RESUMO
OBJECTIVE: To investigate the feasibility, safety, and efficacy of same-day discharge (SDD) after Aquablation specifically in an ambulatory surgery center (ASC). METHODS: A prospective cohort of men with significant BPH underwent Aquablation at a single ASC. Comprehensive preoperative assessments were conducted, including uroflowmetry, IPSS, and PVR. Aquablation was performed as morning cases by a single experienced surgeon. Following the procedure, men were assessed for immediate postoperative outcomes, including pain levels, hematuria, and voiding efficiency. Patients meeting discharge criteria were allowed to return home on the same calendar day. RESULTS: A total of 60 consecutive men with a mean prostate size of 115 mL underwent Aquablation, 59 (98%) of whom were discharged the same day. No transfusions or return to the OR occurred. The procedure demonstrated a significant improvement in urinary flow rates and a substantial reduction in IPSS scores at the 1-month post-operative period. Pain scores were found to be minimal, and the incidence of postoperative complications, including hematuria and urinary retention was low and comparable to previously published outcomes. Despite more meticulous focal cautery, no differences in erectile, ejaculatory or adverse outcomes were observed. CONCLUSION: Aquablation for BPH at an ASC appears to be a safe and effective approach. Morning procedures and attentive cautery and streamlined patient pathways seem essential for SDD. Despite electrosurgical hemostasis, ejaculatory, sexual, and post-operatively pain were not compromised.
RESUMO
INTRODUCTION: A variety of procedures for the endoscopic surgical treatment of symptomatic benign prostatic hyperplasia (BPH) refractory to medical therapy have existed for decades. The present study examined trends in surgeon compensation for these treatments within Canada. METHODS: The physician fee schedule for BPH surgery across 10 Canadian provinces for the years 2010 and 2023 were obtained. A descriptive study examined first the provincial reimbursement for transurethral resection of prostate (TURP) and laser ablative/enucleation surgery; second, the difference in TURP reimbursement between 2010 and 2023; and third, the annual change in TURP reimbursement juxtaposed with the annual change in the provincial Consumer Price Index (CPI) and annual salary for the working population aged 35-44. RESULTS: Seven of 10 Canadian provinces reimburse laser BPH surgery equally to TURP. The average provincial TURP reimbursement is $545, ranging from $451 in Ontario to $688 in Saskatchewan. Since 2010, TURP reimbursement has varied by province from a 0% net change in Ontario to an increase of 21% in Nova Scotia. Reimbursement for TURP has increased at a slower pace than the local CPI, and for half of the provinces at a slower pace than the annual salary for people aged 35-44. CONCLUSIONS: The compensation model for endoscopic BPH surgery does not have a unified structure in Canada that is consistent across provinces, nor does it keep up with inflation, possibly impacting future recruitment, increasing geographic disparities, and most importantly, limiting the adoption of new BPH therapies.
RESUMO
INTRODUCTION: Partial gland ablation (PGA) using high intensity focal ultrasound (HIFU) is an alternative to active surveillance for low to intermediate risk localized prostate cancer. This pilot study assessed quality of life (QoL) outcomes during the implementation of PGA-HIFU at our institution. MATERIALS AND METHODS: We prospectively enrolled 25 men with a diagnosis of localized low/intermediate risk prostate cancer who elected to undergo PGA-HIFU in a pilot study at our institution between 2013 and 2016. Patients underwent pre-treatment mpMRI and transrectal ultrasound-guided biopsies. The primary endpoints were impact on patient-reported functional outcomes (erectile, urinary function, QoL) assessed at 1, 3, 6- and 12-months. RESULTS: The median age was 64 years old (IQR 59.5-67). Baseline median International Index of Erectile Function-15 score was 50, which decreased to 18 at 1 month (p < 0.0005), returned to baseline by 3 months and thereafter. International Prostate Symptom Score median at baseline was 8, which worsened to 12 at 1 month (p = 0.0088), and subsequently improved to baseline thereafter. On the UCLA-Expanded Prostate Cancer Index Composite urinary function, there was a decrease in median score from 92.7 at baseline to 76.0 at 1 month (p < 0.0001), which improved to or above baseline afterwards. QoL remained similar to baseline at each follow up period as assessed by EQ-5D and the Functional Cancer Therapy-Prostate score. CONCLUSIONS: In this initial cohort of PGA-HIFU men at our institution, patients demonstrated a slight, but transient, deterioration in urinary and erectile function at 1 month prior to normalization. All QoL metrics showed no impact upon 1 year of follow up post-treatment.
