP) for the treatment of benign prostatic hyperplasia. Whilst there is a demonstrable link between frailty and general adverse postoperative outcomes, there is limited research on frailty and trial of void (TOV) outcomes post TURP.This study aims to investigate possible associations between frailty, TOV outcomes, and postoperative complications following a TURP. MethodsA retrospective review was conducted of adult patients treated with TURP at 2 hospitals from January 2018 to December 2019, inclusive. Patient demographic data, preoperative Clinical Frailty Scale scores, trial of void outcomes, and complications were recorded and analysed. Clinical frailty scores (CFS) were recorded in accordance with the Dalhousie University Clinical Frailty Scale, ranging from 1 (very fit) to 9 (terminally ill). ResultsA total of 226 patients (median age 70.5 years) were identified for this study. Of these patients, 59 were identified as having a CFS of 1 to 2 (Group A), 140 patients had a CFS of 3 to 4 (Group B), and 27 patients had a CFS of 5 to 7 (Group C). Within the initial TOV, Group C had a statistically significant difference in failure rates compared with the other 2 groups, with Group C having the highest failure rate of 33.3% (9/27), followed by Group B with 14.3% (20/140), and then Group A with 13.6 % (8/59) (P = 0.04). ConclusionIn conclusion, greater preoperative frailty is associated with higher rates of initial TOV failure in post-TURP patients. Early objective identification of elderly patients with increased frailty is useful to help preoperative counselling and decision-making, to manage patient postoperative expectations, and to optimise patient care.

Purpose We aimed to identify the risk factors for salvage procedure (SP) required for refractory adenomatous tissue resistant to morcellation during holmium laser enucleation of the prostate (HoLEP). Methods Patients who underwent HoLEP between January 2010 and April 2020 at Seoul National University Hospital were analyzed. SPs were defined as cases of conversion to resection of the prostatic tissue using an electrosurgical loop after morcellation or secondary morcellation a few days after surgery or conversion to open cystotomy. Results Among a total of 2,427 patients, 260 were identified as having SP (SP group) (transurethral resection-nodule [n = 250, 96.1%], secondary morcellation a few days after surgery [n = 9, 3.5%], and conversion to open cystotomy [n = 1, 0.4%]). Patients in the SP group were older and had higher 5-α reductase inhibitors use, higher prostate-specific antigen, larger total prostate volume, and larger transition zone volume (TZV) than those in the non-SP group. In the multivariable logistic regression analysis, only age and TZV were associated with SP. Compared to 40s and 50s, the odds ratios (ORs) were 3.84 in 60s (95% confidence interval [CI] 1.37–10.78, P = 0.011), 4.53 in 70s (95% CI, 1.62–12.62, P = 0.004), and 6.59 in 80s or older (95% CI, 2.23–19.46, P = 0.001). The ORs of the SP were analyzed per TZV quartile. Compared to TZV ≤ 20.3 mL, the OR was 3.75 in 32.0 mL < TZV ≤ 50.4 mL (95% CI, 2.00–7.04, P < 0.001) and 8.25 in 50.4 mL < TZV (95% CI, 4.06–16.77, P < 0.001). Conclusions The risk of refractory morcellation increased in patients aged > 60 years or those with TZV > 32 mL. In order to more efficiently remove these resistant adenomas, it is necessary to develop more efficient morcellators in the future.

ABSTRACT Introduction: The aim of the study was to investigate clinical and surgical factors associated with early catheter replacement in patients treated with Holmium Laser Enucleation of the Prostate (HoLEP). Materials and Methods: Data of patients treated with HoLEP at our Institution by a single surgeon from March 2017 to January 2021 were collected. Preoperative variables, including non-invasive uroflowmetry and abdominal ultrasonography (US), were recorded. Bladder wall modifications (BWM) at preoperative US were defined as the presence of single or multiple bladder diverticula or bladder wall thickening ≥5 mm. Clinical symptoms were assessed using validated questionnaires. Only events occurred within the first week after catheter removal were considered. Results: Overall, 305 patients were included, of which 46 (15.1%) experienced early catheter replacement. Maintenance of anticoagulants/antiplatelets (AC/AP) therapy at surgery (p=0.001), indwelling urinary catheter (p=0.02) and the presence of BWM (p=0.001) were more frequently reported in patients needing postoperative re-catheterization. Intraoperative complications (p=0.02) and median lasing time (p=0.02) were significantly higher in this group. At univariate analysis, indwelling urinary catheter (p=0.02), BWM (p=0.01), ongoing AC/AP therapy (p=0.01) and intraoperative complications (p=0.01) were significantly associated with early catheter replacement. At multivariate analysis, indwelling urinary catheter (OR: 1.28; p=0.02), BWM (OR: 2.87; p=0.001), and AC/AP therapy (OR: 2.21; p=0.01) were confirmed as independent predictors of catheter replacement. Conclusions: In our experience the presence of indwelling urinary catheter before surgery, BWM and the maintenance of AC/AP therapy were shown to be independent predictors of early catheter replacement after HoLEP.

