Background: We performed a comparison between the Wolf® Piranha™ and the Quanta System® Cyber Blade™ morcellators for the Thulium laser enucleation of the prostate (ThuLEP).
Methods: Overall, 205 patients underwent ThuLEP in three urologic departments (Como, Bordeaux, Madrid). Patients were randomized to Piranha morcellator with disposable blades (100 cases, Group A) or Cyber Blade morcellator (105 cases, Group B). Morcellation efficiency was related to prostate volume (PV) using the cut-off of 100 mL. Complication rate and device malfunctions were reported. The chi-square test was used for the comparison of the study groups. All statistical tests were two-sided with a level of significance at P<0.05.
Results: Mean PV was 82.5 vs. 91.9 mL (P=0.21) in Group A vs. B. Mean morcellation time was 9.7 vs. 10.1 min in Group A vs. B when PV was ≤100 mL (P=0.34), it was significantly lower in Group B when PV was >100 mL (12.7 vs. 10.1 min, P=0.04). Similarly, morcellation efficiency was comparable when PV was ≤100 mL (8.5 vs. 9.1 g/min, P=0.08), while it was significantly higher with the Cyber Blade when PV was >100 mL (10.0 vs. 12.3 g/min, P=0.04). Bladder injury occurred in three and two cases in Group A and B. Complication rate was comparable.
Conclusions: Piranha and Cyber Blade morcellators showed a comparable efficacy when PV was ≤100 mL, while efficacy was significantly higher with the Cyber Blade when PV was >100 ml. Both instruments are safe and reliable according to the risk of bladder injury and the occurrence of mechanical problems.
Postoperative complications remain a significant challenge in surgical care. This study assessed the ability of the BETTY score, a novel user-friendly scoring system, to predict postoperative outcomes in a large multicenter cohort of urological surgeries. We conducted a post-hoc analysis of a prospective, nonrandomized multicenter trial including 415 patients undergoing elective urological surgeries in six French hospitals. The BETTY score, part of a smartphone app, incorporates pre- and intraoperative data to classify patients into risk categories. We evaluated multiple endpoints, including 90-day postoperative overall and major complications, length of stay, prolonged care after discharge, unplanned readmission, reoperation, and days alive and out of hospital. Of the 415 patients, 22% experienced postoperative complications, with 3.9% major complications. Unplanned readmissions, prolonged care after discharge, and reoperation occurred in 8%, 20%, and 2.4% of cases, respectively. We found significant correlations between the BETTY score and all endpoints analyzed. In multivariate analysis, the BETTY score was significantly associated with all postoperative events studied. These findings demonstrate the reliability of the BETTY score in predicting various postoperative outcomes in urological surgery patients, especially for patients undergoing major surgeries. This tool may help optimize perioperative care and improve patient outcomes, potentially contributing to more personalized surgical care.
Background: The aim of this study was to compare the efficacy and safety of Aquablation® with those of holmium laser enucleation of the prostate (HoLEP) for the treatment of patients with benign prostatic hyperplasia (BPH).
Methods: Prospective comparative non-randomized multicenter study conducted between July 2021 and July 2023, consecutive patients undergoing BPH surgery were enrolled to each group. Patients had moderate to severe lower urinary tract symptoms (LUTS), International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate (Qmax) ≤15 mL/s, prostate volume ≥30 mL ≤120 mL, and BPH medical therapy failure. Primary outcome was short-term efficacy measured by IPSS, IPSS-QoL, Qmax, post-void residual volume (PVR), prostate-specific antigen (PSA); secondary outcome was safety (intra and post-operative complications, ejaculatory dysfunction, continence, blood transfusions). A six-month follow-up was performed.
Results: Of 150 patients (75:75) enrolled, both groups showed improvements (P<0.05) in IPSS, IPSS-QoL, Qmax, and PVR at six months. No significant differences were observed between HoLEP and Aquablation® in IPSS (7.6±6.9 vs. 5.05±4.9 points, P=0.11), IPSS-QoL (1.7±1.6 vs. 1.3±1.6 points, P=0.16), Qmax (28.6±8.8 vs. 23.8±9.3 mL/sec, P=0.12), and PVR (7.2±8.2 vs. 20.3±22.6 mL, P=0.19) at six months. No intraoperative complications occurred. Postoperative hemoglobin drop was higher in Aquablation® group (2.6±1.33 vs. 0.4±0.67 g/dL, P<0.001), with no statistically significant differences in transfusion rate (1.3 vs. 1.3%, P=0.31). Ejaculatory dysfunction rate was significantly lower in Aquablation® (6,6%) than HoLEP (89.3%, P<0.001). Mean prostate volume was (mean±SD) 81.8±37.4 and 71.9±34.8 mL (P=0.08) in HoLEP and Aquablation® groups, respectively. Holep demonstrated a smaller prostate volume after treatment (18.1±6.5 vs. 46.5±25.02 mL P<0.001) as well as a significantly greater reduction and lower levels of PSA (1.2±1.4 vs. 2.65±2.8 ng/mL, P<0.001). Aquablation® demonstrated significantly shorter tissue removal time (5.5±2.4 vs. 22.4±9.8 min, P<0.001), but no difference in total operative time (49.1±15 vs. 43.9±26.8 min, P=0.052).
