Correction of Retrograde Ejaculation in Patients with Diabetes Mellitus Using Endourethral Collagen Injection: Preliminary Results.

INTRODUCTION: Diabetic neuropathy secondary to diabetes mellitus type 1 (DM1) is responsible for retrograde ejaculation (RE) in 5-18% of cases. Medical treatment of RE is based either on increasing the sympathetic tone of the bladder or on decreasing the parasympathetic activity. However, the onset of side effects and the lack of response should be considered. AIMS: The aim of this study was to analyze long-term outcome of endourethral injection of volume-forming material (VFM) of collagen type 2 into bladder neck submucosa in patients with RE secondary to DM1. METHODS: Twenty-four patients with complete RE refractory to imipramine and DM1 were included in the study. Patients were single-blinded randomized according to a computer-generated random sequence with a 1:1 ratio in two treatment groups, namely group A (endourethral collage type 2 injection) and group B (endourethral saline water injection). New technique includes an endoscopic injection of VFM such as collagen (Correcting MIT®, Ltd. minimally invasive technologies, Moscow, Russia) into bladder neck submucosa. Primary endpoint of the study was the reduction of semen antegrade volume (mL). Secondary endpoints were considered as the changes of antegrade count (millions/mL), antegrade total motility (%), antegrade progressive motility (%), State-Trait Anxiety Inventory, Beck Depression Questionnaire and International Index of Erectile Function (IIEF-5). Pregnancy rate was calculated in each group. RESULTS: Twenty-three patients completed the study. In group A, significant differences from baseline to 12 months were observed relative to antegrade volume (mL) (mean difference: 0.71, P < 0.05), antegrade count (millions/mL) (mean difference: 45.6, P < 0.05), antegrade total motility (%) (mean difference: 15.4, P < 0.05) and antegrade progressive motility (%) (mean difference: 8.4, P < 0.05). In group A, we observed significant differences in terms State-Trait Anxiety Inventory (mean difference: -20.5, P < 0.05) and Beck Depression Inventory (mean difference: -8.4, P < 0.05) with significant differences compared with group B. We observed significant improvements in group A vs. group B when considering primary and secondary endpoints of the study, but not for the IIEF-5. CONCLUSION: Correction of RE in DM1 patients could be achieved with endourethral injection of collagen type 2.

Prostatic Arterial Embolization vs Open Prostatectomy: A 1-Year Matched-pair Analysis of Functional Outcomes and Morbidities.

OBJECTIVE: To evaluate 1-year surgical and functional results and morbidities of prostatic artery embolization (PAE) vs open prostatectomy (OP). PATIENTS AND METHODS: We undertook 1:1 matched-pair analysis (International Prostate Symptom Score [IPSS], peak flow [PF], postvoid residual [PVR], and prostate volume) of 287 consecutive patients treated for benign prostatic obstruction, including 80 OP and 80 PAE. Inclusion criteria were as follows: lower urinary tract symptoms or benign prostatic obstruction, IPSS ≥12, prostate-specific antigen (PSA) <4 ng/mL, or PSA between 4 and 10 ng/mL but negative prostate biopsy, total prostate volume >80 cm(3), and PF <15 mL/s. Follow-up was performed at 1 month, 6 months, and 1 year at clinic. Primary end points of the study were the comparison regarding IPSS, International Index of Erectile Function-5, PF, PVR, and IPSS quality of life (IPSS-QoL) after 1 year of follow-up. RESULTS: Regarding primary end points, OP group had lower IPSS (4.31 vs 10.40; P <.05), 1-year PVR (6.15 vs 18.38; P <.05), 1-year PSA (1.33 vs 2.12; P <.05), IPSS-QoL (0.73 vs 2.78; P <.05), International Index of Erectile Function-5 (10.88 vs 15.13; P <.05), and greater PF (23.82 vs 16.89; P <.01). The matched-pair comparison showed higher value of postoperative hemoglobin level (mg/dL) and shorter hospitalization (days) and catheterization (days) for PAE group. At the multivariate logistic regression, PAE was associated with persistent symptoms (IPSS ≥8; odds ratio, 2.67; 95% confidence interval [CI], 0.96-7.4; P <.01) and persistent PF ≤15 mL/s (odds ratio, 4.95; 95% confidence interval, 1.73-14.15; P <.05) after 1 year. CONCLUSION: PAE could be considered a feasible minimally invasive technique but failed to demonstrate superiority to OP because of the increased risk of persistent symptoms and low PF after 1 year.

Prostatic artery embolization for prostate volume greater than 80 cm3: results from a single-center prospective study.

OBJECTIVE: To investigate clinical benefits and safety of prostatic artery embolization (PAE) in patients with prostate volume ≥80 cm(3) and Charlson comorbidity index (CCI) ≥2 and affected by benign prostatic obstruction (BPO). PATIENTS AND METHODS: From January 2009 to January 2012, PAE was performed in 88 consecutive patients affected by clinical BPO. Inclusion criteria were symptomatic BPO refractory to medical treatment, International Prostate Symptom Score (IPSS) ≥12, total prostate volume (TPV) ≥80 cm(3), Qmax <15 mL/s, and CCI ≥2. Primary end points were the reduction of 7 points of the IPSS and the increase of Qmax. Secondary end points were the reduction of TPV, postvoid residue (PVR), prostate-specific antigen (PSA), International Index of Erectile Function 5 score, and IPSS-quality of life (QoL). Follow-up was addressed at 3 months, 6 months, and at 1 year. RESULTS: The mean IPSS (10.40 vs 23.98; P <.05) and the mean Qmax (16.89 vs 7.28; P <.05) at 1 year were significantly different with respect to baseline. When considering secondary end points, we observed significant variation in terms of PVR (18.38 vs 75.25; P <.05), TPV (71.20 vs 129.31; P <.05), and PSA level (2.12 vs 3.67; P <.05) at 1 year compared with baseline. Finally, the mean IPSS-QoL significantly changed from baseline to 1 year after PAE (5.10 vs 2.20; P <.05). No minor or major complications were reported. CONCLUSION: We showed clinical benefits of PAE for the treatment of lower urinary tract symptoms and/or BPO by reducing IPSS, TPV, PSA, PVR, and improvement in urinary flow and QoL after 1 year in patients with prostate volume ≥80 cm(3) and CCI ≥2.