We describe the case of a 79-year-old man who presented with progressive aggravation of severe axial neck pain and fever 3 days after transurethral resection of the prostate (TURP), despite maintaining neutral neck posture during surgery. Laboratory examination revealed markedly elevated C-reactive protein levels and erythrocyte sedimentation rates. Computed tomography revealed crown-like calcifications surrounding the odontoid process. We diagnosed crowned dens syndrome (CDS) as the cause of acute-onset neck pain after TURP. The patient was treated with nonsteroidal anti-inflammatory drugs for 5 days, and his symptoms resolved completely. CDS is a rare disease characterized by calcific deposits around the odontoid process with acute onset of severe neck pain and restricted motion. Evidence of inflammation on serological testing and fever are typical of CDS. However, the prevalence and pathophysiology of CDS remain unclear. We hypothesized that systemic inflammation after prostate surgery may have induced a local inflammatory response involving calcification around the odontoid process.

This report presents the case of 75-year-old men with spindle cell neoplasm. The patient underwent percutaneous nephrolithotomy and transurethral resection of the prostate (TURP) for renal stones and benign prostatic hyperplasia. One month postoperatively, the patient was able to void without any difficulty. Five months later, the patient experienced difficulty voiding and presented to the emergency room with severe pelvic pain. Computed tomography (CT) showed regrowth of the prostate mass into the posterior bladder and penile root. The prostate-specific antigen level remained constant at 1.14 ng/mL during the pre-and postoperative periods. Five months before the TURP operation, the patient’s CT scan showed a soft and mildly enlarged prostate with no protrusion into the bladder. Biopsy of the prostate, however, showed a protruding mass, indicative of a spindle cell neoplasm. The patient was subsequently treated with the chemotherapeutic drug adriamycin. Unfortunately, treatment was unsuccessful, and the patient died 18 months later.

Purpose To compare improvement of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia in diabetic versus nondiabetic patients after transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP). Methods The medical records of 437 patients who underwent TURP or HoLEP at a tertiary referral center from January 2006 to January 2022 were retrospectively analyzed. Among them, 71 patients had type 2 diabetes. Patients in the diabetic mellitus (DM) and non-DM groups were matched 1:1 according to age, baseline International Prostate Symptom Score (IPSS), and ultrasound measured prostate volume. Changes in LUTS were assessed at 3 months after surgery using IPSS and evaluated by categorizing patients according to prostatic urethral angulation (PUA;

In comparison to other commercially used lasers, the coagulation layer of the novel 450-nm laser is thinner, and this coagulation layer's thickness is a key factor influencing wound healing. In this study, we investigated whether the novel 200W 450-nm laser system (BR6800, Blueray Medical Ltd., Shaanxi, China) is superior to classic transurethral resection of the prostate (TURP) for wound healing in beagles. Twenty-two 6-to 8-year-old male beagles were treated with TURP or blue laser vaporization of the prostate (BLVP). Prostate wounds were observed via cystoscopy at 3 h and at 1, 2, 3, and 5 weeks post-operation (two beagles per group). Additionally, two elderly beagles without surgery served as normal controls. After cystoscopy examination, prostate samples were collected and fixed for hematoxylin and eosin (H&E) and immunofluorescence staining to observe wound healing progression under microscopy. The urethras of prostates under cystoscopy in BLVP groups were healed three weeks after surgery, while in the TURP group, they were healed five weeks after surgery. H&E staining confirmed that the coagulation necrosis layer in the TURP group was thicker than that in the BLVP group and it took longer to remove coagulation necrosis after surgery. Macrophage polarity transformation was also earlier in the BLVP group. The new 200W 450-nm laser was superior to TURP for wound healing. The thinner coagulation layer of the 450-nm laser was the primary reason for this process. [ABSTRACT FROM AUTHOR]

