BACKGROUND/OBJECTIVE:Convective water vapor thermal therapy (CWVTT) effectively treats Lower Urinary Tract Symptoms (LUTS) from Benign Prostatic Hyperplasia (BPH). While sexual outcomes have been studied across BPH procedures, the influence of prostate size on sexual function after CWVTT is unclear. We aimed to determine whether preservation of sexual function, measured by the Sexual Health Inventory for Men (SHIM), differs by prostate volume, particularly in larger glands. SUBJECTS/METHODS:Following IRB approval, patients aged ≥18 undergoing CWVTT from October 2018 to August 2022 were identified by CPT codes 53,852 and 53,854. After applying inclusion/exclusion criteria, patients were stratified into prostate tertiles: small (≤38.5 cc), medium (38.5-55.6 cc), and large (>55.6 cc). SHIM scores were tracked longitudinally. RESULTS:Baseline demographics were similar across tertiles. Mean SHIM change from baseline to 3 months was -1.02, -2.10, and -0.46 for small, medium, and large prostates, respectively; only the medium group showing a statistically significant decline. Beyond 3 months, SHIM scores improved across all tertiles. Large prostates demonstrated a significant increase in SHIM over time (+0.18/month, p = 0.01) though significance was lost after adjusting for age, comorbidities, and baseline SHIM. Severe baseline erectile dysfunction (ED) predicted the greatest postoperative improvement, while men with no ED experienced mild decline. Age and baseline SHIM were the strongest predictors of outcomes. CONCLUSIONS:Men with larger prostates who undergoe CWVTT do not appear at increased risk of ED. In fact, the men with larger prostates have a faster recovery of sexual function than other prostate sizes. Patients with severe ED should be counseled on the potential for improvement in their sexual function following their procedure, especially 3 months onward with the exact mechanism being unknown. Finally, prostate volume likely plays a role in timing of recovery, although it is overshadowed by the influence of baseline SHIM scores and age.

PURPOSE:Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) affect quality of life. Convective water vapor thermal therapy (CWVTT; Rezūm) is a minimally invasive surgical treatment for LUTS/BPH which produces significant improvement of LUTS in men with prostates between 30 cc and 80 cc with minimal de novo sexual dysfunction. However, outcomes across the prostate volume (PV) spectrum are incompletely described. We aim to elucidate the relationship between PV and outcomes post CWVTT in men with LUTS/BPH. MATERIALS AND METHODS:Patients undergoing CWVTT at a tertiary care center were included. The primary outcome was change in International Prostate Symptom Score (IPSS) pre CWVTT compared with post CWVTT between PV tertiles-small (≤38.5 cc), medium (38.5 to ≤55.6 cc), and large (>55.6 cc). Secondary outcome was time to a minimally clinically important difference of 25% decrease in IPSS. RESULTS:One hundred seventy-one patients were divided into small (n = 56), medium (n = 54), and large (n = 61) PV tertiles. The change in IPSS preoperatively to 3 months was significant for all tertiles with mean difference of -7.51 (-10.14 to -4.83), -10.12 (-12.71 to -7.53), and -11.72 (-14.14 to -9.29) for small, medium, and large PVs, respectively (P = <.001). In multivariable analysis, having diabetes was associated with increased IPSS after 3 months with average increase (95% CI) of 3.67 (0.23-7.11, P = .037) compared with not having diabetes. The median time (Q1, Q3) to -25% in IPSS for small, medium, and large PVs was 16.1 (12.1, 17.5), 12.3 (7.1, 15.7), and 13.8 (10.8, 16.3) months, respectively. In multivariable analysis, medium PV had significantly increased incidence of 25% decrease compared with small PV (HR [95% CI]: 2.10 [1.19-3.72], P = .011). CONCLUSIONS:CWVTT results in significant and durable LUTS improvement across the PV spectrum. All PVs experience the same improvement in LUTS post CWVTT. However, medium and large glands may improve more quickly than small glands.

Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) affects quality of life. Convective water vapor thermal therapy (CWVTT - Rezum) is a minimally invasive surgical treatment for LUTS/BPH which produces significant improvement of LUTS in men with prostates between 30cc-80 cc with minimal de-novo sexual dysfunction. However, outcomes across the prostate volume (PV) spectrum are incompletely described. We aim to elucidate the relationship between PV and outcomes post-CWVTT in men with LUTS/BPH. Patients undergoing CWVTT at a tertiary care center were included. The primary outcome was change in IPSS pre-CWVTT compared post-CWVTT between PV tertiles - small (≤38.5 cc), medium (38.5 - ≤55.6cc), and large (>55.6cc). Secondary outcome was time to a minimally clinically important difference (MCID) of 25% decrease in IPSS. 171 patients were divided into small (n=56), medium (n=54), and large (n=61) PV tertiles. The change in IPSS pre-operatively to 3-months was significant for all tertiles with mean difference of [-7.51 (-10.14, -4.83)], [-10.12 (-12.71, -7.53)], and [-11.72 (-14.14, -9.29)] for small, medium, and large PV, respectively (p=<0.001). In multivariable analysis, having diabetes was associated with increased IPSS after 3mo with average increase (95% CI) of [3.67 (0.23,7.11), p=0.037] compared to not having diabetes The median time (Q1, Q3) to -25% in IPSS for small, medium, and large PV were 16.1 (12.1, 17.5), 12.3 (7.1, 15.7), and 13.8 (10.8, 16.3) months, respectively. In multivariable analysis, medium PV had significantly increased incidence of 25% decrease compared to small PV [HR (95%CI): 2.10 (1.19, 3.72), p=0.011]. CWVTT results in significant and durable LUTS improvement across the prostate volume spectrum. All prostate volumes experience the same improvement in LUTS post-CWVTT. However, medium and large glands may improve more quickly than small glands.

