Flujometría manual en la evaluación clínica y terapéutica de pacientes con hiperplasia prostática benigna / Manual flowmetry in the clinical and therapeutic evaluation of patients with benign prostatic hyperplasia

Introducción: La hiperplasia prostática benigna es una enfermedad frecuente que aumenta su incidencia con la edad. Su patogenia no está clara aún y su cuadro clínico típico es la obstrucción urinaria progresiva con pérdida de calidad de vida. Objetivos: Evaluar el valor predictivo de la flujometría manual en la definición de la conducta terapéutica en pacientes con hiperplasia prostática benigna y determinar la evolución de dichos pacientes en el tiempo. Método: Se realizó un estudio descriptivo, prospectivo y longitudinal de 50 pacientes, diagnosticados como portadores de hiperplasia prostática benigna, desde los puntos de vista clínico e imagenológico, atendidos en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero del 2017 hasta igual periodo del 2019. Resultados: La flujometría manual realizada al inicio demostró que 62,0 % de la muestra tenía una tasa de flujo urinario promedio por debajo del rango fisiológico y 22,0 % se encontraba en rango limítrofe o dudoso. Recibieron tratamiento quirúrgico 37 pacientes (74,0 %); 13 (26,0 %) fueron medicados y con seguimiento clínico. Se realizó la resección transuretral de la próstata con una rápida recuperación de los pacientes y en solo 2,0 % hubo complicaciones. Conclusiones: La flujometría manual resultó útil para determinar la conducta a seguir en la mayoría de los pacientes estudiados y en el seguimiento a corto plazo de quienes fueron operados.

Introduction: The benign prostatic hyperplasia is a frequent disease that increases its incidence with the age. Its pathogenesis is not still clear and its typical clinical pattern is the progressive urinary obstruction with loss of life quality. Objectives: To evaluate the predictive value of manual flowmetry in the definition of the therapeutic behavior in patients with benign prostatic hyperplasia and to determine the evolution of these patients as time goes by. Method: A descriptive, prospective and longitudinal study of 50 patients diagnosed with benign prostatic hyperplasia was carried out, from the clinical and imaging points of view, who were assisted in Saturnino Lora Torres Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba, from January, 2017 to the same period in 2019. Results: The manual flowmetry carried out demonstrated at the beginning that 62.0 % of the sample had a rate of average urinary flow below the physiologic range and 22.0 % was in bordering or doubtful range. Thirty seven patients received surgical treatment (74.0 %); thirteen patients (26.0 %) received medication and with clinical follow up. The transurethral resection of prostate was carried out with a quick recovery of the patients and there were complications just in a 2.0 %. Conclusions: The manual flowmetry was useful to determine what to do in most of the studied patients and in the short term follow up of those who were operated.

Aplicación tópica de ácido tranexámico en urología: ¿Una alternativa de manejo? / Topical Application of Tranexamic Acid in Urology: An Alternative Management?

Los agentes antifibrinolíticos, como el ácido tranexámico, por medio de su administración endovenosa se usan en distintos procedimientos quirúrgicos para prevenir la pérdida de sangrado perioperatorio.[1] Este medicamento es un derivado sintético análogo de la lisina que bloquea los sititos de unión de la lisina en el plasminógeno, inhibiendo su conversión a plasmina e interfiriendo en la fibrinólisis.[2] La aplicación del ácido tranexámico para disminuir el riesgo de sangrado ha sido utilizado en procedimientos urológicos como la resección transuretral prostática (RTUP), prostatectomía radical y nefrolitotomía percutánea (NLP),[3] [4] [5] también se emplea para disminuir las hematurias persistentes en pacientes con poliquistosis renal y en otras hematurias macroscópicas de origen urológico.

Antifibrinolytic agents, such as tranexamic acid, by intravenous administration are used in various surgical procedures to prevent perioperative bleeding loss.[1] This drug is a synthetic lysine analog derivative that blocks the lysine binding sites on plasminogen, inhibiting its conversion to plasmin and interfering with fibrinolysis.[2] The application of tranexamic acid to reduce the risk of bleeding has been used in urological procedures such as transurethral resection of the prostate (TURP), radical prostatectomy and nephrolithotomy. The application of tranexamic acid to reduce the risk of bleeding has been used in urological procedures such as transurethral resection of the prostate (TURP), radical prostatectomy and percutaneous nephrolithotomy (PNL),[3] [4] [5] it is also used to reduce persistent hematuria in patients with polycystic kidney disease and other macroscopic hematuria of urological origin.

