K. Watanabe, A. Otsuka, Y. Kitagawa, et al., “Preoperative Factors Predicting Poor Therapeutic Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Hyperplasia,” Lower Urinary Tract Symptoms 16, no. 4 (2024): e12530, https://doi.org/10.1111/luts.12530.
In the Result section of the Abstract, the second sentence that “Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group” was incorrect. This should have read: “Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR) were lower and the prevalence of OAB was higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group.”
We apologize for this error.
K.Watanabe, A. Otsuka, Y. Kitagawa, et al., "Preoperative Factors Predicting Poor Therapeutic Efficiency of Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Hyperplasia," Lower Urinary Tract Symptoms 16, no.4 (2024): e12530, https://doi.org/10.1111/luts.12530.In 摘要的 "结果 "部分，第二句 "疗效差组的前列腺腔内突出（IPP）、IPSS、IPSS-QOL、排尿后残余尿量（PVR）和膀胱过度活动症（OAB）显著高于疗效好组 "有误。应改为"疗效差组的膀胱内前列腺突出（IPP）、IPSS、IPSS-QOL、排尿后残余尿量（PVR）均低于疗效好组，而膀胱过度活动症的发病率高于疗效好组。"我们对此错误表示歉意。
{"title":"Correction to “Preoperative Factors Predicting Poor Therapeutic Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Hyperplasia”","authors":"","doi":"10.1111/luts.12536","DOIUrl":"10.1111/luts.12536","url":null,"abstract":"<p>K. Watanabe, A. Otsuka, Y. Kitagawa, et al., “Preoperative Factors Predicting Poor Therapeutic Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Hyperplasia,” <i>Lower Urinary Tract Symptoms</i> 16, no. 4 (2024): e12530, https://doi.org/10.1111/luts.12530.</p><p>In the Result section of the Abstract, the second sentence that “Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group” was incorrect. This should have read: “Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR) were lower and the prevalence of OAB was higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group.”</p><p>We apologize for this error.</p>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.12536","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the safety and effectiveness of vibegron, a highly selective β3-adrenoceptor agonist, in Japanese patients with overactive bladder (OAB) in a real-world clinical setting.
Methods
This prospective survey was conducted from August 2019 to July 2023 using a central registration method. Patients newly treated with vibegron for OAB were followed for 12 weeks, and those who continued treatment were observed for up to 52 weeks. Adverse drug reactions (ADRs) and the overall improvement level were assessed, and overactive bladder symptom score (OABSS) and International Prostate Symptom Score-Quality of Life (IPSS QOL) score were collected.
Results
Of the 1848 patients in the safety analysis set, 154 ADRs were reported in 141 patients (7.63%). Common ADRs were increased residual urine volume (1.30%), constipation (1.14%), dysuria and urinary retention (0.97% each), cystitis (0.65%), and dry mouth (0.32%). The incidence of urinary retention-related adverse events (AEs) was higher in male patients, patients ≥ 65 years old, and patients with benign prostatic hyperplasia. The effectiveness rate was 88.8% among the 1561 patients in the effectiveness analysis set. Significant improvement in both OABSS and IPSS QOL scores was observed at all observation periods. The rate of achieving the minimal clinically important change in OABSS total score at the final evaluation was 75.35%. OABSS scores were also significantly reduced in all subgroup analyses.
Conclusions
This survey found no major concerns regarding the safety and effectiveness of vibegron in Japanese OAB patients, except for urinary retention-related AEs. Vibegron is considered to represent a useful drug for treating OAB symptoms in a real-world clinical setting.
