Search

To evaluate the influence of preoperative post-void residual (PVR) volume on the outcomes of Holmium Laser Enucleation of the Prostate (HoLEP). Long-term bladder obstruction can impair bladder contractility, which has been linked to failure to improve lower urinary tract symptoms (LUTS) after bladder outlet procedures. Elevated PVR constitutes a proxy for chronic retention and detrusor underactivity that can be non-invasively determined in office. We evaluated men undergoing "en-bloc" HoLEP from July 2017 to August 2022 from our prospectively maintained database. PVR, prostate-specific antigen, International Prostate Symptom Score (IPSS) and uroflowmetry were assessed before surgery, at 3 months, 6 months and 1 year post- operatively. Patients' clinical characteristics and outcomes were compared according to preoperative PVR measurement by Group 1 (<100 mL), Group 2 (101-300 mL), Group 3 (301-600 mL), and Group 4 (>600 mL). We included 318 men and found no significant differences between groups regarding clinical or perioperative characteristics including operative time, resected volume, catheter time, and complications. Post-operative improvement in voiding parameters was found to be similar in all 4 groups up to 1 year of follow-up. Severity of chronic urinary retention did not impact the outcomes of HoLEP, which provided great improvement in voiding parameters to men with LUTS secondary to benign prostatic hyperplasia, with no significant differences in outcomes between patient with preoperative PVR <100 mL or >600 mL. These findings should assist in reassuring patients with large bladder capacity that HoLEP can provide them with excellent functional voiding outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Open simple prostatectomy (OSP) has been a cornerstone in treating large prostate volumes (> 80 ml) in benign prostatic hyperplasia (BPH). With evolving minimally invasive procedures like minimally invasive simple prostatectomy (MISP) and laser enucleation, the role of OSP needs contemporary evaluation. This way, we assessed the efficacy and safety of OSP to understand its current standing in the treatment of BPH, especially in comparison with newer surgical modalities. Methods: A comprehensive search of MEDLINE, Cochrane and EMBASE was conducted to include randomized controlled trials (RCTs) comparing OSP with other treatments for BPH from 1993 to 2023. A total of 10 RCTs were included in the meta-analysis. Data on various outcomes including IPSS, Qmax, PVR, quality of life, perioperative factors, and postoperative complications were analysed. Results: Our meta-analysis, covering 557 patients, confirms OSP's significant improvement in voiding symptoms and objective voiding metrics. However, it also reveals a higher incidence of postoperative complications, such as bleeding and transfusion requirements. The study found moderate to high heterogeneity in perioperative outcomes, indicating variations in surgical techniques and postoperative care. OSP remains a reliable option with an easily accessible and effective approach for managing large prostates, despite advancements in minimally invasive surgeries. Conclusion: OSP continues to be a relevant surgical option for BPH in large prostates, offering significant symptom relief. However, the associated higher morbidity warrants careful patient selection and highlights the need for continued research into optimizing surgical techniques and improving outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate outcomes of Holmium laser enucleation of the prostate (HoLEP) in individuals presenting with obstructive-uropathy (OU) attributable to bladder outlet obstruction (BOO). Methods: We performed a retrospective review of patients who underwent HoLEP from August 2017 to January 2023 at our institution. We identified patients with preoperative OU defined by presence of chronic hydronephrosis suggestive of BOO and conducted a matched-pair analysis (1:2) with patients undergoing HoLEP without OU. Patients' demographic, perioperative and postoperative voiding parameters, serum creatinine level, and complications were analyzed up to one-year of follow-up. Results: Preoperative OU was present in 42 patients. Demographic and preoperative parameters were comparable except median preoperative creatinine (1.245 vs. 1.065 ng/ml, p < 0.001) and catheterization rates (76.2% vs. 25%, p < 0.001) were higher in the OU group. The mean duration of postoperative catheterization was longer in the OU group (3.83 vs. 2.26 days, p = 0.048). Two patients in the OU group developed postoperative acute kidney injury. There was no difference in the rate of postoperative complications, improvement in International Prostate Symptom Score and maximum urinary flow amongst both groups except a higher post-void residual volume at 3- and 12-months (p = 0.001 and p = 0.037, respectively) in OU patients. Patients noted significant improvement in serum creatinine level at 6–12 weeks postoperatively from peak baseline level (P = 0.002). Conclusion: HoLEP is effective and safe in patients with OU suggestive of BOO, though they are at higher risk of postoperative acute kidney injury. [ABSTRACT FROM AUTHOR]

The article "Comment on: 'Initial Postoperative Prostate Specific Antigen and PSA Velocity Are Important Indicators of Underlying Malignancy After Simple Prostatectomy' by Livingston et al." discusses the importance of prostate-specific antigen (PSA) velocity after simple prostatectomy (SP) in determining prostate cancer (PCa) risk. The authors raise concerns about the theoretical background and methodology used in the study, particularly regarding the relationship between prostate zones and size, as well as the inclusion of all PCa patients regardless of Gleason's Grade group. They recommend caution when interpreting the study's findings and highlight the need for further research in this area. [Extracted from the article]

This article discusses a randomized trial comparing transperineal laser ablation (TPLA) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic obstruction (BPO). The authors raise concerns about the primary aim of the study, which focused on antegrade ejaculation preservation, as it differed from the primary objective mentioned on ClinicalTrials.gov. They also highlight the need for more comprehensive reporting of sexual and voiding outcomes at different time points. Additionally, the authors express concerns about the marginal improvement in voiding parameters with TPLA compared to TURP and the high level of patient dissatisfaction with the procedure. They suggest considering other treatment options that balance ejaculation preservation and voiding improvement. The article concludes by advising caution in interpreting the findings of TPLA as an ejaculation-preserving treatment for BPH. [Extracted from the article]