Transurethral prostate surgery in prostate cancer patients: A population-based comparative analysis of complication and mortality rates

Objective:Prostate cancer(PCa)patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia(BPH).Some of them might be treated for their lower urinary tract symptoms instead of PCa.We aimed to test the effect of PCa versus BPH on surgical outcomes after transurethral prostate surgery,namely complication and mortality rates.Methods:Within the American College of Surgeons National Surgical Quality Improvement Program database(2011-2016),we identified patients who underwent transurethral resection of the prostate,photoselective vaporization,or laser enucleation.Patients were stratified according to postoperative diagnosis(PCa vs.BPH).Univariable and multivariable logistic regression models evaluated the predictors of perioperative morbidity and mortality.A formal test of interaction between diagnosis and surgical technique used was performed.Results:Overall,34542 patients were included.Of all,2008(5.8%)had a diagnosis of PCa.The multivariable logistic regression model failed to show statistically significant higher rates of postoperative complications in PCa patients(odds ratio:0.9,95%confidence interval:0.7-1.1;p=0.252).Moreover,similar rates of perioperative mortality(p=0.255),major acute cardiovascular events(p=0.581),transfusions(p=0.933),and length of stay of more than or equal to 30 days(p=0.174)were found.Additionally,all tests failed to show an interaction between post-operative diagnosis and surgical technique used.Conclusion:Patients diagnosed with PCa do not experience higher perioperative morbidity or mortality after transurethral prostate surgery when compared to their BPH counterparts.Moreover,the diagnosis seems to not influence surgical technique outcomes.

Bladder calculi concomitant with benign prostatic enlargement:is prostate surgery mandatory in patients who have never received medical therapy?

The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned.In this study,we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors.One hundred and seventeen men with bladder stones and concomitant benign prostate enlargement(BPE)who had not received medical treatment before were included in the study.In the first step,only the bladder calculi of patients were removed and medical treatment was given for BPE.The patients who benefited from medical treatment during the follow-up were defined as Group 1 and the patients who required prostate surgery for any indication comprised Group 2.Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a cox regression model.In the follow-up of 117 patients with bladder stones removed and medical treatment initiated,49(41.9%)patients had prostate surgery indications.The indication for 33(67.3%)of 49 patients was medical treatment failure.The presence of intravesical prostatic protrusion(IPP;hazard ratio:2.071,95%confidence interval[Cl]:1.05-4.05,P=0.034),and high postvoiding residual urine volume(hazard ratio:1.013,95%Cl:1.007-1.019,P<0.001)were found to be preoperative risk factors for needing future prostate surgery.In patients who have not received medical treatment for BPE before,bladder calculi developing secondary to BPE do not always constitute an indication for prostate surgery.

Beyond prostate, beyond surgery and beyond urology: The “3Bs” of managing non-neurogenic male lower urinary tract symptoms

Lower urinary tract symptoms(LUTS),consisting storage,voiding and postmicturition symptoms,is a comprehensive definition involving symptoms that may occur due to several causes.Instead of simply focusing on the enlarged prostate,more attention has to be paid to the entire urinary tract as well as multiple system comorbidities.Therefore,prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required.Based on current literature,this paper proposes the“3Bs”concept for managing non-neurogenic male LUTS,namely,“beyond prostate”,“beyond surgery”and“beyond urology”.The clinical application of the“3Bs”enables urologists to carry out integrated,individualized and precise medical care for each non-neurogenic male LUTS patient.

Photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia

Background The treatment of symptomatic benign prostatic hyperplasia （BPH） remains a challenge for most urologic surgeons. We studied a cumulative cohort of patients with symptomatic benign prostatic hyperplasia （BPH） who underwent photoselective vaporization of the prostate （PVP） and evaluated the efficacy and safety of this procedure. Methods A total of 196 patients with lower urinary tract obstruction symptoms secondary to BPH were treated using laser vaporization of the prostate under sacral canal anesthesia at our institutions. The therapeutic results were assessed using following variables ： the safety and efficacy of sacral anesthesia, blood loss, operative time, indwelling catheterization. Preoperative and perioperative parameters were evaluated in the international prostate symptom score （ IPSS）, quality of life score （ QoL）, maximal urinary flow rate （ Qmax）, post-void residual urine volume （PVR） and the change of sexual function. Patients were also assessed for 3-month follow up. Results PVP was performed successfully for all patients. There were 195 patients under sacral anesthesia and 1 patient under epidural anesthesia. Mean operative time was （45.2±18.5 ） minutes. The mean IPSS decreased from （26.6±3.2 ） to （5.6±1.4） and the QoL score decreased from （5.7±0.4） to （ 1.6±0. 5 ）, respectively （ P 〈 0. 05 ）, while mean Qmax increased from （6.7±2.5 ） ml/s preoperatively to （ 19.6± 2.4 ） ml/s, PVR decreased from 158.4 to 25.8 ml, respectively （ P 〈 0.05）. Average catheterization time was （ 1.8±0. 9） days. There was no significant blood loss or fluid absorption during the period of PVP. Complications consisted of transient dysuria in 3 patients （1.5%）, delayed gross hematuria in 5 patients （2. 5% ）, respectively. Significant improvement in clinical outcomes were noted as early as 3 months after PVP treatment. Conclusions PVP is considered as a high satisfaction rate by complication. Hence, PVP is a novel, safe, effective and minimal symptomatic BPH. patient and a minimal postoperative invasive treatment for patients with symptomatic BPH.

Laparoendoscopic single-site radical prostatectomy： technique and initial outcomes

Background Laparoendoscopic single-site surgery radical prostatectomy （LESS-RP） is a challenging urological procedure and needs to be further evaluated. This study was undertaken to illustrate the safety and initial results of pure LESS-RP with conventional available instruments.

EVALUATION OF A TUBULAR MESH AND A SPIRAL STENT WOVEN FROM TITANIUM NICKEL ALLOY FOR PROSTATIC OBSTRUCTION IN PATIENTS AT HIGH RISK FOR SURGERY REPORT OF 62 CASES

The use of two urethral stents woven from titanium nickel alloy (TiNi) in the form of a tubular mesh or a spiral stent (both made in China) is described. They were implanted in 62 patients,vith prostatic outflow obstruction. till patients were considered contraindicated for surgery. They were divided into a spiral stent group (group I) treated between March 1992 and May 1993, comprising 35 cases, and a tubular mesh group (group 2) treated between October 1993 and December 1994, comprising 31 cases, including four failures in group 1. Thirty-three out of the 35 patients in group 1 were treated successfully. Good results were achieved in eight cases (22.8%) and significant improvements occurred in 24 (68.5%), giving a total effective rate of 91.3%, with a follow-up of 11 to 27 months. Fourteen stents were removed within 6 months after the insertion and six more were removed within 12 months. The mean effective time of the stent in situ was 10.8 months. All 31 cases in the mesh group were treated successfully. Dramatically good effects were obtained in 28 cases (over 90%) and distinct improvements were achieved in two, giving a total effective rate of over 96.5%, with a follow-up of 6 to 14 months (mean 10.5 months). Cystoscopy was carried out in 12 patients after 6 months following the insertion. The major part of the meshes became covered by urothelium. Compared with the spiral, the mesh makes it possible to insert a prosthesis with a larger diameter and anti-pressure. The spiral, however, can be used as a temporary alternative for the relief of prostatic obstruction. A tubular mesh can work well for the relief of prostatic obstruction and remain in situ without causing major problems for at least I year.