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1.
Urology ; 136: 196-201, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790785

RESUMO

OBJECTIVE: To compare outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms secondary to benign prostate hyperplasia using 3 different laser fibers and 2 different laser energy modes. MATERIALS AND METHODS: This is a review of a clinic registry of men with lower urinary tract symptoms secondary to benign prostate hyperplasia who underwent HoLEP between August 2018 and January 2019. Patients were assigned to group 1 (50 patients), group 2 (50 patients), and group 3 (50 patients) based on the HoLEP being completed with either a Slimline 550µm, Slimline 1000µm, or MOSES 550 µm laser, respectively. The groups were compared using SSPS for ANOVA comparison of means and multivariate logistic regression. RESULTS: Ten patients who underwent concomitant stone surgery (2 PCNL, 8 ureteroscopy , 3 bilateral cases) and 11 patients had bladder stones removed; ancillary procedures did not significantly differ between groups(P = .2). Prostate enucleation times differed significantly (22.5 + 7.3, 16.4 + 6.9, 18.1 + 8.6 minutes P ≤.001) between groups. However, statistical significance was lost once enucleation time was indexed against enucleated tissue weight. Time to achieve hemostasis (minutes) was statistically different between groups (10.6 + 6.1, 7.7 + 5.2, 6.3 + 4.8 P <.001). This difference in hemostatic time was maintained on multilogistic regression demonstrating that MOSES laser enucleation was associated with a 3.9-minute decrease time to achieve hemostasis after enucleation compared to Slimline 550 HoLEP (P <.001). CONCLUSION: Our findings suggest that modulated pulsed laser energy can improve hemostasis during the enucleation phase of a HoLEP resulting in shorter Operating Room times.


Assuntos
Terapia a Laser/instrumentação , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Sintomas do Trato Urinário Inferior/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Estudos Retrospectivos
2.
J Urol ; 203(1): 171-178, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31430232

RESUMO

PURPOSE: Our current understanding of recent trends in the management of lower urinary tract symptoms associated with benign prostatic hyperplasia is incomplete, particularly in younger men. The 2018 Urologic Diseases in America Project attempted to fill this gap by analyzing multiple large administrative claims databases which include men of all ages and permit longitudinal followup. To our knowledge we report these findings for the first time in the scientific literature. MATERIALS AND METHODS: The 2 data sources used in this study included the de-identified Optum® Clinformatics® Data Mart database for men 40 to 64 years old and the Medicare 5% Sample for men 65 years old or older. To assess trends in lower urinary tract symptoms/benign prostatic hyperplasia related medication prescriptions and surgical procedures from 2004 to 2013 we created annual cross-sectional cohorts and a longitudinal cohort of patients with incident lower urinary tract symptoms/benign prostatic hyperplasia and 5 years of followup. RESULTS: The use of medications related to lower urinary tract symptoms/benign prostatic hyperplasia increased with age, particularly among men 40 to 60 years old. While medication use increased with time, surgical procedures decreased. Increasing age correlated with a higher rate of surgical procedures in the longitudinal cohort. Younger men were more likely to elect treatments of lower urinary tract symptoms/benign prostatic hyperplasia which reportedly optimize sexual function. CONCLUSIONS: Medication use increased and surgery decreased during the study period. Treatment approaches to lower urinary tract symptoms/benign prostatic hyperplasia varied greatly by patient age. While the minority of men in the fifth and sixth decades of life required treatment, a sharp increase in treatment use was seen between these decades. Younger men were more likely to elect less invasive surgical options. Future studies of lower urinary tract symptoms/benign prostatic hyperplasia should focus on age specific treatment selection.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Hiperplasia Prostática/complicações , Adulto , Fatores Etários , Idoso , Estudos Transversais , Humanos , Estudos Longitudinais , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Medicare , Pessoa de Meia-Idade , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Estados Unidos
4.
Actas urol. esp ; 43(9): 488-494, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185250

