Terapia termal con vapor de agua: variaciones técnicas entre hospitales universitarios españoles y eficacia a 2 años de seguimiento / Water vapor thermal therapy: technical variations among spanish hospitals and efficacy at 2-year follow-up

Objetivo El objetivo de este trabajo es conocer experiencia inicial con la terapia térmica con vapor de agua (TTVA) para hiperplasia benigna de próstata (HBP) en los hospitales universitarios españoles, así como describir las diferencias en cuanto a técnica y seguimiento observadas entre los centros. Materiales y métodos Este estudio multicéntrico observacional retrospectivo recogió características basales, datos quirúrgicos, posoperatorios y seguimiento a los uno, tres, seis, 12 y 24 meses, incluyendo cuestionarios validados, variaciones flujométricas, complicaciones y la necesidad de tratamiento farmacológico y quirúrgico tras el procedimiento. También se analizaron los posibles desencadenantes de retención aguda de orina (RAO) en el posoperatorio. Resultados Se incluyeron un total de 105 pacientes. No se observaron diferencias entre los grupos con y sin RAO con respecto a tiempo de sondaje (cinco y 4,3 días respectivamente, p = 0,178), ni volumen prostático (47,9 y 41,4 g, respectivamente, p = 0,147). La mejoría media a los tres, seis, 12 y 24 meses en cuanto de flujo máximo fue de 5,3, 5,2, 4,2 y 3,8 mL/s, respectivamente. En cuanto a la eyaculación, se observa una mejoría en la misma a partir de los tres meses de seguimiento que se mantiene en el tiempo. Conclusiones El tratamiento mínimamente invasivo de HBP con TTVA presenta buenos resultados funcionales a 24 meses de seguimiento, sin afectación significativa de la función sexual y con una baja incidencia de complicaciones. Existen pequeñas variaciones principalmente en cuanto al posoperatorio inmediato entre los hospitales participantes en el estudio. (AU)

Aim The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers. Materials and Methods This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed. Results A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, p = 0.178), or prostate volume (47.9 gr and 41.4 gr respectively, p = 0.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8 ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time. Conclusions Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative period. (AU)

Comparison between thulium laser resection of prostate and transurethral plasmakinetic resection of prostate or transurethral resection of prostate.

Benign prostatic hyperplasia (BPH) is one of the most common diseases in middle-aged and elderly men. In the present study, we aimed to compare the efficacy and safety of thulium laser resection of the prostate (TMLRP) with either transurethral plasmakinetic resection of the prostate (TUPKP) or transurethral resection of the prostate (TURP). A literature search was performed, eventually, 14 studies involving 1587 patients were included. Forest plots were produced by using Revman 5.2.0 software. Our meta-analysis showed that operation time, decrease in hemoglobin level, length of hospital stay, catheterization time, and development of urethral stricture significantly differed, whereas the transitory urge incontinence rate, urinary tract infection rate, and recatheterization rate did not significantly differ between TMLRP and either TURP or TUPKP. The blood transfusion rate was significantly different between TMLRP and TURP, but not between TMLRP and TUPKP. In addition, the retrograde ejaculation rate between TMLRP and TURP did not significantly differ. At 1, 3, 6, and 12 months of postoperative follow-up, the maximum flow rate, post-void residual, quality of life, and International Prostate Symptom Score did not significantly differ among the procedures. Thus, the findings of this study indicate that TMLRP may be a safe and feasible alternative.

[Efficacy and safety of use of likoprofit in patients with chronic prostatitis and prostatic adenoma].

The article summarizes the results of the clinical trials on application of likoprofit in patients with a chronic prostatitis and prostate adenoma, which were conducted by the Russian urologists for the last 8 years. Application of likoprofit in patients after TURP contributes to significantly earlier and effective restoration of microcirculation, which decreases the risk of development of postoperative complications and accelerates rehabilitation of patients. Studies in which likoprofit was applied in patients with a chronic prostatitis and prostate adenoma, proved that likoprofit also has antiedematous effect, improves the urination act, improves ejaculate parameters, positively impacts on sexual function, and has a high safety profile.

[Modern neurological treatment strategies for patients with spinal cord injury]. / Moderne neurourologische Therapiestrategien bei Patienten mit Rückenmarksschädigung.

