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Pathophysiology of Detrusor Underactivity/Acontractile Detrusor
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Juan José Andino, John T. Stoffel
While multiple transurethral options are now available, electrosurgical transurethral resection of the prostate (TURP) remains the gold standard in endoscopic treatment of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH).53 There are little data demonstrating TURP efficacy for treatment of neurogenic DA. Extrapolating from the nonneurogenic BPH/LUTS literature, there is some evidence to suggest that neurogenic male patients with DU could potentially benefit from an outlet ablative procedure.50,54 Potts et al. performed bladder outlet procedures in 21 of their 139 patients with DU and without BOO. They defined success as no future retention, need for catheterizations, or surgery. At 6 months after TURP, 86% of patients had improved.55 In a similar study, patients were followed for 12 years after TURP, and patients with DU showed an improvement in International Prostate Symptom Score (IPSS) up to 7 years.56 These studies will need to be better validated in neurogenic DU/DA patients.57 Sphincterotomy has been reported in some case series for management of urinary retention in neurogenic patients with DSD, although the efficacy of the procedure in patients with pure neurogenic DA is not well studied.58,59
Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS)
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Hamid Abboudi, Jas S. Kalsi, Tev Aho
Which of the following is TRUE with respect to BPH?Is a histological process predominantly characterised by benign prostatic hypertrophy.Always causes lower urinary tract symptoms.May not produce bladder outlet obstruction.Requires the absence of androgens.Is always a progressive disease.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Transurethral resection of the prostate is a common procedure used to treat intractable LUTS and obstructive symptoms of benign and rarely malignant prostate disease where medical therapy has failed. This can be performed under general or spinal anaesthetic. The prostate is visualised using a cystoscope and the prostate is excised using electrocautery. Irrigation with isotonic glycine keeps the operative field clear. The patient usually remains an inpatient for a short time post-operatively and an indwelling catheter is removed 24-48 hours post-operatively. Should a trial of void fail, the patient should be recatheterised and a trial of void delayed for 2 weeks. Complications include bleeding, infection, incontinence and erectile dysfunction. Newer treatments involve laser prostatectomy or microwave ablation of the prostate.
Uncomplicated urinary tract infection in primary health care: presentation and clinical outcome
Published in Infectious Diseases, 2021
Helena Kornfält Isberg, Katarina Hedin, Eva Melander, Sigvard Mölstad, Anders Beckman
Uncomplicated urinary tract infection (UTI) is one of the most common infections treated in primary healthcare (PHC). Almost half of all women will experience at least one episode of uncomplicated UTI during their lifetime [1]. Women attending PHC with symptoms that indicate uncomplicated UTI are, to a high extent, prescribed antibiotics. The gold standard for the diagnosis of uncomplicated UTI is the presence of clinical symptoms and the detection of the pathogen via urine culture [2,3]. The clinical diagnosis is essentially based on a patient’s medical history. Classic lower urinary tract symptoms include dysuria, frequent voiding of small volumes and urinary urgency, which are all indicators for empirical treatment (meaning treatment directed against an anticipated cause of infection taking in account the risk for presence of drug resistant strains) in general practice. According to Swedish and Norwegian treatment recommendations, and recommendations from the European Association of Urology, no further diagnostic examination is needed in the absence of complicating factors [1,3–5]. The median time for resolution of dysuria when treated with antibiotics has been reported to be three days; the corresponding figure when not treated with antibiotics is five days [6]. Uncomplicated UTIs are often self-limiting, 25–42% of untreated women are free from symptoms in one week and 31–41% have a negative culture within a week [7].
A novel metric for treatment durability in clinical trials of minimally invasive treatments for benign prostatic hyperplasia
Published in Expert Review of Medical Devices, 2020
Larry E. Miller, Alexis E. Te, Samir K. Bhattacharyya, Sean Lilienfeld, Ryan A. Dornbier, Kevin T. McVary
Data for this analysis were derived from pivotal trial manuscripts of two minimally invasive BPH treatments – water vapor thermal therapy (WVTT) and prostatic urethral lift (PUL). WVTT utilizes convective radiofrequency to create stored thermal energy in the form of steam, which is delivered transurethrally into the transition zone of the prostate to ablate tissue, thereby reducing LUTS. The PUL procedure involves transurethral placement of permanent suture-based metallic implants that provide mechanical separation of the obstructing lateral prostatic lobes, thereby enlarging the urethral lumen and relieving LUTS. In the American Urological Association BPH Clinical Guidelines for surgical management of lower urinary tract symptoms (LUTS) [2,3], each treatment was recommended for well-selected men who desired a less invasive alternative to transurethral resection of the prostate (TURP). Published results were available through 4 years of follow-up with WVTT [4] and 5 years of follow-up with PUL [5]. Due to the increasing interest and the availability of long-term data with these minimally invasive BPH treatments, 4-year follow-up data from the WVTT and PUL pivotal trials were utilized for all analyses.
The prognostic impact of tumour NSD2 expression in advanced prostate cancer
Published in Biomarkers, 2020
Judith Stangl-Kremser, Ursula Lemberger, Melanie R. Hassler, Nathalie Garstka, Bernhard Grubmüller, Andrea Haitel, Dmitry V. Enikeev, Petr V. Glybochko, Gero Kramer, Martin Susani, Shahrokh F. Shariat
We retrospectively reviewed medical records of 56 patients with lower urinary tract symptoms who were diagnosed with metastatic and/or castration-resistant prostate cancer and who underwent palliative transurethral resection of the prostate (TURP) between 2005 and 2017 at a single centre. The flow of patients is depicted in the flowchart (Figure 1). Besides demographic data, clinical data such as date of first diagnosis and initial treatment were recorded. Specific features of the disease at time of diagnosis and pre-TURP included PSA, the Gleason score and clinical stage. Cancer staging was done according to the 7th edition of the American Joint Committee on recorded Cancer (Edge and Compton 2010). PSA values were recorded on a regular base until PSA progression. We excluded patients with incomplete data on imaging studies and PSA progression due to loss during follow-up. Survival data, including cause of death, were also recorded.