Background & Objective: Spinal anesthesia (SA) has been preferred for transurethral resection of prostate (TURP) due to various advantages over general anesthesia. The most commonly used drug for SA is bupivacaine, but recently ropivacaine has been introduced with better hemodynamic profile. Dexmedetomidine is sedative-analgesic, and can be used through multiple routes. We compared low dose ropivacaine plus dexmedetomidine vs. low dose bupivacaine for SA in TURP. Methodology: This comparative, cross-sectional study was conducted at Anesthesia Department of Combined Military Hospital, Lahore, from December 2021 to June 2022. A total of 197 patients, planned to undergo TURP under SA were included in the study. The patients were randomly allotted to one of the two groups by lottery method and using concealed envelops. Group RD took low dose ropivacaine (7.5 to 10 mg) plus dexmedetomidine (5 µg) and in Group B low dose bupivacaine (7.5 to 10 mg) was used for spinal anesthesia. Parameters of efficacy and safety were compared in both groups during and immediately after the surgery to look for better option among the two regimes. Results: Out of 197 patients randomized into two groups, Group RD, 99 (50.2%) took low dose ropivacaine (7.5 to 10 mg) plus dexmedetomidine (5 µg) and 98 (49.8%) took low dose bupivacaine (7.5 to 10 mg) for spinal anesthesia. Mean age of patients who underwent TURP in our study was 61.66 ± 7.88 y. Hemodynamic instability and requirement of opiate analgesia was not significantly different in both the groups (P > 0.05) while all other efficacy parameters were better in patients who took low dose ropivacaine plus dexmedetomidine (P < 0.05) as compared to those who only took low dose bupivacaine. Conclusion: Both groups showed no difference in safety parameters related to hemodynamic stability but the anesthesia profile was better in patients who took low dose ropivacaine plus dexmedetomidine as compared to the bupivacaine group. [ABSTRACT FROM AUTHOR]

Background: Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention. Objective: To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO. Design, setting, and participants: The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed. Surgical procedure: AFS-preserved EEP starts at the 12 o'clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved. Measurements: Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed. Results and limitations: The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches. Conclusions: The preserved AFS provides a nice landmark at the 12 o'clock position during EEP. [ABSTRACT FROM AUTHOR]

Objective: Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia (BPH) is a sparsely described complication. We describe management of five categories of these strictures in this retrospective observational case series. Methods: One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated. Among them, 76 were eligible for this study and underwent reconstructive surgery. Preoperative and postoperative assessments were done with symptom scores, uroflowmetry, ultrasound for post-void residue, and urethrogram. Any intervention during follow-up was classed as a failure. The recurrence and 95% confidence interval for recurrence percentage were calculated. Results: The following five categories of patients were identified: Bulbo-membranous (33 [43.4%]), navicular fossa (21 [27.6%]), penile/peno-bulbar (8 [10.5%]), bladder neck stenosis (6 [7.9%]), and multiple locations (8 [10.5%]). The average age was 69 years (range: 60–84 years). Overall average symptom score, flow rate, and post-void residue changed from 21 to 7, 6 mL/s to 19 mL/s, and 210 mL to 20 mL, respectively. The average follow-up was 34 months (range: 12–58 months). Overall recurrence and complication rates were 10.5% and 9.2%, respectively. The recurrence in each category was seen in 3, 1, 2, 1, and 1 patient, respectively. Overall 95% confidence interval for recurrence percentage was 4.66–19.69. Conclusion: Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH. The bulbo-membranous strictures need continence preserving approach. Navicular fossa strictures require minimally invasive and cosmetic consideration. Peno-bulbar strictures require judicious use of grafts and flaps. Bladder neck stenosis in this cohort could be treated with endoscopic measures. Multiple locations need treatment based on their sites in single-stage as far as possible.

Objectives: To compare the depth of thermal necrosis after use of bipolar resection and vaporization technique comparing intra-individually bipolar loop and bipolar button electrodes. Methods: Transurethral resection and vaporization of the prostate was performed in 55 male patients (260 specimens in total). In a standardized procedure, a bipolar resection loop was used for resection, and a bipolar button electrode was used for vaporization. Both electrodes were applied in each patient, either in the left or in the right lateral lobe. The depth of necrotic zones in the resected or vaporized tissue of each patient was measured in a standardized way by light microscopy. Results: The mean depth with standard deviation of thermal injury caused by the loop electrode was 0.0495±0.0274 mm. The vaporization electrode caused a mean thermal depth with standard deviation of 0.0477±0.0276 mm. The mean difference of necrosis zone depths between the two types of electrodes (PlasmaButton–resection loop) was −0.0018 mm (p=0.691). Conclusion: For the first time, we present directly measured values of the absolute necrosis zone depth after application of plasma in the transurethral treatment of benign prostatic hyperplasia. The measured values were lower than in all other transurethral procedures. Standardized procedures of measurement and evaluation allow a statistically significant statement that the low necrosis depth in bipolar procedures is independent of the applied electrodes.

