Mitigating Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Ameliorating Sexual Function and Psychological Well-Being in Older Men.

This study aimed to investigate the prevalence of lower urinary tract symptoms (LUTS) in older men (N= 3056) with benign prostatic hyperplasia (BPH) and its effects on their sexual function and mental health. Descriptive, correlation, and regression analyses were used to explore the relationships between prostate and lower urinary tract health and psychological well-being. Better prostate and lower urinary tract health positively affected psychological well-being, and sexual function also had a positive influence. LUTS have an adverse impact on sexual function and mental health. Early intervention is crucial for mitigating the negative impact of LUTS on the quality of life in older men. Addressing prostate and lower urinary tract health issues through appropriate interventions may improve psychological well-being. Health care professionals must consider the adverse effects of BPH and LUTS on sexual function and mental health, and implement interventions to enhance the overall quality of life in older men.

Use of the International Prostate Symptom Score (IPSS) in Chinese male patients with benign prostatic hyperplasia.

PURPOSE: To test the psychometric properties of the International Prostate Symptom Score (Hong Kong Chinese version 2) (IPSS) in Chinese male patients with benign prostatic hyperplasia (BPH) under secondary care. METHODS: A prospective longitudinal study was done by interviewing subjects at baseline, at 2 week after baseline for assessing test-retest reliability and at 26 week after baseline for assessing responsiveness. All subjects were interviewed to complete a structured questionnaire including IPSS, Short Form-12 Health Survey version 2 (SF-12v2) and Depression Anxiety Stress Scale (DASS). RESULTS: The IPSS HRQOL score had weak correlations with SF-12v2 summary and DASS domain scores. For reliability analysis, Cronbach's alpha coefficient was 0.90 for the seven symptom-related items. The intraclass correlation coefficients of the IPSS total symptom score and HRQOL score were 0.90 and 0.86, respectively. For sensitivity, statistically significant differences were detected between the subjects with BPH and those without for IPSS total symptom score (effect size = 0.68) but not the IPSS HRQOL score. The areas under ROC curves for the IPSS total symptom and HRQOL scores were 0.67 and 0.60, respectively. CONCLUSIONS: The IPSS was valid, reliable instrument in Chinese patients with BPH. The IPSS total symptom score, but not the HRQOL score, is sensitive in differentiating subgroups.

Inflammatory myofibroblastic tumours of the urinary bladder: multi-centre 18-year experience.

OBJECTIVE: To review a series of inflammatory myofibroblastic tumours (IMTs) of the urinary bladder in 10 hospitals in Hong Kong. METHODS: A database search in the pathology archives of 10 hospitals in Hong Kong from 1995 to 2013 was performed using the key words 'inflammatory myofibroblastic tumour', 'inflammatory pseudotumour' and 'spindle cell lesion'. Patient characteristics, clinical features, histological features, immunohistochemical staining results and treatment outcomes were reviewed. RESULTS: Nine cases of IMT of the urinary bladder were retrieved. The mean age was 45.4 ± 22.8 years (range 11-78). Eight patients (88.9%) presented with haematuria and 5 patients (55.6%) had anaemia with a mean haemoglobin level of 6.8 ± 1.3 g/dl. Histologically, the majority of patients (77.8%) had a compact spindle cell pattern. Anaplastic lymphoma kinase staining was positive in 75% of cases. During a mean follow-up period of 43.4 months (range 8-94), none of them developed any local recurrence or distant metastasis. CONCLUSIONS: A high index of suspicion of IMT should be maintained for young patients presenting with bleeding bladder tumours and significant anaemia. IMTs of the urinary bladder run a benign disease course, and good prognosis can be achieved after surgical resection.

Heat Damage Zones Created by Different Energy Sources Used in the Treatment of Benign Prostatic Hyperplasia in a Pig Liver Model.

INTRODUCTION: There are different types of transurethral prostatic surgeries and the complication profiles are different. This study aims to compare the heat damage zones (HDZ) created by five different technologies in a pig liver model. MATERIALS AND METHODS: Monopolar resection, bipolar resection, electrovaporization, and Greenlight™ lasers of 120 and 180 W were used to remove fresh pig liver tissue in a simulated model. Each procedure was repeated in five specimens. Two blocks were selected from each specimen to measure the three deepest HDZ. RESULTS: The mean of HDZ was 295, 234, 192, 673, and 567 µm, respectively, for monopolar resection, bipolar resection, electrovaporization, Greenlight laser 120 W, and Greenlight laser 180 W, respectively. The Greenlight laser produced one to three times deeper HDZ than the other energy sources (p=0.000). CONCLUSION: Both 120 and 180 W Greenlight lasers produced deeper HDZ than the other energy sources. Urologists need to be aware of HDZ that cause tissue damage outside the operative field.

Ductal adenocarcinoma of the prostate: a Hong Kong case series.