{"title":"Safety and Effectiveness of Vibegron in Japanese Patients With Overactive Bladder: A Japanese Postmarketing Survey","authors":"Shoko Yoshimura, Hiromitsu Yagi, Kazunori Abe, Masakazu Yamasaki","doi":"10.1111/luts.12535","DOIUrl":"10.1111/luts.12535","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the safety and effectiveness of vibegron, a highly selective β<sub>3</sub>-adrenoceptor agonist, in Japanese patients with overactive bladder (OAB) in a real-world clinical setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective survey was conducted from August 2019 to July 2023 using a central registration method. Patients newly treated with vibegron for OAB were followed for 12 weeks, and those who continued treatment were observed for up to 52 weeks. Adverse drug reactions (ADRs) and the overall improvement level were assessed, and overactive bladder symptom score (OABSS) and International Prostate Symptom Score-Quality of Life (IPSS QOL) score were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1848 patients in the safety analysis set, 154 ADRs were reported in 141 patients (7.63%). Common ADRs were increased residual urine volume (1.30%), constipation (1.14%), dysuria and urinary retention (0.97% each), cystitis (0.65%), and dry mouth (0.32%). The incidence of urinary retention-related adverse events (AEs) was higher in male patients, patients ≥ 65 years old, and patients with benign prostatic hyperplasia. The effectiveness rate was 88.8% among the 1561 patients in the effectiveness analysis set. Significant improvement in both OABSS and IPSS QOL scores was observed at all observation periods. The rate of achieving the minimal clinically important change in OABSS total score at the final evaluation was 75.35%. OABSS scores were also significantly reduced in all subgroup analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This survey found no major concerns regarding the safety and effectiveness of vibegron in Japanese OAB patients, except for urinary retention-related AEs. Vibegron is considered to represent a useful drug for treating OAB symptoms in a real-world clinical setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.12535","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nocturia is considered a clinical problem when nocturnal urinary frequency is two or more times. For affected patients, development of depression, falling, and increased mortality rate are matters of concern. The present study investigated the efficacy and safety of lemborexant for insomnia patients with nocturia.
Methods
Insomnia patients (Athens Insomnia Scale [AIS] ≥ 6) who typically awoke twice or more during the night to urinate and were examined at our institutions from June 2021 to December 2022 were enrolled. Each was administrated 5 mg of lemborexant, one tablet, daily for 4 weeks. Total AIS score, nocturia frequency, individual frequency-volume chart findings, and N-QOL score were examined before and after administration.
Results
Of the 37 patients recruited, 5 were excluded, thus 32 were enrolled and subjected to analyses. Following lemborexant therapy, the mean AIS total score was significantly decreased from 11.4 to 7.8 (p < 0.01) as was mean number of nocturia episodes from 3.4 to 2.3 (p < 0.001). Furthermore, the mean single voided urine volume at night was significantly increased from 182.5 to 225.3 mL (p < 0.001)and mean period of undisturbed sleep was significantly extended from 105.3 to 174.8 min (p < 0.001), while mean total N-QOL score was significantly improved from 49.6% to 64.8% (p < 0.001). As for adverse events, mild somnolence was observed in three cases.
Conclusions
Lemborexant may be effective and safe for use in insomniac patients with nocturia.
{"title":"Efficacy and Safety of Lemborexant for Insomnia Patients With Nocturia—A Prospective Study","authors":"Yoshikazu Togo, Yohei Kaizuka, Seiji Nagasawa, Keisuke Kajio, Nobuyuki Kondoh, Keizo Taguchi","doi":"10.1111/luts.12534","DOIUrl":"10.1111/luts.12534","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Nocturia is considered a clinical problem when nocturnal urinary frequency is two or more times. For affected patients, development of depression, falling, and increased mortality rate are matters of concern. The present study investigated the efficacy and safety of lemborexant for insomnia patients with nocturia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Insomnia patients (Athens Insomnia Scale [AIS] ≥ 6) who typically awoke twice or more during the night to urinate and were examined at our institutions from June 2021 to December 2022 were enrolled. Each was administrated 5 mg of lemborexant, one tablet, daily for 4 weeks. Total AIS score, nocturia frequency, individual frequency-volume chart findings, and N-QOL score were examined before and after administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 37 patients recruited, 5 were excluded, thus 32 were enrolled and subjected to analyses. Following lemborexant therapy, the mean AIS total score was significantly decreased from 11.4 to 7.8 (<i>p</i> < 0.01) as was mean number of nocturia episodes from 3.4 to 2.3 (<i>p</i> < 0.001). Furthermore, the mean single voided urine volume at night was significantly increased from 182.5 to 225.3 mL (<i>p</i> < 0.001)and mean period of undisturbed sleep was significantly extended from 105.3 to 174.8 min (<i>p</i> < 0.001), while mean total N-QOL score was significantly improved from 49.6% to 64.8% (<i>p</i> < 0.001). As for adverse events, mild somnolence was observed in three cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lemborexant may be effective and safe for use in insomniac patients with nocturia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yukio Homma, Yoshiyuki Akiyama, Jang Hwan Kim, Yao-Chi Chuang, Seong Jin Jeong, En Meng, Takeya Kitta, Jia-Fong Jhang, Akira Furuta, Kyu-Sung Lee, Daichi Maeda
The clinical guidelines for interstitial cystitis (IC) and bladder pain syndrome (BPS) have been revised by updating our previous guidelines. The symptoms of IC and BPS, collectively called as hypersensitive bladder (HSB) symptoms, are virtually indistinguishable between IC and BPS; however, IC and BPS should be considered as a separate entity of disorders. We define IC as a bladder disease with Hunner lesions, usually associated with HSB symptoms and bladder inflammation, and BPS as a condition with HSB symptoms in the absence of Hunner lesions and any confusable diseases. Pathophysiology totally differs between IC and BPS. IC involves immunological inflammation probably resulting from autoimmunity, while BPS is associated with the interaction of multiple factors such as neurogenic inflammation, exogenous substances, urothelial defects, psychological stress, and neural hyperactivity. Histopathology also differs between IC and BPS. IC is associated with severe inflammation of the whole bladder accompanied by plasma cell infiltration and urothelial denudation, while BPS shows little pathological changes. Management should begin with a differential diagnosis of IC or BPS, which would require cystoscopy to determine the presence or absence of Hunner lesions. The patients should be treated differently based on the diagnosis following the algorithm, although pain management would be common to IC and BPS. Clinical studies are also to be designed and analyzed separately for IC and BPS.
