Prostatic Artery Embolization as a Treatment Option for Symptomatic Benign Prostatic Hyperplasia: Results from the Prospective Follow-Up Study in Lithuania.

Background: The endovascular treatment of symptomatic benign prostate hypertrophy (BPH) by prostatic artery embolization (PAE) is one of the new treatments proposed. PAE is a minimally invasive alternative that has been shown to successfully treat lower urinary tract symptoms in BPH patients by causing infarction and necrosis of hyperplastic adenomatous tissue, which decompresses urethral impingement and improves obstructive symptoms. The aim of this study was to evaluate the effectiveness and efficacy of PAE in relieving symptoms in patients with symptomatic BPH. Materials and Methods: The material for the study was collected from 2019 to 2022. A total of 70 men with BPH and PAE were studied. Patients underwent an urological examination to measure the International Prostate Symptom Score (IPSS), Quality of Life score (QoL), International Index of Erectile Function short form (IIEF-5), uroflowmetry with Qmax, prostatic volume (PV), and post-void residual volume (PVR) measurements. Statistical analysis for dependent samples was applied. Measured parameters at 2 months and 6 months follow-up were compared to baseline. Results: At baseline, the age of the male (N = 70) subjects was 74 ± 9.6 years with a median of 73.8, but fluctuated from 53 to 90 years. The mean of PV was almost 111 mL and the Qmax was close to 7.7 mL/s. The average PVR was 107.6 mL. The IPSS score mean was 21.3 points and the QoL score was 4.53 points. The IIEF-5 questionnaire score was almost 1.8 points, which shows severe erectile dysfunction. The mean value of the PSA level was 5.8 ng/mL. After 2 and 6 months of PAE, all indicators and scores except erectile function significantly improved. Conclusions: The outcomes of our study show promising results for patients with benign prostatic hyperplasia after PAE. The main prostate-related parameters (PV, Qmax, PVR, IPSS) improved significantly 6 months after embolization.

Transition zone index and bothersomeness of voiding symptoms as predictors of early unfavorable outcomes after transurethral resection of prostate.

INTRODUCTION: The objective of this study was to establish the influence of preoperative parameters on unfavorable outcomes after transurethral resection of the prostate. PATIENTS AND METHODS: In a prospective study, 90 patients underwent transurethral resection of the prostate. The standardized protocol was used to investigate parameters, preoperatively and after 6 months. The baseline values were analyzed with respect to the probability of predicting the effectiveness of the outcome. RESULTS: All preoperative parameters changed significantly, from 55.1 to 116% (p < 0.001). Treatment was effective for 85.6% of the patients, and the outcomes were unfavorable for 14.4%. The monovariate analysis detected the transition zone index (cut-off 0.48, p = 0.002, OR 7.48) as independent predictor of ineffective outcome. Logistic regression analysis found two the most important parameters - transition zone index (OR 30.26, p = 0.002) and bothersomeness of voiding symptoms (OR 20.7, p = 0.008) for unfavorable outcomes. CONCLUSIONS: The parameters that are traditionally used cannot predict unfavorable outcomes. The transition zone index and bothersomeness of voiding symptoms are most important parameters for predicting an unfavorable outcome after TURP.

Transition zone volume measurement--is it useful before surgery for benign prostatic hyperplasia?

OBJECTIVE: The aim of this study was to estimate the equivalence and correlation between transition zone volume, measured by transrectal ultrasound, and removed prostate tissue weight in surgically treated patients due to benign prostatic hyperplasia. MATERIAL AND METHODS: This study involved 168 patients with histologically confirmed benign prostatic hyperplasia. Of these patients, 120 underwent transurethral resection of the prostate and 48 - open prostatectomy. The weights of the specimens were compared with the corresponding volumes of the transition zone. Equivalence and correlation between transition zone volume and removed tissue weight were analyzed. RESULTS: The mean (standard deviation, range) transition zone volume was 25.43 mL (+/-13.19, 5-61.6) in the transurethral resection group and 76.1 mL (+/-42.97, 13-275.8) in the open operation group. The mean removed tissue weight was 22.9 g (+/-13.41, 5-66) and 73.96 g (+/-44.96, 18-280), respectively, in the transurethral resection and open operation groups. The correlation between removed tissue weight and transition zone volume was stronger in the open operation group than it was in the resection group (r=0.957, P<0.001 vs. r=0.878, P<0.001). There was a significant difference between transition zone volume and resected tissue weight (P=0.001). However, in the open operation group, there was an agreement between transition zone volume and enucleated tissue weight (P=0.263). CONCLUSIONS: A significant correlation was detected between removed tissue weight and transition zone volume. There is a significant difference between volume measurement and resected tissue weight while enucleated tissue weight was in agreement with transition zone volume when an open prostatectomy was performed.

Results of treatment of primary liver cancer at Kaunas University of Medicine Hospital.

Though the results of treatment of primary liver cancer depend on many circumstances, the opportunity to perform a curative liver resection remains the main point in prognosis on survival. The aim of the study was to examine our first experience in the treatment of liver cancer. From 1996 to 2001 we observed 54 patients with liver cancer: 46 hepatocellular and 6 cholangiocellular carcinomas, 1 malignant carcinoid, and 1 carcinosarcoma. In presence of liver cirrhosis (21 patients, 38.8%) hepatic function was evaluated using Child Pugh classification. Lesions were multiple in 28 cases and single in 26 cases. Ten patients (18.5%) were radically resected, 12 patients (22.2%) were managed by laparotomy and biopsy, 2 by percutaneous ethanol injections, 1 by trans-ileocolic portal vein embolization + hepatic artery embolization. There were 7 deaths (28%) and 18 complications (72%) after the surgical treatment. The survival results of patients who underwent resection were better (median 240 days) compared with palliative treatment group (median 113.3 days); by Log-Rank test p=0.208. CONCLUSION. The use of liver resections in patients affected by single or monolateral liver cancer is effective and potentially radical treatment. Mortality and morbidity rate is high. Alternative therapies can be conveniently considered in case of multicentric Child B-C patients.