Evaluating the efficacy and safety of Holmium laser enucleation of the prostate in patients with obstructive uropathy attributable to bladder outlet obstruction.

OBJECTIVE: To evaluate outcomes of Holmium laser enucleation of the prostate (HoLEP) in individuals presenting with obstructive-uropathy (OU) attributable to bladder outlet obstruction (BOO). METHODS: We performed a retrospective review of patients who underwent HoLEP from August 2017 to January 2023 at our institution. We identified patients with preoperative OU defined by presence of chronic hydronephrosis suggestive of BOO and conducted a matched-pair analysis (1:2) with patients undergoing HoLEP without OU. Patients' demographic, perioperative and postoperative voiding parameters, serum creatinine level, and complications were analyzed up to one-year of follow-up. RESULTS: Preoperative OU was present in 42 patients. Demographic and preoperative parameters were comparable except median preoperative creatinine (1.245 vs. 1.065 ng/ml, p < 0.001) and catheterization rates (76.2% vs. 25%, p < 0.001) were higher in the OU group. The mean duration of postoperative catheterization was longer in the OU group (3.83 vs. 2.26 days, p = 0.048). Two patients in the OU group developed postoperative acute kidney injury. There was no difference in the rate of postoperative complications, improvement in International Prostate Symptom Score and maximum urinary flow amongst both groups except a higher post-void residual volume at 3- and 12-months (p = 0.001 and p = 0.037, respectively) in OU patients. Patients noted significant improvement in serum creatinine level at 6-12 weeks postoperatively from peak baseline level (P = 0.002). CONCLUSION: HoLEP is effective and safe in patients with OU suggestive of BOO, though they are at higher risk of postoperative acute kidney injury.

Minimally invasive techniques in quest of Holy Grail of surgical management of enlarged prostates: a narrative review.

PURPOSE: Past decade has seen a renewed interest in minimally invasive surgical techniques (MISTs) for management of enlarged prostate. This narrative review aims to explore newer MIST for benign prostatic hyperplasia (BPH) which are not yet integrated into established societal guidelines. METHODS: We conducted a literature search across PubMed, Google Scholar, and FDA ClinicalTrials.gov databases on June 1st, 2023, to identify studies published within the past decade exploring various MISTs for BPH. Additionally, we gathered insights from abstracts presented in meetings of professional associations and corporate websites. We broadly classified these procedures into three distinct categories: energy-based, balloon dilation, and implant/stent treatments. We collected detail information about the device, procedure details, its inclusion and exclusion criteria, and outcome. RESULTS: Our review reveals that newer energy-based MISTs include Transperineal Laser Ablation, Transurethral Ultrasound Ablation, and High-Intensity Focused Ultrasound. In the sphere of balloon dilation, Transurethral Columnar Balloon Dilation and the Optilume BPH Catheter System were gaining momentum. The noteworthy implants/stents that are on horizon include Butterfly Prostatic Retraction Device, Urocross Expander System, Zenflow Spring System, and ProVee Urethral Expander System. CONCLUSION: The exploration of various MISTs reflects ongoing efforts to enhance patient care and address limitations of existing treatments. This review provides a bird-eye view and valuable insights for urologists and researchers seeking to navigate the dynamic landscape of MISTs in the quest for effective and minimally invasive solutions for enlarged prostates.

Content analysis of patient support groups related to myositis on Facebook.