Factors predicting the development of urethral stricture after bipolar transurethral resection of the prostate

SUMMARY OBJECTIVE: We aimed to investigate the rate of urethral stricture development, predictor factors, and the reliability following bipolar transurethral resection of the prostate. METHODS: A total of 124 patients participated in this study. Patient data were retrospectively reviewed. The patients were divided into group 1 (those who developed urethral stricture) and group 2 (those who did not develop urethral stricture). Annual checkups were performed after the postoperative months 1 and 6. The patients were checked by uroflowmetry + post-voiding residue and international index of erectile function. We evaluated the complications that developed during the perioperative period according to the Clavien system. RESULTS: Urethral stricture developed in 10.5% (13/124) of the patients. It was found that patients who underwent transurethral resection of the prostate for the second time (p=0.007), patients with a preoperative catheter or history of catheter insertion (p=0.009), patients with high preoperative median white blood cell (103) counts (p=0.013), and patients with long postoperative catheterization time had a higher rate of urethral stricture after bipolar transurethral resection of the prostate (p=0.046). No grade 4 and grade 5 complications were observed according to the Clavien system in patients. CONCLUSION: Factors such as second transurethral resection of the prostate surgery, history of preoperative catheter insertion, high postoperative white blood cell count, and long postoperative catheterization time increase the risk of urethral stricture after bipolar transurethral resection of the prostate.

Holmium laser ablation of the prostate (HoLAP) with moses technology for the surgical treatment of benign prostatic hyperplasia

ABSTRACT Purpose: The expansion of technology is leading to a paradigm shift in several urological fields (1, 2). In particular, the adoption of lasers within the surgical treatment of patients with benign prostatic hyperplasia (BPH) is considered one of the most relevant innovations (3-5). In this video, we aimed to report our experience with holmium laser for the ablation of the prostate (HoLAP) in patients with obstructive lower urinary tract symptoms (LUTS) due to BPH. Materials and Methods: From 2018 to 2020, 10 patients with obstructive LUTS secondary to BPH were treated at our Institution with HoLAP (120W Holmium laser Lumenis® with Moses® technology). Main inclusion criteria were: 1) International Prostate Symptom Score ≥12; 2) prostate volume ≤65mL, 3) maximal flow rate (Qmax) ≤15ml/s at preoperative non-invasive uroflowmetry. Results: Mean patient age was 65 (range: 59-72) years. Preoperative mean prostate volume was 50 (range: 35-65) mL. Mean operative time was 66 (range: 45-85) minutes with a mean laser time/operative time ratio of 0.51 (range: 0.44-0.60). Voiding symptoms, Qmax and post voiding residual were significantly improved after 3 and 12 months (all p <0.05). No postoperative urinary incontinence was detected. Conclusions: The present findings suggest that HoLAP is a slightly time-spending procedure, thus its use should be limited to prostate volume <70-80mL. However, no postoperative complications were recorded at all. This technique showed to be a safe option in patients with low-intermediate prostate volume, also in patients whose antiaggregant/anticoagulant therapy is maintained.

A novel mouse model simulating transurethral laser vaporization prostatectomy / 亚洲男科学杂志(英文版)

Benign prostatic hyperplasia (BPH) is a common disease in elderly men, and transurethral laser prostatectomy (TULP) has been widely used in the clinic to remove bladder outlet obstruction caused by BPH. Previous animal models for wound repair after prostatectomy have many limitations, and there have been no previous reports of a mouse model of TULP. Therefore, this study aimed to establish a novel mouse model of TULP. Twelve healthy adult Kunming (KM) mice received transurethral laser vaporization prostatectomy with a 200-μm thulium laser. The mice were sacrificed, and wound specimens from the prostatic urethra and bladder neck were harvested at 1 day, 3 days, 5 days, and 7 days after surgery. Hematoxylin-eosin (HE) and immunohistochemistry were applied to confirm the establishment of the mouse TULP model. One day after the surgery, urothelium expressing uroplakin (UPK) was absent in the urethral wound site, and a large number of necrotic tissues were found in the wound site. There was no UPK-positive urothelium in the wound 3 days after surgery. At 5 days after surgery, monolayer urothelium expressing UPK was found in the wound site, indicating that the re-epithelization of the wound had been completed. On the 7th day after surgery, there were multiple layers of urothelium with UPK expression, indicating that the repair was completed. It is feasible to establish a mouse TULP model by using a microcystoscope system and a 200-μm thulium laser.