Modern treatment methods for neurogenic bladder dysfunction take into consideration the primacy of obtaining good bladder storage capacity by merely lowering the leak point pressure. The medical benefit for the patient is seen in the stability of renal function and the social advantage in achieving continence. The development of modern findings on the management of neuro-urological disorders in spinal cord injury as well as the underlying principles, indications, and benefits of the most frequently applied treatment approaches are described.

Prostate growth and prevalence of prostate diseases in early onset spinal cord injuries.

BACKGROUND: Controversial data on modifications of prostate size, function and disease of spinal cord injury (SCI) patients has been previously reported. OBJECTIVE: An analytical observational cohort study on male SCI patients was planned in order to evaluate prostate gland growth, including benign prostatic hyperplasia in relation to the age of the patient at SCI onset. Additional evaluations considered hormonal and biochemical parameters and prostate cancer. DESIGN, SETTING AND PARTICIPANTS: 113 SCI patients (mean age 61.3) and 109 age-matched able bodied subjects (mean age 65.4) were enrolled and stratified according to the patient age at SCI onset (< or = 30, 31-49, and > or = 50 years). INTERVENTION: A complete medical history was then collected from all SCI patients and able bodied subjects. MEASUREMENTS: Total prostate antigen (PSA) and testosterone (T) serum levels and urine culture were collected. Digital rectal examination and transrectal ultrasonography were performed. RESULTS AND LIMITATIONS: Patients with SCI showed PSA value and prostate size significantly lower than those observed in able bodied subjects, and an inverse relationship was observed in SCI patients between these two parameters and patient age at the time of lesion onset. T serum levels were lower in SCI patients when compared to able bodied subjects. No SCI patient presented prostate cancer, while 9.7% of control subjects were affected by prostate cancer. CONCLUSIONS: Prostate volume and PSA levels are lower in SCI patients and are inversely related to the patient age at lesion onset. Whether this effect is mediated directly or indirectly by a impaired nerve supply to the prostate remains to be determined. Despite the present observation of reduced prostate disease, as during the last twenty years life expectancy in SCI patients has improved significantly, the need to screen these patients for the occurrence of prostate disease should not be disregarded.

The load on family and primary healthcare in the first six weeks after transurethral resection of the prostate.

OBJECTIVE: The extent of load on spouses and primary healthcare after transurethral resection of the prostate (TURP) and the number of treatment-related symptoms in the first 6 weeks after TURP were studied. MATERIAL AND METHOD: A combined interview (qualitative) and questionnaire (quantitative) study was carried out. In the first part of the study 10 spouses underwent semi-structured interviews concerning their husbands' treatment-related symptoms 6 weeks after TURP. Based on these interviews a questionnaire was framed. In the second part questionnaires were sent to 78 spouses whose husbands had undergone TURP 6 weeks before. RESULTS: 69 questionnaires were returned (88.5%). The median age of spouses and their husbands was 65 years (range 43-90) and 70 years (range 46-85), respectively. Length of hospitalization, including day of operation, was 3 days (range 2-9). There were 43 (62%) unscheduled contacts with the health system after discharge. In relation to discharge, 55 (79.7%) were incontinent to some degree and 29 (42%) were incontinent for more than 4 weeks, 26 (37.7%) had urinary tract infection, 30 (40%) had long-lasting bleeding, 10 (14%) urinary retention, and 41 (59.4%) urgency. Of the spouses, 20 (34.8%) had sleep disorders, 27 (39%) an affected social life and 22 (31.9%) extra work at home; 19 (27.5%) of the spouses felt that their husbands had been discharged too early, 55 (80%) were satisfied with the information given before the operation and 46 (68%) were satisfied with the information given in relation to discharge. The treatment results after 6 months are comparable to other studies. CONCLUSIONS: Among patients discharged after TURP there is a considerable number of treatment-related symptoms in the first few weeks affecting the family as well as health services. The study has resulted in better oral and written information in relation to discharge. More pads are delivered and patients have a urine culture and telephone consultation with a nurse 1 week after discharge.

[Complex therapy of irritative voiding disorders after transurethral resection of the prostate and adenomectomy].

