Changes in benign prostatic hyperplasia management in Valencia: a real-world evidence analysis.

INTRODUCTION AND OBJECTIVES: A training program was developed to increase general practitioners' engagement in the optimal management of Benign Prostatic Hyperplasia (BPH). The goal of this study was to evaluate changes in BPH management after the implementation of a training program. MATERIAL AND METHODS: This observational retrospective cohort study was conducted between 2019 and 2020. Aggregated data were analyzed in three evaluation periods (2010, 2012 and 2015), addressing quality indicators for diagnosis, treatment, and treatment outcomes. RESULTS: Overall, 118 795 patients who presented any data points were included. All quality indicators (number of IPSS and PSA determinations) increased between the first period and the last. Combination (α-blocker + 5-ARI) therapy was increasingly prescribed during the study periods whereas the proportion of prescriptions for single-agent α-blocker showed no significant differences among the periods analyzed. However, the total number of patients eligible for combination therapy who actually received this treatment was low in all periods (7.5%, 17.9%, and 20.1%, in 2010, 2012, and 2015, respectively). The outcome indicators revealed a decrease in referrals to the urology unit mostly among newly diagnosed patients. Even though the proportion of patients who underwent BPH-related surgeries increased significantly from the first to the second period, the number of surgeries remained stable between the second and third periods. CONCLUSIONS: The training program had a generally positive impact on the management of BPH patients in PC, but the overall study period may be insufficient to show an effect on some outcome indicators such as the number of surgeries.

Initial experience with thulium fiber laser for prostate enucleation: Analysis of the intraoperative and short-term outcomes in a prospective, multicenter cohort.

INTRODUCTION: Holmium laser enucleation of the prostate has rapidly become the gold standard for the surgical treatment of benign prostate hyperplasia, although thulium fiber laser (TFL) has also been postulated as an effective and safe alternative for prostate enucleation. The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate. MATERIAL AND METHODS: All patients proposed to TFL prostate enucleation were included in the analysis, regardless their prostate volume, catheter status and severity of symptoms, in 3 centers. Preoperative characteristics, intraoperative times and functional 3-months follow-up variables were collected, along with complications. RESULTS: Fifty-six patients were available, with a mean age of 68.7 years. Enucleation and morcellation efficiencies were 2.04 and 7.47 g/min, respectively. Median hospital stay was one day. Comparable functional data, pre and 3-month post-surgery was: mean prostate volume 88.9 vs 21.3 g, maximum urinary flow 13.2 vs 27.3 ml/s, post-void residual volume 149 vs 7.8 ml, prostatic specific antigen level 11.2 vs 1 ng/ml, and International Prostate Symptom Score 20.75 vs 3.96. Fourteen out of 56 (25%) patients presented with complications grade ≤2, according to the Clavien-Dindo classification. DISCUSSION: With wider evidence for other urological indications, very recent evidence about the suitability of TFL for prostate enucleation has arisen, since the first case described in 2021. Our results seem to back up these previous successful experiences as long as we obtained good intraoperative and short term follow-up functional results. However, there is still a need of longer follow-up data. CONCLUSIONS: TFL represents a novel technology for prostate enucleation, with a good intraoperative and short follow-up functional results, and a safety profile similar to the observed for those techniques that have been wider used for this indication. Further studies with longer follow-up periods and comparative with these other techniques are necessary.

Evaluating the effects of preoperative treatment with 5-alpha reductase inhibitors in holmium laser enucleation of the prostate.

INTRODUCTION AND AIM: Patients treated with HoLEP are frequently treated with previous treatments, including 5-alpha-reductase inhibitors (5-ARIs). We investigated the impact of pretreatment with 5-ARIs on perioperative and immediate postoperative parameters in patients treated with HoLEP. MATERIAL AND METHODS: A retrospective study was performed using a prospectively collected database including all patients treated with HoLEP at our center between January 2017 and January 2023. The resected tissue weight, enucleation and morcellation efficiency (enucleation weight/time and morcellation weight/ time), postoperative complications, hospital stay and hemoglobin drop have been analyzed. RESULTS: A total of 327 patients were included. Of these, 173 (52.9%) were treated with 5-ARIs. No differences were found among the perioperative parameters investigated to determine efficiency. No differences were observed in peri- or postoperative complications, hospital stay or hemoglobin drop. CONCLUSIONS: Therapy with 5-ARIs had no impact on the immediate postoperative outcomes of patients treated with HoLEP. In our cohort, we observed that the use of 5-ARIs did not affect surgical efficiency, enucleation or morcellation. Further multicenter studies will be necessary to validate these findings.

Terapia termal con vapor de agua: variaciones técnicas entre hospitales universitarios españoles y eficacia a 2 años de seguimiento / Water vapor thermal therapy: technical variations among spanish hospitals and efficacy at 2-year follow-up

Objetivo El objetivo de este trabajo es conocer experiencia inicial con la terapia térmica con vapor de agua (TTVA) para hiperplasia benigna de próstata (HBP) en los hospitales universitarios españoles, así como describir las diferencias en cuanto a técnica y seguimiento observadas entre los centros. Materiales y métodos Este estudio multicéntrico observacional retrospectivo recogió características basales, datos quirúrgicos, posoperatorios y seguimiento a los uno, tres, seis, 12 y 24 meses, incluyendo cuestionarios validados, variaciones flujométricas, complicaciones y la necesidad de tratamiento farmacológico y quirúrgico tras el procedimiento. También se analizaron los posibles desencadenantes de retención aguda de orina (RAO) en el posoperatorio. Resultados Se incluyeron un total de 105 pacientes. No se observaron diferencias entre los grupos con y sin RAO con respecto a tiempo de sondaje (cinco y 4,3 días respectivamente, p = 0,178), ni volumen prostático (47,9 y 41,4 g, respectivamente, p = 0,147). La mejoría media a los tres, seis, 12 y 24 meses en cuanto de flujo máximo fue de 5,3, 5,2, 4,2 y 3,8 mL/s, respectivamente. En cuanto a la eyaculación, se observa una mejoría en la misma a partir de los tres meses de seguimiento que se mantiene en el tiempo. Conclusiones El tratamiento mínimamente invasivo de HBP con TTVA presenta buenos resultados funcionales a 24 meses de seguimiento, sin afectación significativa de la función sexual y con una baja incidencia de complicaciones. Existen pequeñas variaciones principalmente en cuanto al posoperatorio inmediato entre los hospitales participantes en el estudio. (AU)

Aim The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers. Materials and Methods This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed. Results A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, p = 0.178), or prostate volume (47.9 gr and 41.4 gr respectively, p = 0.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8 ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time. Conclusions Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative period. (AU)

Water vapor thermal therapy: Technical variations among spanish hospitals and efficacy at 2-year follow-up.