Background Transurethral resection of the prostate gland (TURP) frequently leads to the development of dilutional hyponatremia. Copeptin has been established as a surrogate marker of vasopressin and is measured for clinical assessment of various sodium and water disturbances. This study aims to assess the utility of serum concentration of copeptin and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for prediction of post-TURP alterations of serum sodium concentration. Methods Forty-three patients with benign prostatic hyperplasia undergoing TURP were enrolled. Serum sodium and copeptin were measured before the procedure, then 12 hours after its completion. NT-proBNP was assessed at baseline. The total amount of fluids and sodium administered intravenously and used to flush the bladder during TURP was calculated in each patient. Receiver operator characteristic (ROC) curve analysis was used to determine value of copeptin and NT-proBNP for prediction of hyponatremia after TURP Results In forward stepwise multiple regression analysis of serum copeptin before surgery and the duration of TURP explained the significant portion of the sodium concentration variation 12 hours from the start of the surgery. ROC curve analysis showed that serum copeptin before surgery predicted development of hyponatremia 12 hours after TURP (area under the curve, 0.775; 95% confidence interval, 0.62–0.89; p < 0.001) with a cut-off point of >78.6 pg/mL with 77% sensitivity and 64.7% specificity. Serum NT-proBNP before surgery did not predict hyponatremia 12 hours after TURP. Conclusion Serum copeptin before TURP surgery, but not NT-proBNP, may be a clinically use-ful marker of the risk of hyponatremia after TURP.

This paper summarized the nursing cooperation in transurethral resection of prostate under comprehensive body temperature control. The clinical data of 80 patients who received transurethral resection of prostate were retrospectively analyzed. The comprehensive body temperature control strategy was carried, including adequate preoperative preparation and targeted nursing interventions during operation. There was no intraoperative hypothermia or massive hemorrhage reported, and patient’s blood pressure was stable during the surgery. Based on perioperative nursing cooperation, adopting comprehensive body temperature control showed a positive effect on reducing the risk of intraoperative hypothermia and postoperative complications. (总结综合控温干预下经尿道前列腺电切术的护理配合。回顾医院2021年12月—2022年12月收治的经尿道前列腺电切术治疗的80例患者的临床资料。采取综合控温措施实施干预, 包括充分的术前准备, 术中针对性护理措施。患者术中无低体温发生, 无大出血, 血压平稳, 手术顺利进行, 术后无相关并发症。对经尿道前列腺电切术患者采取综合控温干预措施, 同时完善围手术期护理, 对降低术中低体温和术后相关并发症发生风险具有积极意义。)

Background: Intraoperative hypothermia is a common but severe condition that is defined as a core body temperature below 36 °C. Accidental hypothermia can produce coagulopathy, immunosuppression and peripheral hypoperfusion that can ultimately lead to life-threatening ventricular arrhythmias and vital organ injury, and it is significantly associated with perioperative complications and mortality. Case description: We report the case of an 82-year-old man who presented with persistent ventricular tachycardia intraoperatively due to accidental hypothermia. The patient was diagnosed with benign prostatic hypertrophy and scheduled for transurethral resection of the prostate. Laboratory tests showed moderate anemia, and echocardiography indicated mild tricuspid and mitral regurgitation. The patient received general anesthesia with endotracheal intubation. Four hours after the start of surgery, the patient developed sudden ventricular tachycardia with severe hypotension. Arterial blood gas sampling indicated that there was no disturbance of electrolytes, acid-base balance or excessive bleeding. The rectal temperature was measured immediately, and the core temperature was 32 °C. The patient received antiarrhythmic therapy and rewarming measures. No additional ventricular arrhythmias appeared after the core temperature rose to 35 °C and the blood pressure returned to normal. The patient was transferred to the intensive care unit after surgery for further observation and was moved to the general ward the next day. He was discharged 4 days later without significant organ damage. Conclusions: Intraoperative hypothermia may increase ventricular arrhythmia risk, especially in elderly patients. Surgeons and anesthesiologists should pay more attention to preventing and reversing accidental hypothermia, necessitating aggressive efforts to maintain normothermia during surgery.