Rehabilitation therapy was performed in 5 groups (n=122) of patients operated for prostatic adenoma (TUR of the prostate, transvesical prostatectomy) and having postoperative marked irritative miction disorders. Group 1 received antibacterial therapy (AT); group 2-- AT+alpha-adrenoblockers; group 3-- AT+transrectal laser and magnetic physiotherapy; group 4-- AT+alpha-adrenoblockers+transrectal laser and magnetic physiotherapy; group 5-- AT+prostatotropic phytotherapy (gentos). The worst result was achieved in group 1, the best one--in groups 3 and 4. Thus, adjuvant physiotherapy inclusion in the complex of postoperative rehabilitation of patients operated for prostatic adenoma is justified as it improves treatment efficacy.

[Efficacy of setegis administration after transvesical adenomectomy].

We studied efficacy ofsetegis in different doses for therapy of lower urinary tract symptoms in patients after transvesical adenomectomy (TVAE). The analysis of case histories of 41 patients after open TVPE for prostatic adenoma has shown that setegis (terazosin) is effective in therapy of urinary bladder overactivity which is present in the majority of patients after TVAE. Compared to the controls, terazosin-treated patients improved urination more noticeably. Thus, alpha-adrenoblocker segetis is effective and safe in therapy of imperative voiding disorders with symptoms of urgent incontinence in patients after TVAE. Use of this drug can significantly contribute to successful postoperative rehabilitation of postadenomectomy patients. Setegis can be recommended for wide clinical practice.

[Combined therapy of voiding irritative disorders after surgical treatment of benign prostatic hyperplasia with Andro-Gin].

The results of operative and rehabilitative treatment of benign prostatic hyperplasia (BPH) was analysed for 69 BPH patients with postoperative irritative disorders of voiding. The patients were divided into four groups by rehabilitative therapy: group 1 received antibacterial therapy; group 2--antibacterial therapy+alpha-adrenoblockers; group 3--antibacterial therapy+transrectal laser and magnetic physiotherapy; group 4--antibacterial therapy+alpha-adrenoblockers+transrectal laser and magnetic physiotherapy. The worst result was obtained in group 1, the best one in groups 3 and 4 (the response was compatible). Thus, the addition of physiotherapy to the complex of postoperative rehabilitation of patients operated for BPH is justified and provides treatment improvement.

Transurethral resection of the prostate: the new old standard.

A literature search was performed for articles between June 2000 and July 2001 pertaining to transurethral resection of the prostate. Eight of the most interesting and/or groundbreaking articles, as deemed by the authors, were selected for review. Topics discussed include transurethral vaporization of the prostate, laser prostatectomy, preoperative finasteride, pelvic floor rehabilitation, the impact of the quantity of tissue removed, bladder infusion prior to catheter removal, and ethanol-glycine in assessment of the absorption of irrigation fluid.

Impact of early pelvic floor rehabilitation after transurethral resection of the prostate.

We examined the results of teaching pelvic floor muscle exercises (PME) on micturition parameters, urinary incontinence, post-micturition dribbling, and quality of life in patients after transurethral prostatectomy (TURP). Fifty-eight consecutive patients who were selected to undergo TURP for benign prostatic hyperplasia (BPH) were admitted into the study: 28 were randomly assigned to a control group (A), 30 formed the investigational group (B) during an initial visit conducted before surgery. In group B patients, perineal exercises were demonstrated in detail, and tested for their correct use via simultaneous rectal and abdominal examination. After the removal of the urethral catheter, these patients were instructed to perform pelvic floor muscle exercises at home and were evaluated before the exercises and at weekly intervals postoperatively. The American Urological Association Symptom Score improved significantly after TURP in both groups. The average quality of life score improved more significantly in group B after TURP, from 5.5 to 1.5 (P < 0.001). The grade of muscle contraction strength after 4 weeks of PME increased from 2.8 to 3.8 in group B (P < 0.01); it was unchanged in the group A. The number of patients with incontinence episodes and post-micturition dribbling was significantly lower in the group B at weeks 1, 2, and 3 (P < 0.01). Our results show that pelvic floor muscle re-education produces a quicker improvement of urinary symptoms and of quality of life in patients after TURP. Its early practice reduces urinary incontinence and post-micturition dribbling in the first postoperative weeks. The exercises are simple and easy to perform in the clinical setting and at home, and therefore should be recommended to all cooperative patients after TURP.

