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Purpose: Holmium laser enucleation of the prostate (HoLEP) showed higher efficacy than transurethral resection for treating benign prostatic hyperplasia (BPH). The present study aims to report the outcome of BPH treatment by HoLEP in a tertiary center. Patients and Methods: An observational prospectively collected data for consecutive symptomatic BPH patients undergoing HoLEP between January 2020 and December 2021. Demographic and perioperative data were collected with the International Prostate Symptom Score (IPSS), quality of life, peak flow rate (Qmax), residual urine postvoid residual (PVR), and prostate-specific antigen (PSA) changes, in addition to perioperative and late adverse events. Results: One hundred patients were included with a median age of 73 years (range 65-80). The IPSS improved by 80% postoperatively (25 vs. 5, P < 0.001). Similarly, Qmax significantly improved. Seven patients were found to have incidental prostate cancer. No patient needed a perioperative blood transfusion. Compared to its preoperative values, follow-up PSA has been reduced by 75% (P < 0.001). Urethral stricture and bladder neck contracture were noted in < 2% of the patients. Conclusions: HoLEP is feasible for all prostate sizes and a safe and effective treatment for BPH patients; our results are consistent with the reported data in the literature regarding functional outcomes, complication rates, and urinary incontinence rates.
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BACKGROUND: Prostate cancer is a common type of cancer in Saudi Arabia with a high incidence rate. Trans-rectal ultrasound guided prostatic biopsy (TRUSBx) has been the standard diagnostic study for prostate cancer since a landmark study in 1989 which showed that it is better than digitally directed biopsy sampling of the prostate. As an alternative to TRUSBx, transperineal biopsies (TPBx) have gained popularity as they give a higher accuracy rate and avoid many complications. A new study has been conducted in Riyadh, Saudi Arabia to compare TRUSBx and TPBx showed that TPBx has a significantly higher detection rate of prostate cancer cases compared to TRUSBx (45.1% vs. 29.1%, p=0.003). The aim of this study is to determine the diagnostic value and safety of freehand transperineal prostate biopsy in patients with an elevated prostatic specific antigen (PSA) and/or abnormal digital rectal exam in King Fahad Specialist Hospital KFSH in Buraydah, Qassim region, Saudi Arabia. METHODS: This is an observational retrospective study of all patients (n=39) who underwent transperineal biopsies at KFSH to assess the diagnostic value and safety of the procedure. RESULTS: The mean age of the patients was 70.3 (SD 10.1) years. The most commonly found diagnosis was adenocarcinoma (61.5%), and incidence of complications was detected in (5.1%) of the patients. CONCLUSION: We concluded that the freehand technique TPBx has a high accuracy rate in detecting prostatic cancer. However, the learning curve could be a limiting factor in implementing it. Increasing the number of biopsies could positively affect diagnostic accuracy, especially with our low complication rate in this procedure. A low number of biopsies in the older age group can give an accurate result with a low risk of complications. Although template-guided TPBx and robot-guided TPBx are better options, the freehand technique represents a cost-effective and time-saving alternative. However, more studies are needed to compare the outcome of such a technique.
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INTRODUCTION: Currently, there are several treatment options for Peyronie disease (PD). Although surgical interventions have better reported outcomes than conservative therapy, surgery is not suitable for all patients with PD. Therefore, oral therapy for PD is still a frequently used treatment due to low cost, convenience and limited side effects. However, current literature on the efficacy of oral therapy in PD is inconclusive. Pentoxifylline and colchicine have both shown some promise though further studies are required to confirm their effectiveness. AIM: The aim of this study was to assess the efficacy of oral therapy for PD, including pentoxifylline and colchicine, coupled with the Andropenis penile traction therapy (PTT) extender on degree of penile curvature and plaque size. METHODS: Between March 2015 and June 2018, a prospectively collected database for patients receiving oral therapy for PD (pentoxifylline and/or colchicine) was reviewed. MAIN OUTCOME MEASURE: Collected data variables were compared at baseline and after 6 months of treatment, including degree of curvature, plaque size, and penile Doppler ultrasound parameters (peak systolic velocity, minimum diastolic velocity, and pulsatility index). PTT was applied by the patient for a total of 1 hour per day for 6 months. RESULTS: A total of 46 patients were involved in this study. Mean age was 56 ± 10 years. There was a significant decrease in the degree of penile curvature after 6 months (55.8º ± 20º vs 41.4º ± 20.8º; P = .03). Likewise, the plaque size decreased significantly from 5.42 ± 2.7 to 2.42 ± 1.71 cm2; P = .0001. There was a significant increase in the peak systolic velocity from 29.8 ± 10.02 to 38.2 ± 11cm/sec; P = .02, whereas no statistically significant difference could be detected regarding end diastolic velocity (M = 0.56 ± 3.1 vs 1.59; P = .415) or pulsatility index (Mdiff = 0.03; CI = -0.06 to 0.12; P = .473). Furthermore, there was no statistically significant difference in medication type of pentoxifylline or colchicine (Mdiff = 17.23; CI = -3.31 to 37.77; P = .09). CONCLUSION: Altogether, pentoxifylline and colchicine, taken with concomitant PTT, present a potentially convenient, low cost, and effective treatment for penile curvature and plaque resulting from PD. Prospective randomized trials are still required for better evaluation of the course of PD with patients undergoing conservative management. Ibrahim A, Gazzard L, Alharbi M, et al. Evaluation of Oral Pentoxifylline, Colchicine, and Penile Traction for the Management of Peyronie's Disease. Sex Med 2019;7:459-463.
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PURPOSE: We report our experience with long-term outcomes of holmium laser enucleation of the prostate during a period of 18 years. MATERIALS AND METHODS: We reviewed a prospectively collected database from March 1998 through June 2016 for patients who underwent holmium laser enucleation of the prostate for symptomatic benign prostatic hyperplasia as performed or supervised by a single expert surgeon. Demographic and perioperative data were collected, including scores on the I-PSS (International Prostate Symptom Score), quality of life, peak flow rate, post-void residual urine and prostate specific antigen. Perioperative and late adverse events were also assessed. RESULTS: At a median followup of 9.1 years 1,476 patients with a mean age of 70.7 years were included in study. Mean catheter time and hospital stay were 1.2 and 1.3 days, respectively. Mean ± SD I-PSS and quality of life scores (15.9 ± 6.5 vs 6.8 ± 5.6 and 3.1 ± 1.4 vs 1.5 ± 1.4, respectively, each p <0.001) were significantly improved after holmium laser enucleation of the prostate compared to preoperative values. Likewise the mean peak flow rate and post-void residual urine were significantly improved (mean 7.2 ± 4.0 vs 17.7 ± 10.4 ml per second and 204 ± 258 vs 43 ± 73 ml, respectively, each p <0.001) in the 132 patients who could be followed more than 10 years. Perioperative blood transfusion was required in 0.8% of patients. Prostate specific antigen was significantly reduced by 66.7% at the most recent followup (p <0.001). Postoperative complications included urethral stricture and bladder neck contracture in 21 (1.4%) and 30 patients (2.1%), respectively. Repeat holmium laser enucleation of the prostate was required in 21 patients (1.4%). CONCLUSIONS: Holmium laser enucleation of the prostate is a safe, effective and durable procedure to treat benign prostatic hyperplasia during long-term followup.