Assuntos
Disfunção Erétil , Neoplasias da Próstata , Masculino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Projetos Piloto , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Antígeno Prostático Específico , Resultado do TratamentoRESUMO
INTRODUCTION: Most robot-assisted surgery (RAS) systems in Canada are donor-funded, with constraints on implementation and access due to significant costs, among other factors. Herein, we evaluated the impact of the growing multispecialty use of RAS on urologic RAS access and outcomes in the past decade. METHODS: We conducted a retrospective review of all RAS performed by different surgical specialties in two high-volume academic hospitals between 2010 and 2019 (prior to the COVID pandemic). The assessed outcomes included the effect of increased robot access over the years on annual robotic-assisted radical prostatectomy (RARP) volumes, surgical waiting times (SWT), and pathologically positive surgical margins (PSM). Data were collected and analyzed from the robotic system and hospital databases. RESULTS: In total, six specialties (urology, gynecology, general, cardiac, thoracic, and otorhinolaryngologic surgery) were included over the study period. RAS access by specialty doubled since 2010 (from three to six). The number of active robotic surgeons tripled from seven surgeons in 2010 to 20 surgeons in 2019. Moreover, there was a significant drop in average case volume, from a peak of 40 cases in 2014 to 25 cases in 2019 (p=0.02). RARP annual case volume followed a similar pattern, reaching a maximum of 166 cases in 2014, then declining to 137 cases in 2019. The mean SWT was substantially increased from 52 days in 2014 to 73 days in 2019; however, PSM rates were not affected by the reduction in surgical volumes (p<0.05). CONCLUSIONS: Over the last decade, RAS access by specialty has increased at two Canadian academic centers due to growing multispecialty use. As there was a fixed, single-robotic system at each of the hospital centers, there was a substantial reduction in the number of RAS performed per surgeon over time, as well as a gradual increase in the SWT. The current low number of available robots and unsustainable funding resources may hinder universal patient access to RAS.
RESUMO
INTRODUCTION: To report the 5-year efficacy and safety of Aquablation compared with transurethral resection of the prostate for the management of lower urinary tract symptoms secondary to benign prostatic hyperplasia in men with prostate volumes 50-80 mL. MATERIALS AND METHODS: In a large double-blinded, multicenter, and prospective randomized controlled trial, 96 randomized men with 50-80 mL prostates who underwent Aquablation or transurethral prostate resection were prospectively identified for subgroup analysis. Follow up was performed for up to 5 years. The primary efficacy endpoint was the reduction in International Prostate Symptom Score (IPSS) at 6 months. The primary safety endpoint was the occurrence of Clavien-Dindo (CD) postoperative complications grade 1 persistent and grade 2 or higher at 3 months. RESULTS: Both groups had comparable baseline characteristics. Reduction in IPSS score was significantly higher in the Aquablation group across 5 years of follow up (-14.1 vs. -10.8, p = 0.02). The Aquablation group achieved a significantly lower rate of CD1P and CD2 or higher events at 3 months follow up (risk difference of -23.1%). Among recorded adverse events, de novo postoperative ejaculatory dysfunction was notably lower in Aquablation (risk difference of -21.9%), while the risk of bleeding remained similar after 6 months. The surgical and medical retreatment rate at 6 months was also lower in Aquablation (risk difference of -14.4%). CONCLUSIONS: In the 50-80 mL prostate volume subgroup, Aquablation yields superior long-term symptom relief and lower complication rates than standard transurethral resection, with notably lower rates of ejaculatory dysfunction. This further supports the adoption of Aquablation for men with medium-sized prostates.