AIM: The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers. MATERIALS AND METHODS: This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed. RESULTS: A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, P=.178), or prostate volume (47.9g and 41.4g respectively, P=.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time. CONCLUSIONS: Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative period.

Unidades Hounsfield: una herramienta no invasiva prometedora para el diagnóstico de la hiperplasia benigna de próstata / Hounsfield units: A promising non-invasive tool for diagnosing benign prostatic hyperplasia

Objetivo Los síntomas clínicos en la hiperplasia benigna de próstata (HBP) son directamente proporcionales al volumen de la próstata. Nuestro objetivo es definir el tipo de paciente que debe ser intervenido de forma no invasiva, así como el momento idóneo para esta intervención, correlacionando los síntomas subjetivos del paciente con las herramientas objetivas de diagnóstico. Material y método Se utilizó el cuestionario International Prostate Symptom Score (IPSS) en los pacientes que acudieron por primera vez a la consulta externa de urología con síntomas del tracto urinario inferior (STUI). A continuación, se solicitaron niveles de PSA, urea, creatinina, análisis de orina completos, uroflujometría, ecografía del tracto urinario y tomografía computarizada (TC) abdominal inferior sin contraste. Se registraron los valores de las unidades Hounsfield (UH) de la zona central (zona de transición) y de la zona periférica de la próstata, la longitud de la uretra prostática y los valores de UH de la pared vesical mediante la TC. Se utilizó la fórmula del elipsoide para las mediciones ultrasonográficas y tomográficas del tamaño de la próstata (diámetro anteroposterior × diámetro transversal × diámetro longitudinal × 0,52). Resultados Se halló una correlación negativa estadísticamente significativa entre la proporción de UH de la zona periférica de la próstata/zona central y el flujo máximo medido en la uroflujometría. Conclusión Este es el primer estudio de la literatura en evaluar la correlación entre los parámetros miccionales, como las puntuaciones de Qmáx, Qave e IPSS, y las puntuaciones de UH de la próstata y la pared vesical obtenidas mediante TC en pacientes con HBP. Se ha detectado una relación significativa entre la proporción de UH de la zona periférica/zona central y Qmáx (AU)

Objective The clinical symptoms in benign prostatic hyperplasia (BPH) are directly proportional to prostate volume. We aimed to show whom and when to intervene in a noninvasive way, correlating the patient's subjective symptoms with objective diagnostic tools. Material and method International Prostate Symptom Score (IPSS) was evaluated in patients who consulted the urology outpatient clinic for the first time with lower urinary tract symptoms (LUTS). Subsequently, PSA, urea, creatinine, complete urinalysis, uroflowmetry, urinary tract ultrasound and non-contrast lower abdominal computed tomography (CT) examinations were requested. Prostate central (transitional zone) zone and peripheral zone HU scores, prostatic urethral length and bladder wall Hounsfield units (HU) scores were recorded by using computed tomography (CT). The ellipsoid formula was used for ultrasonographic and tomographic measurements of prostate size (anteroposterior diameter × transverse diameter × longitudinal diameter × 0.52). Results A statistically significant negative correlation was found between the prostate peripheral zone/central zone HU ratio and the maximum flow rate measured in the uroflowmetry test. Conclusion This is the first study in the literature to evaluate the correlation between voiding parameters such as Qmax, Qave and IPSS scores, and prostate and bladder wall HU scores obtained by computed tomography examination in BPH patients. A significant relationship has been detected between the peripheral zone/central zone HU ratio and Q max. Additional studies with larger patient populations could better clarify the contribution of HU in the diagnosis of BPH and treatment decision making of these patients (AU)

Hounsfield units: A promising non-invasive tool for diagnosing benign prostatic hyperplasia.

OBJECTIVE: The clinical symptoms in benign prostatic hyperplasia (BPH) are directly proportional to prostate volume. We aimed to show whom and when to intervene in a noninvasive way, correlating the patient's subjective symptoms with objective diagnostic tools. MATERIAL AND METHOD: International Prostate Symptom Score (IPSS) was evaluated in patients who consulted the urology outpatient clinic for the first time with lower urinary tract symptoms (LUTS). Subsequently, PSA, urea, creatinine, complete urinalysis, uroflowmetry, urinary tract ultrasound and non-contrast lower abdominal computed tomography (CT) examinations were requested. Prostate central (transitional zone) zone and peripheral zone HU scores, prostatic urethral length and bladder wall Hounsfield units (HU) scores were recorded by using computed tomography (CT). The ellipsoid formula was used for ultrasonographic and tomographic measurements of prostate size (anteroposterior diameter × transverse diameter × longitudinal diameter × 0.52). RESULTS: A statistically significant negative correlation was found between the prostate peripheral zone/central zone HU ratio and the maximum flow rate measured in the uroflowmetry test. CONCLUSION: This is the first study in the literature to evaluate the correlation between voiding parameters such as Qmax, Qave and IPSS scores, and prostate and bladder wall HU scores obtained by computed tomography examination in BPH patients. A significant relationship has been detected between the peripheral zone/central zone HU ratio and Q max. Additional studies with larger patient populations could better clarify the contribution of HU in the diagnosis of BPH and treatment decision making of these patients.

