Objectives The aim of this study was to elucidate the impact of prior transurethral resection of the prostate (TURP) on functional and surgical outcomes following robot-assisted radical prostatectomy (RARP). Methods Electronic medical records of 6,031 patients who underwent RARP were retrospectively reviewed to identify 173 patients with a previous surgical history of TURP self-reported at admission. Patients were propensity-score matched at a 1:4 ratio for age, body mass index (BMI), biopsy Gleason grade group (GG), and clinical stage. Perioperative International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) scores were assessed, as were achievement of continence and rate of postoperative re-catheterization. Results A total of 865 cases were included in the final analysis, with 173 and 692 patients with and without a recorded history of TURP. Patients with TURP were more likely to harbor less aggressive pathology at RARP including lower pathologic stage (pT≥3 26.2% vs. 36.3%; p=0.012) and lower mean PSA (10.3±10.7 vs. 14.2±24.8; p=0.002). Operation time and console time were longer in the TURP (+) group (p=0.001 and 0.022, respectively), with higher rate of estimated blood loss (p=0.004). The positive surgical margin rate did not differ significantly (p=0.063). The re-catheterization rate after RARP was not adversely affected (4.6% vs. 2.2%, p=0.072), although TURP (+) patients were more likely to experience immediate urinary leakage or retention (6.9% vs. 3.2%, p=0.023). Rate of achieving pad-free status was not significantly different (88.3% vs. 90.0%, p=0.532), although patients with previous TURP took longer to achieve continence (6.0±9.9 months vs. 4.3±5.5 months, p=0.044). Conclusion RARP following TURP is challenging, with longer console times and increased blood loss, but does not necessarily prevent eventual continence. Patients with prior TURP should be educated on longer times to reach pad-free status and the favorable prognosis after surgery.

Purpose PI-RADS 3 lesions represent a diagnostic challenge in repeat prostate biopsy. We investigated whether PI-RADS 3 independently predicts negative biopsy outcomes and how PSA density (PSAD) modifies cancer detection across PI-RADS categories. Materials and Methods We retrospectively analyzed 684 patients who underwent repeat MRI-guided prostate biopsy between 2015 and 2022. PI-RADS scores, clinicopathologic variables, biopsy Gleason Scores, and radical prostatectomy findings were assessed. Univariate and multivariate logistic regression identified predictors of positive biopsy. Subgroup analysis examined detection rates stratified by PI-RADS and PSAD. Results Overall, 238 patients (34.8%) had positive biopsies. PI-RADS 3 was identified in 210 patients (30.7%) and PI-RADS 4-5 in 274 (40.1%). Cancer detection differed significantly: 19.0% for PI-RADS 3 versus 51.8% for PI-RADS 4-5 (p<0.001). Multivariate analysis confirmed PI-RADS 3 as an independent predictor of negative biopsy (OR 0.582, 95% CI 0.364-0.929, p=0.023), while PI-RADS 4-5 predicted positive biopsy (OR 2.438, p<0.001). PSAD strongly stratified risk in PI-RADS 4-5 lesions (33.8% vs 62.4%, p<0.001) but showed minimal effect in PI-RADS 3 lesions (16.2% vs 20.7%, p=0.564). Conclusion PI-RADS 3 lesions independently predict negative biopsy in repeat MRI-guided prostate biopsy. PSAD demonstrates differential predictive utility across PI-RADS categories. Risk-stratified management incorporating imaging and clinical biomarkers may optimize decision-making while minimizing unnecessary procedures.

Purpose: This study evaluated the clinical impact of escalating tamsulosin dosage from 0.2 to 0.4 mg in men with benign prostatic hyperplasia (BPH) who exhibited inadequate responses to the lower dose. Materials and Methods: A retrospective review was performed on 57 patients treated at Seoul National University Bundang Hospital in 2022. Uroflowmetry parameters, International Prostate Symptom Score (IPSS), and postvoid residual volume (PVR) were compared before and after dose escalation. Subgroup analysis was conducted by age, prostate volume, and concomitant 5-alpha-reductase inhibitor use. Results: The mean maximum urinary flow rate value improved significantly from 14.4 to 17.7 mL/s (p<0.001), with consistent benefits across subgroups. No significant changes were observed in IPSS or PVR overall, although PVR decreases were significant in prostates >50 mL. Conclusions: Escalating tamsulosin from 0.2 to 0.4 mg can meaningfully improve urinary flow in certain BPH patients, particularly those with larger prostates or concomitant 5-alpha-reductase inhibitor therapy.