Assuntos
Técnicas de Ablação , Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Humanos , Masculino , Técnicas de Ablação/efeitos adversos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Estudos Prospectivos , Próstata/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/diagnóstico , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Água , Método Duplo-CegoRESUMO
Benign prostatic obstruction (BPO) is a prevalent condition that affects men, primarily toward their old age. The condition is often accompanied by lower urinary tract symptoms (LUTS), which can significantly impair a patient's quality of life and lead to other medical complications. Accurate diagnosis of BPO is essential for effective management of complications secondary to BPO, and treatment plans should be tailored patients, and occasionally according to surgeon experience. As such, this literature review aims to analyze the current available data on male LUTS secondary to BPO by providing a comprehensive overview of relevant studies, as well as the surgical and medical management guidelines from the Canadian Urological Association (CUA), American Urological Association (AUA), and European Association of Urology (EAU). By synthesizing the existing literature, this review purports to summarize the current body of knowledge surrounding BPO and male LUTS, and support healthcare providers in making informed decisions about the management of male LUTS secondary to BPO, ultimately improving patient outcomes and quality of life.
Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Hiperplasia Prostática/complicações , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Sintomas do Trato Urinário Inferior/terapia , Humanos , Masculino , Resultado do Tratamento , Qualidade de Vida , Guias de Prática Clínica como AssuntoRESUMO
INTRODUCTION: In this study, we sought to investigate the impact of 5-alpha reductase inhibitors (5-ARI) on the perioperative and functional outcomes of 180-Watt XPS GreenLight photovaporization of the prostate (PVP) using a large international database. MATERIALS AND METHODS: Data were obtained from the Global GreenLight Group (GGG) database, which includes eight high-volume, experienced surgeons from seven international centers. All men with established benign prostatic hyperplasia (BPH) with known 5-ARI status who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on the preoperative use of 5-ARI. Analyses were adjusted for patient age, prostate volume, and American Society of Anesthesia (ASA) score. RESULTS: We included 3,500 men, of which 1,246 (36%) had preoperative 5-ARI use. Patients in both groups were similar with regards to age and prostate size. On multivariable analysis, total operative time was slightly shorter (-3.26 min 95% CI: 1.20 - 5.32, p < 0.01) and required 35.6kJ less laser energy (95% CI: -48.0kJ - -23.3kJ, p < 0.01) for patients on 5ARI compared to those without 5-ARI. However, no clinically significant difference was appreciated regarding postoperative transfusion rates [OR 0.048 (95% CI -0.82-0.91; p = 0.91)], hematuria rates [OR 0.96 (95% CI 0.72-1.3; p = 0.81)], 30-day readmission rates [OR 0.98 (95% CI 0.71-1.4; p = 0.90)], or overall functional outcomes. CONCLUSION: Our findings suggest that preoperative 5-ARI is not associated with any clinically significant different perioperative or functional outcomes for GreenLight PVP using the XPS-180W system. There is no role for the initiation or discontinuation of 5-ARI prior to GreenLight PVP.
Assuntos
Terapia a Laser , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Masculino , Humanos , Próstata/cirurgia , Resultado do Tratamento , Terapia a Laser/efeitos adversos , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/complicações , PelveRESUMO
INTRODUCTION: The present study analyzes the largest international GreenLight database, the Global GreenLight Group (GGG), to evaluate the functional and safety profile of GreenLight photoselective vaporization of the prostate (PVP) in octogenarians. METHODS: The GGG is a database comprised of patients that underwent GreenLight PVP from 2011 to 2019 performed by 8 experienced urologists at 7 international hospitals. Patients 80 years or older at the time of surgery were categorized as octogenarians. They were compared to a similar group of PVP patients below the age of 80. RESULTS: Among 3,648 patients, 586 men were above the age of 80. Compared to patients under the age of 80, octogenarians had larger prostates (76.0 vs 71.9 ml, p = 0.02) and a lower BMI (25.6 vs 26.7, p = 0.045). Operative time was not significantly longer in octogenarians. The improvement in functional outcomes between 80-year-old patients and control patients was not significantly different at one-year follow-up, with the exception of maximum urinary flow (Qmax) that favoured younger patients (10.3 vs 12.6 ml/s, p = 0.02). The odds of transfusion were greater for older patients [OR 8.2 (95% CI 3.6-18.9, p < 0.01)], but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0 vs 11.9%, p < 0.01). CONCLUSIONS: GreenLight PVP is a safe option in well-selected octogenarians in a cohort of patients treated by surgeons experienced with the technology. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was higher in octogenarians.