RESUMO

Introducción: El tratamiento de los síntomas del tracto urinario inferior secundarios a hiperplasia benigna de próstata con la utilización del sistema Urolift(R) se lleva realizando desde 2005 con buenos resultados a medio plazo. En este trabajo presentamos nuestra experiencia realizando esta técnica bajo anestesia local y sedación en 2 centros españoles. Material y métodos: Se llevó a cabo un estudio prospectivo con 20 pacientes tratados con Urolift(R) bajo anestesia local y sedación entre abril de 2017 y abril de 2018. El protocolo anestésico consistía en la colocación de 2 lubricantes con lidocaína fríos (el primero 10 min antes de la intervención y el segundo momentos antes de iniciar la endoscopia). A un tercio de los pacientes se les añadió un bloqueo prostático similar al que se realiza en las biopsias de próstata y, según la tolerancia, durante el procedimiento, se les añadió 1 mg de midazolam intravenoso. El objetivo primario es evaluar la tolerabilidad de este procedimiento bajo anestesia local usando la escala visual analógica. Resultados: El procedimiento ha sido realizado en 20 pacientes en 2 centros diferentes usando el mismo protocolo anestésico. La puntuación media en la escala escala visual analógica de dolor fue de 1,37 para la introducción del cistoscopio y de 1,19 para la colocación de los implantes. A la pregunta de si el dolor había sido mayor, menor o igual al de la cistoscopia diagnóstica, solo el 20% de los pacientes respondieron que había sido mayor. En todos los casos hubo una buena tolerancia al procedimiento, no precisándose en ninguno de ellos el cambio del tipo de anestesia. Conclusiones: Consideramos que la utilización del Urolift(R) bajo anestesia local y sedación es un método bien tolerado, seguro y eficaz para el tratamiento de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata


Introduction: The treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia with the Urolift(R) system has been carried out since 2005 with good results in the medium term. In this work, we present our experience performing this technique under local anaesthesia and sedation in 2 Spanish centres. Material and methods: A prospective study was conducted with 20 patients treated with Urolift(R) under local anaesthesia and sedation between April 2017 and April 2018. The anaesthesia protocol consisted in the placement of 2 lubricants with cold lidocaine (the first one, 10 min before the intervention, and the second one, just before introducing the cystoscopy). A prostate block (similar to the one employed in prostate biopsies) was administered to one third of the patients and 1mg of intravenous midazolam was added if required during the procedure. Our primary objective is to evaluate the tolerability of this procedure under local anaesthesia using the validated Visual Analogue Scale measurement instrument. Results: The procedure has been performed under the same anaesthetic protocol to 20 patients from 2 different centres. The average pain scores on the Visual Analogue Scale were 1.37 for the cystoscopy procedure and 1.19 for the placement of the implants. When asked whether the pain sensations had been higher, lower or the same during the procedure or at the preoperative cystoscopy, only 18% of the patients responded it was higher. In all cases there was a good tolerance to the procedure, and changes to the anaesthesia protocols were never required. Conclusions: We consider that the Urolift(R) system under local anaesthesia and sedation is a well-tolerated, safe and effective method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hiperplasia Prostática/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Sintomas do Trato Urinário Inferior/cirurgia , Anestesia Local/métodos , Estudos Prospectivos , Escala Visual Analógica , Cistoscopia/métodos
5.
Transplant Proc ; 51(9): 2921-2926, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627917

RESUMO

BACKGROUND: With the aging of recipients of renal transplantation (RT) one of the emerging issues is the incidence of low urinary tract symptoms (LUTS), which may have negative consequences on the graft survival and function. The aim of our study was to assess the influence of LUTS and the treatment with transurethral resection of the prostate (TURP) on the outcome of RT. MATERIALS AND METHODS: We collected data from men over 55 who underwent RT at our center from January 2007 to December 2016. We analyzed the incidence of LUTS; the rate of treatment with TURP; the eGFR (estimated glomerular filtration rate) at 6 months and 1, 3, and 5 years from transplantation; and graft survival. RESULTS: Fifty-five patients out of 268 experienced LUTS, and 19 of them had a bladder outlet obstruction (BOO). Patients experiencing BOO had a significantly higher hazard ratio (HR) of graft failure (HR 5.7, CI 1.56-21.4) compared to the other recipients. Of the 18 patients treated with TURP, 10 received the procedure within 6 months from the LUTS onset. They had a significantly absolute eGFR improvement at 6 months from the intervention (+14.25 mL/min ± 8.10) compared to the patients treated later (-8.4 mL/min ± 14.43). DISCUSSION: We showed the negative effects of LUTS on kidney graft function and survival. Although TURP is the standard therapy for such an issue, the best timing for it still has to be defined. Our experience supports the need for an early treatment of the LUTS for promoting the outcome of the RT.


