Metabolic syndrome and smoking are associated with persistence of nocturia after transurethral resection of the prostate.

AIMS: The aim of our study was to evaluate the relationship between smoking, metabolic syndrome (MetS) and persistence of nocturia in patients with moderate/severe nocturia (nocturia episodes ≥2), lower urinary tract symptoms (LUTSs), and benign prostatic enlargement (BPE) undergoing transurethral resection of the prostate (TURP). METHODS: From 2015 onward, a consecutive series of patients with moderate/severe nocturia (nocturia episodes ≥2), LUTS, and BPE undergoing TURP were prospectively enrolled. Medical history, physical examination, and smoking status were recorded. MetS was defined according to Adult Treatment Panel III. Moderate/severe persistent nocturia after TURP was defined as nocturia episodes ≥2. Binary logistic regression analysis was used to evaluate the risk of persisting nocturia. RESULTS: One hundred two patients were enrolled with a median age of 70 years (interquartile range: 65/73). After TURP, moderate/severe nocturia was reported in 43 of 102 (42%) of the patients. Overall 40 of 102 (39%) patients presented a MetS, and out of them, 23 of 40 (58%) presented a moderate/severe persistent nocturia after TURP ( P = .001). Overall 62 of 102 (61%) patients were smokers, and out of them, 32 of 62 (52%) presented moderate/severe persistent nocturia after TURP ( P = .034). On multivariate analysis, prostate volume, MetS, and smoking were independent risk factors for moderate/severe persistent nocturia after TURP. CONCLUSION: In our single-center study, MetS and smoking increased the risk of moderate/severe persistent nocturia after TURP in patients with LUTS-BPE. Although these results should be confirmed, and the pathophysiology is yet to be completely understood, counseling smokers and MetS patients about the risk of postoperative persistent nocturia is warranted.

Young Academic Urologists' benign prostatic obstruction nomogram predicts clinical outcome in patients treated with transurethral resection of prostate: an Italian cohort study.

BACKGROUND: The aim of this study was to test the Young Academic Urologist nomogram for the prediction of transurethral resection of prostate outcome in patients with lower urinary tract symptoms and benign prostatic enlargement. METHODS: Between April 2014 and March 2016, a consecutive series of patients with lower urinary tract symptoms undergoing trans-urethral resection of prostate in one center were enrolled. At baseline patients were assessed with international prostate symptom score, prostate specific antigen, prostate volume, transitional zone volume, maximal urinary flow rate and post void residual urine. At 3 months after trans-urethral resection of prostate patients were evaluated with uroflowmetry and international prostate symptom score questionnaire. Maximum urinary flow and transitional zone volume were plotted on the Young Academic Urologist nomogram to predict trans-urethral resection of prostate outcome. Receiver-operator characteristics curve analysis was used to evaluate predictive properties of the nomogram for the outcome of transurethral resection of the prostate. RESULTS: A total of 232 patients were consecutively enrolled. Out of them, 149 patients (65%) presented a positive outcome. The novel Young Academic Urologist nomogram presented an area under the curve of 0.77 (95% CI: 0.70-0.83) for trans-urethral resection of prostate outcome prediction. At the best cut-off value of 75% (nomogram probability) the sensitivity was 62% and specificity was 73%, the positive predictive value was 81% and the negative predictive value was 52%. CONCLUSIONS: The Young Academic Urologist nomogram was, in our experience, an excellent tool to predict a positive outcome after transurethral resection of prostate, although further studies are needed to confirm our results.

Monopolar Transurethral Enucleation of Prostatic Adenoma: Preliminary Report.

OBJECTIVE: To describe preliminary results of our monopolar transurethral enucleation of prostatic adenoma (mTUEPA). MATERIALS AND METHODS: A consecutive series of male patients treated with mTUEPA, a retrograde enucleation of the prostatic adenoma performed by means of a standard monopolar resectoscope, were prospectively enrolled. Symptoms, uroflowmetry parameters, and post-voiding residual were assessed at baseline and at 1, 6, and 12 months postoperatively. Prostate volume was evaluated at baseline by means of transrectal ultrasound. Antiplatelet and anticoagulant drugs were stopped at least 1 week before the operation. RESULTS: Forty-seven patients were enrolled. Mean preoperative prostate volume was 64.9 ± 28.5 g. When assessed at baseline, the mean total International Prostatic Symptoms Score was 15.2 ± 3.9, peak flow rate (Qmax) was 8.4 ± 2.9 mL/s and the post-voiding residual was 103.2 ± 90.6 mL. Four weeks after surgery, patients reported a mean International Prostatic Symptoms Score of 5.3 ± 3. This lower urinary tract symptoms relief was further maintained at 6 and 12 months after surgery. A significant postoperative improvement in uroflowmetry parameters was described, being the 6 and 12 months mean Qmax of 23.4 ± 10.6 mL/s and 18.8 ± 9.2 mL/s, respectively (P < .001). Overall, 14 postoperative complications were reported by 13 of 47 (27.6%) patients: most of them were minor complications (Clavien-Dindo Grade I-II), whereas 1 patient reported capsule perforation during surgery, requiring interruption of the procedure and its further completion (Clavien-Dindo IIIb). CONCLUSION: mTUEPA is a safe and effective technique, merging the principles of laser enucleation and the advantages of mechanical enucleation with standard monopolar transurethral resection of the prostate equipment.