OBJECTIVES: To review and report our local experience in the management of ductal adenocarcinoma of the prostate. METHODS: Retrospective review of patients diagnosed with ductal adenocarcinoma of the prostate in two regional urological centres in Hong Kong during 1995-2009. Clinical information, treatment and outcomes were retrieved for further analysis. RESULTS: We identified 19 Chinese patients diagnosed with ductal adenocarcinoma of the prostate. Majority of our patients presented with retention of urine and haematuria. At presentation, seven patients were already at an advanced stage with evidence of rectal invasion or distant metastasis. The overall treatment outcome was poor with high failure rate after either local or systemic hormonal therapy. CONCLUSION: We observed a predilection of this tumour to be locally aggressive, and hence a relatively high incidence of intra-luminal growth and rectal invasion. We observed a high failure rate after either radical prostatectomy or hormonal therapy.

Pre-operative tumor localization and evaluation of extra-capsular extension of prostate cancer: how misleading can it be?

PURPOSE: To verify the accuracy of transrectal ultrasound-guided prostatic biopsy (TRUS Bx), magnetic resonance imaging (MRI) and their combination in evaluating the laterality of prostate cancer and to determine the accuracy of MRI in assessing extra-capsular extension of prostate cancer. MATERIALS AND METHODS: We retrospectively reviewed our past 100 consecutive series of radical prostatectomy performed between February 2010 and April 2012 at our institution. Their TRUS Bx and MRI results were compared with the pathology of the radical prostatectomy specimens. For tumor localization, we calculated the accuracies in unilateral diseases, bilateral diseases, overall accuracies and Cohen Kappa concordance coefficient of TRUS Bx, MRI and their combination. For the assessment of extra-capsular extension, we calculated the sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, likelihood ratio positive and likelihood ratio negative of MRI. RESULTS: Eighty-two percent of our radical prostatectomy specimens had bilateral tumor involvement and 32% had extra-capsular extension. The accuracies of TRUS Bx in unilateral disease, bilateral disease and overall accuracy were 15.2%, 91.4% and 43.6%, respectively. The accuracies of MRI in unilateral disease, bilateral disease and overall accuracy were 11.1%, 66.7% and 38.9%, respectively. When combining the assessment of TRUS Bx and MRI, the accuracies in unilateral disease, bilateral disease and overall accuracy were 16.7%, 75% and 55.6%, respectively. The Cohen Kappa concordance co-efficient of TRUS Bx, MRI, and combination of them were 0.1165, -0.2047 and -0.1084, respectively. The positive predictive value, negative predictive value, sensitivity, specificity, overall accuracy, likelihood ratio positive and likelihood ratio negative of MRI in assessing extra-capsular extension were 33.3%, 69.8%, 5.9%, 94.9%, 67.9%, 1.16 and 0.99, respectively. CONCLUSION: TRUS Bx, MRI, and their combination had poor concordance and limited accuracies in assessment of the laterality of tumor involvement. The combination of TRUS Bx and MRI offered a better of accuracy when compared to either modality alone. MRI was a specific, but not sensitive tool in assessing the presence of extra-capsular extension.

A prospective study comparing bipolar endoscopic enucleation of prostate with bipolar transurethral resection in saline for management of symptomatic benign prostate enlargement larger than 70 g in a matched cohort.

PURPOSE: This study aims to compare the efficacy and safety of bipolar endoscopic enucleation of prostate with transurethral resection in saline for large BPE greater than 70 g. METHODS: All patients from two urology centres who had bipolar enucleation or bipolar resection performed for large BPE greater than 70 g from December 2008 to April 2012 were prospectively assessed. The pre-operative and post-operative measures included IPSS, QOL score, uroflowmetry results, PSA and prostate volume. The perioperative measures were compared, and the post-operative complications/resumption of medical treatment for lower urinary tract symptoms were also assessed. RESULTS: There were 74 and 86 consecutive patients with bipolar enucleation and bipolar resection performed, respectively. No difference in pre-operative characteristics was observed between the two groups with mean prostate size 115 cc in each group. Comparing bipolar enucleation with bipolar resection, there was longer operative time (156 vs 87 min, p = 0.000), more haemoglobin drop (1.8 vs 1.1 g/dL, p = 0.006), but more prostate tissue resected (61.4 vs 45.7 g, p = 0.000). There was no difference in overall transfusion requirement and hospital stay. At 12 month after the procedure, patients with bipolar enucleation performed had better IPSS (6.4 vs 11.6, p = 0.032), QOL (1.7 vs 2.6, p = 0.040) and peak flow rate (19.5 vs 15.1 ml/s, p = 0.019). The post-operative complications had no significant difference between the two groups. CONCLUSIONS: For surgical treatment of big BPE, bipolar endoscopic enucleation of prostate provided superior functional outcome than bipolar resection but required longer operative time.