INTRODUCTION: Idiopathic inflammatory myopathies (IIM) are heterogeneous and complex, and routine consultation can be overwhelming for patients, or sometimes so rushed that patients feel unable to discuss their needs and wishes adequately. As a result, online patient support groups (PSGs) on social media platforms like Facebook may help provide them with information they are seeking, and the support of the patient community who are living with this condition. Our goal is to explore the current landscape of PSGs in IIM to discuss the future of such groups and their role in supporting patient-driven self-management of complex connective tissue diseases. METHODS: We investigated factors that influence engagement in publicly accessible support groups on Facebook for patients with myositis. We analysed posts from myositis-related Facebook groups and pages between July 10, 2022, and October 2022. Data were extracted from each post, including presentation format (text, picture, video or mixed media) and content type (news, personal feelings or information). To gauge the post's impact, we measured engagement metrics, such as likes, comments, shares and reactions. RESULTS: Nearly three-quarters of the groups were private. Among the open ones, most posts seem to comprise pictures with text. Notably, engagement levels were higher for multimedia posts, with the exception of comments in groups, where engagement was comparatively lower. In terms of content, the majority of posts fell under the 'personal' category, followed by 'information' and 'news' posts, with information posts in groups receiving the most interactions. Moreover, groups exhibited higher total engagement compared to pages when considering all posts cumulatively. CONCLUSIONS: Our observations indicate that patients with myositis seek information on the condition online, and the multimedia nature of content presentation significantly influences engagement. These digital forums serve as valuable platforms for fostering connections among diverse individuals, providing a perceived safe space for sharing their personal experiences and varied perspectives, and potentially mitigating social isolation. Key Points • Patient support groups on myositis are a key source of support and information for patients. • Public posts with multimedia content garner the most engagement. • The majority of posts are personal in nature, with a smaller proportion of content providing news or information.

Application of Natural Language Processing in Electronic Health Record Data Extraction for Navigating Prostate Cancer Care: A Narrative Review.

Introduction: Natural language processing (NLP)-based data extraction from electronic health records (EHRs) holds significant potential to simplify clinical management and aid research. This review aims to evaluate the current landscape of NLP-based data extraction in prostate cancer (PCa) management. Materials and Methods: We conducted a literature search of PubMed and Google Scholar databases using the keywords: "Natural Language Processing," "Prostate Cancer," "data extraction," and "EHR" with variations of each. No language or time limits were imposed. All results were collected in a standardized manner, including country of origin, sample size, algorithm, objective of outcome, and model performance. The precision, recall, and the F1 score of studies were collected as a metric of model performance. Results: Of the 14 studies included in the review, 2 articles focused on documenting digital rectal examinations, 1 on identifying and quantifying pain secondary to PCa, 8 on extracting staging/grading information from clinical reports, with an emphasis on TNM-classification, risk stratification, and identifying metastasis, 2 articles focused on patient-centered post-treatment outcomes such as incontinence, erectile, and bowel dysfunction, and 1 on loneliness/social isolation following PCa diagnosis. All models showed moderate to high data annotation/extraction accuracy compared with the gold standard method of manual data extraction by chart review. Despite their potential, NLPs face challenges in handling ambiguous, institution-specific language and context nuances, leading to occasional inaccuracies in clinical data interpretation. Conclusion: NLP-based data extraction has effectively extracted various outcomes from PCa patients' EHRs. It holds the potential for automating outcome monitoring and data collection, resulting in time and labor savings.

A systematic review and network meta-analysis comparing Rezum with transurethral needle ablation and microwave thermotherapy for the management of enlarged prostate.

Objectives: We aim to compare efficacy and safety of water vapour therapy (Rezum), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms. Materials: PubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual-independent study selection. We analysed only randomized clinical trials. RoB-2, NIH-quality assessment tool and GRADE guidelines were used for quality-of-evidence (QoE) assessment. Relevant prospective studies without a critical risk-of-bias were included. Results: At 12 months, Rezum showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score - Rezum versus TUMT: 1.33 points (95% CI: -1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rezum versus TUNA: 0.07 points (95% CI: -3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak-Flow Rate (Qmax): Rezum versus TUMT: 1.05 mL/s (95% CI: -4.88 to 2.82) favouring Rezum (QoE: Low) and Rezum versus TUNA: 0.37 mL/s (95% CI: -4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post-void residual volume (PVR) comparisons demonstrated that Rezum was similar, or inferior to other techniques at 12 months - Rezum versus TUMT: 11.20 mL (95% CI: -32.40 to 10.30) favouring TUMT (QoE: Low) and Rezum versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low). Rezum also had a similar surgical retreatment rate with TUMT and TUNA up to 3-years - TUMT versus Rezum RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rezum showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rezum had a higher rate of serious adverse events (Clavien-Dindo ≥ Grade 3) than TUMT and TUNA. TUMT versus Rezum with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rezum with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low). Conclusions: Moderate to weak evidence suggests that Rezum is not superior to TUNA and TUMT in all domains studied.