Assuntos
Transplante de Rim , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Idoso , Sobrevivência de Enxerto , Humanos , Transplante de Rim/efeitos adversos , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/epidemiologia , Obstrução do Colo da Bexiga Urinária/epidemiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia
6.
Urology ; 134: 199-202, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31563537

RESUMO

OBJECTIVE: To report long-term safety and efficacy data on middle lobe only-transurethral resection of the prostate (TURP) (MLO-TURP). MATERIALS AND METHODS: We evaluated: (1) efficacy: International Prostate Symptom Score, Quality of Life, peak flow rate (Qmax), postvoid residual urine, International Index of Erectile Function and ejaculatory function, which was assessed by the Male Sexual Health Questionnaire. Men were evaluated at 1 month, 6 months, and yearly thereafter. RESULTS: A total 312 men (mean age 61.3 ± 8.6) with significant lower urinary tract symptoms (n = 147) or urinary retention (n = 175 were treated with MLO-TURP from 2005 to 2017. Mean baseline prostate volume was 79.8 g (30-178 g); mean baseline intravesical-prostatic protrusion was 13.6. Improvements in International Prostate Symptom Score, Quality of Life, Qmax and postvoid residual urine were durable throughout the study period. There was no difference in outcomes between monopolar and bipolar MLO-TURPs. Postoperatively, the incidence of ejaculatory dysfunction was 2.6% (N = 8) and there was 1 case of new onset ED (0.3%). There were modest improvement in bother due to ejaculatory function (baseline: 2.4 and at 5 years: 1.27). CONCLUSION: MLO-TURP is a safe and effective treatment for men with lower urinary tract symptoms. Patients experience long-term improvement of symptoms and preserve antegrade ejaculation. In select men with prominent middle lobes, MLO-- should be considered a therapeutic, ejaculation-sparing option.


Assuntos
Ejaculação , Terapia a Laser , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Idoso de 80 Anos ou mais , Disuria/etiologia , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Próstata/cirurgia , Qualidade de Vida , Ressecção Transuretral da Próstata/efeitos adversos , Cateterismo Urinário , Retenção Urinária/cirurgia , Infecções Urinárias/etiologia
7.
Curr Urol Rep ; 20(8): 47, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31278441

RESUMO

INTRODUCTION: In the last decade, there has been a growing interest in minimally invasive treatment for benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS). In this field, one of the options currently available is the temporary implantable nitinol device (iTIND) (Medi-Tate®; Medi-Tate Ltd., Or Akiva, Israel). PURPOSE OF THE WORK: To review the recent data available in the literature regarding the role of the first-generation (TIND) and second-generation (iTIND) devices for the management of BPH with LUTS, especially focusing on follow-up of functional outcomes. EVIDENCE ACQUISITION: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were screened for clinical trials on this topic. EVIDENCE SYNTHESIS: Literature evidences regarding implantation of TIND and iTIND for PBH with LUTS are limited. There are only three studies available, one with a medium-term follow-up. The results of these studies suggested that both the TIND and iTIND implantations are safe, effective, and well-tolerated procedures, allowing spare ejaculation in sexually active patients. CONCLUSIONS: Current evidences emphasize that the temporary implantable nitinol devices are promising alternatives to the standard minimally invasive surgical options for BPH-related LUTS. Further studies are needed to confirm the effectiveness over a long-term follow-up.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/cirurgia , Stents , Ligas , Materiais Biocompatíveis , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Hiperplasia Prostática/complicações , Implantação de Prótese
8.
Urology ; 132: 164-169, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279692

RESUMO

OBJECTIVE: To evaluate the impact of photoselective vaporization of the prostate (PVP) on erectile function (EF) utilizing a 160W GreenLight laser system with up to 36 months of follow-up in men with lower urinary tract symptoms caused by benign prostatic hyperplasia. METHODS: A prospectively maintained database of patients who underwent GreenLight PVP was retrospectively reviewed. International Index of Erectile Function-5 (IIEF-5) questionnaire was used to assess EF. In total, 265 sexually active patients who underwent 160W GreenLight laser PVP were identified and divided into Group A with baseline IIEF-5 <19 and group B with baseline IIEF-5 ≥19. IIEF-5, International Prostate Symptom Score, quality of life, postvoid residual, and Qmax were recorded preoperatively, perioperatively, and at follow-up after 1, 3, 6, 12, 24, and 36 months. Recorded data were analyzed statistically using t- and χ2 tests. RESULTS: The preoperative and perioperative data of the 2 groups were comparable. Significant improvements in International Prostate Symptom Score, Qmax, quality of life, and postvoid residual were observed in both groups at every follow-up visit throughout the 36 months with no significant difference between the groups. EF was sustained postoperatively compared with the baseline in the whole study population. In Group A (preoperative IIEF-5 <19), EF was significantly improved at 1 month and 12 month (P= .02 and P= .002). CONCLUSION: In patients undergoing PVP by 160W GreenLight laser for lower urinary tract symptoms secondary to benign prostatic hyperplasia, no significant detrimental effect was observed in the EF at up to 3 years of follow-up. However, in patients with preoperative erectile dysfunction (ED), we showed a significant improvement.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Ereção Peniana , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Idoso , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Período Pós-Operatório , Hiperplasia Prostática/complicações , Estudos Retrospectivos , Resultado do Tratamento
9.
Urology ; 132: 170-176, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31252003