Conclusions: HoLEP and Aquablation® show similar effectiveness and safety for BPH-related-LUTS at 6 months. Aquablation® has lower ejaculatory dysfunction rates. Larger randomized trials and with longer follow-up time are needed for validation.
Background: Despite a large amount of literature focused on pharmacologic and surgical therapy for benign prostate hyperplasia (BPH), little is known about clinical presentation and management of outpatient clinic patients. We aimed to conduct a tailored analysis of BPH-affected patients, comparing men with known BPH versus newly diagnosed. The analysis was made through International Prostate Symptom Score (IPSS) and BPH Impact index (BII).
Methods: "Intensive prostate benefit" project working group designed a questionnaire prospectively administered by urologists to patients affected by lower urinary tract symptoms (LUTS) related to BPH.
Results: Overall, 3198 (64%) patients were previously diagnosed with BPH versus 1800 (36%) received a first diagnosis. Patients previously diagnosed with BPH were older (median 69 vs. 66 years) and more comorbid (P<0.001). Moreover, median IPSS score was higher in these patients (16 vs. 14), who also experienced a higher rate of severe symptoms (32.0% vs 21.5%, P<0.0001). At BII, concerns for one's health and time lost due to urinary problems were higher in patients previously diagnosed with BPH (P<0.0001). In these patients, a BPH-specific therapy was already established (88.5% vs. 75.1%) and a higher rate of therapy adherence (55.0% vs. 27.0%, P<0.0001) was observed. Roughly 90% of patients already taking BPH therapy changed their therapy after urological examination. In these patients, supplements/phytotherapeutics, alpha blockers, 5-alfa-reductase inhibitors, were prescribed in 32.8%, 37.4%, 17.4%, respectively.
Conclusions: Patients with prior BPH diagnosis have severe LUTS that worsen over time, affecting quality of life despite treatment. LUTS management in primary care is crucial, emphasizing counseling for a healthy lifestyle, cardiovascular risk control, and medication adherence.
Background: The aim of the current study was to identify predictors of erectile dysfunction (ED) and obstructive sleep apnea syndrome (OSAS) in male participants at Italian web-survey.
Methods: A cross-sectional web-based survey was administered via Google Forms between July 17 and October 31, 2022, among Italian participants. The erectile function and the excessive daytime sleepiness were measured through the International Index of Erectile Function - 5 (IIEF5) and Epworth Sleepiness Scale (ESS), respectively. Two separate and independent multivariable logistic regression models (mLRMs) were fitted to predict ED and OSAS, respectively, in men answering to the survey.
Results: A total of 238 patients were identified. Of those, 58 (24%) reported to be affected by OSAS disease. Higher proportion of mild (21 vs. 6%), mild-to-moderate (9 vs. 5%), and severe (16 vs. 7%) ED were recorded in OSAS vs. non-OSAS patients (P<0.001). In mLRMs predicting ED (IIEF5≤7), age (OR: 1.04, 95% confidence interval [CI]: 1.01-1.06; P=0.002), and IPSS total score (OR:1.08, 95% CI: 1.02-1.15; P=0.006) were independent predictors. In mLRMs predicting OSAS, age (OR: 1.08, 95% CI: 1.05-1.12; P<0.001), Body Mass Index (BMI; OR: 1.12, 95% CI: 1.05-1.21; P<0.001), and ESS score (OR:1.14, 95% CI: 1.05-1.24; P=0.001) were independent predictors. In the subgroup analyses predicting severe ED, ESS and age or BMI or IPSS resulted as independent predictors (OR from 0.7 to 0.8; all P<0.05).
Conclusions: The ESS score independently predicted severe ED in males. As a result, the OSAS disease should be explored in patients who harbored severe ED to address those patients for a prompt ear, nose and throat evaluation.
Background: Available evidence suggests that monogenic causes of kidney stones are likely under-diagnosed, particularly in young adults, needing expert multidisciplinary recommendations to improve diagnosis, management and therapeutic outcomes. To increase the awareness among the medical community on the recognition of the signs and symptoms of genetically determined kidney stone disease in adult patients, with a special focus on primary hyperoxaluria (PH), a group of nephrologists and urologists started a consensus process through the Delphi method.
Methods: A list of 40 statements (23 regarding genetically determined stone disease and 17 regarding primary hyperoxaluria) was defined by the authors and included in an online Delphi survey, which was sent to 16 urologists and 22 nephrologists with expertise in managing patients with kidney stone disease. An agreement threshold of 75% was established for consensus.
Results: After two rounds of Delphi voting, consensus was reached for 33 statements, 18 regarding genetically determined stone disease and 15 regarding PH.
Conclusions: The Delphi process highlighted several areas of agreement with regard to the characteristic or anamnestic data suggesting diagnostic investigation, optimal diagnostic patterns, treatment strategies and management of patients with genetically determined nephrolithiasis. The process also highlighted some grey areas, which deserve further investigation and highlight the need for educational initiatives focused on rare diseases in the field of kidney stones.
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