间质性膀胱炎（IC）和膀胱疼痛综合征（BPS）的临床指南已经修订，更新了我们之前的指南。间质性膀胱炎和膀胱疼痛综合征的症状统称为高敏感性膀胱（HSB）症状，两者几乎没有区别；但是，间质性膀胱炎和膀胱疼痛综合征应被视为不同的疾病。我们将 IC 定义为伴有 Hunner 病变的膀胱疾病，通常伴有 HSB 症状和膀胱炎症；将 BPS 定义为伴有 HSB 症状但无 Hunner 病变和任何可混淆疾病的情况。IC 和 BPS 的病理生理学完全不同。IC 涉及可能由自身免疫引起的免疫性炎症，而 BPS 则与神经源性炎症、外源性物质、尿道缺陷、心理压力和神经亢进等多种因素的相互作用有关。IC 和 BPS 的组织病理学也有所不同。IC 与整个膀胱的严重炎症有关，伴有浆细胞浸润和尿路上皮变性，而 BPS 几乎没有病理变化。治疗应从鉴别诊断 IC 或 BPS 开始，这需要进行膀胱镜检查以确定是否存在 Hunner 病变。虽然 IC 和 BPS 的疼痛治疗方法相同，但患者应根据诊断结果按照算法进行不同的治疗。临床研究也应针对 IC 和 BPS 分别进行设计和分析。
{"title":"Definition Change and Update of Clinical Guidelines for Interstitial Cystitis and Bladder Pain Syndrome","authors":"Yukio Homma, Yoshiyuki Akiyama, Jang Hwan Kim, Yao-Chi Chuang, Seong Jin Jeong, En Meng, Takeya Kitta, Jia-Fong Jhang, Akira Furuta, Kyu-Sung Lee, Daichi Maeda","doi":"10.1111/luts.12532","DOIUrl":"https://doi.org/10.1111/luts.12532","url":null,"abstract":"<div>\u0000 \u0000 <p>The clinical guidelines for interstitial cystitis (IC) and bladder pain syndrome (BPS) have been revised by updating our previous guidelines. The symptoms of IC and BPS, collectively called as hypersensitive bladder (HSB) symptoms, are virtually indistinguishable between IC and BPS; however, IC and BPS should be considered as a separate entity of disorders. We define IC as a bladder disease with Hunner lesions, usually associated with HSB symptoms and bladder inflammation, and BPS as a condition with HSB symptoms in the absence of Hunner lesions and any confusable diseases. Pathophysiology totally differs between IC and BPS. IC involves immunological inflammation probably resulting from autoimmunity, while BPS is associated with the interaction of multiple factors such as neurogenic inflammation, exogenous substances, urothelial defects, psychological stress, and neural hyperactivity. Histopathology also differs between IC and BPS. IC is associated with severe inflammation of the whole bladder accompanied by plasma cell infiltration and urothelial denudation, while BPS shows little pathological changes. Management should begin with a differential diagnosis of IC or BPS, which would require cystoscopy to determine the presence or absence of Hunner lesions. The patients should be treated differently based on the diagnosis following the algorithm, although pain management would be common to IC and BPS. Clinical studies are also to be designed and analyzed separately for IC and BPS.</p>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the possible association between androgenic alopecia (AGA) and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).
