Comparison of low- and high-power thulium laser enucleation for benign prostatic hyperplasia with prostates over 80 g

A recent study demonstrated that low-power YAG VapoEnucleation (ThuVEP) is safe, feasible, and effective, showing results similar to high-power ThuVEP in managing benign prostatic obstruction (BPO). The results of this study were published in the World Journal of Urology.
An analysis was carried out on 80 patients with symptomatic BPO and prostatic enlargement exceeding 80 ml. The patients were randomly split into two groups, each consisting of 40 patients. Group A underwent treatment with low-power ThuVEP, while Group B received high-power ThuVEP. Preoperative and early postoperative evaluations were conducted for all patients, with a follow-up analysis of 12 months. Complications were recorded and categorized based on the modified Clavien classification system.
The average age of patients at the time of surgery was 68 (± 6.1) years. The mean prostate volume was 112 (± 20.1) cc. The groups exhibited no significant variations (p value = 0.457). The average operative time for Group A was 88.4 ± 11.79 minutes, and for Group B it was 93.4 ± 16.34 minutes. Group A had a mean enucleation time of 59.68 ± 7.24 minutes, whereas Group B had a mean enucleation time of 63.13 ± 10.75 minutes. Quality of life (QoL), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), prostate volume, and postvoiding residual urine (PVR) all showed significant improvement after treatment and were not significantly different between those treated with different energies. Complications were rare and showed no variation between the two groups.
The above study indicates that low-power ThuVEP is safe, feasible, and effective, demonstrating outcomes comparable with high-power ThuVEP in the management of BPO.
 

Efficacy and safety of Vibegron in managing residual symptoms of an overactive bladder following laser vaporization of the prostate

According to a recent study, the administration of fifty mg of Vibegron once daily for twelve weeks exhibited significant improvement in bladder storage symptoms related to overactive bladder (OAB) following laser vaporization of the prostate for symptomatic benign prostatic hyperplasia when compared to the untreated follow-up period. The findings of this study were published in the journal, Lower Urinary Tract Symptoms.Split into two groups: one group received Vibegron 50 mg once daily, while the other group had no treatment and were only followed up for 12 weeks.The median age (interquartile range) was 75.5 (72.5-78.5) years for the Vibegron group, while it was 76.5 (71.0-81.0) years for the control group. At twelve weeks post-randomization, the intergroup difference in the mean change (95% CI) in twenty-four hour urinary frequency was -3.66 (-4.99, -2.33) with a significant decrease in the Vibegron group. Significant improvements were noted in the International Prostate Symptom Score, Overactive Bladder Questionnaire score, Overactive Bladder Symptom Score, and IPSS storage score for the Vibegron group. Additionally, in the Vibegron group the voided volume per micturition increased.
Therefore, the treatment with fifty mg of Vibegron once a day for a duration of twelve weeks resulted in notable enhancement in bladder storage symptoms associated with overactive OAB after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia when compared to the untreated follow-up period.
 

The use of prostatic urethral lift to effectively alleviate lower urinary tract symptoms while preserving sexual function in patients with benign prostatic hyperplasia

A recent study demonstrated that prostatic urethral lift (PUL) offers benefits compared to control interventions, showing promising potential for managing benign prostatic hyperplasia (BPH). This study findings were published in the journal, Archivio italiano di urologia, andrologia. 
Cochrane CENTRAL, EBSCO, MEDLINE, ScienceDirect, and Google Scholar databases were searched using relevant terms related to PUL and BPH. Only randomized controlled trials (RCTs) from 2013 to 2023 were considered, following the PRISMA checklist. The assessment focused on lower urinary tract symptoms (LUTS), sexual function, quality of life, and adverse events within 3 months. Post-treatment mean values were compared with Sham (controls), and the progress from baseline to post-treatment follow-up duration was considered. The statistical analysis and assessment of bias risk were carried out with Review Manager 5.4.1, showcasing findings in terms of mean difference (MD) and risk ratios (RR).
A meta-analysis involving 378 confirmed BPH patients across 7 RCTs and utilizing a Random Effects Model revealed significant improvements in the PUL arm. These improvements included international prostate symptom score (IPSS) (MD 5.51, p<0.0001), maximum urinary flow rate (Qmax) (MD 2.13, p=0.0001), IPSS-QoL (MD 1.50, p<0.0001), and BPH Impact Index (BPHII) (MD 2.14, p=0.0001) . There was no significant increase in adverse events (RR 1.51; p=0.50). Additionally, positive outcomes were observed in post-void residual measurements and sexual function variables when post-treatment values were compared to baseline.
The above study showed that PUL provides benefits when compared to control treatments, displaying promising potential for the management of BPH. 
 