[Sexual readaptation after the surgical treatment of benign prostatic hyperplasia]. / Seksual'naia readaptatsiia posle operativnogo lecheniia dobrokachestvennoi giperplazii prostaty.

Sexual function was studied in 818 patients with benign prostatic hyperplasia (BPH) before and after surgical treatment of this disease. Before surgery, sexual activity was absent in 276 examinees. After surgery 4.3% of them retained erection, 95.7% remained impotent. 542 patients before operations were sexually active. Surgical treatment of BPH (transurethral resection, transvesical adenomectomy) creates grounds for deterioration of sexual function and risk of erection loss. Thus, 77 operated patients had no erection, 176 had weak libido, 159--insufficient erection, 244 retrograde ejaculation, 188 painful orgasm. Transurethral resection led to a complete loss of copulative function in 5.3% of patients, transvesical adenomectomy--in 9.9%. Sexual readaptation after transurethral resection and transvesical adenomectomy has been improved due to a special complex developed by the authors. This complex consists of 14 therapeutic and prophylactic procedures.

The use of generic measures of health-related quality of life in the assessment of outcome from transurethral resection of the prostate.

OBJECTIVES: To investigate the performance of the EuroQol (EQ) quality-of-life measure and the Nottingham Health Profile (NHP) in assessing the outcome of transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO), and to determine which men experience the greatest increase in health-related quality of life (HRQL) after TURP. PATIENTS AND METHODS: A prospective cohort study was undertaken over 12 months from Arpil 1992 of 314 men who completed the EQ, the NHP and a symptom inventory before undergoing elective TURP for probable BPO (Group 1). Identical postal questionnaires were used to follow up this group at 6 weeks, 6 months and 12 months post-operatively, with response rates of 79%, 74% and 69%, respectively. Overall, 92% of patients responded at either 6 or 12 months after surgery. A group of 51 men who had not undergone operation, also with LUTS and probable BPO, were similarly followed over 6 months, before eventually undergoing TURP (Group 2). These patients differed from Group 1 in being younger, less symptomatic and having a higher baseline quality-of-life score, but the inclusion of this group from a broadly similar diagnostic category allowed outcome to be assessed over time in the absence of surgery. RESULTS: There was a significant improvement in all LUTS 6 weeks after TURP; post-micturition dribbling and storage symptoms continued to improve for up to one year. The NHP revealed pre-operative morbidity in all dimensions of the profile. At 12 months after surgery there were significant improvements in the domains of social interaction, energy, pain, emotional reactions and sleep. The EQ profile also showed morbidity in all dimensions before surgery, with significant improvement at 12 months in usual activities, mood and pain/discomfort. The EQ self-rated health and composite quality-of-life score also showed improvement with TURP which continued for 12 months after surgery. The patients in Group 2 tended to deteriorate over the 6 months of follow-up using all measures, but the changes were not significant. The EQ composite quality-of-life score also discriminated between patients on the basis of age, number of symptoms and ASA grade, suggesting that these subgroups experienced differing amounts of benefit from surgery. CONCLUSION: TURP led to significant improvement in the indices of generic HRQL as measured using the NHP and EQ; this improvement continued for 12 months after surgery and mirrored the symptomatic improvement. The EQ confirmed clinical experience, in that men who were younger, fitter and most symptomatic experienced the greatest benefit from surgery. This has not been shown previously using a quality-of-life measure. Generic HRQL measures can be incorporated easily into clinical trials and both the measures used in this study have sufficient sensitivity to be used in this population. The EQ has the advantage of generating a composite quality-of-life score which is easy to interpret and can be used in cost-utility analysis. The addition of HRQL measures leads to a more robust appraisal of the results of surgical intervention. Ultimately, patient-based outcome from TURP will be assessed using a combination of psychometrically tested disease-specific and generic measures, together with symptom scoring.

Prostatic urethral strictures after transurethral microwave thermal therapy for benign prostatic hyperplasia.

Prostatic urethral strictures are rare. We present 3 cases in a study group of 27 who underwent high energy transurethral microwave therapy for benign prostatic hyperplasia. In all 3 cases, midprostatic strictures with ectopic area proximal to the stricture were seen by cystoscopy. Two of the strictures were urodynamically significant. The most likely explanation for their occurrence is direct damage of the prostatic urethra due to ischemia or heat damage of the prostatic urethra.

