Comparative Analysis between Monopolar and Bipolar TURP - A Single Institute Prospective Controlled Study

Background: The ‘gold standard’ surgical treatment of clinically obstructive BPH is TURP, but life-threatening complications such as transurethral resection syndrome are occasionally observed. This has traditionally been provided as monopolar TURP, but morbidity associated with MTURP has led to the introduction of other surgical techniques. Objectives: To compare the effects of bipolar and monopolar TURP. Methods: In this prospective comparative study, 50 patients of each group undergo transurethral resection of prostate were enrolled and randomized to surgery by M‑TURP or B-TURP. International Prostate Symptom Score (IPSS), uroflowmetry, ultrasonography, prevoid, postvoid and international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed. Results:No significant differences found in baseline characteristics or operative data, No differences found in IPSS, Qmax or PVRU volume. Conclusions:Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and Bipolar -TURP for the treatment of BPH. Accordingly, M-TURP continues to be a valid option for the treatment of BPE. Keywords: Transurethral resection of prostate, Monopolar, Bipolar.

Comparison of different en bloc holmium laser enucleation of the prostate techniques to reduce the rate of postoperative transient urinary incontinence

Objective To investigate postoperative risk factors for transient urinary incontinence (TUI) after different en bloc holmium laser enucleation of the prostate (HoLEP) techniques. Methods We retrospectively analyzed 169 consecutive patients who underwent HoLEP using the original en bloc technique (n = 41), en bloc with early mucosal strip detachment technique (n = 72), and three horseshoe-shaped incisions technique (n = 56) to treat bladder outlet obstruction from January 2017 to October 2019. Preoperative variables and surgical quality indexes were compared between the groups. TUI was defined as any hygienic or social problem caused by involuntary loss of urine at 2 weeks postoperatively. The postvoid residual urine volume, maximum urinary flow rate, and International Prostate Symptom Score (IPSS) were assessed. Results Among all three techniques, the three horseshoe-shaped incisions technique was significantly associated with the lowest incidence of TUI and the lowest IPSS. Although not statistically significant, the three horseshoe-shaped incisions group also showed a trend toward a faster enucleation time. No life-threatening intraoperative complications occurred in any group. Conclusion Use of three horseshoe-shaped incisions in en bloc HoLEP prevented urethral sphincter damage with a low rate of postoperative TUI. Further long-term, multicenter comparative assessment is required. Research Registry number: 6848

A Modified Technique of Thulium Laser Enucleation for Benign Prostatic Hyperplasia With Non-morcellator Approach

Background: Until recently, most enucleation techniques of the prostate were performed with the application of morcellator. We introduce a modified enucleation technique of thulium laser with non-morcellator approach, which is about incising and vaporizing remaining prostate tissue instead of a morcellator.Methods: A retrospective evaluation of 223 patients undergoing ThuLEP from January 2014 to December 2015 was performed in our institution. One hundred five of the patients used morcellator while the other 118 used non-morcellator approach. All patients were assessed with the International Prostate Symptom Score (IPSS), quality of life (Qol), ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR). We reassessed these parameters at 1-, 3-, 6-, and 12-months after operation. Operative time, perioperative, and postoperative complications were also recorded.Results: Significant improvement was noted in the IPSS, QoL, Qmax, and PVR in both groups at the 12-month follow-up, and assessment showed no differences in these parameters between the two groups. Comparisons of the total operation time and enucleation time demonstrated no significant differences between the two groups. Our non-morcellator approach needed more time to incise and vaporize the enucleated tissue compared to morcellation when the prostate volume was about 40–80 ml (p < 0.05), while it showed a significant lower rate of superficial bladder injury than using morcellator (p < 0.05). There were no significant differences in other complications between the two groups (p > 0.05).Conclusions: Our modified technique is a safe and effective procedure for the treatment of BPH avoiding the potential complications caused by morcellator.

Clinical Significance of Intravesical Prostatic Protrusion Index in Patients with Clinical Diagnosis of Benign Prostatic Hyperplasia.

Purpose: To investigate the clinical significance of the intravesical prostatic protrusion (IPP) index in benign prostatic hyperplasia (BPH) patients to clarify its diagnostic value in predicting the clinical and structural abnormalities of the prostate. Materials and Methods: In this descriptive and analytical cross-sectional study, we include every man older than 50 years old with lower urinary tract symptoms (LUTS), predominantly voiding or obstructive, suggestive of BPH. The patients were evaluated to determine the following indices: IPSS (International Prostate Symptom Score) Index, QoL (quality of life), prostate volume (PV) and postvoid residual urine (PVR), serum PSA level, and the maximum urinary flow rate (Qmax) obtained by uroflowmetry. Subsequently, the assessment of the IPP index was undertaken by transabdominal ultrasonography. The categorization of the IPP index was done into 3 grades: grade one (below 5 mm), grade two (between 5 and 10 mm), and grade three (greater than 10 mm). Results: The significant direct correlation between the intravesical prostatic protrusion and international prostate symptom score, quality of life, prostate volume, postvoid residual urine, and serum PSA as well as inversely with the maximum urinary flow rate was confirmed both before and after the medical treatment. Also, the need for surgical intervention increased significantly with increasing IPP levels. Conclusion: The intravesical prostatic protrusion can be used to evaluate and predict the severity of symptoms and outcomes in patients with clinical BPH.