Resultados preliminares de un trabajo multicéntrico a nivel nacional para el tratamiento de STUI secundario a hiperplasia benigna de próstata mediante el sistema con vapor de agua Rezum / Preliminary results of a national multicenter study on the treatment of LUTS secondary to benign prostatic hyperplasia using the Rezum steam system

Introducción y objetivo El sistema Rezūm® t/o es una técnica mínimamente invasiva que emplea la inyección intraprostática transuretral de vapor de agua para la ablación del tejido prostático. El objetivo del estudio es reflejar los resultados funcionales a corto plazo y de seguridad obtenidos aplicando la técnica en la práctica clínica real. Material y métodos Estudio prospectivo realizado en 5 hospitales españoles para el tratamiento de STUI secundario a HBP mediante el sistema Rezūm®. Se incluyeron pacientes con lóbulo medio prostático (LM) y portadores de sonda vesical (SV). La valoración pre- y postoperatoria se realizó con los cuestionarios IPSS, IIEF-5 y QoL, los resultados flujométricos y el residuo posmiccional. Se registraron las complicaciones acontecidas, así como la tasa de retratamientos al año de seguimiento. Resultados Un total de 137 pacientes fueron incluidos, presentando 64 pacientes LM y 10 pacientes SV. La media de volumen prostático fue de 50cm3 (15-131). A los 3 meses de seguimiento se objetivó una mejoría estadísticamente significativa tanto del IPSS (−6,37 puntos) como del Qmax (+4,95mL/s) y el QoL (−1,29) que se mantuvo hasta los 12 meses: −10,78 puntos, +4,62mL/s y −2,73 (p<0,001), respectivamente. No se objetivaron cambios significativos en la esfera sexual. Todas las complicaciones fueron de carácter leve (≤ClavienII). La tasa de retratamiento al año fue del 4,3%. Conclusión Los resultados a corto plazo de esta técnica son prometedores, mostrando mejoría en los resultados funcionales, sin repercusión en la esfera sexual y asumiendo complicaciones de carácter leve y corta duración. Sin embargo, son necesarios seguimientos más prolongados para establecer su durabilidad y realizar comparaciones directas con otros tratamientos (AU)

Introduction and objective Rezūm® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice. Material and methods Prospective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezūm® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported. Results 137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50cm3 (15-131). At 3 months follow-up, significant improvement was observed in IPSS (−6,37 points), Qmax (+4,95mL/s) and QoL (−1,29); and was maintained until 12 months: −10,78 points,+4,62mL/s and −2,73 respectively (p<0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤Clavien II). Retreatment rate at one year was 4%. Conclusion Short-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments (AU)

Preliminary results of a national multicenter study on the treatment of LUTS secondary to benign prostatic hyperplasia using the Rezum® steam system.

INTRODUCTION AND OBJECTIVE: Rezum® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice. MATERIAL AND METHODS: Prospective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezum® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported. RESULTS: 137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50 cm3 (15-131). At 3 months follow-up, significant improvement was observed in IPSS (-6.37 points), Qmax (+4.95 mL/s) and QoL (-1.29); and was maintained until 12 months: -10.78 points, +4.62 mL/s and -2.73 respectively (p < 0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤ Clavien II). Retreatment rate at one year was 4%. CONCLUSION: Short-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments.

[Effectiveness of treatment with Pygeum africanum in patients with lower urinary tract symptoms and benign prostatic hyperplasia: a cross-sectional study in the real-world clinical practice in Spain (The PROFIT Study)]. / Efectividad del tratamiento con Pygeum africanum en pacientes con síntomas del tracto urinario inferior e hiperplasia benigna de próstata: estudio transversal en la práctica clínica real en España (Estudio PROFIT).

OBJECTIVES: To assess the effectivenessand tolerability of treatment with P africanum(P. africanum) in patients with lower urinary tractsymptoms (LUTS) associated with benign prostatichyperplasia (BPH) in routine clinical practice. MATERIAL AND METHODS: Cross-sectional observationalstudy in which 115 patients with LUTS/BPHtreated for 6 months with P. africanum (Tebetane® compuesto)in real-world clinical practice conditions wereincluded. The primary objective was to assess thequality of life (QoL) according to changes in the scoresof item 8 of the International Prostate Symptom Score(IPSS) questionnaire (a score ≥ 4 indicates a significantimpairment of QoL). Secondary objectives includedimprovement of urinary symptoms, urinary flow, satisfactionand compliance with treatment as well astolerability. Data were collected in a single scheduledvisit at 6 months of treatment with P. africanum andwere compared with data registered in the medicalrecords at the beginning of treatment. RESULTS: After 6 months of treatment withP. africanum, the percentage of patient with significantimpairment of QoL was 22.6% as compared with45.2% at the initiation of treatment (P 0,-001). Theoverall IPSS score showed a mean decreas of -4,-5points (median -4,0, interquartile range [IQR] -7,-0 to-2,0) and 69 patients (60%) showed a clinically significantimprovement (reduction of ≥ 4 points). Therewere significant decreases in IPSS subscales of storage(mean -1,-8; median -2,-0, IQR -3,-0 to 0 (P 0,-001)and voiding (mean -1,-9; median -2,-0, IQR -3,-0 to 0)(P 0,-001) symptoms. The degree of satisfaction and compliance with treatment was high with mean scores(median) of 6,9 (7,0) and 9,2 (10), respectively in the1-10 visual analogue scale. Treatment-related adverseeffects did not occur. CONCLUSIONS: Treatment with P. africanum during6 months improved significantly QoL and LUTS inpatients with BPH, with a high level of satisfaction andcompliance with treatment, without adverse events.

