Aquablation Treatment for Benign Prostate Hyperplasia: Current Standardized Procedure.

The following video Atlas summary reviews all technical elements of the standardized setup, robotic execution, aquablation procedure, and hemostasis for efficient rapid benign prostate hyperplasia treatment.

Male Voiding Behavior: Insight from 19,824 At-Home Uroflow Profiles.

PURPOSE: Benign prostatic hyperplasia is one of the most common conditions seen by a general urologist. Validated questionnaires provide insight into patient symptoms, however office based uroflow devices are limited by the variability of voiding behavior. Using a home uroflow device, we assessed individual voiding variability, temporal distribution of voiding parameters and the impact of age on voiding. MATERIALS AND METHODS: Between April 2019 and June 2020, 19,824 unique voiding profiles were captured using the Stream Dx Uroflowmeter and retrospectively analyzed. Age and number of voids were summarized by mean±standard deviation. We used mixed effects models to compare average values and intrapatient variability of voiding parameters to time of day and age. The coefficient of variation was used to assess intrapatient variability. RESULTS: A total of 637 patients were identified with 625 meeting inclusion criteria, producing 19,824 voids. Mean age was 67 (±10.2) years old, and each patient provided on average 5 (±3.3) voids a day through 7 days. Average intrapatient voiding parameters showed notable variability, where the coefficient of variation for maximum flow was 27.6% (95% CI 26.6-28.6). Early morning voids were associated with higher volume and lower number of voids. As age progressed, voiding profiles worsened in a linear fashion. Afternoon and evening voids were associated with reduced intrapatient variability relative to early morning voids. CONCLUSIONS: Assessment of 19,824 uroflows using an accurate and precise home uroflow device demonstrates that an individual's voiding parameters vary greatly from day to day, throughout the day, and worsen with age. Multiple measurements performed at home provides a more realistic assessment of true voiding behavior by capturing individual voiding variability and can help urologists make better decisions in patient care.

Anatomic restoration technique of continence mechanism and preservation of puboprostatic collar: a novel modification to achieve early urinary continence in men undergoing robotic prostatectomy.

OBJECTIVES: The puboprostatic ligaments, puboperinealis muscle, and arcus tendineus are all recognized as important for continence in men and women. This complex of ligaments, muscles, and tendineus aponeurosis acts in unison to provide continence and can be disrupted during robotic prostatectomy. We propose that preservation of the puboprostatic collar during robotic surgery will help to restore early continence in men undergoing robotic prostatectomy. METHODS: We performed cadaveric studies in 10 fresh cadavers to devise strategies to leave intact the puboprostatic ligaments, muscular collar, and arcus tendineus supporting the continence mechanism. We developed reconstructive strategies to reconnect the ligaments to the urethrovesical anastomosis, reapproximated the muscles, and fixed the distal bladder to the arcus tendineus. These modifications were then attempted in 50 consecutive patients who underwent robotic prostatectomy for clinically localized prostate cancer. The patient-reported outcomes were then used to assess the efficacy of this procedure. RESULTS: The technique was reproducible, and the average additional time taken for the final reconstruction was only 2 to 5 minutes. The continence rate was 29% in the first week, 62% at 6 weeks, 88% at 12 weeks, and 95% in 16 weeks after catheter removal. No other differences were found in the operative, oncologic, or perioperative outcomes. CONCLUSIONS: This modification helped in the early return of continence. It is unlikely that the long-term results will be any different, but shortening the recovery time will have psychological, financial, and health-related quality-of-life benefits for the patients.