A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications

ABSTRACT Objective: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadadscale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.

Clinicopathological Features and Expression of P504s,E-cadherin,Erythroblast Transformation-specific Related Gene and Estrogen Receptor in Prostate Adenocarcinoma in Tibet / 中国医学科学院学报

Objective To investigate the clinicopathological features and immunohistochemical expression of P504s,E-cadherin,erythroblast transformation-specific related gene(ERG)and estrogen receptor(ER)in prostate adenocarcinoma in Tibet.Methods The clinical data of 15 patients with prostate adenocarcinoma diagnosed by the Department of Pathology of Tibet Autonomous Region People's Hospital from September 2013 to September 2020 were analyzed retrospectively.All patients were assigned to prognostic grade groups based on Gleason score according to the WHO 2016 criteria.Immunostaining of P504s,E-cadherin,ERG,and ER was performed.Results The age of all 15 patients ranged from 61 to 86 years.The serum prostate specific antigen(PSA)concentration was ≥20 ng/ml in 12 patients and<20 ng/ml in 3 patients.Among the 15 patients,11 underwent needle biopsy,1 transurethral resection of the prostate,and 3 radical prostatectomy.Prognostic grouping results revealed 5 cases in grade groups 1-3,4 cases in grade group 4,and 6 cases in grade group 5.Immunohistochemistrically,15 cases(100%)were positive for P504s,E-cadherin and PSA;one case(7%)was positive for ERG;all cases were negative for P63,ER and CK34βE12.Thirteen cases were followed up for 2-48 months,with 2 cases treated with total prostatectomy and 11 cases with non-surgical treatment.Two cases were lost to follow-up. Conclusions Prostate adenocarcinoma is rare relatively in Tibet.The accuracy of diagnosis can be improved by using multiple immunohistochemical markers.The cases of grades 4 and 5 by pathological confirmed are relatively common in Tibet.P504s and E-cadherin are highly expressed in prostate adenocarcinoma patients in Tibet,while ERG presents low expression,ER is unexpressed.

A clinical analysis of 14 cases of prostatic stromal tumor of uncertain malignant potential / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical and pathologic characteristics, diagnosis, treatment, prognosis and survival of prostatic stromal tumor of uncertain malignant potential.@*METHODS@#Overall 14 patients with prostatic stromal tumor of uncertain malignant potential were treated from October 2008 to April 2020, the patient age ranged from 27 to 78 years (mean 54 years). The disease duration was 1 to 180 months (mean duration of 46 months). The clinical manifestations mainly included urinary obstructive symptoms and urethral irritating symptoms. The tumors were located in the peripheral zone or the transition zone. Digital rectum examination indicated prostatic tumor. Serum prostatic specific antigen level was always normal or elevated. Transrectal ultrasonography and magnetic resonance imaging indicated prostatic tumor. Magnetic resonance imaging in showed large, round, well-defined masses, which were diffusely heterogeneous signal on T2 weighted imaging. Following the administration of intravenous contrast medium, the lesion had diffuse and heterogeneous enhancement.@*RESULTS@#In the study, 3 cases underwent prostate biopsy, 2 cases underwent transurethral resection of the prostate, 9 cases underwent radical excision or transurethral resection of the prostate with definite diagnosis of pathologic features. Under the light microscope, the interstitial cells of stromal tumor of uncertain malignant potential were overgrowth and fusiform cells showed some degree of pleomorphism, nuclei with few mitotic figures, and necrosis was not often seen. Immunohistochemical staining showed that prostate specific antigen was negative, while vimentin was positive in the tumor tissue, CD34, progesterone receptor and smooth muscle actin were positive in the majority, and Ki67 positive index was 1%-20% (mean 6%). Twelve cases were followed-up, and the time of survival varied from 10 to 96 months (mean 65 months), two cases were lost to the follow-up, one case died of disease at the end of 10 months, nine cases were free of disease recurrence after surgery, two cases underwent more transurethral resection of the prostate due to local recurrence.@*CONCLUSION@#STUMP is a very rare tumor of the specialized prostatic stroma with an unpredictable clinical behavior. The clinical manifestations, transrectal ultrasonography and magnetic resonance imaging are valuable for the diagnosis of prostatic stromal tumor of uncertain malignant potential. Its definite diagnosis depends on pathological examination. Up to now, early surgery and combined therapy are effective treatments for prostatic stromal tumor of uncertain malignant potential.

