Habib, E. I., M. S. Elsheemy, ahmed hossam, S. morsy, H. A. Hussein, A. Y. Abdelaziz, M. S. Abdelazim, and H. Fathy, "Holmium Laser Enucleation Versus Bipolar Plasmakinetic Resection for Management of Lower Urinary Tract Symptoms in Patients with Large-Volume Benign Prostatic Hyperplasia: Randomized-Controlled Trial.", Journal of endourology, vol. 35, issue 2, pp. 171-179, 2021. Abstract

To compare the safety and efficacy of holmium laser enucleation of prostate (HoLEP) bipolar plasmakinetic resection of prostate (BPRP) in the management of large-sized (≥75 g) benign prostatic hyperplasia (BPH). This randomized-controlled trial recruited 145 symptomatic BPH patients who had failed medical management, and who had undergone either HoLEP (Versa pulse 100 W;  = 73) or BPRP (AUTOCON II 400 ESU;  = 72). Both groups were compared using the Mann-Whitney, chi-square, Student-, or Fisher exact tests as appropriate. Preoperative postoperative findings (24 months) were compared using paired -test or Wilcoxon signed-rank test. The two groups were comparable for most preoperative findings including prostate size ( = 0.629), although HoLEP included more patients on anticoagulants ( = 0.001). HoLEP was associated with significantly less operative duration ( < 0.001), hemoglobin loss ( < 0.001), catheterization duration ( = 0.009), and hospital stay ( < 0.001). There was no significant difference in total complications ( = 0.291) and each separate complication. Blood transfusion was reported only with BPRP ( = 0.058). At 24 months of follow-up, there was significant improvement in all the parameters in each group (International Prostate Symptom Score [IPSS], maximum urinary flow rate [Q] quality of life [QoL], and postvoid residual urine [PVRU];  < 0.001). There was no significant difference between both groups in postoperative IPSS ( = 0.08), Q ( = 0.051), QoL ( = 0.057), or PVRU ( = 0.069). There was significantly better percentage improvement of both IPSS ( = 0.006) and QoL ( = 0.025) in HoLEP. HoLEP and smaller removed (resected or enucleated) tissues were associated with a reduction in the primary outcomes (hemoglobin loss and operative duration) in logistic regression analysis. HoLEP showed better safety profile with significantly less operative duration, hemoglobin loss, hospital stay, and catheterization duration. Although both procedures were effective, HoLEP showed significantly better percentage improvement of both IPSS and QoL. ClinicalTrials.gov Identifier: NCT04143399.

Abdelhakim, M. A., A. Rammah, A. H. Abozamel, M. G. El-Sheikh, M. S. Abdelazeem, S. M. Abdallah, and A. Y. Abdelaziz, "Does detrusor underactivity affect the results of transurethral resection of prostate?", International urology and nephrology, vol. 53, issue 2, pp. 199-204, 2021. Abstract

PURPOSE: We aimed to evaluate the outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and diagnosed to have weak detrusor contractility by urodynamic study.

METHODS: A prospective study of 32 male patients had BPH candidate for TURP diagnosed to have impaired detrusor contractility by preoperative urodynamic study. We studied the postoperative outcome after TURP regarding international prostate symptoms score (IPSS), maximum flow rate (Q), post-voiding residual urine (PVR), the patients need for catheter, and urodynamic pressure flow study (PFS) parameters (maximum detrusor contractility, bladder contractility index (BCI), maximum bladder capacity and compliance) after 6 month follow-up.

RESULTS: Twenty-one cases presented with urethral catheter because of chronic or refractory retention. Twenty patients voided preoperatively during PFS with mean detrusor pressure (Pdet) at Q 23.97 ± 25.54 cmH2O and the mean BCI was 51.04 ± 23.86, while twelve patients did not void with mean maximum Pdet 21.75 ± 7.34. After 6 month follow-up, there was significant improvement in IPSS, Q, and detrusor contractility (Pdet at Q and BCI) postoperatively in all patients, and there was no significant postoperative improvement of post-voiding residual urine (p value 0.92). Finally, 11 patients voided normally without RU, 7 patients needed timed triple voiding with crede maneuver and small RU, and 14 patients needed CIC.

CONCLUSIONS: There were significant improvements in IPSS, detrusor contractility, and urine flow after TURP in patients with BPH and weak bladder contractility, although the risk of postoperative urine retention in approximately 43% of cases and needed CIC.

El-Adawy, M. S., A. Y. Abdelaziz, A. Salem, W. Aboulela, A. S. Moussa, R. Ibrahim, F. Zanaty, M. H. Abdelhamid, H. Aldaqadossi, A. M. Ragheb, et al., "Relation of baseline prostate volume to improvement of lower urinary tract symptoms due to tamsulosin monotherapy in benign prostatic hyperplasia: An exploratory, multicenter, prospective study.", Urology annals, vol. 12, issue 3, pp. 271-275, 2020. Abstract

Aims: The aim of the study was to investigate the relation between baseline prostate volume (PV) and the improvement of lower urinary tract symptoms (LUTS) induced by tamsulosin monotherapy after 2-year follow-up in Egyptian benign prostatic hyperplasia (BPH) patients.

Settings and Design: This was a prospective comparative multicenter study.

Subjects and Methods: Three hundred and eighty-one BPH patients were included in the study from January 2014 to January 2017. The patients were divided according to their PV into two groups. Group A included patients with small-sized prostate (≤40 ml) and Group B included those with PV larger than 40 ml. Full evaluation was done at presentation. The patients are followed up at 6, 12, and 24 months of continued medical treatment with tamsulosin 0.4 mg once daily.

Statistical Analysis Used: Data were coded and entered using the Statistical Package for the Social Sciences version 24. Data were summarized using mean and standard deviation in quantitative data. Comparisons between quantitative variables were done using unpaired -test or the nonparametric Mann-Whitney test. A comparison between paired measurements in the same person was done using paired -test (Chan, 2003). P < 0.05 was considered as statistically significant.

Results: The mean age was 60.1 ± 7.2 years. The mean value of the International Prostate Symptom Score (IPSS) was recorded for the 381 patients at presentation. In Group A, the mean value of IPSS was 20.44 ± 3.18, whereas in Group B, the mean value of IPSS was 21.23 ± 3.5. There was a significant improvement in symptoms (Q-IPSS) in both groups, but we found that this improvement was significantly better in Group A ( = 0.017).

Conclusions: PV is an important prognostic factor affecting the improvement of the LUTS by α1-blocker monotherapy. Tamsulosin monotherapy may not be enough for large prostate (>40 mg) to maintain adequate symptom relief, and it is better to start with other medical options such as combined therapy or early nonmedical therapy. Starting α1-blocker monotherapy in smaller prostates may be of benefit in symptomatic patients without considering watchful waiting.

A.Y.Abdelaziz, H.Shaker, H.Aly, H.Aldaqados, and E.M.Hussein, "Early outcome of pediatric pyeloplasty in kidneys with split renal function less than 10%: A prospective study of 25", african journal of urology, vol. 24, issue 4, pp. 324-330, 2018.
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Yehia, A., W. Fouda, A. Mosharafa, M. A. Elrasoul, A. Fayad, and K. Fawzy, "Forgotten ureteral stents: Risk factors, complications and management", African journal of urology, vol. 24, issue 1, pp. 28-33, 2018.
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