OBJETIVO: Evaluar la efectividad y latolerabilidad del tratamiento con Pygeum africanum (P.africanum) en pacientes con síntomas del tracto urinarioinferior (STUI) asociados a hiperplasia benigna depróstata (HBP) en la práctica clínica habitual.MATERIAL Y MÉTODOS: Estudio observacionaltransversal en el que se incluyeron 115 pacientes conSTUI/HBP tratados durante 6 meses con P. africanum (Tebetane® compuesto) en condiciones de prácticaclínica real. El objetivo primario fue evaluar la calidadde vida (CdV) en función del cambio en la pregunta 8del cuestionario de Puntuación Internacional de losSíntomas Prostáticos (IPSS) (puntuación ≥ 4 indicaafectación significativa de la CdV). Los objetivos secundariosincluyeron la mejoría de síntomas urinarios,flujo urinario, satisfacción y cumplimiento con eltratamiento, así como la tolerabilidad del mismo. Losdatos se recogieron en una única visita programada alos 6 meses de tratamiento con P. africanum y se compararoncon los registrados en la historia clínica alinicio del tratamiento. RESULTADOS: Tras 6 meses de tratamiento conP. africanum, el porcentaje de pacientes con afectaciónsignificativa de la CdV fue del 22,6% en comparacióncon un 45,2% al inicio del tratamiento (P 0,001).La puntuación global del IPSS disminuyó de mediaen -4,5 puntos (mediana -4,0, rango intercuartílico [RIQ] -7,0 a -2,0) y 69 pacientes (60%) mostraron unamejoría clínicamente significativa (disminución ≥ 4puntos). Se observaron disminuciones significativasen las subescalas del IPSS de los síntomas de llenado(media -1,8; mediana -2,0, RIQ -3,0 a 0) (P 0,001) yvaciado (media -1,9; mediana -2,0, RIQ -3,0 a 0) (P 0,001). El grado de satisfacción y cumplimiento con eltratamiento fue elevado con valores medios (mediana)de 6,9 (7,0) y 9,2 (10) respectivamente, en una escalaanalógica visual 1-10 cm. No se registraron efectosadversos relacionados con el tratamiento. CONCLUSION: El tratamiento con P. africanum(P. africanum) durante 6 meses mejoró significativamentela CdV y los STUI en pacientes con HBP, con unalto grado de satisfacción y cumplimiento con el tratamiento,sin registrarse reacciones adversas.

Complicaciones postoperatorias en pacientes con hiperplasia benigna de próstata según técnica quirúrgica

RESUMEN Introducción: La hiperplasia benigna de próstata tiene elevada prevalencia en mayores de 50 años. En quienes fracasa o es mal tolerado el tratamiento médico, se plantea cirugía. Objetivo: Analizar las complicaciones postoperatorias en pacientes operados por hiperplasia benigna de próstata, según diferentes técnicas. Métodos: Se analizaron 161 historias clínicas de pacientes de 60 o más años de edad, con diagnóstico de hiperplasia benigna prostática, intervenidos quirúrgicamente con las técnicas: adenomectomía abierta transvesical, retropúbica y endoscópica monopolar. Resultados: La variación de la hemoglobina ≥ 3mg/dl, con la técnica transvesical fue 17 % y con la retropúbica 27,3 %. El tiempo de sondaje vesical ≤ 4 días en la transvesical un 48,9 %; > 4 a < 7 días en la retropúbica en 59,1 % y ≤ 4 días en la endoscópica monopolar 68,5 %. La estancia hospitalaria ≥ de 5 días, en la transvesical 51,1 % y en la retropúbica 59,9 %; de 1 a < 3 días, con la endoscópica monopolar, 58,7 %. La infección del tracto urinario fue más frecuente con la transvesical (31,9 %), la infección del sitio operatorio (17 %); mientras que la orquiepididimitis fue más frecuente en la retropúbica (40,9 %). El síndrome posresección transuretral prostática monopolar, se presentó en el 17,4 % de los operados. Conclusión: La adenomectomía retropúbica fue la técnica quirúrgica con mayor frecuencia de complicaciones y la resección transuretral la de menor frecuencia. La retención aguda de orina por técnica retropúbica, fue la complicación más frecuente.

ABSTRACT Introduction: Benign prostate hyperplasia has a high prevalence in people over 50 years of age. In those who fail or is poorly tolerated medical treatment, surgery is considered. Objective: To analyze postoperative complications in patients operated on for benign prostatic hyperplasia, according to different techniques. Methods: 161 medical records of patients 60 years of age or older, with a diagnosis of benign prostatic hyperplasia, who underwent surgery with the techniques: open transvesical, retropubic and monopolar endoscopic adenomectomy were analyzed. Results: The variation of hemoglobin ≥ 3mg / dl, with the transvesical technique was 17% and with the retropubic one 27.3%. The time of bladder catheterization ≤ 4 days in the transvesical one 48.9%; > 4 to <7 days in the retropubic in 59.1% and ≤ 4 days in the monopolar endoscopic 68.5%. The hospital stay ≥ 5 days, in the transvesical 51.1% and in the retropubic 59.9%; from 1 to <3 days, with the monopolar endoscopic, 58.7%. Urinary tract infection was more frequent with transvesical (31.9%), surgical site infection (17%); while epididymo-orchitis was more frequent in retropubic (40.9%). Monopolar prostatic transurethral post-resection syndrome appeared in 17.4% of those operated on. Conclusion: Retropubic adenomectomy was the surgical technique with the highest frequency of complications and transurethral resection the least frequent. Acute retention of urine by retropubic technique was the most frequent complication.

Unusual case of infectious endocarditis in a patient subjected to transurethral resection of the prostate (TURP) without cardiovascular risk factors. / Endocarditis en un paciente sujeto a RTU de próstata sin factores de riesgo cardiovascular.

OBJECTIVE: Transurethral resection of the prostate (TURP) is the gold standard for the treatment of obstructive prostatic hyperplasia. A bacteremia leading to infectious endocarditis (IE) can be the result of urological procedures. IE post TURP is rare. METHODS: We report an unusual case of an infectious endocarditis complicating TURP for benign prostatic hyperplasiain absence of known previous cardiovascular risk factors or conditions. RESULTS AND CONCLUSIONS: The patient developed intermittent episodes of fever lasting more than two months starting 3 weeks from hospital discharge, and he was never referred to the hospital by his general practitioner, until he was evaluated by his Surgeon, admitted to the Emergency Department and diagnosed with infectious endocarditis, later dying for cardiac arrest before getting a cardiac valve replacement. This report aims to be a reminder of how invasive procedures can trigger secondary distant complications that should be taken into account while assessing a post-operative patient.