Current trends in minimally invasive surgery for benign prostatic hyperplasia

The prevalence of benign prostatic hyperplasia (BPH) is rising with Korea becoming an aging society. As patients age, their comorbidities and the risks associated with anesthesia increase. Recently, there has been an increasing concern regarding sexual function after surgery. As a result, interest in minimally invasive surgery for BPH that does not require anesthesia or affect sexual function has grown. This review article introduces newly developed minimally invasive surgeries for BPH divided into four categories based on the strategy—mechanical, anatomical, atrophic, and laparoscopic. Here, the mechanisms for each surgical method have been introduced. Furthermore, recent representative studies of these procedures with a focus on randomized controlled trials and meta-analyses have also been reviewed. Side effects related to sexual function have also been mentioned briefly along with the efficacy and indication for robotic BPH surgery, which has recently been attracting attention. However, these newer, minimally invasive procedures require additional comparative randomized controlled trials and long-term results to produce more robust evidence for their use.

The relation between the storage symptoms before and after transurethral resection of the prostate, analysis of the risk factors and the prevention of the symptoms with solifenacin

ABSTRACT Objective and Hypothesis We aimed to investigate the reasons of storage symptoms ( SS) after transurethral resection of the prostate (TURP). The hypothesis was that a positive correlation would be identified between preoperative and postoperative SS in patients with undergoing TURP and starting early solifenacin treatment in patients with high preoperative SS would be reasonable. In addition, we aimed to analyze multiple other risk factors for post-TURP SS. Materials and Methods A total of 160 patients undergoing TURP were prospectively evaluated and divided into two groups according to their OABS. Those with a score of ≥10 points were Group 1 (G1), and those with <10 points Group 2 (G2). In addition, patients in each group were randomly further divided into two subgroups: those who were started on 5 mg solifenacin succinate in the early postoperative period (G1/G2 A) and those who were not (G1/G2 B). In additions to SS Preop, perop and at the 3rd-month of postoperatively 14 variable were evaluated. The effects of these factors, surgery and the efficacy of an early medical treatment on the postoperative SS were investigated. LUTS were assessed by International Prostate Symptom Score (IPSS) and SS were assessed by sum of IPSS 2, 4 and 7 questionnaires (Storage, S- IPSS). Results Preoperative IPSS and S-IPSS were significantly higher in G1 (p<0.001); there was a significant improvement at IPSS, S-IPSS, QoL score, Qmax, and PVR for all groups after surgery. Only preoperative S-IPSS was found to have significant effect on postoperative SS (p<0.001). There was a significant difference between G1A and G1B but no significant difference between G2A and G2B in terms of SS at postoperatively. In addition to this, prostatic volume was found smaller than non-symptomatic patients in de novo SS patients. Conclusion TURP provides significant improvement in both storage and voiding symptoms. The predictive value of the preoperative S-IPSS on postop SS is significant. These results suggest that 5 mg solifenacin succinate treatment in the early postoperative period may be beneficial for patients with high preoperative SS and may not be beneficial in others. Small prostatic volume may bode ill for postoperative SS in the patients with de novo SS.

Stress urinary incontinence post-holmium laser enucleation of the prostate: a single-surgeon experience

ABSTRACT Purpose To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP). Materials and Methods We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI. Results 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p <0.0001). On univariate analysis, laser energy used (p <0.0001), laser "on" time (p=0.0204), resected prostate weight (p <0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI. Conclusion Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.

Factores de riesgo asociados a complicaciones perioperatorias en la resección transuretral de próstata con bipolar. Revisión narrativa de la literature / Bipolar transurethral resection of prostate: risk factors for perioperative complications. A literature review