Objective To explore the effect of transurethral plasma prostate enucleation (TUKEP; Transurethral plasma enucleation of the prostate) on IPSS, QoL score, and in patients with prostatic hyperplasia. Methods 100 patients with Phyperplasia admitted to our hospital from January 1,2017 to September 1,2021 were selected as the subjects of this study・ According to the different treatment methods adopted by patients, 50 cases of observation group and control group, the control group underwent transurethral electric resection of the prostate (TURP; Transurethral electrical resection of the prostate), the observation group underwent transurethrfd plasma enucleation of the prostate, observe and compare the surgical conditions of the two groups (intraoperative blood loss, operation time, quality of prostate resection, bladder washing time, indwlling catheter time, etc.), residual urine volume before and after treatment (PVR; postvoid residual), international prostate symptom score (IPSS), patient quality of life (QoL; quality of life) score, maximum urinary flow rate (Q彌;Maximum urinary flow rate), postoperative complications. Results Hie operation time, bladder irrigation time, indwelling catheter time, and intraoperative blood loss of the observation group were (106・ 45 ± 18・ 29) min, (58・ 24 ± 17・ 23) mL, (3・ 53 ±0・ 92) d, and (19・ 45 ± 1.62) h respectively, and significantly shorter than the control group (132.76 ±32.11) min, (120,05 ±26.79) mL, (5.73 ±1.13) d, (27-74 ±4.12) h. Tlie excised tissue weight (55.76 ±16.43) g was higher than that of the control group (48・27 ±24・ 89) g, the difference was statistically significant (P <0・ 05); 3 months after the operation, the two groups of patients were improved to a certain extent, and the IPSS score, RUV value of the observation group were (5.95±l・08), (21.38 土2.12) mL was significantly lower than the control group (7・ 10 ± 0.94), (24.01 ± 2.31) mL, Q却 value (20・ 57 土 0・ 97) mL/s. It was significantly higher than the control group (17・ 88 ± 1.16) mL/s, and the difference was statistically significant (P <0.05). There was no significant difiference in the QoL score between the two groups after operation (P >0・ 05). Hie incidence of complications in the observation group was 5. 00% (3/50) was significandy lower than 16.00% (8/50) of the control group, and the difiference was statistically significant (P <0,05)・ Condusion Transurethral plasma enucleation of the prostate has a significant therapeutic effect on patients with benign prostatic hyperplasia. It can effectively improve IPSS, QoL scores and, with fewer postoperative complications and higher safety. [ABSTRACT FROM AUTHOR]

Purpose: We report 5-year safety and efficacy outcomes of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia and large-volume prostate glands. Materials and Methods: A total of 101 men with moderate to severe benign prostatic hyperplasia symptoms and prostate volumes between 80 and 150 mL underwent a robotic-assisted Aquablation procedure in a prospective multicenter international trial (NCT03123250). Herein we report the final 5-year results. Results: The study successfully met its safety and efficacy performance goal, which was based upon transurethral resection of the prostate outcomes typically done in smaller prostates, at 3 months. Mean prostate volume was 107 mL (range 80-150) at baseline. Patient symptoms showed a significant improvement where the mean (SD) International Prostate Symptom Score of 22.6 (6.4) at baseline to 6.8 (4.6) at 5 years, resulting in a change score of 15.9 (7.7, P < .001). Uroflowmetry measurements also demonstrated improvement where the mean maximum urinary flow rate increased from 8.6 (SD 3.4) to 17.1 (9.8) mL/s at 5 years, resulting in a change score of 9.2 (11.1) mL/s at 5 years (P < .001). A regression analysis evaluating change in PSA as a function of baseline PSA across all time points out to 5 years resulted in a 50% reduction. A prespecified subgroup analysis using a baseline prostate volume cutoff of 100 mL showed no difference in efficacy outcomes through 5 years. Freedom from a secondary benign prostatic hyperplasia procedure at 5 years was 96.3% based on Kaplan-Meier. Conclusions: At 5-years of prospective follow-up, the Aquablation procedure was shown to be safe with durable efficacy and low rates of retreatment in men with large prostates (80-150 mL). [ABSTRACT FROM AUTHOR]

Purpose:To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP).Materials and methods:We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI.Results:52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p < 0.0001). On univariate analysis, laser energy used (p < 0.0001), laser "on" time (p=0.0204), resected prostate weight (p < 0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI.Conclusion:Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.