Robotic nephron-sparing surgery is traditionally performed via a transperitoneal (TP) approach. However, the retroperitoneal (RP) approach has gained popularity, particularly for posterolateral renal masses. The RP approach is associated with shorter operative time, less blood loss, and shorter length of stay, while preserving oncologic outcomes in selected masses. Here, we aim to assess the feasibility of the RP approach in excising anterior renal masses. Patients ≥ 18 years of age who underwent robotic nephron-sparing surgery for anterior renal masses were retrospectively identified (2008–2022). Baseline demographics, tumor characteristics, and perioperative data were collected and characterized based on TP vs RP approaches. Wilcoxon rank sum test and Pearson’s Chi-squared test were used to compare continuous and categorical variables, respectively. Two hundred and sixteen patients were included—178 (82.4

You have accessJournal of UrologyCME1 Apr 2023MP13-18 LARGE PROSTATE SIZE AND ITS EFFECT ON LUTS IMPROVEMENT AND SEXUAL PRESERVATION FOLLOWING CONVECTIVE WATER VAPOR THERMAL THERAPY Owen Lewer, Michael Felice, Gaurav Pahouja, Amy Wozniak, and Kevin McVary Owen LewerOwen Lewer More articles by this author , Michael FeliceMichael Felice More articles by this author , Gaurav PahoujaGaurav Pahouja More articles by this author , Amy WozniakAmy Wozniak More articles by this author , and Kevin McVaryKevin McVary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: LUTS/BPH can affect quality of life in men. Convective water vapor thermal therapy (CWVTT - Rezum) is a minimally invasive surgical treatment (MIST) for LUTS/BPH which produces significant, 5-year improvement of LUTS in men with prostates between 30 and 80 cc with minimal de-novo sexual dysfunction. However, CWVTT outcomes based on variable prostate volume (PV) are incompletely described thus is an unmet need. We aim to elucidate the relationship between PV and outcomes post-CWVTT in men with LUTS/BPH. METHODS: In this retrospective study of men undergoing CWVTT from 1/2018 to 3/2022, PV was categorized by tertiles. The primary outcome measured was mean change in I-PSS post-CWVTT between tertiles over 24 months, and analyzed using general linear mixed models. Secondary outcomes include SHIM and IPSS-QOL. Results were adjusted for relevant patient characteristics. RESULTS: 232 patients were included and broken into PV tertiles: small (≤38.5 cc, N=78), medium (38.5-≤55.6 cc, N=76), and large (>55.6 cc, N=78). For IPSS, the change from baseline to 3-months post-op was -7.6 (p=<0.01), -10.4 (p=<0.01) and -11.6 (p=<0.01), small, medium, and large PV, respectively. Post-operatively, small and medium PV had decreasing IPSS scores while large PV IPSS scores were relatively stable. Large PV tended to have the lowest IPSS scores, regardless of time. These trends were similar for IPSS-QOL. For SHIM scores, all PV tertiles decreased from baseline to 3-months post-op. All 3 tertiles had improved SHIM scores over time. Large PV had significant increases in SHIM scores when unadjusted for other patient factors [0.18 per month (95% CI: 0.03 - 0.33, p=0.02)]. Small PV tended to have the lowest SHIM scores, regardless of time. In all three outcomes, when adjusted for other patient characteristics, the trends were not statistically significant. CONCLUSIONS: Interestingly, patients with larger PV may exhibit a more dramatic improvement in sexual function as measured by SHIM than those with smaller PV. In contrast, larger prostates may have a less dramatic improvement in LUTS as measured by I-PSS and I-PSS QoL than smaller ones. However, adjusted analyses show no significant improvement or decline in any of our outcomes by PV after the first post-operative appointment. Source of Funding: NIAID T35 AI125220 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e180 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Owen Lewer More articles by this author Michael Felice More articles by this author Gaurav Pahouja More articles by this author Amy Wozniak More articles by this author Kevin McVary More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction:Malignant ureteral obstruction is associated with a poor prognosis, with a median survival of 3 to 7 months. These patients are ideal candidates for concurrent palliative care services, consistent with American Society of Clinical Oncology guidelines. We aimed to characterize palliative care, hospice, and end-of-life health care utilization in patients with malignant ureteral obstruction.Methods:Patients >= 18 years old at our institution and diagnosed with malignant ureteral obstruction between May 2014 and August 2020 were retrospectively identified and pertinent data extracted. Palliative care, hospice, and end-of-life health care utilization was described, and factors associated with each were assessed with logistic regression models. Overall survival was assessed with Cox proportional hazard regression models.Results:One hundred fifteen patients qualified for analysis; 39.1% (45/115) utilized palliative care and spent a median of 12.5 days (IQR 3-52 days) on nonhospice palliative care. On adjusted analysis Black ethnicity (aOR 3.44, 95% CI: 1.08-10.94) was associated with palliative care utilization. Of the patients, 53.9% (62/115) utilized hospice. The median time from hospice initiation to death was 12 days (IQR 5-23 days). On adjusted analysis, prior extirpative surgery (aOR 3.63, 95% CI 1.01-13.05) and palliative care utilization (aOR 4.38, 95% CI 1.70-11.31) were associated with hospice utilization. Median survival following diagnosis was 141 days (IQR 37.5-442.5). Of the patients, 43.0% (37/86) had high end-of-life health care utilization. On multivariable analysis, only hospice (aOR 0.03, 95% CI 0.01-0.14) was associated with less end-of-life health care utilization.Conclusions:Palliative care is underutilized in malignant ureteral obstruction. Hospice, but not palliative care utilization, was associated with decreased end-of-life health care utilization.