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Neutrophil-to-lymphocyte ratio (NLR), a marker for subclinical inflammation, has been previously shown to be associated with erectile dysfunction (ED). We studied the potential predictive value of the NLR on ED after prostate brachytherapy (PB) for PCa.Between July 2005 and January 2021, 842 patients were included in this retrospective study of a prospectively maintained database. ED was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) physician-reported scale. ED was defined as a Grade 2 or 3 function. NLR count was determined 1-2 months before PB and separated into values PB2 and ≥2. Patient characteristics and erectile function at last follow-up were compared for patients with a Univariate and multivariate analyses were performed to evaluate the predictive value of baseline NLR ≥2 on post-PB ED.Baseline NLR ≥2 was found to be a statistically significant predictor of post-PB ED on both univariate (p = 0.002) and multivariate analyses (p = 0.008). Furthermore, the difference in ED prevalence between the NLR2 and NLR ≥2 groups became more pronounced with longer follow-up after PB. The ED rate at 5 years post-PB was 43% for the NLR ≥2 groups, compared to 29% for the NLR2 groups.Subclinical systemic inflammation is a potentially important factor for predicting sexual toxicity after pelvic radiotherapy. NLR may be used as a proxy for predicting post-PB ED.

We analyzed the rate of preserved potency after prostate brachytherapy (PB) with radioactive seeds and the impact of patient comorbidities on post-PB erectile dysfunction (ED).We included 627 patients who were assessed for pre- and postimplant potency between 2005 and 2017. Assessment was based on the Common Terminology Criteria for Adverse Events Scale (CTCAEs). Logistic regression models were used to assess clinical predictors of preserved potency after PB defined as having sufficient erections for sexual activity with or without the need of oral pharmacologic assistance. Covariates included age, diabetes (DM), hypertension (HTN), dyslipidemia (DLP), coronary artery disease (CAD), International Prostate Symptom Score (IPSS), prostate volume, and Cancer of the Prostate Risk Assessments (CAPRA) score. Patients on androgen deprivation therapy or using five alpha reductase inhibitors were excluded from analyses.Post-PB potency was assessed at an average of 6 months (n = 627), 1 year (n = 538), 2 years (=440), 4 years (n = 272), and 5 years (n = 124). At 2 and 5 years, post-PB potency was preserved in 87% and 84% of patients, respectively. When adjusting for all available covariates, advanced age, pre-PB potency, and the presence of vascular comorbidities (HTN, DM, and DLP) were all predictors of potency at 2 years after PB (all p0.01). When performing a sensitivity analysis for vascular comorbidities, the presence of DM had the strongest impact on ED than either HTN or DLP (p0.01).More than 84% of patients had preserved potency 5 years after PB. Advanced age, pre-PB potency, and vascular comorbidities had a statistically significant impact on potency after PB.

To evaluate the surgical performance of the new Greenlight XPS-180 W laser system (American Medical Systems, Minnetonka, MI) and the effect of prostate volume (PV), in comparison with the former HPS-120 W system, for the treatment of benign prostatic hyperplasia by photo-selective vaporization of the prostate.Between July 2007 and March 2012, 1809 patients underwent laser photo-selective vaporization of the prostate (1187 patients with the use of HPS-120 W and 622 patients with the use of XPS-180 W) at 7 international centers. All data were collected prospectively. Comparative analysis was performed between XPS and HPS according to PV measured by transrectal ultrasound.The XPS compared with HPS, allowed significantly reduced laser and operative time (29.6 minutes vs 65.8 minutes and 53 minutes vs 80 minutes, respectively; P.01 for both). The number of fiber used during the procedures was significantly reduced with the XPS system (1.11 vs 2.28; P.01), whereas total energy delivered was lower (250.2 kJ vs 267.7 kJ; P = .043). Overall, the mean operative time, mean laser time, and mean energy were all significantly increased according to PV80 mL vs80 mL. However, when stratified according to PV, XPS demonstrates significant advantages compared with HPS, regardless of prostate size in all operative parameters (P.01).The new XPS-180 W system exhibits significant advantages in all surgical parameters compared with the HPS-120 W system. Overall, with XPS-180 W and HPS-120 W, mean operative time, laser time, and energy usage increased according to PV. This suggests that preoperative evaluation of PV by transrectal ultrasound should be mandatory.