RESUMEN Introducción: la resección transuretral de próstata (RTUP), independiente de si es con equipo monopolar o bipolar (RTUP-B), es la cirugía estándar en el manejo quirúrgico de los síntomas del tracto urinario inferior (STUI) o de las complicaciones derivadas de la obstrucción por hiperplasia prostática benigna (HPB). Objetivo: revisar la literatura sobre frecuencia y factores de riesgo para complicaciones de la RTUP con bipolar. Resultados: se hizo una revisión de la literatura mediante la búsqueda en Medline desde 1996 hasta 2017. De 76 artículos revisados, 50 se incluyeron. Estos reportan que la RTUP-B ofrece buenos resultados a largo plazo. Las complicaciones en su mayoría son grado I según la clasificación de Clavien-Dindo y las más frecuentes son la eyaculación retrógrada, hematuria secundaria, retención o infección urinaria y estrechez uretral o contractura del cuello vesical. Los factores de riesgo fueron comorbilidades, gravedad de la enfermedad al momento de la intervención, técnica y habilidad del cirujano, entre otros. Discusión: aunque la mayoría de las complicaciones secundarias a la RTUP-B son leves, definir el momento óptimo para la realización de la cirugía e intervenir los factores de riesgo modificables, podría contribuir a mejorar los resultados de esta técnica quirúrgica.

SUMMARY Introduction: Regardless of the technique used, either bipolar or monopolar, transurethral resection of the prostate (TURP) is considered the cornerstone of surgical management for low urinary tract symptoms (LUTS), and benign prostatic obstruction (BPO). Objective: To review the available literature regarding the frequency of bipolar TURP (B-TURP) complications and the risk factor associated with them. Results: The search was conducted using Medline and studies addressing the research question published between 1996 and 2017 were retrieved. Seventy six article were screened and 50 were included. Those papers reported that B-TURP was associates with good long-term outcomes. According to Clavien-Dindo classification, a high proportion of complications were grade I, and the most frequent ones were: retrograde ejaculation, urine retention, urinary tract infection, bleeding and urethral stricture. Risk factors most commonly associated with these complications were: patient's medical status before surgery, the extent of disease at the time of the procedure, skills and technique of the surgeon, amongst other. Discussion: The majority of the surgical complications associated with B-TURP are mild, and identifying the best moment to conduct the procedure and intervening on modifiable risk factors before surgery, may contribute to improve outcomes of the B-TURP.

Low power seven-step two-lobe holmium laser enucleation of the prostate technique for surgical treatment of benign prostatic hyperplasia / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the safety and efficacy of the seven-step two-lobe holmium laser enucleation of the prostate (HoLEP) technique with low power laser device, and to introduce the detailed operating procedures, key points, short-term outcomes of this modified HoLEP technique.@*METHODS@#From March 2016 to November 2017, 90 patients underwent HoLEP in Peking University Third Hospital. The patients were divided into two groups: high-power group (32 patients) were performed with traditional Gilling's three-lobe enucleation using high power (90 W) laser; Low-power group (58 patients) were performed with seven-step two-lobe enucleation using low power (40 W) laser. The main steps of the low power seven-step two-lobe HoLEP phase included: (1) The identification of the correct plane between adenoma and capsule at 5 and 7 o'clock laterally to the veru montanum; (2) The connection of the bilateral plane by making a adenoma incision at the proximal point of veru montanum; (3) The extension of the dorsal plane under the whole three lobes between adenoma and capsule towards the bladder neck; (4) The separation of the middle lobe from two lateral lobes by making two retrograde incisions separately from apex 5 and 7 o'clock towards the bladder neck; (5) The enucleation of the middle lobe adenoma by extending the dorsal plane through into the bladder; (6) The prevention of the apex mucosa by making a circle incision at the apex of the prostate; (7) The en-bloc enucleation of the two lateral lobe adenomas by extending the lateral and ventral plane between adenoma and capsule from 5 and 7 o'clock to 12 o'clock conjunction and through into the bladder.@*RESULTS@#The mean patient age was (66.25±5.37) years vs. (68.00±5.18) years; The mean body mass indexes were (24.13±4.06) kg/m2 vs. (24.57±3.50) kg/m2; The mean prostate specific antigen values were (3.23±2.47) μg/L vs. (6.00±6.09) μg/L; The average prostatic volumes evaluated by ultrasound was (49.03±20.63) mL vs. (67.55±36.97) mL. There was no significant difference between the two groups. Furthermore, there were no significant differences in terms of perioperative and follow up data, including operative time; enucleation efficiencies; hemoglobin decrease; blood sodium and potassiumthe change postoperatively; catheterization duration and hospital stay; the international prostate symptom scores and quality of life scores pre- and post-operatively. There was 1 transurethral resection of the prostate (TURP) conversion in high-power group and 1 transfusion in low-power group during the operations. The follow-up one month after operation showed no severe stress incontinence in both the groups, whereas 3 cases ejaculatory dysfunctions in high-power group versus 1 case in low-power group were observed; Other surgeryrelated complications included: 2 cases postoperative hemorrhage (Clavien II and Clavien IIIb) in high-power group, 2 cases postoperative temperature more than 38 °C (Clavien I) and 1 case dysuria following catheter removal (Clavien I) in low-power group.@*CONCLUSION@#Low power laser device can be applied safe and effectively for HoLEP procedure using the seven-step two-lobe HoLEP technique. The outcomes comparable with high power laser HoLEP can be achieved.