Methods
A total of 148 patients aged over 45 with LUTS secondary to BPH were prospectively enrolled in this study. According to the Norwood–Hamilton classification, the patients were divided into two groups: AGA (n = 69) and non-AGA (n = 79). In addition, the cases of AGA were categorized as vertex (n = 39) and frontal baldness (n = 30). The International Prostate Symptom Score (IPSS), uroflowmetry parameters, prostate volume, serum total testosterone (TT), and free and total prostate-specific antigen concentrations of all patients were assessed and compared between the groups. Correlations between the AGA grade and other variables were also investigated.
Results
The serum TT level (354 ± 97.1 vs. 308.6 ± 73.1 ng/dL, p = 0.01), total IPSS (16.1 ± 8.1 vs. 13.4 ± 7.7, p = 0.04), IPSS storage subscore (IPSS-S) (7.1 ± 3.5 vs. 5.8 ± 3.6, p = 0.03), and number of nocturia episodes (2.5 ± 1.4 vs. 1.8 ± 1.4, p < 0.01) were significantly higher in the AGA group than in the non-AGA group. There were no significant differences in any of the parameters between the patients with vertex and frontal baldness. The AGA grade showed a significant positive correlation with the TT level (r = 0.407, p = 0.003), IPSS-S (r = 0.164, p = 0.04), and number of nocturia episodes (r = 0.203, p = 0.015).
Conclusions
This study demonstrated that among patients with LUTS, those with AGA had worse symptoms and higher TT levels compared with those without AGA of similar age. Furthermore, the AGA grade was positively correlated with the TT level and storage symptoms.
目的 评估雄激素性脱发（AGA）与继发于良性前列腺增生症（BPH）的下尿路症状（LUTS）之间可能存在的关联。 方法 本研究前瞻性地纳入了 148 名 45 岁以上、继发于良性前列腺增生症的下尿路症状患者。根据诺伍德-汉密尔顿分类法，患者被分为两组：AGA组（69人）和非AGA组（79人）。此外，AGA病例还分为顶秃病例（39人）和额秃病例（30人）。对所有患者的国际前列腺症状评分（IPSS）、尿流率参数、前列腺体积、血清总睾酮（TT）、游离和总前列腺特异性抗原浓度进行评估，并在各组之间进行比较。此外，还研究了 AGA 分级与其他变量之间的相关性。 结果 血清 TT 水平（354 ± 97.1 vs. 308.6 ± 73.1 ng/dL，p = 0.01）、总 IPSS（16.1 ± 8.1 vs. 13.4 ± 7.7，p = 0.04）、IPSS 存储子分数（IPSS-S）（7.1 ± 3.5 vs. 5.8 ± 3.6, p = 0.03）和夜尿次数（2.5 ± 1.4 vs. 1.8 ± 1.4, p < 0.01）在 AGA 组明显高于非 AGA 组。顶秃和额秃患者的任何参数均无明显差异。AGA 等级与 TT 水平（r = 0.407，p = 0.003）、IPSS-S（r = 0.164，p = 0.04）和夜尿次数（r = 0.203，p = 0.015）呈显著正相关。 结论 本研究表明，在 LUTS 患者中，与年龄相仿的非 AGA 患者相比，AGA 患者的症状更严重，TT 水平更高。此外，AGA 等级与 TT 水平和贮积症状呈正相关。
{"title":"Androgenic Alopecia Is Associated With More Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia","authors":"Yasar Pazir, Mustafa Kadihasanoglu","doi":"10.1111/luts.12531","DOIUrl":"https://doi.org/10.1111/luts.12531","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the possible association between androgenic alopecia (AGA) and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 148 patients aged over 45 with LUTS secondary to BPH were prospectively enrolled in this study. According to the Norwood–Hamilton classification, the patients were divided into two groups: AGA (<i>n</i> = 69) and non-AGA (<i>n</i> = 79). In addition, the cases of AGA were categorized as vertex (<i>n</i> = 39) and frontal baldness (<i>n</i> = 30). The International Prostate Symptom Score (IPSS), uroflowmetry parameters, prostate volume, serum total testosterone (TT), and free and total prostate-specific antigen concentrations of all patients were assessed and compared between the groups. Correlations between the AGA grade and other variables were also investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The serum TT level (354 ± 97.1 vs. 308.6 ± 73.1 ng/dL, <i>p</i> = 0.01), total IPSS (16.1 ± 8.1 vs. 13.4 ± 7.7, <i>p</i> = 0.04), IPSS storage subscore (IPSS-S) (7.1 ± 3.5 vs. 5.8 ± 3.6, <i>p</i> = 0.03), and number of nocturia episodes (2.5 ± 1.4 vs. 1.8 ± 1.4, <i>p</i> < 0.01) were significantly higher in the AGA group than in the non-AGA group. There were no significant differences in any of the parameters between the patients with vertex and frontal baldness. The AGA grade showed a significant positive correlation with the TT level (<i>r</i> = 0.407, <i>p</i> = 0.003), IPSS-S (<i>r</i> = 0.164, <i>p</i> = 0.04), and number of nocturia episodes (<i>r</i> = 0.203, <i>p</i> = 0.015).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrated that among patients with LUTS, those with AGA had worse symptoms and higher TT levels compared with those without AGA of similar age. Furthermore, the AGA grade was positively correlated with the TT level and storage symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karen M. Doersch, Laena Hines, Timothy D. Campbell, Rajat K. Jain, Scott O. Quarrier
Objectives
To evaluate factors impacting continence recovery following holmium laser enucleation of the prostate (HoLEP) for surgeons early in their HoLEP experience.