RESUMO

OBJECTIVE: To evaluate the outcomes of thulium laser enucleation of the prostate (ThuLEP) in men aged ≥75 years compared to youngers. Traditional surgery has increased and significant morbidity in older men. Lasers have been introduced as an alternative approach to overcome the morbidity of traditional surgery. MATERIAL: We retrospectively evaluated 412 men who underwent en bloc ThuLEP. Inclusion criteria were lower urinary tract symptoms refractory to medical therapy, maximum urinary flow rate (Qmax) ≤15 mL/s, International Prostate Symptom Score (IPSS) ≥8 and absolute indications for surgery. Prostate volume, prostate specific antigen, IPSS, and Qmax, antiplatelet/anticoagulant therapy, ASA score, operation time, length of catheterization, discharge day, early complications, and reoperations were gathered. Differences between groups were estimated using propensity scores, by fitting a stepwise logistic regression model with age group as the dependent variable. RESULTS: One hundred twenty-nine patients were aged ≥75 years (Group 2). Mean age was 65.6 ± 6.0 years in Group 1 and 79 ± 3.7 years in Group 2. Propensity scores retrieved 206 patients. Median operation, catheterization time, and hospital stay were similar in both groups (55 minutes, 2 and 3 days). Overall, 85.9% of men had no complications, with no differences between the groups (82.5% in Group 1 and 89.3% in Group 2). The incidence of Clavien grade III-IV complications was comparable (3.8% in Group 1, 1% in Group 2). By 1 year, there were no statistically significant differences in IPSS, Qmax, QoL, or reoperation rate between the groups. CONCLUSION: En bloc ThuLEP is a safe and effective treatment even in men aged ≥75 years old.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/cirurgia , Túlio/uso terapêutico , Ressecção Transuretral da Próstata/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Hiperplasia Prostática/complicações , Estudos Retrospectivos , Resultado do Tratamento
10.
Curr Urol Rep ; 20(8): 46, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31227924

RESUMO

PURPOSE OF REVIEW: To explore the potential applicability of a novel, heat-free, and robotically controlled ablative therapy for surgical management of benign prostatic enlargement. RECENT FINDINGS: With the emergence of new technology to provide personalized care and overcome the complications associated with options such as TURP, holmium laser enucleation of the prostate, GreenLight laser, or simple prostatectomy, Aquablation has been studied across a variety of prostate volumes. The functional outcome of Aquablation seems to be uncompromised by prostate volume. The sexual profile seems superior to TURP and the risk of retrograde ejaculation is lower. The robotic system provides a reproducible ablation, independent of prostate volume, without requiring extensive training for performing the procedure. The mean ablation time in the prostate as large as 150 ml does not exceed 9.1 min, and the blood transfusion rates do not seem to be higher than open prostatectomy.


Assuntos
Técnicas de Ablação/métodos , Sintomas do Trato Urinário Inferior/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Humanos , Hidroterapia/métodos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/complicações
11.
Urology ; 130: 126-131, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31129193

RESUMO

OBJECTIVE: To determine how often prostate- and bladder-specific medications for lower urinary tract symptoms are used following a transurethral prostatectomy (TURP). METHODS: This study utilized several linked, routinely collected datasets from the province of Ontario, Canada to identify men older than 66 years who underwent their first TURP between April 2003 and March 2016. The primary outcome was the probability of using at least 30 days of either prostate-specific alpha blockers (AB), 5-alpha reductase inhibitors (5ARI), or anticholinergics/beta-3 agonists (AC/B3) after their TURP. RESULTS: We identified 58,038 men (median age 75), with a median follow-up of 4.9 years. In the 6 months prior to their TURP, AB, 5ARIs or AC/B3 were used by 62%, 32%, and 6%, respectively. Following a 90-day washout period after TURP, these medications were used by 27%, 20%, and 15% of men, respectively. The cumulative probability of using these medications within the first 10 years after TURP was 38%, 28%, and 20%, respectively. Family physicians prescribed the majority of AB, while urologists prescribed the majority of the AC/B3. Among men on AC/B3 prior to TURP, 46% used them after TURP; in multivariate cox regression analysis age ≥75, diabetes, preoperative use of AC/B3, and no preoperative urinary retention predicted postoperative utilization of AC/B3 medications. CONCLUSION: There is considerable use of AB and 5ARIs despite a lack of evidence for using these medications after a TURP. Given the well-characterized placebo response in BPH patients, this practice should be properly evaluated for clinical efficacy.