Multicenter observational trial on symptomatic treatment of benign prostatic hyperplasia with alfuzosin: clinical evaluation of impact on patient's quality of life. The Italian Alfuzosin Cooperative Group.

The main aim of this multicenter observational study was to assess the impact on quality of life (QoL) of 3 months' treatment with an alpha 1-blocker, alfuzosin, 2.5 mg t.i.d., in patients suffering from symptomatic benign prostatic hyperplasia (BPH). Safety and efficacy evaluations were secondary objectives. Nine hundred and ninety patients were enrolled; 940 were evaluable for per-protocol analysis. On day 84, all the three indices of the QoL self-questionnaire were significantly improved in comparison with baseline: mental health +0.4 (2.0%; p < 0.01); general health +0.6 (5.4%; p < 0.01, and, especially, activity +1.4 (13.4%; p < 0.01). Improvement was more marked in patients with severe symptoms at baseline (activity index: +25.6%). Alfuzosin also significantly relieved BPH symptoms according to the Maine Medical Assessment Program (total mean score: day 28 -3.07; day 84 -4.44) and Madsen-Iversen indexes (total mean score: day 28 -5.29; day 84 -7.98). Improvement was more marked in patients with severe symptoms at baseline. Subjective improvement was confirmed by objective measurements (uroflowmetry and residual volume). Fifty-two patients (5.2%) experienced one or more drug-related adverse medical events, mainly within the first 4 weeks of treatment (n = 46; 4.6%). Twenty-seven (2.7%) patients dropped out prematurely from the study for safety reasons. Forty vasodilatory events and 45 nonvasodilatory events were reported. Slight, not clinically significant decreases of blood pressure were observed but heart rate was not modified. In this study, 3 months' treatment with alfuzosin had a positive impact on patients' QoL by relieving their symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assessment of quality of life after transurethral resection of prostate for benign prostatic hyperplasia].

The quality of life (QOL) after transurethral resection of the prostate (TURP) was studied. A total of 113 patients were operated and released, and 86 (76%) cases responded to the TURP follow-up survey. The average age was 69 years and the average time elapsed after the operation was 220 days. Data regarding the patients undergoing TURP was gathered from a questionnaire consisting of 22 questions concerning the preoperative condition and 28 about the post-operative state. Performance status was not changed post-TURP. The patients showed improvements in nocturia, pollakisuria and dysuria. These urological symptoms were in accordance with the findings of uroflowmetry and American Urological Association Symptom Index. Ten questions addressing the patients mental and physical conditions revealed that good quality was generally retained. Sexual activity showed a tendency of gradual decrease in relation to increasing age. Ejaculatory function and actual satisfaction with the sexual act were obviously damaged by the operation. TURP showed no changes in regard to morning erection, sexual desire in an arousing atmosphere, penile hardness at sex and total satisfaction with the sexual life. Social life, family life and mental status were not influenced, but the physical status of 21 (26%) of the patients was decreased by the operation and hospital stay. Over all, 78% of the patients could maintain a good quality of life in post-TURP.

Patient-perceived health status before and up to 12 months after transurethral resection of the prostate for benign prostatic hypertrophy.

As part of a prospective cohort study of 388 men undergoing transurethral resection of the prostate (TURP) for benign prostatic hypertrophy, the perceived physical, social and emotional health before and 3, 6 and 12 months after surgery was assessed using the Nottingham Health Profile. Before surgery, 88% of patients reported one or more specific health problems, most commonly concerning sleep (75%). The areas of daily life considered by the patients to be most affected by their health status were employment (by 33% of those currently in work), sex life (31%), social life (29%) and holidays (29%). Comparisons with other patient groups are described. Three months after surgery the proportion of patients reporting at least one health problem had fallen to 66%. Significant improvements occurred in all aspects of health, particularly sleeping problems. The improvements persisted for all aspects during the year following surgery with the exception of physical mobility, which deteriorated. These improvements were reflected in a significant reduction in perceived limitations in the patients' daily lives, with a tendency for the patients to perceive fewer limitations 1 year after surgery than at the 3-month assessment.