Meta-analysis and systematic review of interventional therapy versus anticoagulation for isolated femoropopliteal deep venous thrombosis.

OBJECTIVE: Percutaneous endovenous intervention (PEVI) is gaining acceptance for select patients with symptomatic proximal lower extremity deep venous thrombosis (DVT), but the benefits are uncertain in patients with isolated femoropopliteal DVTs. We performed a systematic review and meta-analysis of the literature to assess the safety and effectiveness of PEVI vs systemic anticoagulation for patients with isolated femoropopliteal DVT. METHODS: We systematically searched PubMed, Embase, and the Cochrane Library from inception to March 2018. All studies comparing clinical outcomes between PEVI and systemic anticoagulation were included. The main end points were post-thrombotic syndrome and bleeding complications. Secondary outcomes included femoropopliteal patency rate, venous obstruction, and recurrent DVT. RESULTS: No studies directly comparing PEVI with systemic anticoagulation in isolated femoropopliteal DVTs were identified by the systematic review. A traditional literature review identified one randomized controlled trial comparing the two, which found no difference in rates of post-thrombotic syndrome in PEVI vs systemic anticoagulation (risk ratio, 0.96; 95% confidence interval, 0.82-1.11; P = .56). We additionally identified five retrospective case series containing patients with isolated femoropopliteal DVTs, of which two reported on patency rates (46%-100% at 2 years). CONCLUSIONS: More data are required to definitively state that PEVI should be the preferred intervention for patients with isolated femoropopliteal DVTs, although the initial evidence is promising.

Does urodynamics predict voiding after benign prostatic hyperplasia surgery in patients with detrusor underactivity?

OBJECTIVE: We sought to determine if urodynamic study (UDS) predicted voiding outcomes in men with detrusor underactivity (DU) and benign prostatic enlargement (BPE) who underwent photovaporization of the prostate (PVP). METHODS: Between September 2010 and July 2015, 106 male patients with BPE and DU were identified. All patients underwent PVP. Urinary retention was noted by the preoperative necessity for an indwelling or intermittent catheter. Data collection included comorbidities, quality of life (QoL) scores, prostate volume, prostate-specific antigen (PSA), UDS and perioperative outcomes. UDS parameters included volume at first desire to void, volume at first urge to void, volume of severe urge, volume at capacity, compliance, detrusor contractions, maximum urinary flow rate (Qmax), and postvoid residual (PVR). RESULTS: A total of 106 men were included in this analysis, who had urinary retention with a Foley catheter or clean intermittent catheterization (CIC) at the time of surgery. At baseline we found patients who voided had a detrusor pressure at Qmax (Pdet@Qmax) of 10.05 ± 6.45 cmH2O compared to 16.78 ± 12.17 cmH2O in those who did not void (p = 0.071). Postoperatively, 96 (90.6%, mean age 76.9 ± 26.2 years) of patients voided successfully while 10 (9.4%, mean age 80.52 ± 9.61 years) of patients remained in urinary retention. Mean baseline Qmax was 4.895 ± 5.452 mL/s and 2.900 ± 3.356 mL/s (p = 0.087) in those who voided and did not respectively. PVR was 319.23 ± 330.62 mL in those who voided and 276.88 ± 263.27 mL (p = 0.344) in those who did not void. No UDS parameter predicted who would void postoperatively or improvements in QoL. CONCLUSIONS: The patients with DU and BPE might be able to successfully void after undergoing PVP regardless of UDS findings. All men who voided had improved international prostate symptom score and QoL scores compared to baseline and these parameters were durable up to 12 months.