Green light vaporization of the prostate: is it an adult technique?

INTRODUCTION: Intending to overcome transurethral resection of the prostate (TURP) in terms of safety maintaining its efficacy profile, have led to the introduction of minimally invasive laser therapies to treat men with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO), each one with its unique properties. The aim of this review was to analyze and summarize all the existing data regarding the 180 W Xcelerated Performance System (XPS) photoselective vaporization of the prostate (PVP). EVIDENCE ACQUISITION: A systematic review was conducted: 45 papers were identified. After excluding those not in English language, duplicates, case reports and "expert opinion" papers, 39 articles were reviewed. EVIDENCE SYNTHESIS: The XPS emits a 532 nm wavelength generated using a lithium triborate crystal in a quasi-continuous mode through a 750 µm, continuously saline-cooled, metal capped MoXy™ fibre. This system has overcome the previous model in terms of surgical and functional outcomes. Although several techniques have been proposed, the IGLU modular one is considered the standard approach for 180 W PVP. Authors estimated the need for at least 120 cases to reach an expert level of competence. The GOLIATH Study has proven the non-inferiority of XPS PVP to TURP. The procedure is safe and effective also in large glands but long operative times still represent an issue. Considering the total average costs, XPS PVP provides and advantage over TURP. International guidelines consider PVP the best option to manage patients receiving anticoagulants or with a high cardiovascular risk. CONCLUSIONS: PVP should be considered an adult technique and, as suggested by the EAU Guidelines, is the best surgical option to manage patients receiving anticoagulant medication or with a high cardiovascular risk. The development of new surgical techniques such as APV, PEBE and seminal spearing approaches could represent a possibility to further implement the XPS indications. Dedicated unit could improve the management LUTS/BPO men.

Patients With Prostatic Inflammation Undergoing Transurethral Prostatic Resection Have a Larger Early Improvement of Storage Symptoms.

OBJECTIVE: To evaluate the association between prostate inflammation, metabolic syndrome (MetS), and postoperative lower urinary tract symptoms in patients treated with transurethral resection of the prostate (TURP). METHODS: From April 2011, a consecutive series of patients treated with TURP were prospectively included in this observational study. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. Patients were evaluated at baseline and 1 month postoperative with the International Prostate Symptom Score (IPSS), including the storage IPSS (sIPSS) and voiding IPSS (vIPSS) subscores, the Overactive Bladder questionnaire (OAB-q), and uroflowmetry. Prostate volume was evaluated at baseline. Complications were classified using the modified Clavien system. TURP specimens were examined to define grade, location, and extent of the inflammatory infiltrate according to the standardized classification system of chronic prostatitis and/or chronic pelvic pain syndrome. RESULTS: One hundred and thirty-one subjects were enrolled, in which 54 patients (41.3%) presented with MetS. No differences were observed in terms of preoperative prostate-specific antigen, OAB score, IPSS, vIPSS, sIPSS, Qmax, post void residual, and prostate volume in subjects with and without MetS. An incidence of postoperative complications of 10.6% was recorded: 79% were classified as Clavien type I or II; 21% Clavien IIIb. Of 131 subjects, 97 (74.1%) presented with an inflammatory infiltrate. Patients with MetS presented a high proportion of inflammatory infiltrates compared to patients without MetS (45 of 54; 83% vs 52 of 77; 67%, P = .01). Patients with prostate inflammation presented a 50% risk reduction of postoperative storage urinary symptoms. CONCLUSION: We confirmed the association between MetS and prostate inflammation.Patients with inflammatory infiltrates mostly benefit from TURP, particularly regarding storage symptoms.