Cheney, Scott M

Abstract Purpose The temporarily implanted nitinol device (TIND) is a minimally invasive surgical technique (MIST) for benign prostatic hyperplasia (BPH) that promises fewer unwanted side effects compared with traditional bladder outlet procedures for small glands with high-riding bladder necks, including transurethral incision of the prostate (TUIP). This study sought to compare the effect of TIND vs. TUIP on ejaculatory function in sexually active males using the Male Sexual Health Questionnaire Ejaculatory Function Short Form (MSHQ-EjD-SF). Methods A retrospective review of a prospectively maintained database of all patients who underwent TIND at our institution between 1/1/2022 and 10/1/2024. Patients were excluded if they reported no postoperative ejaculations. Patients who underwent TUIP during the same period were compared. Age, prostate volume, PSA, and urinary parameters were collected. MSHQ-EjD-SF scores were collected for all patients. Continuous variables were compared using Wilcoxon Rank sum test and categorical variables using Fisher’s exact test. Results A total of 27 patients underwent TIND, of which 17 reported postoperative ejaculations and were compared with 17 patients who underwent TUIP during the same period with similar baseline age, prostate volume, and urinary parameters. Median MSHQ-EjD-SF score was higher after TIND compared with TUIP (15.0 (14.0, 15.0) vs. 13.0 (11.0, 13.0), p < 0.01), while bother score was lower (0.0 (0.0, 0.0) vs. 1.0 (0.0, 2.0), p = 0.02). Conclusions Patients experienced negligible effect on ejaculatory function after TIND compared with TUIP. This may be an effective bladder outlet procedure for patients who prioritize their postoperative ejaculatory function.

Background: Postoperative stress urinary incontinence (SUI) after Holmium Laser Enucleation of the Prostate (HoLEP) has improved with the early apical release (EAR) technique. However, some patients develop SUI despite using EAR HoLEP. The aim of this study is to investigate whether a novel classification of the external sphincter is correlated with postoperative SUI. Methods: The data of 98 patients who underwent EAR HoLEP for benign prostatic hyperplasia were prospectively analyzed. We propose a novel endoscopic classification of external sphincter appearance after HoLEP graded from 0 (best preserved) to 3 (most degraded). Patients were followed for 6 months postoperatively and administered validated questionnaires. A logistic regression was performed to compare moderate SUI rates at sphincter grade 3, controlling for age, obesity, catheter dependency, and grams resected at 6 weeks and 3 months. Results: The sphincter grades included 6 grade 0, 47 grade 1, 30 grade 2, and 15 grade 3. Patients were divided into a group without SUI ( n = 51), and a group with SUI ( n = 47) at 6 weeks postoperatively by International Consultation on Incontinence Questionnaire (ICIQ). Patients with reported SUI on ICIQ were more likely to have sphincter grades ≥2 at 6 weeks (p= 0.001) and 3 months ( p < 0.0001). At 6 months, persistent SUI was associated with sphincter grade 3 ( p < 0.0001). Logistic regression demonstrated that sphincter grade 3 was associated with clinically significant SUI at 3 months ( p < 0.01). Conclusions: Lower sphincter grades are associated with improved return of continence after EAR HoLEP.

Purpose: The Manufacturer and User Facility Device Experience database contains anonymous, voluntary medical device reports. A review of device-related adverse events associated with Benign Prostatic Hyperplasia surgeries was completed. The objective was to evaluate the occurrence and contributing factors to clinically significant complications in a cohort of patients electing to undergo surgical intervention for Benign Prostatic Hyperplasia. Methods: The Manufacturer and User Facility Device Experience database was queried for “Aquablation, Greenlight Laser, Holmium Laser, Morcellator, Water Vapor Thermal Therapy, Loop Resection, and Prostatic Urethral Lift” from 2018 through 2021. A complication classification system (Level I–IV) based on the Clavien-Dindo system was used to categorize events. These events were then correlated with procedural technology malfunctions and classified as “device related” and “non-device related.” Chi squared analysis was performed to identify associations between procedural technology and complication classification distribution. Results: A total of 873 adverse events were identified. The adverse events were classified into level I (minimal harm) versus levels II–IV (clinically significant). Aquablation ( p < 0.017) and Water Vapor Thermal Therapy ( p < 0.012) were associated with a higher proportion of reports with Level II-IV complications compared with other procedure types. Level II-IV complications were not associated with a reported device related malfunction. Conclusions: Aquablation and water vapor thermal therapy demonstrated noteworthy clinically significant complications which were not driven by device-related malfunctions.