Clinical E ffect of Pressing Needle on Nocturnal Enuresis in Children

Objective:With the fast dev elopment of economy and culture, medical professionalsand parents are paying more and more attention to nocturnal enuresis (NE) since it raisedthe negative impact on children’s health and imposes a long term burden on families.The present clinical investigation aims to evaluate the clinical effect of pressing needleon nocturnal enuresis in children through a randomized controlled clinical trial.Materials andMethods: A total of 120 children with nocturnal enuresis were randomlyassigned into pressing needle group, desmopressin group and pills Capsule group, 40cases in each group. The children in pressing needle group were treated with pressingneedles, and those in the desmopressin group and Suoquan pills were orallyadministrated with desmopressin and Suoquan pills, respectively. Combined behavioraltherapy was also given in all the three groups during the treatment. Enuresis frequency,degree of arousal, functional b ladder capacity (FBC) and postvoid residual urine volume(PRUV) were employed as the indicators to evaluate the clinical efficacy in the threegroups. After 6 months of follow up, the recurrence rate of the three groups was alsoanalyzed for efficacy assessment.Results:The total responsive rate in pressing needle group was 95.0%, which was higherthan 87.5% of Suoquan pills group (p < 0.05), and significantly higher than 77.5% of desmopressin group (p < 0.01)desmopressin group (p < 0.01).. The frequency of enuresis was significantly The frequency of enuresis was significantly lowered after lowered after treatment (p < 0.01), concurrently with an evident improvement in arousal levels in all treatment (p < 0.01), concurrently with an evident improvement in arousal levels in all of the three groups (p < 0.01), and the interof the three groups (p < 0.01), and the inter--group difference in postgroup difference in post--treatment enuresis treatment enuresis frequencyfrequency and arousal level between pressing needle group and thand arousal level between pressing needle group and the other two groups was e other two groups was also statialso statistically significant (p < 0.05).stically significant (p < 0.05). The recurrence rate of pressing needle group, The recurrence rate of pressing needle group, desmopressin group and Suoquan pills group was 7.89%, 48.39% and 22.86%, desmopressin group and Suoquan pills group was 7.89%, 48.39% and 22.86%, respectively, with a difference which was statistically significant betrespectively, with a difference which was statistically significant between pressing needle ween pressing needle group and desmopressin group (p < 0.01), but not between pressing needle group and group and desmopressin group (p < 0.01), but not between pressing needle group and Suoquan pills group (p > 0.05). Suoquan pills group (p > 0.05). Conclusion: Conclusion: Pressing needle treatment showed a Pressing needle treatment showed a substantial clinical effect on enuresis in children by improving the bladsubstantial clinical effect on enuresis in children by improving the bladder function, der function, increasing the FBC and reducing PRUV of the bladder, as well as by enhancing the increasing the FBC and reducing PRUV of the bladder, as well as by enhancing the degree of arousal and lowering the recurrence rate, therefore is suggested to be degree of arousal and lowering the recurrence rate, therefore

Is There a Correlation Between Behçet Disease and Lower Urinary Tract Symptoms?

Purpose: In this study, we aimed to determine the prevalence of lower urinary tract symptoms (LUTS) in patients with Behçet disease (BD) and to investigate the relationship between the severity of BD and LUTS.Methods: Fifty-five patients with BD were included in this study from January to December 2018. All patients received a detailed urological evaluation. Additionally, BD activity was investigated using the Behçet Disease Current Activation Form. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire Short Form, 8-item overactive bladder questionnaire forms, uroflowmetry, and postvoid residual urine volume were evaluated.Results: The mean age of the patients was 42.6 years. The mean activity score of BD was 4.6±3.2 and the mean IPSS score was 7.3±7.3. Sex had no significant effect on the BD activity score. The BD activity score was significantly correlated with the IPSS score, frequency of daytime urination, nocturia, and urgency. It was also correlated with the presence and the severity of urinary incontinence and the effect of urinary incontinence on daily life. Peak flow rate, voided volume, and the postvoid residual urine volume were not correlated with the BD activity score.Conclusions: LUTS were highly prevalent in patients with BD, and the severity and current activity of BD were correlated with frequency, nocturia, urgency, and urinary incontinence. Therefore, a urological evaluation of patients with BD in whom the activity and severity of the disease is elevated should be carried out comprehensively and patients should be managed accordingly.

Should We Always Use Antibiotics after Urodynamic Studies in High-Risk Patients?

Aim. The aim of this observational study was to evaluate the effectiveness of a phytotherapic drug (Canephron N) in preventing urinary tract infection (UTI) in high-risk women undergoing urodynamic studies (UDS). Methods. The study protocol was approved by the local institutional ethical committee. Adult women with at least one risk factor for acquiring UTI (defined as: age over 70, elevated postvoid residual urine>100 ml, recurrent UTI, pelvic organ prolapse (POP) ≥II in POP-Q scale, and neurogenic bladder) had received after UDS either a single oral dose of fosfomycin trometamol (FT) (3 grams) or a phytodrug containing centaury herb, lovage root, and rosemary leaves (5 ml taken orally three times daily for one week). All patients included in the study had no pyuria according to urine dipstick (nitrite and/or blood and/or leukocyte esterase) and negative urine culture (CFU < 103/ml) before UDS. Urine samples were also tested 7 days after UDS. Results. Seventy-two high-risk participants completed the study. Seven days after urodynamic studies UTI symptoms, pyuria (nitrite and/or blood and/or leukocyte esterase) and bacteriuria with E. coli occurred in two patients (one (2.8%) in the FT and one (2.7%) in the phytodrug group, respectively). No statistical differences in UTI incidence were found between both treatment groups. We did not observe any additional adverse events in both groups. The major disadvantage of prophylaxis with the phytodrug as compared to FT was the necessity of continuing therapy for 7 days. Conclusion. Prophylaxis of UTI with a phytodrug (Canephron N) may be considered a good alternative to antibiotic prophylaxis use after UDS in high-risk female patients.