Assuntos
Terapia a Laser , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Masculino , Idoso de 80 Anos ou mais , Humanos , Octogenários , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Terapia a Laser/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVE: To report the effect of surgeon and facility volume on outcomes of transurethral resection of the prostate (TURP) and laser treatment of benign prostatic hyperplasia (BPH). We also investigate disparities in access to care by identifying demographic predictors of receipt of treatment at high-volume facilities. METHODS: We used New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) data. We included 18,041 (41.4%) and 25,577 (58.6%) adult patients that underwent TURP and laser procedures in the outpatient setting between January 2005 and December 2018, respectively. Average annual surgeon and facility volumes were broken down by tertile. The effect of volume on short-term outcomes (30-day and 90-day readmission) was examined using mixed-effect logistic regression models. Cox-proportional-hazard models were used to assess the association between volume and long-term stricture development and reoperation. Demographic predictors of treatment at high-volume facilities were assessed using multinomial logistic regression. RESULTS: High-volume facilities were more likely to offer laser procedures compared to low-volume facilities. Higher facility and surgeon volume were associated with lower odds of 30 and 90-day readmissions compared to low-volume facilities. There was no difference in reoperation and stricture development between surgeon volume groups. Medicaid insurance, Hispanic ethnicity, and Black race were inversely associated with treatment at high-volume facilities. CONCLUSION: Higher surgeon and facility volumes were associated with lower odds of readmission. Higher facility volume was associated with lower hazards of reoperation and developing strictures. Medicaid insurance and non-white race were associated with lower odds of treatment at high-volume facilities, highlighting racial and socioeconomic disparities in access to high-volume BPH surgery facilities.
Assuntos
Hiperplasia Prostática , Cirurgiões , Ressecção Transuretral da Próstata , Masculino , Humanos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Constrição Patológica/cirurgia , Acessibilidade aos Serviços de SaúdeRESUMO
INTRODUCTION: GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80 cc) vs. small prostates (< 80 cc). METHODS: Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe. RESULTS: 3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12 months (p = 0.005). There were no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28). CONCLUSIONS: Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80 cc, with durable outcomes relatively independent from prostate size.
Assuntos
Terapia a Laser , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Masculino , Humanos , Próstata/cirurgia , Volatilização , Hiperplasia Prostática/cirurgia , Resultado do TratamentoRESUMO
Introduction: Previous systematic reviews related to machine learning (ML) in urology often overlooked the literature related to endourology. Therefore, we aim to conduct a more focused systematic review examining the use of ML algorithms for the management of benign prostatic hyperplasia (BPH) or urolithiasis. In addition, we are the first group to evaluate these articles using the Standardized Reporting of Machine Learning Applications in Urology (STREAM-URO) framework. Methods: Searches of MEDLINE, Embase, and the Cochrane CENTRAL databases were conducted from inception through July 12, 2021. Keywords included those related to ML, endourology, urolithiasis, and BPH. Two reviewers screened the citations that were eligible for title, abstract, and full-text screening, with conflicts resolved by a third reviewer. Two reviewers extracted information from the studies, with discrepancies resolved by a third reviewer. The data collected were then qualitatively synthesized by consensus. Two reviewers evaluated each article according to the STREAM-URO checklist with discrepancies resolved by a third reviewer. Results: After identifying 459 unique citations, 63 articles were retained for data extraction. Most articles consisted of tabular (n = 32) and computer vision (n = 23) tasks. The two most common problem types were classification (n = 40) and regression (n = 12). In general, most studies utilized neural networks as their ML algorithm (n = 36). Among the 63 studies retrieved, 58 were related to urolithiasis and 5 focused on BPH. The urolithiasis studies were designed for outcome prediction (n = 20), stone classification (n = 18), diagnostics (n = 17), and therapeutics (n = 3). The BPH studies were designed for outcome prediction (n = 2), diagnostics (n = 2), and therapeutics (n = 1). On average, the urolithiasis and BPH articles met 13.8 (standard deviation 2.6), and 13.4 (4.1) of the 26 STREAM-URO framework criteria, respectively. Conclusions: The majority of the retrieved studies effectively helped with outcome prediction, diagnostics, and therapeutics for both urolithiasis and BPH. While ML shows great promise in improving patient care, it is important to adhere to the recently developed STREAM-URO framework to ensure the development of high-quality ML studies.