AbstractPurpose/ObjectivesHolmium laser enucleation of the prostate (HoLEP) is commonly performed in patients with significant bladder outlet obstruction. However, there are few reports on the toxicity of external beam irradiation (RT) for prostate cancer in patients after prior HoLEP. In this study, we evaluate the side effects and treatment outcomes of RT after HoLEP.Materials/MethodsEighteen patients who had HoLEP and subsequently received RT for prostate cancer were included. Data collected included patient and disease characteristics, urinary function, and radiation dose. Acute and late urinary (GU) and gastrointestinal (GI) side effects were evaluated. Disease control and survival rates were calculated using Kaplan–Meier method.ResultsMedian follow‐up was 18 months (range: 4–46 months). Median prostate volume was 107 ml before HoLEP and 24 ml after HoLEP. Median International Prostate Symptom Score (IPSS) was 17 (range: 5–32) before HoLEP. Median decline in IPSS score after HoLEP was 7 (range: −2–21). On uroflow study, peak flow rate, and post‐void residual were significantly improved after HoLEP. After radiation, peak flow rate and average flow rate showed a decline but remained significantly improved compared to pre‐HoLEP measurements. Maximum acute Common Terminology Criteria for Adverse Events (CTCAE) adverse events were 12 grade 1 and 3 grade 2 for GU, and 3 grade 1 for GI, respectively. Maximum late adverse events were 13 grade 1 and 2 grade 2 for GU, and all grade 0 for GI, respectively. At last follow‐up, there were 8 grade 1 and 1 grade 2 late GU, and 3 grade 1 late GI adverse events, respectively. There was no significant increase in urinary incontinence after RT compared to before RT. The 18‐month biochemical control, local control, distant control rates were 78%, 94%, and 80%, respectively.ConclusionsPatients who received RT as definitive treatment for prostate cancer after prior HoLEP had low risk of serious acute and late side effects. HoLEP can be safely performed and should be considered in patients with significant bladder outlet obstruction and large prostate volume before RT.

Objectives To compare the enucleation efficiency of Moses 2.0 with non‐Moses technology in patients undergoing holmium laser enucleation of the prostate (HoLEP). Patients and Methods A double‐blinded, randomised study of patients undergoing HoLEP at the Mayo Clinic in Arizona, using the Lumenis Pulse™ 120H laser system. Patients were randomised to either right lobe enucleation using Moses 2.0 and left lobe enucleation using non‐Moses, or the opposite. The primary outcome was individual lobe enucleation efficiency. Secondary outcomes included individual lobe laser time, laser energy, individual enucleation and haemostasis laser energies, and fibre burn back. Two independent reviewers watched videos of the procedures and provided a subjective evaluation of the technologies. Results A total of 27 patients were included in the study. For the entire cohort, Moses 2.0 had less fibre degradation (3.5 vs 16.8 mm, P < 0.01) compared to non‐Moses. When HoLEP procedures were performed by an expert, Moses 2.0 resulted in shorter enucleation time (21 vs 36.7 min, P = 0.016) and higher enucleation efficiency (1.75 vs 1.05 g/min, P = 0.05) compared to non‐Moses. When HoLEP was performed by trainees, the Moses 2.0 cohort had a shorter haemostasis laser time (4.1 vs 9 min, P = 0.035) compared to the non‐Moses. Fibre degradation was lower with Moses 2.0 compared to non‐Moses for both experts and trainees. Moses 2.0 received a higher score than the standard technology for the incision sharpness, fibre control, tissue separation, tissue damage, haemostasis, visibility, and charring. The overall inter‐observer correlation coefficient was 0.63. Conclusion Moses 2.0 has higher enucleation efficiency compared to non‐Moses when used by experts. The subjective evaluation favoured Moses 2.0.

Objective To evaluate outcomes of the first 18 patients treated with robot‐assisted retroperitoneal lymph node dissection ( RA‐RPLND ) for non‐seminomatous germ cell tumours ( NSGCT ) and paratesticular rhabdomyosarcoma ( RMS ) at our institution. Patients and Methods Between M arch 2008 and M ay 2013, 17 patients underwent RA‐RPLND for NSGCT and one for paratesticular RMS . Data were collected retrospectively on patient demographics, preoperative tumour characteristics, and perioperative outcomes including open conversion rate, lymph node ( LN ) yield, rate of positive LNs , operative time, estimated blood loss ( EBL ), and length of stay ( LOS ). Perioperative outcomes were compared between patients receiving primary RA‐RPLND vs post‐chemotherapy RA‐RPLND . Medium‐term outcomes of tumour recurrence rate and maintenance of antegrade ejaculation were recorded. Results RA‐RPLND was completed robotically in 15 of 18 (83%) patients. LNs were positive in eight of 18 patients (44%). The mean LN yield was 22 LNs . For cases completed robotically, the mean operative time was 329 min, EBL was 103 mL, and LOS was 2.4 days. At a mean (range) follow‐up of 22 (1–58) months, there were no retroperitoneal recurrences and two of 17 (12%) patients with NSGCT had pulmonary recurrences. Antegrade ejaculation was maintained in 91% of patients with a nerve‐sparing approach. Patients receiving primary RA‐RPLND had shorter operative times compared with those post‐chemotherapy (311 vs 369 min, P = 0.03). There was no significant difference in LN yield (22 vs 18 LNs , P = 0.34), EBL (100 vs 313 mL, P = 0.13), or LOS (2.75 vs 2.2 days, P = 0.36). Conclusion This initial selected case series of RA‐RPLND shows that the procedure is safe, reproducible, and feasible for stage I – IIB NSGCT and RMS in the hands of experienced robotic surgeons. Larger studies are needed to confirm the diagnostic and therapeutic utility of this technique.