OBJETIVO: La resección transuretral de próstata es el gold estándar en el tratamiento de la hiperplasia benigna de próstata. Una bacteriemia que comporta endocarditis infecciosa (EI) puede ser como resultado de procedimientos urológicos. La EI post RTU próstata es rara. METODOS: Describimos un caso inusual de endocarditis infecciosa complicada post RTU de próstata por hiperplasia benigna de próstata en ausencia de factores de riesgo cardiovascular conocidos u otras patológicas. RESULTADOS Y CONCLUSIONES: El paciente desarrolló episodios intermitentes de fiebre por más de 2 meses iniciándose a las 3 semanas del alta hospitalaria. El paciente nunca fué mandado al hospital por el medico de familia hasta que fue evaluado por su cirujano, ingresado en el servicio de urgencias y diagnosticado de endocarditis infecciosa. Finalmente murió de parada cardiorespiratoria antes de someterse a cirugía de sustitución valvular. Este caso pretende recordar lo invasivo que es el procedimiento y que puede desencadenar complicaciones secundarias que deben tenerse en consideración en el contexto postoperatorio del paciente.

Embolización prostática como tratamiento para pacientes con hiperplasia benigna de próstata portadores de sonda vesical permanente no tributarios a cirugía desobstructiva / Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery

Introducción: La hiperplasia benigna de próstata se considera la causa más común de los síntomas del tracto urinario inferior. El sondaje vesical es el tratamiento urgente en pacientes con retención urinaria y la cirugía el de aquellos refractarios al tratamiento médico. Existe un grupo de personas con comorbilidades importantes no tributarias a cirugía. La embolización arterial prostática (EAP) podría presentarse como una alternativa segura y eficaz para conseguir el vaciamiento vesical y la micción espontánea, evitando así el sondaje vesical permanente en pacientes con comorbilidades importantes que contraindiquen la cirugía. En este estudio retrospectivo, evaluamos la eficacia de la EAP en pacientes portadores de sonda vesical permanente no tributarios de tratamiento quirúrgico.Material y métodosEstudio retrospectivo de 26 pacientes portadores de sonda vesical permanente a los que se les realizó una embolización prostática. Se revisaron los datos demográficos y clínicos (edad, uso de anticoagulación, volumen prostático, tiempo de ingreso, embolización unilateral o bilateral), la evaluación del índice de comorbilidad de Charlson y la clasificación de Clavien-Dindo para las complicaciones del procedimiento. Se analizó el éxito de la retirada de la sonda vesical permanente al mes del procedimiento.ResultadosUn total de 26 pacientes fueron incluidos en la revisión. La mediana de edad fue de 85 años, con un volumen prostático mediano de 90mL. El 88,5% de los sujetos puntuó más de 7 en la escala de comorbilidad de Charlson. Un único paciente presentó una complicación Clavien-Dindo III. De los 26 sujetos, 17 (65,4%) tuvieron una micción espontánea y un residuo posmiccional inferior a 100mL al mes del procedimiento. En total, se logró retirar la sonda vesical en 19 de los 26 sujetos (73,1%). (AU)

Introduction: Benign prostatic hyperplasia is considered the most frequent cause of lower urinary tract symptoms. Urinary catheterization is the emergency treatment for patients with urinary retention and surgery is indicated in patients refractory to medical treatment. There is a group of people with important comorbidities that make them ineligible for surgery. Prostatic arterial embolization (PAE) could be presented as a safe and effective alternative to achieve bladder emptying and spontaneous urination, thus avoiding permanent urinary catheterization in patients with significant comorbidities that represent a contraindication for surgery. In this retrospective study, we evaluated the efficacy of PAE in patients with permanent urinary catheterization who are ineligible for surgical treatment.Material and methodsRetrospective study of 26 patients with permanent urinary catheter who underwent prostatic embolization. Demographic and clinical data (age, use of anticoagulation, prostate volume, length of hospital stay, unilateral or bilateral embolization), Charlson comorbidity index evaluation and Clavien-Dindo classification for procedural complications were reviewed. Successful removal of permanent urinary catheter was analyzed at one month after the procedure.ResultsA total of 26 patients were included in the review. The median age was 85 years with a median prostate volume of 90mL. A Charlson comorbidity score above 7 was obtained in 88.5% of the subjects. Only one patient had one Clavien-Dindo III complication. Of the 26 subjects, 17 (65.4%) had spontaneous micturition and a postvoid residual lower than 100mL at one month post procedure. Overall, catheter removal was achieved in 19 out of 26 subjects (73.1%). (AU)

Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery.

INTRODUCTION: Benign prostatic hyperplasia is considered the most frequent cause of lower urinary tract symptoms. Urinary catheterization is the emergency treatment for patients with urinary retention and surgery is indicated in patients refractory to medical treatment. There is a group of people with important comorbidities that make them ineligible for surgery. Prostatic arterial embolization (PAE) could be presented as a safe and effective alternative to achieve bladder emptying and spontaneous urination, thus avoiding permanent urinary catheterization in patients with significant comorbidities that represent a contraindication for surgery. In this retrospective study, we evaluated the efficacy of PAE in patients with permanent urinary catheterization who are ineligible for surgical treatment. MATERIAL AND METHODS: Retrospective study of 26 patients with permanent urinary catheter who underwent prostatic embolization. Demographic and clinical data (age, use of anticoagulation, prostate volume, length of hospital stay, unilateral or bilateral embolization), Charlson comorbidity index evaluation and Clavien-Dindo classification for procedural complications were reviewed. Successful removal of permanent urinary catheter was analyzed at one month after the procedure. RESULTS: A total of 26 patients were included in the review. The median age was 85 years with a median prostate volume of 90 mL. A Charlson comorbidity score above 7 was obtained in 88.5% of the subjects. Only one patient had one Clavien-Dindo III complication. Of the 26 subjects, 17 (65.4%) had spontaneous micturition and a postvoid residual lower than 100 mL at one month post procedure. Overall, catheter removal was achieved in 19 out of 26 subjects (73.1%). CONCLUSION: PAE is a safe and effective treatment for patients with permanent urinary catheterization who are ineligible for surgical treatment.