Assuntos
Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 3/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/complicações , Retratamento , Estudos Retrospectivos
12.
J Urol ; 202(3): 592-598, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31059668

RESUMO

PURPOSE: Male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is common in men and can have negative effects on quality of life (QoL). It is the hope that this Guideline becomes a reference for effective evidence-based surgical management of LUTS/BPH. MATERIALS AND METHODS: The evidence team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality database to identify studies indexed between January 2007-September 2017. Following initial publication, this guideline was amended in 2019 and reflects relevant literature published through January 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table 1 in supplementary unabridged guideline, https://www.jurology.com). RESULTS: This Guideline provides evidence-based recommendations regarding management of LUTS/BPH utilizing surgery and minimally invasive surgical therapies (MIST). Additional statements are made regarding diagnostic and pre-operative tests. Clinical statements are made in comparison to what is generally accepted as the gold standard (i.e. transurethral resection of the prostate [TURP] monopolar and/or bipolar). This guideline is designed to be used in conjunction with the associated treatment algorithm (see figure).[Figure: see text]Conclusions:The prevalence and the severity of LUTS increases as men age and is an important diagnosis in the healthcare of patients and the welfare of society. This document will undergo updating as knowledge regarding treatments and future surgical options continues to expand.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/complicações , Sociedades Médicas/normas , Procedimentos Cirúrgicos Urológicos Masculinos/normas , Urologia/normas , Idoso , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/psicologia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Qualidade de Vida , Estados Unidos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Urologia/métodos
13.
Urol Int ; 103(1): 102-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30965341

RESUMO

BACKGROUND: The treatment options for male lower urinary tract symptoms (LUTS) widely range from self-monitoring to oral medications to surgical procedures. As far as concerns surgical treatment of obstructive LUTS, transurethral incision of the prostate is considered as the gold standard in patients with mild benign prostatic enlargement. OBJECTIVES: The aim of our study is to describe this novel approach to perform ejaculation sparing Holmium laser bladder neck incision (ES-HoBNI), with particular regard to its effect on ejaculation and LUTS relief. METHODS: We evaluated prospective clinical data from 143 consecutive patients who underwent ES-HoBNI at our institution from January 2012 to February 2018. Procedures were performed with a continuous flow 26 Ch resectoscope and a 550 µm holmium laser end-fire fiber. The stenotic bladder neck was deeply incised at 3 and 9'o clock down to the prostatic capsule in a retrograde direction to either side in front of the veromontanum. RESULTS: Median Qmax, postvoid residual volume, International Prostate Symptom Score, and quality of life were 9 mL/s (7.4-10.2), 130 mL (100-190), 15 (13-19), and 3 (2-4), respectively. In total, 110 (76.9) reported regular anterograde ejaculation. Median operative time was 20 min (15-26). Median catheterization time and hospital stay were 3 days (3-4) and 22 h (20-24), respectively. Moreover, we have compared the frequency of anterograde ejaculation, which slightly increases after ES-HoBNI (77 vs. 81.2%) when compared to baseline data, despite not reaching statistical significancy. CONCLUSIONS: ES-HoBNI is a safe, reproducible technique to relieve obstructive LUTS in men with small prostates while preserving ejaculation in younger and sexually active individuals.


Assuntos
Ejaculação , Lasers de Estado Sólido , Sintomas do Trato Urinário Inferior/cirurgia , Tratamentos com Preservação do Órgão , Próstata/cirurgia , Bexiga Urinária/cirurgia , Idoso , Cateterismo , Hólmio , Humanos , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/cirurgia , Qualidade de Vida
14.
Curr Urol Rep ; 20(6): 29, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30989392

RESUMO

PURPOSE OF REVIEW: Compare outcomes of medical therapy as compared to minimally invasive surgical therapy (MIST) for treatment of bladder outlet obstruction RECENT FINDINGS: Treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) remains largely driven by patient symptomatology with medical therapy or watchful waiting as the first-line management strategies. However, most patients are not adherent to prescribed medical therapies and are hesitant to accept the risks associated with more invasive therapies. Minimally invasive surgical therapies are treatments providing short-term symptom relief superior to medical therapies without the sequela of more invasive procedures. Though there are few direct comparisons, MIST seems to relieve LUTS/BPH symptoms at least as well as medical therapy without the need for daily adherence.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Procedimentos Cirúrgicos Minimamente Invasivos , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Transtornos Urinários/terapia , Agentes Urológicos/uso terapêutico , Humanos , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Obstrução do Colo da Bexiga Urinária/tratamento farmacológico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Transtornos Urinários/tratamento farmacológico , Transtornos Urinários/etiologia , Transtornos Urinários/cirurgia
16.
Urology ; 127: 91-96, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30822484