Methods
Predefined factors were evaluated from a prospectively maintained database for their impact on the recovery of continence after HoLEP. Both surgeons had performed fewer than 150 HoLEPs as attending physicians. Inclusion criteria were subjects with at least 6 months of incontinence data or documented recovery of continence. One or fewer pads per day was defined as continence. Statistical analyses were performed using R and Prism and included Spearman correlations, linear modeling, and Mantel–Cox log-rank testing as appropriate.
Results
From December 2020 to May 2023, 152 subjects met inclusion criteria with a median age of 70 (range: 51–93). The median case number was 56 (1–146). Within the study period, 144/152 (94.7%) recovered continence at a median of 1.6 months postoperatively. Linear modeling demonstrated that younger age (p = 0.01) and shorter enucleation time (p = 0.001) predicted recovery. Enucleation time less than 100 min predicted earlier continence recovery based on Mantel–Cox testing (p = 0.0004).
Conclusions
During the surgeons' HoLEP learning curve, age, and enucleation time were predictive of the recovery of continence. Enucleation time under 100 min predicted a faster rate of continence recovery. The relationship between enucleation time and continence recovery may be demonstrative of case difficulty or may be a result of pressure on the external urethral sphincter during enucleation. These findings further our understanding of HoLEP outcomes early in a surgeon's learning curve.
{"title":"Predictors of Postoperative Urinary Incontinence After Holmium Laser Enucleation of the Prostate (HoLEP) for Surgeons Early in Their Experience","authors":"Karen M. Doersch, Laena Hines, Timothy D. Campbell, Rajat K. Jain, Scott O. Quarrier","doi":"10.1111/luts.12533","DOIUrl":"https://doi.org/10.1111/luts.12533","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate factors impacting continence recovery following holmium laser enucleation of the prostate (HoLEP) for surgeons early in their HoLEP experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Predefined factors were evaluated from a prospectively maintained database for their impact on the recovery of continence after HoLEP. Both surgeons had performed fewer than 150 HoLEPs as attending physicians. Inclusion criteria were subjects with at least 6 months of incontinence data or documented recovery of continence. One or fewer pads per day was defined as continence. Statistical analyses were performed using R and Prism and included Spearman correlations, linear modeling, and Mantel–Cox log-rank testing as appropriate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From December 2020 to May 2023, 152 subjects met inclusion criteria with a median age of 70 (range: 51–93). The median case number was 56 (1–146). Within the study period, 144/152 (94.7%) recovered continence at a median of 1.6 months postoperatively. Linear modeling demonstrated that younger age (<i>p</i> = 0.01) and shorter enucleation time (<i>p</i> = 0.001) predicted recovery. Enucleation time less than 100 min predicted earlier continence recovery based on Mantel–Cox testing (<i>p</i> = 0.0004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>During the surgeons' HoLEP learning curve, age, and enucleation time were predictive of the recovery of continence. Enucleation time under 100 min predicted a faster rate of continence recovery. The relationship between enucleation time and continence recovery may be demonstrative of case difficulty or may be a result of pressure on the external urethral sphincter during enucleation. These findings further our understanding of HoLEP outcomes early in a surgeon's learning curve.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sánchez Rodríguez Maria, Marco Franco, Roger Freixa Sala, Carlos Gasanz Serrano, Mauro Bernardello Ureta, Ramón Bultó Gonzalvo, Jordi Cervera Alcaide, Carla Casanova García, Mireia García Puche, Maria Segura Alabart, Juan José Areal Calama, Fernando Ágreda Castañeda
Introduction and Objectives
Our goals were to study prostatic volume as a limiting factor after HoLEP surgery with short-circuit outpatient care (4 h) and to define other factors that affect the success of the proposed circuit.