Assuntos
Hiperplasia Prostática , Urolitíase , Masculino , Humanos , Hiperplasia Prostática/diagnóstico , Urolitíase/diagnóstico , Urolitíase/terapia , Aprendizado de MáquinaRESUMO
PURPOSE: As benign prostatic hyperplasia (BPH) is an age-related process, growing interest in surgical management for elderly men has emerged. Recently, Aquablation was approved for treatment of BPH associated lower urinary tract symptoms (LUTS) and utilizes robotic ultrasound guided surgeon-controlled waterjet ablation. We assessed the differences in functional and surgical outcomes between elderly and young men undergoing Aquablation for BPH/LUTS. MATERIALS AND METHODS: We retrospectively assessed prospectively collected data from the WATER I (NCT02505919) and WATER II (NCT03123250) clinical trials reporting safety and efficacy of Aquablation in the treatment of LUTS/BPH in men 45-80 years with a prostate between 30 and 80 cc, and 80 cc and 150 cc, respectively. Men ≥ 65 years were defined as elderly and men < 65 years as young. RESULTS: Of 217 patients included, 83 (38.2%) were young and 134 (61.8%) were elderly. Mean age (SD) was 59.3 (± 3.4) years and 71.2 (± 4.2) years for young and elderly men, respectively. At 3 years of follow-up compared to baseline, elderly men showed similar reductions in total IPSS (7.68 points vs 7.12 points, p > 0.05) and similar increases in Qmax (20.6 mL/s vs 19.3 mL/s, p > 0.05) compared to young men. The ejaculatory dysfunction rate was similar for both cohorts (12.0% vs 9.7%, p > 0.05). Elderly men experienced similar annual retreatment rates compared to young men (1.5% vs 0.8% p > 0.05). CONCLUSIONS: Elderly men undergoing Aquablation have similar functional and surgical outcomes as young men. Elderly patient BPH surgical counseling should, therefore, consider Aquablation as a treatment option for LUTS/BPH.
Assuntos
Técnicas de Ablação , Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Idoso , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , ÁguaRESUMO
PURPOSE: To evaluate changes in global perioperative data of GreenLight-XPS 180-Watt photo-selective vaporization of the prostate (GL-XPS) of the Global Greenlight Group (GGG) database. METHODS: 3441 men, who underwent GL-XPS for symptomatic BPH between 2011 and 2019 at seven high volume international centers, were included. Primary outcome measurements were operative time (OT; min), effective laser time (LT; min of OT), as well as intraoperative and postoperative adverse events (AEs), all analyzed by year of surgery (2011-2019) and prostate volume (PV) group (< 80 ml vs. 80-150 ml vs. > 150 ml). RESULTS: The median age was 70 years (interquartile range 64-77), the median PV was 64 ml (IQR 47-90). The OT and LT slightly increased but stayed highly efficient all in all. Median OT was 60 min (IQR 45-83) and LT was 33 min (IQR 23-46). Median energy use was 253 kJ (IQR 170-375) with an energy density of 3.94 kJ/ml (IQR 2.94-5.02). The relative probability of perioperative AEs decreased by 17% each year (p < 0.001). The relative probability of perioperative transfusion dropped significantly from 2% in 2011 to 0% in 2019 (p = 0.007). The early postoperative complications (within 30 days after surgery) decreased significantly from 48.8% (n = 106) in 2011 to 24.7% (n = 20) in 2019 (p > 0.001). CONCLUSION: These findings from the GGG demonstrate significant improvement secondary to growing experience with GL-XPS between 2011 and 2019 in intraoperative AEs, including transfusions, and postoperative AEs. While staying highly efficient in OT and LT of GL-XPS within a 9-year period of experience.