RESUMO

OBJECTIVE: To assess the impact of systemic comorbidities on a validated health phenotype score (ACTIONS: Anxiety, Cardiovascular, Testosterone, Insulin/diabetes, Obesity, Neurologic, Sleep apnea) on outcomes of transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH) for symptoms and medication discontinuation. MATERIALS AND METHODS: Comorbidities of men undergoing TURP for BPH from 2004 to 2015 were assessed with the validated ACTIONS phenotype totaling a score from 0 to 2 for each domain (Anxiety, Cardiovascular, Testosterone, Insulin/diabetes, Obesity, Neurologic, Sleep apnea). BPH medication discontinuation, change in International Prostate Symptom Score, postvoid residual, and patient satisfaction were assessed. Descriptive and comparative statistics were calculated with significance set at P <.05. RESULTS: The 319 men had a median age of 74.0 (interquartile range 67-78). Mean ACTIONS score was significantly lower in men who discontinued alpha-blockers or 5-alpha reductase inhibitors compared to those who did not (3.37 ± 2.14vs 4.79 ± 2.75, P <.0001). ACTIONS score <4 was significantly associated with medication discontinuation (P = .0014). Lower scores in Testosterone (P = .04), Neurologic (P = .003), and Sleep apnea (P = .04) domains were significantly associated with medication discontinuation. Total ACTIONS score was not independently associated with changes in International Prostate Symptom Score or postvoid residual. CONCLUSION: Lower ACTIONS score was associated with BPH medication discontinuation after TURP, suggesting men with lower comorbidity burdens do better after the procedure. The ACTIONS phenotype score is easily calculated and may aid the preoperative counseling of men undergoing TURP for BPH.


Assuntos
Antagonistas Adrenérgicos alfa/administração & dosagem , Sintomas do Trato Urinário Inferior/epidemiologia , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Agentes Urológicos/administração & dosagem , Idoso , Estudos de Coortes , Comorbidade , Seguimentos , Humanos , Incidência , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Fenótipo , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Hiperplasia Prostática/diagnóstico , Estudos Retrospectivos , Medição de Risco , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Agentes Urológicos/efeitos adversos , Suspensão de Tratamento
17.
Int Braz J Urol ; 45(3): 641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735333

RESUMO

INTRODUCTION: Simple prostatectomy is the gold standard for prostates >80 grams, robotic system has proven to help into speed the recovery of the patient and in morbid obesity the advantages of the robotic system can help to perform a successful surgery. CASE: 80 years old male with morbid obesity (BMI 45) and several other comorbidities, with history of an umbilical hernia and obstructive lower urinary tract symptoms in acute urinary retention. PSA was 7 ng/dl, DRE demonstrates a >100gr prostate gland. A robotic simple prostatectomy, urethropexy, umbilical hernia repair and panniculectomy in Fleur-de-Lis was performed. RESULTS: Operative time (OT) and estimated blood loss (EBL) were 438 min and 160 ml respectively. A JP drain was placed in the pelvis and 2 additional were left in the abdominal cavity with several Penrose drains. No immediate or intraoperative complications were observed. The length of stay (LOS) was 6 days without complications. Pathology report showed prostate of 304gr and benign prostatic tissue. DISCUSSION: In patients with multiple comorbidities robot-assisted surgery provides advantages of shorter LOS, EBL, less transfusion and lower rate of complications. In patients with morbid obesity where the increased girth makes difficult the open approach, robotic surgery is an ideal way to provide definitive treatment; concomitant, Fleur-de-Lis panniculectomy can correct the abdominal contour in both vertical and horizontal orientation at the same time that provides a better plane for trocar insertion, an accurate location of the needle tip and a proper position of the remote center decreasing the possible complication of port placement.