Analysis of Present Status for Surgery of Benign Prostatic Hyperplasia in Korea Using Nationwide Healthcare System Data / 대한배뇨장애요실금학회지

PURPOSE: There are no established statistical data available for the comparison of different surgical methods adopted for the resection of benign prostatic hyperplasia (BPH). This study investigates the present status related to BPH surgery in Korea for the past 8 years. METHODS: National-level data from the National Health Insurance Service and National Statistical Office were analyzed in this study. From 2010 to 2017, the trends of surgeries for BPH were reviewed according to the procedure code including transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), or high-power potassium titanyl phosphate (KTP), and this trend also analyzed by age, geographic distribution, and hospital type. RESULTS: Over the past 8 years, there was not much change in the total number of BPH-related surgeries (range, 10,393– 11,072). Although there was not much alteration in the number of conventional TURP (from 6,801 in 2010 to 6,645 in 2017), the number of HoLEP has dramatically increased (from 278 in 2010 to 3,805 in 2017). The number of HoLEP surgeries after 2011 exceeded the number of surgeries using KTP, and the gap is anticipated to rise. The number of surgeries by age group was most common in the 70s and the total number of surgeries is decreasing in all age groups; for HoLEP, the trend is steadily increasing over the age of 60 years. Most of the BPH surgeries were performed in metropolitan areas, such as Seoul, Gyeonggi-do, and Busan, and in larger hospitals compared to smaller hospital settings. CONCLUSIONS: Through the data of the National Health Insurance Service, we could apprehend the present status of BPH-related surgery in Korea. Then, we could know about the trend according to several factors and we think these results will be valuable as academic references as well.

¿Qué hacer ante un pT0 en cáncer de próstata? Revisión a propósito de un caso / What to do with a pT0 in Prostate Cancer? Review of the Literature and Case Report

Introducción y Objetivos El cáncer de próstata es la segunda causa de mortalidad por cáncer en hombres en Colombia y en el mundo. El efecto "vanishing" en cáncer de próstata, es un fenómeno poco frecuente que se define como la ausencia de tumor en el estudio histológico postquirúrgico de pacientes llevados a prostatectomía radical como manejo curativo diagnóstico previo confirmado por biopsia o RTUP. Su incidencia en diferentes series llega hasta el 0,86%, por lo cual existen pocos estudios aleatorizados al respecto y aún no es clara la conducta con ese tipo de tumores. Reportamos un caso de un paciente con cáncer de próstata pT0 y realizamos una revisión de la literatura respecto del seguimiento y manejo que se deberían seguir al enfrentarnos a ese tipo de tumor. Métodos y Materiales Revisión de la literatura y reporte de caso clínico. Reporte de Caso Hombre de 58 años sintomático urinario, con PSA elevado por lo que se realizó biopsia transrectal de próstata, con resultado de adenocarcinoma de próstata confirmado por inmunohistoquímica. Al realizarse la prostatectomía radical no se encuentra tumor en la patología. En la literatura se encuentran factores asociados con la presencia del tumor cuando hay RTUP previa y uso de hormonoterapia neoadyuvante en el contexto de tumores de bajo volumen. A pesar de no encontrarse tumor en la patología, está descrita la recaída bioquímica y progresión clínica de esos tumores, por lo que debe realizarse el seguimiento usual para esa patología. Conclusiones El hallazgo de pT0 en cáncer de próstata, aunque poco frecuente, demanda una guía de manejo Proponemos la revisión de la patología con el protocolo descrito para reducir los falsos positivos y el seguimiento usual con los pasos estandarizados en las guías internacionales.