Assuntos
Terapia a Laser , Hiperplasia Prostática , Idoso , Humanos , Terapia a Laser/efeitos adversos , Masculino , Próstata/cirurgia , Hiperplasia Prostática/complicações , Resultado do Tratamento , VolatilizaçãoRESUMO
INTRODUCTION: Patients with non-alcoholic fatty liver disease (NAFLD) have higher prevalence of nephrolithiasis. The aim of the present study was to determine prevalence of hepatic steatosis on ultrasonography in nephrolithiasis patients. METHODS: Charts of 318 consecutive nephrolithiasis patients seen in stone clinic between January and February 2018 were retrospectively reviewed. Ultrasound reports were reviewed for hepatic steatosis. Subsequent liver investigations were noted. Patients' demographic predictors of hepatic steatosis were identified using univariable logistic regression models. RESULTS: A total of 162 patients was included, of which 76 (46.9%) were found to have hepatic steatosis and 22 (13.6%) were found to have moderate-to-severe hepatic steatosis. Median followup was 2.03 years. Predictors of hepatic steatosis included higher body mass index and smoking (both p<0.05). Progression of fatty liver on ultrasound was noted for 13 (17.1%) and regression was noted for two (2.6%). Of the 16 patients with a Fibrosis-4 (FIB-4) score, four (25.0%) patients required further investigation and 12 (75.0%) were unlikely to have advanced fibrosis. Of 12 patients who underwent fibroscan, one (8.3%) had both fibrosis and cirrhosis, two (16.7%) fibrosis only, and two (16.7%) moderate-to-severe steatosis. CONCLUSIONS: Hepatic steatosis on ultrasound followup of nephrolithiasis patients is common, especially in smokers and overweight patients. Current recommendations suggest that primary care physicians calculate a FIB-4 score upon the detection of hepatic steatosis on ultrasound. The decision to refer to hepatology for a corroborative fibroscan is then based on the FIB-4 score.
RESUMO
Objectives: To assess the accuracy, quality, and readability of online educational health information in English related to the most common benign prostatic hyperplasia (BPH) guideline-approved surgical treatments. Methods: The terms "benign prostatic hyperplasia," "BPH," and all eight guideline-approved treatment modalities studied, were searched to retrieve the first five relevant websites and first two paid advertised websites related to the surgical treatment options for BPH. These modalities included transurethral resection of the prostate (TURP), GreenLight photovaporization, endoscopic enucleation of the prostate, Rezum, Urolift, Aquablation, open simple prostatectomy, and robotic simple prostatectomy (RSP). All relevant websites were assessed for their accuracy, quality, and readability using standardized scoring systems. Results: The mean accuracy score for each of the treatment modalities were all indicative of good accuracy, with 76%-99% of the information presented as being accurate. The median quality score was statistically different across the eight treatment modalities (p = 0.015). The median readability grade level was statistically different across the eight treatment modalities (p = 0.009). Websites that described TURP (median readability grade level, 9.00 [interquartile range (IQR) 8.00-10.80]) were significantly easier to read than those related to RSP (median readability grade level, 14.35 [IQR, 11.08-16.50]) (p = 0.011). No other statistically significant differences were found within the other treatment modality websites. Conclusions: The majority of websites retrieved were found to be of high accuracy, good quality, and poor readability. Additionally, it was found that none of the retrieved websites included descriptions for all the other included treatment modalities. Given these findings, the authors recommend the development of centralized resources with all guideline-approved treatment modalities and accurate, readable, and high-quality information related to the surgical treatment of BPH.
Assuntos
Hiperplasia Prostática , Ressecção Transuretral da Próstata , Compreensão , Humanos , Internet , Masculino , Próstata/cirurgia , Prostatectomia , Hiperplasia Prostática/cirurgiaRESUMO
INTRODUCTION: The growing number of surgical options available to treat benign prostatic hyperplasia (BPH), may overwhelm patients and urologists when deciding on an optimal treatment. Therefore, we developed an online patient decision aid (PtDA) that includes all guideline-approved surgical modalities. The objective of this study was to assess the acceptability of the PtDA among former BPH surgery patients and urologists that treat BPH surgically. METHODS: The International Patient Decision Aids Standards were used to develop a PtDA that includes monopolar transurethral resection of the prostate (TURP), bipolar TURP, GreenLight photovaporization, endoscopic enucleation of the prostate, Rezum, Urolift, Aquablation, open retropubic prostatectomy, and robotic simple prostatectomy as management options. Eleven urologists that regularly treat BPH and 19 patients who received BPH surgery were recruited. Alpha-testing was performed using a validated acceptability scoring system. RESULTS: For all sections of the PtDA, most urologists agreed that the language used was easy to follow (91.9%), that the amount of information provided was adequate (63.6%), that the length of the PtDA was appropriate (63.6%), and that the outcomes reported were correct (81.8%). All 19 patient participants agreed that the language used was easy to follow, and most found that the amount of information provided was adequate (84.2%), that the length of the PtDA was appropriate (84.2%), and that the outcomes reported were well-explained (89.5%). CONCLUSIONS: Our PtDA was found to be acceptable among urologists and patients. These results demonstrate that most of the participants either recommend the use of this tool or plan to incorporate it in their clinical practice.