Materials and Methods
An observational analysis and review was performed using a prospective database. Preoperative, intraoperative, and postoperative variables were included for patients who were scheduled for short-circuit outpatient care (SCOC) and who underwent HoLEP between 2020 and 2023. We defined SCOC as a postoperative hospital stay of 4 h. Subjects who required more than 4 h in hospital were categorized as conventional hospital admission (CHA). A descriptive populational study was conducted, expressing the mean using a 95% confidence interval and percentages for the continuous variables. In order to analyze them, we used the Student's t-test for the continuous variables and the chi-squared test for the categorical variables.
Results
Sixty-eight patients were included, 54 of which completed SCOC, which represented a success ratio of 79.5%. The mean age and prostatic volume of the whole cohort were 68.9 (±6.8) years and 79.5 (±29.1) mL, respectively. We found no significant differences in age, prostatic volume, antiplatelet drug use, indwelling bladder catheter, or applied energy among the subjects who completed SCOC and those who required CHA. No patient was presented with a complication of Grade 3 (or higher) in the modified Clavien–Dindo classification. At the six-month follow-up, no differences were observed in the uroflowmetry or International Prostate Symptoms Score variables.
Conclusions
Prostatic volume does not seem to be a limiting factor after undergoing HoLEP with short-circuit outpatient care.
{"title":"Holmium laser enucleation of the prostate (HoLEP) in short-circuit outpatient care: Is prostatic volume a limiting factor?","authors":"Sánchez Rodríguez Maria, Marco Franco, Roger Freixa Sala, Carlos Gasanz Serrano, Mauro Bernardello Ureta, Ramón Bultó Gonzalvo, Jordi Cervera Alcaide, Carla Casanova García, Mireia García Puche, Maria Segura Alabart, Juan José Areal Calama, Fernando Ágreda Castañeda","doi":"10.1111/luts.12525","DOIUrl":"10.1111/luts.12525","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction and Objectives</h3>\u0000 \u0000 <p>Our goals were to study prostatic volume as a limiting factor after HoLEP surgery with short-circuit outpatient care (4 h) and to define other factors that affect the success of the proposed circuit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>An observational analysis and review was performed using a prospective database. Preoperative, intraoperative, and postoperative variables were included for patients who were scheduled for short-circuit outpatient care (SCOC) and who underwent HoLEP between 2020 and 2023. We defined SCOC as a postoperative hospital stay of 4 h. Subjects who required more than 4 h in hospital were categorized as conventional hospital admission (CHA). A descriptive populational study was conducted, expressing the mean using a 95% confidence interval and percentages for the continuous variables. In order to analyze them, we used the Student's <i>t</i>-test for the continuous variables and the chi-squared test for the categorical variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-eight patients were included, 54 of which completed SCOC, which represented a success ratio of 79.5%. The mean age and prostatic volume of the whole cohort were 68.9 (±6.8) years and 79.5 (±29.1) mL, respectively. We found no significant differences in age, prostatic volume, antiplatelet drug use, indwelling bladder catheter, or applied energy among the subjects who completed SCOC and those who required CHA. No patient was presented with a complication of Grade 3 (or higher) in the modified Clavien–Dindo classification. At the six-month follow-up, no differences were observed in the uroflowmetry or International Prostate Symptoms Score variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prostatic volume does not seem to be a limiting factor after undergoing HoLEP with short-circuit outpatient care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We assessed preoperative factors predicting the poor therapeutic efficacy of holmium laser enucleation of the prostate (HoLEP) in benign prostatic hyperplasia (BPH) patients.
Methods
The present study included 159 patients who underwent HoLEP between August 2015 and June 2021 at our institution. Overall therapeutic efficacy was divided into good and poor therapeutic efficacies according to changes in the international prostate symptom score (IPSS), IPSS quality of life (IPSS-QOL), and the maximum urinary flow rate. Patients were divided into good and poor therapeutic efficacy groups based on findings obtained 3 months after HoLEP, and comparative assessments were performed between the two groups.
Results
The therapeutic efficacy of HoLEP was poor in 53 (33.3%) out of 159 patients. Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group. A multivariable analysis of several factors identified the preoperative presence of OAB and short IPP as independent risk factors for the poor therapeutic efficacy of HoLEP. When treatment efficacy was divided according to risk factors, poor therapeutic efficacy was observed in only 14% of patients with prolonged IPP and the absence of OAB.