Purpose This study aimed to evaluate the correlation between bladder outlet obstruction (BOO) and bladder trabeculation in patients with benign prostatic hyperplasia (BPH). Methods We analyzed data from consecutive BPH patients from July 2014 to June 2024, who underwent urodynamic study (UDS) and cystourethroscopy. The results of free uroflowmetry, filling cystometry, and pressure-flow study were analyzed to evaluate functional parameters. For anatomical parameters, bladder trabeculation grade, lateral lobe protrusion of prostate, and bladder neck elevation (BNE) measured in cystourethroscopy were used. BOO was defined as the BOO index of 40 or higher in UDS. Bladder trabeculation was graded using our previous studies. Results Among total of 1,452 BPH patients, 1,028 patients had trabeculation on cystoscopy. Age, serum prostate-specific antigen, postvoid residual, total prostate volume, transition zone volume, terminal type detrusor overactivity, detrusor pressure at the maximal flow rate, bladder contractility index (BCI), and BOO index increased according to increase in bladder trabeculation. Multivariable logistic analysis showed that bladder trabeculation was significantly associated with age (odds ratio [OR], 1.05; P<0.001), kissing sign (OR, 1.55; P=0.007), BNE (OR, 1.76; P<0.001), detrusor overactivity (OR, 1.88; P=0.002), BCI (OR, 1.01; P=0.037), BOO (OR, 2.27; P<0.001). BOO had the greatest correlation with bladder trabeculation. In addition, BOO index showed a positive correlation (r=0.39, P<0.001) with bladder trabeculation. BOO index well distinguished between moderate trabeculation of grade 2 or higher in receiver operating characteristic analysis (area under curve=0.72, P<0.001). Conclusions Our results showed that the severity of BOO is positively associated with the severity of bladder trabeculation.

PURPOSE:Gleason grade group (GG) concordance between prostate biopsy and radical prostatectomy (RP) is critical for treatment planning, particularly for active surveillance (AS). We compared GG concordance, upgrade rates, and AS misclassification between institutional and outside biopsies and evaluated the impact of pathologic re-evaluation. MATERIALS AND METHODS:In this propensity score-matched cohort study, 3,744 patients (1,872 institutional and 1,872 outside biopsies) who underwent RP were analyzed. Outside biopsies were stratified by re-evaluation status (re-evaluated, n=570; not re-evaluated, n=1,302). Primary outcomes included overall GG concordance, clinically significant upgrade (≥2 GG), and AS misclassification (biopsy GG 1 to RP ≥GG 3). Agreement was assessed using weighted kappa statistics, and predictors of upgrade were identified by multivariable logistic regression. RESULTS:Overall GG concordance was 44.7%. Institutional biopsies showed the highest concordance (47.8%) compared to outside biopsies with (45.3%) and without re-evaluation (40.0%) (p<0.001). Among biopsy GG 1 patients, AS misclassification to ≥GG 3 occurred in 9.6% of institutional biopsies, compared to 27.0% of outside re-evaluated biopsies and 20.0% of outside non-re-evaluated biopsies (p<0.0001). Outside biopsy source (odds ratio [OR] 1.351, p=0.013) and absence of re-evaluation (OR 1.451, p=0.028) were identified as independent predictors of GG upgrade. CONCLUSIONS:Outside prostate biopsies exhibit 2.1- to 2.8-fold higher AS misclassification rates compared to institutional biopsies. Pathologic re-evaluation provides only modest improvement and does not eliminate upgrade risk, supporting systematic second-opinion review and careful confirmation before AS enrollment.

Transurethral enucleation with bipolar energy (TUEB) is one of endoscopic enucleation methods for the surgical treatment of benign prostatic hyperplasia (BPH). Authors investigated initial outcomes of TUEB performed by a single surgeon. From 04/2016 to 06/2021, prospectively collected clinical data of 387 patients who underwent TUEB were retrospectively analyzed. TUEB was performed by transurethral resection in a saline system with a spatula loop (one-lobe enucleation technique). Patients were stratified by surgery period (early vs. late) and evaluated perioperatively. A total of 387 patients were included in the final analysis. Mean age was 72.4 years and total prostate volume was 73.1 cc as in the whole group. Total procedure time (116.0 vs. 116.8 min, p = 0.863), detailed procedure time (enucleation: 49.2 vs. 46.1 min, p = 0.099; morcellation: 26.5 vs. 23.6 min, p = 0.162) and enucleated tissue weight (26.1 g vs. 27.9 g, p = 0.350) did not differ significantly between groups. However, there were significant differences in enucleated tissue weight per unit time (g/min) (0.52 vs. 0.58, p = 0.037), reoperation rates due to bleeding (9.8

OBJECTIVE:This study aimed to analyze the outcomes of clinical management of patients with interstitial cystitis (IC). PATIENTS AND METHODS:We retrospectively analyzed the electronic medical records of patients with IC who visited outpatient clinics with pelvic pain between October 2005 and December 2019. Pain was managed with cystoscopic surgery based on transurethral fulguration (TUF) for bladder ulcers. Cystectomy was performed for intractable pelvic pain. Patients were regularly followed and clinical outcomes were analyzed. RESULTS:Of the 275 patients, 240 patients (57 men, 23.7% and 183 women, 76.3%) underwent initial cystoscopic surgery. Overall median follow-up duration was 21.0 months and mean number of TUF was 1.0 (±0.8). Of these 240 patients, 71 (29.6%) did not require further surgical treatment, whereas 64 (26.7%) required a second TUF for recurrent pelvic pain. The median recurrence interval was 12.0 (interquartile range: 6.0-25.0) months. Of the 64 patients who received a second TUF, 15 (23.4%) underwent a third TUF after a median of 12.0 (interquartile range: 12.0-32.0) months. Of the 15 patients who received a third TUF, five patients required a fourth TUF because of recurrence of pain. One patient received until a seventh TUF. Overall, 168 of 240 patients (70.0%) achieved pain control with TUF. Eighteen patients (7.5%) underwent cystectomy (six patients with urinary diversion and 12 patients with cystectomy with bladder replacement). CONCLUSION:TUF-based cystoscopic surgery is an effective basic treatment for pelvic pain management in patients with IC.