RESUMO
OBJECTIVES: Men with nonobstructive azoospermia (NOA), cryptozoospermia and severe oligozoospermia are candidates for microdissection testicular sperm extraction (micro-TESE) and intracytoplasmic sperm injection (ICSI). We sought to evaluate micro-TESE outcomes and the need for bilateral testicular exploration in the three groups of men. METHODS: We conducted a retrospective study of 233 consecutive micro-TESEs in men with nonobstructive azoospermia (n = 173), cryptozoospermia (n = 43) and severe oligozoospermia (n = 17). The decision to terminate the micro-TESE after a unilateral or bilateral testicular exploration was determined at the time of surgery and was based on the presence or absence of mature spermatozoa in the harvested micro-biopsies. Final assessment of sperm recovery, on the day of ICSI, was reported as successful (available spermatozoon for ICSI) or unsuccessful (no spermatozoon for ICSI). RESULTS: Unilateral testicular exploration resulted in successful sperm retrieval in 43% (75/173), 79% (34/43) and 100% (17/17) of men with NOA, cryptozoospermia and severe oligozoospermia respectively. Therefore, 57%, 21% and none of the men with NOA, cryptozoospermia and severe oligozoospermia, respectively, required a bilateral micro-TESE. Overall, micro-TESE resulted in successful sperm retrieval in 52% (90/173), 91% (39/43) and 100% (17/17) of men with NOA, cryptozoospermia and severe oligozoospermia respectively. CONCLUSION: Our data indicate that men with severe oligozoospermia are unlikely to require a bilateral testicular exploration at micro-TESE. Moreover, most cryptozoospermic men will have a successful sperm retrieval by micro-TESE with the majority of these patients requiring a unilateral exploration. In contrast, over 50% of the men with nonobstructive azoospermia will require a bilateral micro-TESE.
Assuntos
Azoospermia , Oligospermia , Azoospermia/cirurgia , Humanos , Masculino , Microdissecção , Oligospermia/terapia , Estudos Retrospectivos , Recuperação Espermática , Espermatozoides , Testículo/cirurgiaRESUMO
PURPOSE: To compare the safety and durability of transurethral resection of the prostate (TURP) and Laser prostatectomy (LP) among multi-morbid and elderly patients. METHODS: Using data retrieved from the New York State Department of Health Statewide Planning and Research Cooperative System and the California Office of Statewide Health Planning and Development, we selected cohorts of 1) multi-morbid (Charlson comorbidity index ≥ 3) and 2) elderly (aged ≥ 75) patients with benign prostatic hyperplasia who underwent laser coagulation, vaporization, enucleation, or TURP between January 2005 and December 2016. We assessed the post-operative incidence of hospital readmission and ER visit at 30 days and 90 days, complications at 90 days, and reoperation and the development of urethral stricture at 6 months or longer. RESULTS: We found 12,815 and 29,806 patients in the multi-morbid and elderly cohort, respectively. Compared to LP, TURP was associated with lower odds of 90-day hospital readmission and ER visit in the multi-morbid cohort (OR 0.92, 95% CI 0.85-1.00) and higher odds in the elderly cohort (OR 1.07, 95% CI 1.01-1.14). The multi-morbid cohort showed lower odds of urinary tract infections (Ref: LP, OR 0.83, 95% CI 0.73-0.93). The elderly cohort showed higher odds of experiencing hematuria (OR 1.28, 95% CI 1.03-1.59) post TURP. TURP was associated with a 19% (95% CI 0.66-1.00) and 20% (95% CI 0.71-0.91) reduced hazard of reoperation at 6 months or longer for multi-morbid and elderly cohorts, respectively. CONCLUSION: Compared to LP, TURP was associated with higher complication rates for the multi-morbid and elderly cohorts overall but a lower hazard of reoperation, supporting its durability.
Assuntos
Prostatectomia/métodos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Humanos , Terapia a Laser , Masculino , Prostatectomia/efeitos adversos , Estudos Retrospectivos , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do TratamentoRESUMO
INTRODUCTION: Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. METHODS: Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. RESULTS: At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64-77), 64 (47-90), 3.1 ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62 min (46-85), respectively. Median energy use was 250.0 kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.