Introduction and Objectives Prostate cancer is the second leading cause of death related with cancer in men in Colombia and the world. "Vanishing" phenomenon in prostate cáncer is a rare event, where the post-surgical histologic review in patiets that underwent radical prostatectomy is negative, all of them with previous diagnosis of CaP by biopsy or TUR. The incidence of CaP in different series reaches 0.86%, whereby there are few randomized studies and the management and follow up of this type of tumors is not clear. In this article we report a case of a pT0 prostate cancer patient. We perform a systematic review of the literature to determine the medical behavior and medical follow up in cases presenting with pT0 prostate cancer. Materials and Methods Review of the literature & case report. Results Patient of 58 years old with medical history of recent progressive LUTS and high PSA levels that underwent a trans-rectal prostate biopsy with report of adenocarcinoma, that were confirmed by immunohistochemistry. In the pathology report after the radical prostatectomy no tumor cells were found. In the literature, there is reference about factors associated with pT0 prostate cancer in patients with previous RTUP and that were taken to hormonal coadjutant therapy in lesser degree tumors. Despite the absent of cancer findings in the pathology, it is well described biochemistry relapses and clinical progression of this tumors; usual protocol follow up must be made. Conclusion In patients with pT0 prostate cancer, even though to be a rare finding, must be studied and follow up with the steps mentioned above with the aim to reduce the false positive cases. Also the follow-ups steps must fully meet the requirements of standardized protocols guidelines.

Abscesos prostáticos y manejo con resección transuretral de próstata / Prostatic Abscesses and Prostate Management with Transurethral Resection

Objetivos Caracterizar una serie de pacientes con abscesos prostáticos tratados con resección transuretral de próstata, analizar los factores de riesgo, y los resultados del tratamiento. Métodos Se realizó un estudio retrospectivo de 2015 a 2016 en 2 hospitales de III y IV nivel en la ciudad de Bogotá en pacientes con diagnóstico tomográfico de absceso prostático, tratados con resección transuretral de próstata. Resultados Se documentaron 6 casos de hombres diagnosticados con absceso prostático con edad promedio de 57 años (40-78 años) que fueron llevados a RTUP para el drenaje del absceso. El promedio de hospitalización fue de 11.4 días (3-34 días); el aislamiento microbiológico positivo se alcanzó en el 83% de los pacientes. El 50% de los pacientes usaban sonda uretral a permanencia. La curación fue completa. Conclusiones La RTU de próstata en el drenaje de abscesos prostáticos, es un tratamiento seguro y eficaz en logrando resolución completa de la enfermedad.

Objectives To characterize patients with prostate abscesses treated with transurethral resection of the prostate, analyze risk factors, and treatment outcomes. Methods A retrospective study was conducted from 2015 to 2016 in 2 hospitals of III and IV level in the city of Bogotá in patients with tomographic diagnosis of prostate abscess, treated with transurethral resection of the prostate. Results Six cases of men diagnosed with prostate abscess with an average age of 57 years (40­78 years) who were taken to TURP for drainage of the abscess were documented. The average hospitalization was 11.4 days (3­34 days); Positive microbiological isolation was achieved in 83% of patients. 50% of patients used a urethral catheter permanently. The healing was complete. Conclusions The Transurethral resection of the prostate is a safe and effective intervention in achieving complete resolution and drainage of prostatic abscesses.

Prostatectomía convencional versus resección endoscópica de próstata monopolar en pacientes con Hiperplasia Prostática: un estudio de corte retrospectivo / Conventional prostatectomy vs. endoscopic resection of monopolar prostate in patients with Prostatic Hyperplasia: a retrospective study

La resolución quirúrgica de la hiperplasia prostática benigna se modifca conforme el acceso a las diferentes tecnologías en salud. Las complicaciones del abordaje endoscópico versus el convencional son similares. El Objetivo de este estudio fue analizar retrospectivamente los resultados de la cirugía convencional y la resección endoscópica monopolar de la hiperplasia de próstata en un hospital terciario del Ecuador. Pacientes y Métodos: Estudio retrospectivo, analítico. Fueron incluidos en el estudio 232 pacientes con diagnóstico histopatológico de hiperplasia prostática benigna atendidos en el servicio de urología del hospital Luis Vernaza en el período enero 2015 ­ diciembre 2016. Los pacientes fueron divididos en 2 subgrupos de acuerdo con el abordaje terapéutico ­ quirúrgico: prostatectomía convencional (n = 120) y resección endoscópica (n = 112). Resultados: Mediante estadística inferencial se comprobó una relación estadísticamente signifcativa entre el tipo de abordaje terapéutico con el tiempo quirúrgico (p= <0.001) y con el índice de sangrado (p= <0.001) y entre la edad y el tiempo quirúrgico (p= <0.001). Las complicaciones más importantes fueron: hemorragia inmediata (n=9) e infecciones de la herida (n=10) para la cirugía convencional y hemorragia inmediata (n=2) y sepsis (n=3) para la cirugía endoscópica. La media de tiempo quirúrgico fue 103.03 min y 75.14 min respectivamente. Conclusión: El desarrollo tecnológico ha traído la certeza de que la cirugía endoscópica tiene menores complicaciones, disminuye los tiempos quirúrgicos. Siendo una opción por considerar frente a la cirugía tradicional para la hiperplasia de próstata