Conclusions
The therapeutic efficacy of HoLEP may be poor in patients with OAB and short IPP, resulting in the significant deterioration of lower urinary tract symptoms. Accordingly, it is important to consider the presence or absence of OAB and IPP measurements when selecting indications for HoLEP.
{"title":"Preoperative factors predicting poor therapeutic efficacy of holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia","authors":"Kyohei Watanabe, Atsushi Otsuka, Yuichi Kitagawa, Asuka Sano, Ryo Sato, Yuto Matsushita, Hiromitsu Watanabe, Keita Tamura, Daisuke Motoyama, Toshiki Ito, Sanki Takada, Hideaki Miyake","doi":"10.1111/luts.12530","DOIUrl":"10.1111/luts.12530","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We assessed preoperative factors predicting the poor therapeutic efficacy of holmium laser enucleation of the prostate (HoLEP) in benign prostatic hyperplasia (BPH) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The present study included 159 patients who underwent HoLEP between August 2015 and June 2021 at our institution. Overall therapeutic efficacy was divided into good and poor therapeutic efficacies according to changes in the international prostate symptom score (IPSS), IPSS quality of life (IPSS-QOL), and the maximum urinary flow rate. Patients were divided into good and poor therapeutic efficacy groups based on findings obtained 3 months after HoLEP, and comparative assessments were performed between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The therapeutic efficacy of HoLEP was poor in 53 (33.3%) out of 159 patients. Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group. A multivariable analysis of several factors identified the preoperative presence of OAB and short IPP as independent risk factors for the poor therapeutic efficacy of HoLEP. When treatment efficacy was divided according to risk factors, poor therapeutic efficacy was observed in only 14% of patients with prolonged IPP and the absence of OAB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The therapeutic efficacy of HoLEP may be poor in patients with OAB and short IPP, resulting in the significant deterioration of lower urinary tract symptoms. Accordingly, it is important to consider the presence or absence of OAB and IPP measurements when selecting indications for HoLEP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the efficacy and safety of Vibegron for the treatment of residual overactive bladder (OAB) symptoms after laser vaporization of the prostate (photo-selective vaporization of the prostate, contact laser vaporization of the prostate, and thulium laser vaporization).
Methods
This randomized, open-label, parallel-group, single-center superiority trial with a 12-week observation (jRCTs071190040) enrolled male patients with OAB aged 40 years or older who had undergone laser vaporization of the prostate for not less than 12 weeks and not more than 1 year earlier. Patients were allocated to receive Vibegron 50 mg once daily or follow-up without treatment for 12 weeks.
Results
Forty-seven patients were enrolled between January 2020 and March 2023. The median age (interquartile range) was 75.5 (72.5–78.5) years for the Vibegron group and 76.5 (71.0–81.0) years for the control group. The intergroup difference in the mean change (95% confidence interval) in the 24-hour urinary frequency at 12 weeks after randomization was −3.66 (−4.99, −2.33), with a significant decrease for the Vibegron group. The Overactive Bladder Symptom Score, International Prostate Symptom Score, IPSS storage score, and Overactive Bladder Questionnaire score significantly improved for the Vibegron group. Voided volume per micturition also increased for the Vibegron group.
Conclusions
The administration of 50 mg of Vibegron once daily for 12 weeks showed significant improvement compared with follow-up without treatment in bladder storage (OAB) symptoms after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia.