To evaluate the safety, efficacy, and short-term outcomes of the new GreenLight XPS (GL-XPS) 180W laser system (AMS, Minnetonka, MI) in comparison to the former generation GL-HPS 120W system for the treatment of benign prostatic hyperplasia (BPH) in a prospective nonrandomized single-center study.From June 2010 to March 2012, 200 consecutive patients with lower urinary tract symptoms secondary to BPH were included: 80 patients were treated with GL-HPS 120W and 120 with GL-XPS 180W laser vaporization of the prostate. Perioperative variables (International Prostate Symptom Score [IPSS], quality f life [QOL], maximum flow rate (Qmax), post-void residual (PVR), and Sexual Health Inventory for Men (SHIM) were recorded at baseline, 3 months, and 6 months. Serum prostate-specific antigen (PSA) was assessed at baseline and 6-month follow-up.Patient preoperative characteristics were comparable, all P .05. Mean operating room time (43 vs 79 minutes) and mean laser time (22 vs 37 minutes) were significantly shorter for the GL-XPS group (both P .01) and mean energy delivery was comparable (226 vs 268 kJ, P = .21), GL-XPS vs GL-HPS. Mean fiber use (1.0 vs 1.5) and 3L saline bags (4.1 vs 7) were significantly lower with GL-XPS, all P .01. There were no significant differences in the 30-day complication rate. To date, no urethral strictures and 1 GL-HPS retreatment were observed. PSA reduction at 6 months was significantly greater with GL-XPS (54% vs 79%, P .01).Both GreenLight systems provide safe, effective, tissue vaporization with significant clinical relief of BPH obstruction. The GL-XPS 180W system seems to be more favorable with regard to reduced operative time, fiber use, and PSA-reduction, suggesting more cost-effective and efficient tissue removal.

OBJECTIVES To revisit whether the perioperative mortality differs between septuagenarian and octogenarian patients and younger patients in a large contemporary population-based cohort. The data from tertiary care centers have suggested that perioperative mortality after radical cystectomy is not considerably different in septuagenarian or octogenarian patients compared with younger patients. However, population-based data have stated otherwise. METHODS From 1988 to 2006, 12 722 radical cystectomies were performed for urothelial carcinoma of the urinary bladder in 17 Surveillance, Epidemiology, and End Results registries. Of those 12 722 patients, 4480 (35.2%) were aged 70-79 years and 1439 (11.3%) were aged >= 80 years. Univariate and multivariate logistic regression models tested the 90-day mortality after radical cystectomy. Covariates consisted of sex, race, year of surgery, Surveillance, Epidemiology, and End Results registry, and histologic grade and stage. RESULTS The overall 90-day mortality rate was 4% for the entire population, 2% for patients aged

operative VTE in two groups of patients operated on by two surgeons; one who consistently used heparin with SCDs (Group 1) and the other who used SCDs alone (Group 2) for prophylaxis. METHODS: An IRB approved prospectively managed database was analyzed. Group 1 received SCDs just prior to induction and 5,000 units of heparin subcutaneously just after induction. SCDs continued postoperatively and heparin was given twice a day until discharge. Group 2 maintained SCDs until ambulatory. VTE rate, patient age, BMI, operative time, lymphocele rate, estimated blood loss, and pathologic stage were compared between the two groups. Categorical variables were analyzed with chi square test of proportions and continuous variables with t-test using SPSS v 14 software. RESULTS: 1,035 consecutive patients underwent robotic prostatectomy between August 1, 2007 and September 30, 2010. 652 patients received heparin/SCDs and 383 received SCDs alone. Patient age, BMI, estimated blood loss, and pathologic stage were the same in the two groups. There was one lymphocele in each group. Although operative times were longer in Group 2 (228.0 v 165.4 min, p 0.001), the incidence of VTE was the same (0.8% v 0.8%, p .620). BMI, operative time, EBL, and the performance of lymph node dissection were not associated with VTE. CONCLUSIONS: The risk of VTE in patients undergoing robotic prostatectomy is low and not significantly reduced with the administration of prophylactic heparin/SCDs compared to SCDs alone.