Erectile dysfunction, lower urinary tract symptoms, and quality of life in men above 50 years of age. / Disfunción eréctil, síntomas del tracto urinario inferior y calidad de vida en varones mayores de 50 años.

BACKGROUND: Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are relevant health problems worldwide, especially in men 50 years of age and older. With the increase in life expectancy, their prevalence is expected to rise in the coming years. AIM: To estimate the prevalence of LUTS and ED in adults 50 years of age and older and evaluate their relation to quality of life. MATERIALS AND METHODS: An analytic cross-section-al study was conducted through a personal interview with the participants. Erectile dysfunction (IIEF-5), prostate symptom (IPSS), and quality of life (EuroQoL) questionnaires were employed. The frequency and grade of LUTS and ED were evaluated and correlated with health-related quality of life perception in 300 men above 50 years of age. Summary measures were calculated. The association of LUTS and ED with quality of life was evaluated with prevalence odds ratios (ORs) and 95% confidence intervals (CIs), calculated using unconditional logistic regression models. RESULTS: Information on 300 subjects was analyzed. The general prevalence of LUTS and ED was 88.3% and 81.7%, respectively. Quality of life was classified as very poor - regular (≤ 60 points) in 18.3% of the subjects. In the multiple analysis, the presence of moderate LUTS (OR = 5.27, 1.08 - 9.73) or severe LUTS (OR = 7.05, 1.84-10.34) was associated with an increase in the possibility of presenting with a lower quality of life. CONCLUSION: Our findings suggest that erectile dysfunction and prostate symptoms were frequent events in the population studied, as was a low perception of quality of life. The opportune and efficacious treatment of those pathologies can potentially improve the individual and social dynamics of the persons affected.

ANTECEDENTES: A nivel mundial, los Síntomas del Tracto Urinario Inferior (STUI) y la Disfunción Eréctil (DE) son un problema relevante de salud pública, especialmente en varones de 50 o más años. Se espera que con el aumento de la esperanza de vida, su prevalencia se incrementa aún más en los próximos años. OBJETIVO: Estimar la prevalencia de los STUI y DE en adultos de 50 años o más de edad y evaluar su relación con la calidad de vida.MATERIAL Y MÉTODOS: Se realizó un estudio transversal analítico a través de una entrevista personal con los participantes. Se emplearon los cuestionarios de disfunción eréctil (IIEF-5), de síntomas prostáticos (IPSS) y la calidad de vida (EuroQoL). Se evaluó la frecuencia y grados de los Síntomas del Tracto Urinario Inferior y Disfunción Eréctil y se correlacionó con la percepción de Calidad de Vida relacionada a la salud en 300 varones mayores de 50 años. Se estimaron medidas sumarias. La asociación de STUI y DE con la calidad de vida fue evaluada con razones de momios (RM) prevalentes e intervalos de confianza (IC) del 95% estimados con modelos de regresión logística no condicional. RESULTADOS: Información de 300 sujetos fue analizada. La prevalencia general de STUI y DE fue 88,3% y 81,7% respectivamente. El 18,3% de los sujetos fueron clasificados como con una calidad de vida muy mala ­ regular (≤ 60 puntos). En el análisis múltiple, la presencia de STUI moderados (RM = 5,27, 1,08 ­ 9,73) o severos (RM = 7,05, 1,84 -10,34) se asoció con un incremento en la posibilidad de presentar una menor calidad de vida.CONCLUSIÓN: Nuestros hallazgos sugieren que la disfunción eréctil y los síntomas prostáticos son eventos frecuentes en la población estudiada, al igual que una baja percepción de la calidad de vida. La atención oportuna y eficaz de estas patologías puede potencialmente mejorar la dinámica individual y social de los sujetos afectados.

Relationship between lower urinary tract symptoms and prostatic anatomic characteristics in patients with obesity and severe obesity.

OBJECTIVE: The objective of the study was to compare lower urinary tract symptoms and prostatic anatomic characteristic with prostatic enlargement in obese patients. MATERIALS AND METHODS: A comparative and cross-sectional study was conducted from October 2018 to November 2018. Lower urinary tract symptoms were compared in patients with body mass index (BMI) 30-34.9 and BMI 35-39. To evaluate these symptoms, the International Prostatic Symptom Score (IPSS) was used on 537 patients. The variables were age, weight and size, BMI, prostatic volume measurement by ultrasound, prostate-specific antigen (PSA), and finasteride treatment. Descriptive statistic was used, Cronbach's alpha, Fisher's exact test, and Chi-square. RESULTS: One hundred fulfilled inclusion criteria. Mean values were age 68.73 years, weight 84.98 kg, size 1.61 m, BMI 32.62, ultrasonographic prostatic size was 69.09 cm3, and PSA 1.94 ng/dl. The IPSS was severe in 3.6% (Group 1), 17.6% (Group 2); moderate 72% (Group 1), 70.5% (Group 2); and mild 33.3% (Group 1), 11.7% (Group 2), with significant differences between both groups (p = 0.05). Differences between values of prostatic volume and BMI did not show statistical significance (p ≥ 0.05). CONCLUSION: Statistical association between obesity and severe obesity and lower urinary tract symptoms is positive.