Surgical resolution of benign prostatic hyperplasia is modifed as access to different health technologies. Complications of endoscopic versus conventional approach are similar. The objective of this study was to retrospectively analyze the results of conventional surgery and monopolistic endoscopic resection of prostate hyperplasia in a tertiary hospital in Ecuador. Patients and Methods: Retrospective, analytical study. 232 patients diagnosed with benign prostatic hyperplasia were included in the study in the urology service of the Luis Vernaza hospital in the period January 2015 ­ December 2016. Patients were divided into 2 subgroups according to the therapeutic­surgical approach: conventional prostatectomy (n.120) and endoscopic resection (n. 112). Results: By inferential statistics, a statistically signifcant relationship was found between the type of therapeutic approach with the surgical time (p. 0.001) and with the bleeding index (p. 0.001) and between age and surgical time (p. 0.001). The most important complications were: immediate bleeding (n-9) and wound infections (no. 10) for conventional surgery and immediate bleeding (n-2) and sepsis (no. 3) for endoscopic surgery. The surgical mean time was 103.03 min and 75.14 min respectively. Conclusions: Technological development has brought the certainty that endoscopic surgery has fewer complications, decreases surgical times. Being an option to consider against traditional prostate hyperplasia surgery

Los Procesos de Comunicación Educativos sobre el Cáncer de Próstata / The Educational Communication Processes on Prostate Cancer

Introducción: El cáncer de próstata es una neoplasia en la cual la comunicación y el conocimiento de la población puede ayudar al diagnóstico temprano y tratamiento temprano. El objetivo de este estudio fue investigar que conocen los pacientes y acompañantes sobre los procesos de comunicación educativa para la salud en cáncer de próstata. Métodos: El presente estudio descriptivo, fue realizado en el Instituto Oncológico Nacional "Dr Juan Tanca Marengo" Solca-Guayaquil. Se utilizó una encuesta de salud sobre el conocimiento de la entidad nosológica, el conocimiento de los métodos diagnósticos y la predisposición a acudir a charlas educativas. La muestra fue calculada en 80 encuestas a familiares, acompañantes y pacientes del Instituto. Resultados: Se registraron 80 encuestas. Sobre el cáncer de próstata el 52.5 % de los encuestados declara no tener conocimiento alguno sobre el mismo, un 31.25 % asegura tener poco conocimiento sobre el cáncer de próstata, y el 16.25 % declara tener un conocimiento apropiado sobre el cáncer de próstata. Sobre el diagnóstico de Cáncer de Próstata el 58.75 % de los encuestados no sabe cómo se diagnostica, un 22.5% % está informado someramente y un 18.75 % tiene conocimiento del diagnóstico. Conclusión: En este reporte se evidencia el desconocimiento sobre cáncer de próstata que tienen los encuestados sobre su concepto y diagnóstico

Introduction: Prostate cancer is a neoplasm in which communication and knowledge of the population can help early diagnosis and early treatment. The objective of this study was to investigate what patients and companions know about the processes of educational communication for health in prostate cancer. Methods: The present descriptive study was carried out in the National Drugs Institute "Dr Juan Tanca Marengo" Solca-Guayaquil. A health survey was used on the knowledge of the nosological entity, the knowledge of the diagnostic methods and the predisposition to attend educational talks. The sample was calculated in 80 surveys to relatives, companions and patients of the Institute. Results: 80 surveys were registered. Regarding prostate cancer, 52.5% of the respondents declare to have no knowledge about it, 31.25% claim to have little knowledge about prostate cancer, and 16.25% declare to have an appropriate knowledge about prostate cancer. About the diagnosis of Prostate Cancer, 58.75% of respondents do not know how it is diagnosed, 22.5%% is briefly informed and 18.75% have knowledge of the diagnosis. Conclusion: This report shows the lack of knowledge about prostate cancer that respondents have about their concept and diagnosis.