Assuntos
Abdominoplastia/métodos , Hérnia Umbilical/cirurgia , Obesidade Mórbida/cirurgia , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso de 80 Anos ou mais , Humanos , Tempo de Internação , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Duração da Cirurgia , Reprodutibilidade dos Testes , Resultado do Tratamento , Retenção Urinária/cirurgia
18.
Int Braz J Urol ; 45(4): 856-857, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735341

RESUMO

INTRODUCTION: Pelvic Organ Prolapse (POP) is a common condition in elderly resulting from the weakening of the organ suspension elements of multifactorial origin. It compromises significantly the quality of life and can affect more than 50% of multiparous women. Stage IV prolapse or complete uterovaginal eversion corresponds to 10% of the cases and the only form of curative treatment is the surgical correction. The aim of this video is to demonstrate our technique of sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh for treatment of this challenge condition, focusing on technical details in order to prevent mesh related complications. Major, but rare complications, include: infection, prolapse recurrence, abscess formation, bladder perforation and urinary fistula. These situations are related mostly to low volume centers. MATERIALS AND METHODS: A 70 years old female with a stage IV POP had obstructive lower urinary tract symptoms. Only after reducing prolapse, it was possible to urinate, but without stress urinary incontinence. No topic estrogen was prescribed before the surgery and she also didn´t take any kind of hormone replacement therapy. Transvaginal ultrasound and the Pap smear screening were done with normal results. Cystoscopy wasn´t employed at anytime of this procedure. Hydrodissection of vaginal wall was followed by longitudinal incision from the level of bladder neck to the cervix. Notice that the ideal dissection should maintain the vaginal thickness, and address the plane of the connective tissue between the bladder and the vagina. Bladder base is then released from the anterior aspect of the cervix in order to create a site to pericervical ring repair and to fix the apex of the Calistar Soft® with polypropylene 3.0 stitches. A blunt dissection extended downwards through the lateral aspect of the levator ani fascia till the identification of the ischial spine and sacrospinous ligaments bilaterally. Two polypropilene 2.0 threads mounted on a specially designed tissue anchor system (TAS) are then fixed into each sacrospinous ligament 1.5 to 2 cm away from the ischial spine and repaired for further prosthesis anchoring. Then, a longitudinal incision is done at the posterior vaginal wall and the recto-vaginal fascia detachment from the posterior aspect of the pericervical ring is identified and corrected with interrupted polypropylene 2.0 stitches to the cervix and to the pericervical aspect of elongated uterosacrus ligaments bilaterally. The Calistar Soft A (anterior) and P (posterior)® prosthesis were fixed at the anterior and posterior aspects of the cervix, respectively, with interrupted polypropylene 3.0 stitches and meshes' arms are fixed to the sacrospinous ligament using the previously implanted TAS. Then, the distal Calistar Soft A® arms were bilaterally fixed into the internal obturator muscles using its fish spine-like multipoint fix device in order to prevent mesh folding. Finally, perineal body repair was done and vaginal wall was closed with individual absorbable interrupted polyglactin 2.0 sutures and a 16 Fr Foley catheter as well as a vaginal pack embedded on neomicin-bacitracin cream were kept overnight. RESULTS: A high satisfaction rate has been computed with synthetic mesh to POP surgery correction. Approximately 10% of cases of mesh exposure may occur, most of them oligosymptomatic and easy handed by excision or with topic estrogen preparations. After 1 year follow-up, our patient is still satisfied without any complain and no relapse. CONCLUSION: We described a successful treatment of stage IV POP in an old female patient. This technique can be used for advanced end stage POP patients, especially those with some contraindication to sacropromontopexy, but who want to keep vaginal length and uterus. Anatomical knowledge, obedience to technical care, and intensive training are the keys for minimizing the risk of complications. Although we had success with this technique, more studies with proper randomization are necessary to compare success and complications of sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh to sacropromontopexy.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Polipropilenos/uso terapêutico , Telas Cirúrgicas , Útero/cirurgia , Vagina/cirurgia , Idoso , Feminino , Humanos , Sintomas do Trato Urinário Inferior/cirurgia , Resultado do Tratamento , Bexiga Urinária/cirurgia
19.
Cochrane Database Syst Rev ; 2: CD013143, 2019 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-30759311