OBJETIVO: Comparar los síntomas del tracto urinario bajo y las características anatómicas de la próstata en pacientes con crecimiento prostático y obesidad. MÉTODO: Estudio comparativo, transversal, realizado de octubre a noviembre de 2018. Se compararon los síntomas del tracto urinario bajo y las características anatómicas de la próstata presentados por pacientes con obesidad y obesidad grave. Se aplicó el Índice Específico de Síntomas Prostáticos (IPSS) para evaluar los síntomas del tracto urinario bajo. Variables: edad, peso, talla, índice de masa corporal (IMC), volumen prostático por ultrasonido, antígeno prostático específico (PSA) y finasterida. Estadística: descriptiva, alfa de Cronbach, pruebas exacta de Fisher y ji al cuadrado. RESULTADOS: De 537 pacientes, 100 cumplieron los criterios de inclusión. Edad media: 68.73 años; peso medio: 84.98 kg; talla media: 1.61 m; IMC medio: 32.62; tamaño prostático ultrasonográfico medio: 69.09 cm3; cuantificación media de PSA: 1.94 ng/dl. El 72% tuvieron un IPSS moderado en ambos grupos. La diferencia entre IMC y síntomas del tracto urinario bajo tuvo una p = 0.05; no así el volumen prostático y el IMC en ambos grupos (p > 0.05). CONCLUSIÓN: Existe asociación entre la obesidad y la obesidad grave con los síntomas del tracto urinario bajo.

[Greenlight laser vaporization: Past, present and future?] / Fotovaporización próstata (FVP) con láser Greenlight. Pasado, presente y... futuro?

Greenlight laser prostate vaporization is considered a valid alternative to transurethral prostate resection (TURP) for patient with LUTS due to BPH. The current review highlights the current evidence on greenlight technique and current state of-the-art. We will review clinically relevant concerns such as size limitation, economic issues and same-day surgery options. We will also describe technological improvements overtime and its relationship with current vaporization practices.CURRENT SITUATION: Based on clinical trial Goliath, Greenlight 180W vaporization showed non-inferiority to TURP and similar mid-term functional outcomes. A benefit towards length of hospital stay, similar complication rate (below 80% at 2 years). The current laser generators (higher potency) are able to provide an ablative effect on tissue that is associated to a shorter operative time. The major advantage of greenlight laser is the same day discharge, with a low readmission rates. Greenlightlaser is more cost-effective than TURP. CONCLUSIONS: Green light laser remains as an alternativevalid option despite the technological improvementsin the field.

La Fotovaporización Prostática (FVP) con láser Greenlight es considerada como una alternativa válida a la Resección Transuretral de Próstata (RTU) para el tratamiento de los pacientes con sintomatología de tracto urinario inferior (STUI) condicionado por la hiperplasia benigna de próstata (HBP). En este artículo revisamos la evidencia actual de la técnica y el papel o estado actual de la misma. Analizamos los distintos puntos de mayor interés clínico, como son la limitación de tamaño prostático de los pacientes a intervenir, las consecuencias o repercusiones económicas de su aplicación o la posibilidad de realizar la misma en régimende Cirugía Mayor Ambulatoria (CMA). Por otra parte detallamos las cambios evolutivos en loque respecta a la tecnología Greenlight desde su introduccción hasta la época actual, con el impacto asociado en las nuevas técnicas de vaporización.SITUACIÓN ACTUAL: En base a la evidencia obtenida con el ensayo clínico Goliath, la FVP Greenlight 180W se considera como una técnica no inferior a la RTU de Próstata, con similares resultados funcionales, a medio plazo, con beneficio respecto a la misma en lo que respeta esencialmente a la estancia hospitalaria, manteniendo una tasa de ausencia de complicaciones mayor del 80% a los 2 años. Con los nuevos generadores láser, de mayor potencia, se puede coseguir un efecto de ablación tisular más eficaz, lo que se asocia a menor tiempo operatorio. Una de las claras ventajas de la FVP Greenlight es la posibilidad de realizar la intervención quirúrgica en régimen de CMA, con una muy baja tasa de re-ingresos hospitalarios, lo que la hace una técnica más coste-efectiva que la RTU de Próstata. CONCLUSIONES: Pese el avance de nuevas técnicas, minimamente invasivas, aún en fase de experimentación, o las técnicas de enucleación láser que se están expandiendo en los últimos años, la FVP Greenlight sigue siendo actualmente una alternativa válida y plenamente vigente respecto a la RTU de Próstata.

[Benign prostatic hyperplasia management during COVID-19 pandemia.] / Manejo de la hiperplasia benigna de próstata durante la pandemia COVID-19.

OBJECTIVES: The pandemic caused by the new SARS / Cov-2 Coronavirus represents an unprecedented scenario in modern medicine that affects many aspects of daily healthcare. Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) has a high prevalence and is related to high consumption of health resources. For this reason, we performed a revision of the management of LUTS and HBP during and after COVID-19 pandemic. MATERIAL AND METHODS: A group of experts in benign prostatic hyperplasia from different regions of Spain were selected to design a strategy to reorganize the management of benign prostatic hyperplasia and lower urinary tract symptoms during the pandemic. A comprehensive review of the literature was undertaken and a set of recommendations are generated. RESULTS: Recommendations for the management of LUTS-BPH during and after the SARS/CoV2 coronavirus pandemic outbreak consist of promoting telemedicine and developing joint protocols with Primary Care Attention .Clear diagnostic and treatment criteria and referral criteria must be established. Referral of patients for risk complications such as kidney failure, recurrent hematuria and obstructive uropathy are a priority. Surgeries due to BPH are generally potentially delayed until phases I and II of the pandemic, in which the percentage of hospitalized patients with COVID-19 does not exceed 25%, and it is necessary to determine COVID19 negativity. The surgical technique that associates the least complications and the shortest stay should be selected. CONCLUSIONS: The diagnosis and prescription of treatment for BPH during the COVID-19 pandemic should be based on telemedicine and joint protocols for primary care attention and urology. Elective surgical treatment can be delayed until we are in phases I or II, individualizing the surgical and anaesthetic technique of choice to minimize risks.