Efficacy of Tamsulosin 0.4 mg versus 0.8 mg in the treatment of lower urinary tract symptoms associated with benign prostatic enlargement

According to a new study, Tamsulosin 0.8 mg has demonstrated superior efficacy in managing lower urinary tract symptoms caused by benign prostatic enlargement compared to Tamsulosin 0.4 mg, and it is well tolerated by patients. This study was published in the journal, International Urology and Nephrology. 
In this study, ninety-three patients who met the criteria were allocated randomly into two groups: Group A, who received Tamsulosin 0.4 mg/day, and Group B, who received Tamsulosin 0.8 mg/day. The post void residual urine volume, international prostate symptom score and maximum flow rate of urine were measured before and after 4 weeks of treatment
Both study groups exhibited a notable decline in storage sub-score but only Group B demonstrated a significant decrease in frequency (P < 0.001).Tamsulosin 0.8 mg was found to be superior to Tamsulosin 0.4 mg in terms of voiding sub-score, except for straining (P = 0.325). The total international prostate symptom score exhibited a significant improvement in Group B when compared to Group A (P < 0.001). Additionally, maximum flow rate and post-void residual urine volume were notably improved in Group B when compared to Group A (P < 0.001).
Thus, it can be concluded that Tamsulosin 0.8 mg is more effective than Tamsulosin 0.4 mg in addressing lower urinary tract symptoms caused by benign prostatic enlargement, and patients tolerate it well. 

Patients who receive a double J substitution with a pigtail suture stent experience a reduction in symptoms associated with the stent

According to a recent study, patients who were treated with double J (DJ) substitution utilizing a pigtail suture stent (PSS) subsequent to the ureteroscopy (URS) procedure experienced a significant alleviation of stent-related symptoms (SRS). Urologists could consider the placement of PSS after URS in patients who have been pre-stented to mitigate the effects of SRS. The results of the study were documented in the World Journal of Urology.

This study enrolled 93 patients with DJ stents undergoing URS for stone management. The Ureteral Symptom Score Questionnaire (USSQ) was submitted at three distinct time points: two weeks after the DJ stent insertion, two weeks following the PSS placement, and four weeks after the PSS removal [baseline]. The primary endpoint of the study was to compare the Urinary Symptom Index Score and the prevalence of pain in patients two weeks after the DJ and PSS procedures. The secondary endpoints included comparing various USSQ scores and single responses two weeks after the DJ and PSS placements, as well as evaluating the USSQ scores for both DJ and PSS in relation to the baseline measurements.

The results indicated a significant improvement in the Urinary Symptom Index Score after two weeks (p value < 0.001), along with a notable difference in the percentage of patients experiencing pain (60.2% for PSS compared to 88.2% for DJ, p value < 0.001), both of which favored PSS. The two-week scores revealed significant enhancements with PSS relative to DJ in various indices: Pain Index (p value < 0.001), General Health Index (p value < 0.001), VAS (p value < 0.001), and Work Performance Index (p value < 0.001). All urinary symptoms were significantly alleviated with PSS, including renal pain during urination and pain affecting quality of life. The Pain Index Score (p value = 0.622) and VAS (p value = 0.169) were similar to baseline with PSS, differing with the results observed with DJ.

Therefore, patients who underwent DJ substitution with PSS after URS demonstrated a significant decrease in SRS. Urologists could consider PSS following URS for patients who have previously been pre-stented to alleviate stent-related symptoms.