Postoperative Lower Urinary Tract Storage Symptoms: Does Prostate Enucleation Differ from Prostate Vaporization for Treatment of Symptomatic Benign Prostatic Hyperplasia?

Elkoushy, Mohamed A.; Elshal, Ahmed M.; Elhilali, Mostafa

doi:10.1089/end.2015.0202

Cited by 14 publications

(15 citation statements)

References 21 publications

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“…Several studies have shown improvements in storage symptoms after transurethral surgery for bladder outlet obstruction. [27][28][29][30] As was seen in the current study, storage symptoms often take slightly longer to improve compared with voiding symptoms, likely as a result of neuromuscular changes that must take place in the detrusor muscle once the obstruction is removed.…”

Section: Discussionsupporting

confidence: 55%

Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due to BPH in various prostate anatomies

Gilling

Roehrborn

Barber

et al. 2021

BMJ Surg Interv Health Technologies

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ObjectivesTo evaluate functional outcomes following Aquablation in various prostate volume and anatomical subgroups.DesignA meta-analysis with individual patient data undergoing Aquablation therapy from four prospective, global, clinical studies that have been conducted with Aquablation; WATER, WATER II, FRANCAIS WATER and OPEN WATER.SettingAustralia, Canada, Lebanon, Germany, New Zealand, UK and the USA.Participants425 men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 1-year follow-up.InterventionsAquablation therapy is an ultrasound guided, robotically executed waterjet ablative procedure for the prostate.Main outcome measuresThe analyses focus International Prostate Symptom Score (IPSS), uroflowmetry, postoperative Incontinence Severity Index (ISI) and surgical retreatment.Results425 men with prostates ranging in size from 20 to 150 mL underwent Aquablation therapy. The outcomes from the seven questions in the IPSS questionnaire were grouped by the following; prostates <100 mL, prostates ≥100 mL, prostate anatomy with an obstructive median lobe identifed by imaging, and prostate anatomy without an obstructive median lobe. Regardless of subgroup, all outcomes are consistent and demonstrate a significant improvement from baseline. Specifically, improvements in frequency, urgency and nocturia demonstrated bladder function improvement. Patients entering treatment with severe incontinence, ISI score >4, and regardless of prostate size, showed a reduction in incontinence during patient follow-up. Surgical retreatment due to BPH symptoms occurred in 0.7% (95% CI 0.1%–2.0%).ConclusionsAcross a variety of prostate anatomies, Aquablation therapy showed remarkable functional improvements following the index procedure. Additionally, men with moderate to severe LUTS/BPH and overactive bladder resulting in urge incontinence showed a reduction in incontinence symptoms postprocedure.

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Section: Discussionsupporting

confidence: 55%

Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due to BPH in various prostate anatomies

Gilling

Roehrborn

Barber

et al. 2021

BMJ Surg Interv Health Technologies

View full text Add to dashboard Cite

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“…Meanwhile, storage symptoms are also troubling for patients with BPH. The recovery of detrusor function after a surgical procedure for clinical BPH may be influenced by the degree of de-obstruction [22] . TURP is often not extended down to the fibre of the capsule for fear of capsular perforation and severe venous bleeding, therefore amass of adenoma tissues remains after TURP, usually leading to a high postoperative recurrence rate [9] .…”

Section: Discussionmentioning

confidence: 99%

Bipolar transurethral enucleation and resection of the prostate: Whether it is ready to supersede TURP?

Chen

et al. 2018

Asian Journal of Urology

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ObjectiveAccording to the EAU Guidelines, transurethral resection of the prostate (TURP) has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia (BPH). However, its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique. We reported the patient outcomes with our technique.MethodsWe retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate (B-TUERP) between March 2015 and September 2015. Pre- and perioperative parameters were obtained from medical charts. Postoperative follow-ups were administrated at 1, 3, 6, 12 and 24 month(s) after surgery, respectively.ResultsAll the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%. Qmax was significantly improved immediately after surgery, followed by a continuous improvement throughout the follow-ups. Following a steep decrease in mean prostate specific antigen (PSA) and post void residual (PVR) observed within the first half year after surgery, the serum PSA was then maintained at a constant level of 0.61 ng/mL. Temporary urinary retention was found in four cases (7.7%). Stress urinary incontinence occurred in five patients (9.6%), with the condition resolved in 1–2 weeks without extra treatment. Urethral strictures and bladder neck contractures, as the most commonly observed long-term complications, developed in four patients (7.7%). No recurrence was found during 2 years of follow-ups. An improvement in International Index of Erectile Function (IIEF-5) scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery, and sustained throughout the 24-month period.ConclusionsEnucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practice. Currently, bipolar resection is a commonly employed procedure in clinical settings, and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists. Based on these findings, we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.

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“…has proved that storage urinary symptoms significantly improved more after retrograde enucleation of the prostate compared with prostate vaporization and baseline degree of storage symptoms, prolonged operative time, and lower percent of postoperative PSA level reduction negatively predicts postoperative improvement of storage symptoms. 18 However, storage urinary symptoms also cannot be resolved by retrograde enucleation of the prostate. Therefore, it was critically important to perform the preoperative UDS detection for BPO, which can confirm the operative indication and judged the prognosis of bladder function, especially for the storage function of the bladder.…”

Section: Discussionmentioning

confidence: 99%

Can the lower urinary tract storage symptoms be completely resolved after plasmakinetic enucleation of the prostate?

Chen

Xin

et al. 2017

Asian J Androl

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The aim of this study was to determine whether the lower urinary tract storage symptoms of benign prostatic obstruction (BPO) could be completely resolved after plasmakinetic enucleation of the prostate (PKEP) and the possible predictors of persistent symptoms. Two hundred and sixty-seven cases of BPO performed PKEP from July 2008 to June 2009 were retrospectively analyzed. Five-year postoperative data were collected and compared with the preoperative data. According to the urodynamic results, the patients were divided into involuntary detrusor contraction (IDC) group (n = 95) and no IDC group (n = 172) preoperatively; the patients with IDC were divided into IDC-persistent group (n = 33) and IDC-resolved group (n = 62) after PKEP. The predictors of persistent IDC were analyzed. Compared with the preoperative data, the 5-year postoperative data showed that the IDC rate was lower (P = 0.000), Overactive Bladder Symptom Score (OABSS) was lower (P = 0.000), maximum cystometric capacity (MCC) was larger (P = 0.000), Prostate volume (PV) was smaller (P = 0.000), and prostate-specific antigen (PSA) was lower (P = 0.000). Compared with the no IDC group, the IDC group showed that the age was older (P = 0.016), MCC was smaller (P = 0.004), PSA was higher (P = 0.016), and Chronic Inflammation rate was higher (P = 0.004). Compared with IDC-resolved group after PKEP, IDC-persistent group showed that the age was older (P = 0.019), MCC was smaller (P = 0.000), PSA was higher (P = 0.013), and Chronic Inflammation rate was higher (P = 0.032). The present study shows that the storage symptoms are still needed to be focused on after PKEP. The advanced patient age, MCC, PSA, and chronic inflammation may be the important clinical predictors of persistent IDC.

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Postoperative Lower Urinary Tract Storage Symptoms: Does Prostate Enucleation Differ from Prostate Vaporization for Treatment of Symptomatic Benign Prostatic Hyperplasia?

Cited by 14 publications

References 21 publications

Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due to BPH in various prostate anatomies

Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due to BPH in various prostate anatomies

Bipolar transurethral enucleation and resection of the prostate: Whether it is ready to supersede TURP?

Can the lower urinary tract storage symptoms be completely resolved after plasmakinetic enucleation of the prostate?

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