OBJETIVOS: La pandemia causada por el nuevo Coronavirus SARS/Cov-2 supone un escenario sin precedentes en la medicina moderna que afecta de manera indirecta en numerosos aspectos de nuestra actividad diaria como sanitarios. La hiperplasia benigna de próstata (HBP) es una patología con una elevada prevalencia y consumo de recursos sanitarios. Por ello, es necesaria una revisión en el manejo de la misma con el fin de adecuarlo a las necesidades impuestas por los acontecimientos recientes.MATERIAL Y MÉTODOS: Un grupo de expertos en hiperplasia benigna de próstata de distintas comunidades autónomas de España fueron contactados para diseñar una estrategia para reorganizar el manejo de la hiperplasia benigna de próstata y los síntomas del tracto urinario inferior durante la pandemia. Se realiza una revisión narrativa de la literatura publicada y se generan una serie de recomendaciones de manejo. RESULTADOS: Entre las recomendaciones para el manejo de HBP en tiempos de pandemia por coronavirus SARS/CoV2 se incluyen la promoción de teleconsulta y la realización de protocolos conjuntos con Atención Primaria estableciendo criterios de diagnóstico, tratamiento y derivación claros y homogéneos. Deben priorizarse las derivaciones pacientes complicaciones de riesgo tales como insuficiencia renal, hematuria recidivante y uropatía obstructiva. Desde el punto de vista quirúrgico, se trata generalmente de cirugías potencialmente demorables hasta fases I y II de la pandemia, donde el porcentaje de pacientes hospitalizados con Covid-19 no supera el 25%, siendo preciso determinar negatividad de COVID19. Debe seleccionarse la técnica quirúrgica que asocie una menor tasa de complicaciones así como una estancia más baja. CONCLUSIONES: El diagnóstico y el inicio del tratamiento médico de la HBP durante la pandemia debe basarse en la instauración de la telemedicina y protocolos conjuntos con atención primaria y urología. El tratamiento quirúrgico electivo se puede demorar hasta encontrarnos en fases I o II, individualizando la técnica quirúrgica y anestésica de elección para minimizar riesgos.

Nevus verrugoso gigante con componente angiomatoso cavernoso. Presentación de un caso / Giant Warty Nevus with Cavernous Angioma Component. Case Presentation

RESUMEN El nevus verrugoso es una hiperplasia benigna y congénita de la epidermis superficial y los anexos. Se considera un hamartoma derivado del ectodermo, posiblemente ocasionado por una aberración cromosómica localizada en el brazo largo del cromosoma 1. Se presenta el caso de un paciente de sexo masculino, de 3 años de edad, portador de nevus verrugoso gigante con componente angiomatoso cavernoso, en región occipital, sin otras anomalías. Se utilizaron los datos provenientes de fuentes documentales (carné obstétrico, carné pediátrico, historias clínicas hospitalaria y ambulatoria), exámenes de laboratorio e imagenológicos, así como información obtenida a partir de la entrevista a la madre, para describir la evolución desde el nacimiento. Se realizó búsqueda bibliográfica y se comentan aspectos relacionados con la incidencia, localizaciones, edad de presentación, las características clínicas e histopatológicas, el tratamiento y la evolución. Se realiza este reporte por la baja frecuencia de esta patología en el Hospital Pediátrico General Luis Ángel Milanés de Bayamo, Granma.

ABSTRACT The warty nevus is a benign and congenital hyperplasia of the superficial epidermis and the annexes. It is considered a hamartoma derived from the ectoderm, possibly caused by a chromosomal aberration located on the long arm of chromosome 1.The case of a 3 year-old male patient is presented, with a giant warty nevus with an angioma cavernous component in the occipital region, without other anomalies. Data from documentary sources (such as obstetric card, pediatric card and hospital and outpatient medical records), laboratory and imaging tests, as well as information obtained from the mother's interview, were used to describe the evolution from birth. Issues related to the incidence, locations, age of presentation, clinical and histopathological characteristics, treatment and evolution are discussed, on the bases of a bibliographic search. This report is made due to the low frequency of this pathology at the Paquito González Cueto de Cienfuegos University Pediatric Hospital.

[Comparison of monopolar versus bipolar transurethral resection of the prostate: Evaluation of the impact on sexual function]. / Comparación entre resección monopolar vs. resección bipolar transuretrales de próstata y su impacto sobre la función sexual.

OBJECTIVES: To assess the effects of monopolar transurethral resection of the prostate (M-TURP) and bipolar TURP (B-TURP) on overall sexual function. METHODS: From December 2014 to September 2016, 100 eligible candidates with benign prostatic hyperplasia were prospectively recruited and randomized 1:1 into M-TURP/B-TURP arms (58 and 42 patients, respectively) and followed up at 1, 3 and 6 months. A univariate and multivariate analyses using the chi-squared test and a logistic regression model were performed. We recorded the age, medical conditions such as hypertension and diabetes, history of smoking, preoperative prostatic volume, prostatic symptoms scale, sexual function assessment, surgeon experience, resected grams, percentage of resected tissue and presence of retrograde ejaculation. Prostatic symptoms and erectile function (EF) assessment were quantified using self-administered IPSS scores and IIEF-5, respectively, at baseline and in each subsequent visit. RESULTS: Mean age was 66 years (50-82). No statistical differences were found between both groups regarding medical comorbidities, preoperative IPSS and IIEF-5. Mean prostatic volume was 37.2 cm3 (10-68) and mean amount of resected tissue was 11.75g (6-58). At baseline 77,6% of patients has severe LUTS, and 50% has moderate-severe erectile dysfunction. Univariate analyses show that in both groups, history of diabetes mellitus, age and preoperative IIEF-5 were associated with poor EF. However, multivariate analyses revealed that age was the only factor associated with a poor EF. These results were similar at 3 and 6 postoperative months. We did not find an association between surgeon experience, source of energy employed or percentage of resected tissue with the development of postoperative retrograde ejaculation (52%). At first postoperative month, 44% of patients were still referring moderate prostatic symptoms and 50% had severe erectile dysfunction maintained at 6 months in both groups. CONCLUSIONS: There were no differences between the source of energy employed and changes on overall sexual function. Age is the only factor associated with a poor EF status.