RESUMO

BACKGROUND: New, minimally invasive surgeries have emerged as alternatives to transurethral resection of the prostate (TURP) for the management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Aquablation is a novel, minimally invasive, water-based therapy, combining image guidance and robotics for the removal of prostatic tissue. OBJECTIVES: To assess the effects of Aquablation for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. SEARCH METHODS: We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Web of Science, and LILACS), trials registries, other sources of grey literature, and conference proceedings published up to 11 February 2019, with no restrictions on the language or status of publication. SELECTION CRITERIA: We included parallel-group randomised controlled trials (RCTs) and cluster-RCTs, as well as non-randomised observational prospective studies with concurrent comparison groups in which participants with BPH who underwent Aquablation. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion at each stage, and undertook data extraction and 'Risk of bias' and GRADE assessments of the certainty of the evidence. We considered review outcomes measured up to and including 12 months after randomisation as short-term and beyond 12 months as long-term. MAIN RESULTS: We included one RCT with 184 participants comparing Aquablation to TURP. The mean age and International Prostate Symptom Score were 65.9 years and 22.6, respectively. The mean prostate volume was 53.2 mL. We only found short-term data for all outcomes based on a single randomised trial.Primary outcomesUp to 12 months, Aquablation likely results in a similar improvement in urologic symptom scores to TURP (mean difference (MD) -0.06, 95% confidence interval (CI) -2.51 to 2.39; participants = 174; moderate-certainty evidence). We downgraded the evidence certainty by one level due to study limitations. Aquablation may also result in similar quality of life when compared to TURP (MD 0.27, 95% CI -0.24 to 0.78; participants = 174, low-certainty evidence). We downgraded the evidence certainty by two levels due to study limitations and imprecision. Aquablation may result in little to no difference in major adverse events (risk ratio (RR) 0.84, 95% CI 0.31 to 2.26; participants = 181, very low-certainty evidence) but we are very uncertain of this finding. This would correspond to 15 fewer major adverse events per 1000 participants (95% CI 64 fewer to 116 more). We downgraded the evidence certainty by one level for study limitations and two levels for imprecision.Secondary outcomesUp to 12 months, Aquablation may result in little to no difference in retreatments (RR 1.68, 95% CI 0.18 to 15.83; participants = 181, very low-certainty evidence) but we are very uncertain of this finding. This would correspond to 10 more retreatments per 1000 participants (95% CI 13 fewer to 228 more). We downgraded the evidence certainty by one level due to study limitations and two levels for imprecision.Aquablation may result in little to no difference in erectile function as measured by International Index of Erectile Function questionnaire Erectile Function domain compared to TURP (MD 2.31, 95% CI -0.63 to 5.25; participants = 64, very low-certainty evidence), and may cause slightly less ejaculatory dysfunction than TURP, as measured by Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MD 2.57, 95% CI 0.60 to 4.53; participants = 121, very low-certainty evidence). However, we are very uncertain of both findings. We downgraded the evidence certainty by two levels due to study limitations and one level for imprecision for both outcomes.We did not find other prospective, comparative studies comparing Aquablation to TURP or other procedures such as laser ablation, enucleation, or other minimally invasive therapies. AUTHORS' CONCLUSIONS: Based on short-term (up to 12 months) follow-up, the effect of Aquablation on urological symptoms is probably similar to that of TURP (moderate-certainty evidence). The effect on quality of life may also be similar (low-certainty evidence). We are very uncertain whether patients undergoing Aquablation are at higher or lower risk for major adverse events (very low-certainty evidence). We are very uncertain whether Aquablation may result in little to no difference in erectile function but offer a small improvement in preservation of ejaculatory function (both very low-certainty evidence). These conclusions are based on a single study of men with a prostate volume up to 80 mL in size. Longer-term data and comparisons with other modalities appear critical to a more thorough assessment of the role of Aquablation for the treatment of LUTS in men with BPH.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Água , Idoso , Idoso de 80 Anos ou mais , Ejaculação , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Ereção Peniana , Próstata/patologia , Hiperplasia Prostática/complicações , Qualidade de Vida , Retratamento/estatística & dados numéricos , Cirurgia Assistida por Computador/métodos , Ressecção Transuretral da Próstata
20.
Urol Int ; 102(3): 306-310, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30731471

RESUMO

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) is becoming the new standard procedure for treating benign prostatic hyperplasia (BPH), a common condition in aging men. Most studies have focused on proving its efficacy in treating large prostates. In this study, we compared its efficacy in treating small (< 80 mL) and large (> 80 mL) prostates. METHODS: This prospective study included 119 patients with BPH who underwent HoLEP by the same surgeon between June 2015 and December 2017. They were divided into 2 groups according to their prostate volumes (≤80 mL: Group 1; > 80 mL: Group 2). Various pre- and postoperative parameters were compared within and between the groups. RESULTS: International Prostate Symptom Score (IPSS), postvoid residual (PVR) volume, and voiding time (VT) significantly decreased, and the peak urinary flow rate (Qmax), average urinary flow rate (Qave), and quality of life (QoL) score significantly increased postoperatively in both groups. The postoperative changes in IPSS, QoL score, Qmax, Qave, VT, PVR volume, and hemoglobin levels were not significantly different between the groups. In addition, no significant difference was observed in postoperative complications between the groups. CONCLUSIONS: Our results indicate that HoLEP is an effective procedure for treating both small and large prostates.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Hólmio , Humanos , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Hiperplasia Prostática/psicologia , Qualidade de Vida , Resultado do Tratamento
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