{"title":"Efficacy and safety of Vibegron for the treatment of residual overactive bladder symptoms after laser vaporization of the prostate: A single-center prospective randomized controlled trial (VAPOR TRIAL)","authors":"Narihito Seki, Hiroyuki Masaoka, Yoohyun Song, Takashi Dejima, Yoshiaki Sato, Shotaro Maeda","doi":"10.1111/luts.12529","DOIUrl":"10.1111/luts.12529","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to evaluate the efficacy and safety of Vibegron for the treatment of residual overactive bladder (OAB) symptoms after laser vaporization of the prostate (photo-selective vaporization of the prostate, contact laser vaporization of the prostate, and thulium laser vaporization).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This randomized, open-label, parallel-group, single-center superiority trial with a 12-week observation (jRCTs071190040) enrolled male patients with OAB aged 40 years or older who had undergone laser vaporization of the prostate for not less than 12 weeks and not more than 1 year earlier. Patients were allocated to receive Vibegron 50 mg once daily or follow-up without treatment for 12 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-seven patients were enrolled between January 2020 and March 2023. The median age (interquartile range) was 75.5 (72.5–78.5) years for the Vibegron group and 76.5 (71.0–81.0) years for the control group. The intergroup difference in the mean change (95% confidence interval) in the 24-hour urinary frequency at 12 weeks after randomization was −3.66 (−4.99, −2.33), with a significant decrease for the Vibegron group. The Overactive Bladder Symptom Score, International Prostate Symptom Score, IPSS storage score, and Overactive Bladder Questionnaire score significantly improved for the Vibegron group. Voided volume per micturition also increased for the Vibegron group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The administration of 50 mg of Vibegron once daily for 12 weeks showed significant improvement compared with follow-up without treatment in bladder storage (OAB) symptoms after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. İrfan Dönmez, Ismail Selvi, Tayfun Oktar, Orhan Ziylan
Objectives
To analyze the management strategies in the children who had treatment-resistant dysfunctional voiding (DV).
Methods
Among 75 children with DV who underwent pelvic floor biofeedback therapy (BF) between 2013 and 2020, 16 patients (14 girls, 87.5%) with a mean age of 9.81 ± 2.53 years that showed incomplete clinical response following urotherapy and initial BF sessions were retrospectively reviewed. The demographic and clinical characteristics, DVSS, and uroflowmetry parameters were recorded before and after the initial BF sessions. Subsequent treatments after initial BF and clinical responses of patients were noted.
Results
Clinical success was observed in one patient by addition of an anticholinergic and in three patients with combination of salvage BF sessions and anticholinergics, whom had predominant overactive bladder (OAB) symptoms. The success rate of TENS alone and in combination with other treatment modalities was 88.8% (8/9 patients). In addition, salvage BF sessions (range 2 to 3) enabled clinical success in five (50%) of 10 cases as a combination with anticholinergics or TENS. In case of incomplete emptying without OAB, adequate clinical response to Botulinum-A was observed during an average follow-up of 29 months in two boys who did not respond to alpha-blockers, even though one required repeat injection after 10 months. The total clinical success rate was 87.5% (14/16 patients) after a median follow-up of 24 months. VV-EBC and Qmax increased by a mean of 30.89% and 7.13 mL/min, respectively, whereas DVSS decreased by a mean of 8.88 points and PVR-EBC decreased by a median of 19.04%.
Conclusions
Our findings showed that clinical success in resistant DV was achieved by various combination treatments in the majority of children. However, a small group may still have persistent, bothersome symptoms despite multiple treatment modalities.
{"title":"Urotherapy and biofeedback resistant dysfunctional voiding: How to deal with?","authors":"M. İrfan Dönmez, Ismail Selvi, Tayfun Oktar, Orhan Ziylan","doi":"10.1111/luts.12528","DOIUrl":"https://doi.org/10.1111/luts.12528","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To analyze the management strategies in the children who had treatment-resistant dysfunctional voiding (DV).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among 75 children with DV who underwent pelvic floor biofeedback therapy (BF) between 2013 and 2020, 16 patients (14 girls, 87.5%) with a mean age of 9.81 ± 2.53 years that showed incomplete clinical response following urotherapy and initial BF sessions were retrospectively reviewed. The demographic and clinical characteristics, DVSS, and uroflowmetry parameters were recorded before and after the initial BF sessions. Subsequent treatments after initial BF and clinical responses of patients were noted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinical success was observed in one patient by addition of an anticholinergic and in three patients with combination of salvage BF sessions and anticholinergics, whom had predominant overactive bladder (OAB) symptoms. The success rate of TENS alone and in combination with other treatment modalities was 88.8% (8/9 patients). In addition, salvage BF sessions (range 2 to 3) enabled clinical success in five (50%) of 10 cases as a combination with anticholinergics or TENS. In case of incomplete emptying without OAB, adequate clinical response to Botulinum-A was observed during an average follow-up of 29 months in two boys who did not respond to alpha-blockers, even though one required repeat injection after 10 months. The total clinical success rate was 87.5% (14/16 patients) after a median follow-up of 24 months. VV-EBC and Qmax increased by a mean of 30.89% and 7.13 mL/min, respectively, whereas DVSS decreased by a mean of 8.88 points and PVR-EBC decreased by a median of 19.04%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings showed that clinical success in resistant DV was achieved by various combination treatments in the majority of children. However, a small group may still have persistent, bothersome symptoms despite multiple treatment modalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"16 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141453572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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