Background:Benefit of pentosan polysulfate sodium (PPS) for reducing chronic pain and lower urinary tract symptomin patients with interstitial cystitis/bladder pain syndrome (IC/BPS) remains inconclusive with modest effect. We aimed to evaluate the impact of PPS on improvement of lower urinary tract symptom based on the International Prostate Symptom Score (IPSS), quality of life (QoL), and uroflowmetry (UFM) in patients with IC/BPS. Materials and methods:A total of 204 patients who were prescribed oral PPS for IC/BPS from October 2006 to May 2021 were retrospectively reviewed. Patients were divided by age for treatment effect comparison. Linear mixed models were utilized to evaluate improvements in IPSS, QoL, and UFM parameters after PPS treatment. Results:There were significant gains in total IPSS (-0.335, P < 0.001) and QoL (-0.061, P < 0.001) over time, achieving stable phase within 3 months from the initiation of PPS treatment. For UFM parameters, postvoid residual decreased significantly over time (-1.052, P = 0.029), while maximum flow rate (0.093, P = 0.334) and voiding volume (0.751, P = 0.586) showed no significant differences. Compared to patients older than 65 years, those younger than 65 years showed significantly better improvements in the IPSS (-0.492 vs. -0.184, P = 0.018) but worse in voiding volume (-2.481 vs. 5.032, P = 0.006). Conclusions:PPS provides clinical benefits in urinary symptoms voiding symptoms and QoL over time, arriving plateau within 3 months. Such benefits based on the IPSS tend to be more evident in younger patients, suggesting that PPS mostly benefits early treatment if suspected for IC/BPS.

BACKGROUND:The purpose of this study is to evaluate the efficacy and safety of holmium laser prostatectomy in patients diagnosed with primary bladder neck obstruction (PBNO), compared with patients with benign prostatic hyperplasia (BPH). METHODS:We analyzed the databases of patients who underwent a holmium laser prostatectomy or enucleation of the prostate for PBNO and BPH between January 2018 and August 2022. PBNO was diagnosed primarily based on cystourethroscopic findings. Patients were followed up according to a regular protocol at 2 weeks, 3 mo, and 6 mo postoperatively. RESULTS:In total, 28 and 447 patients with PBNO and BPH, respectively, were identified. Preoperative urodynamic studies showed that detrusor underactivity was significantly more prevalent in the PBNO group (78.6%) than in the BPH group (57.5%) (p < 0.01). Both PBNO and BPH groups showed significant improvements in the total International Prostate Symptom Score, Overactive Bladder Symptom Score, and maximum flow rate at 6 mo postoperatively compared with the preoperative values (p < 0.01). Subjective satisfaction 6 mo after operation was not significantly different between the PBNO and BPH groups (p > 0.05). Complications in the PBNO group included recatheterization (n = 1, 3.5%), with no patients requiring blood transfusion or transurethral coagulation. CONCLUSIONS:Holmium laser prostatectomy was effective and safe for patients with PBNO, with elevated subjective patient satisfaction.

ObjectiveTo analyze the results of excluding confusable diseases in patients with a presumptive diagnosis of interstitial cystitis (IC).MethodsWe retrospectively reviewed the electronic medical records of consecutive patients with IC between October 2005 and December 2019.ResultsPatients with pelvic pain underwent an initial workup. Of these, 646 patients (164 men, 25.4%; 482 women, 74.6%) underwent observational cystoscopy under the suspicion of IC. Fourteen patients had genitourinary tract malignancies (2.2%) (bladder cancer, n = 13; prostate cancer, n = 1). Of the 13 patients with bladder cancer, three were diagnosed during initial observation cystoscopy. The remaining 10 patients were diagnosed during subsequent follow-up cystoscopic surgery. Urinary tuberculosis was identified in seven (1.1%) of 646 patients during the examination. Five (0.8%) of the six patients with suspected urinary tuberculosis at baseline imaging were positive for tuberculosis in the acid-fast bacillus test. One patient developed tuberculous granulomas in the bladder tissue after a cystectomy for intractable pelvic pain.ConclusionOur results show that continuous efforts to rule out bladder tumors or tuberculosis are still essential in the follow up of patients with suspected IC, even if these diseases are not excluded at the initial examination. Imaging studies are necessary to rule out tuberculosis. Screening for confusable diseases, including bladder malignancy and tuberculosis, remains crucial for suspected interstitial cystitis patients, even if these conditions were not excluded initially.

ObjectiveTo evaluate the effect of detrusor underactivity (DUA) on the postoperative outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH).Patients and MethodsPatients with BPH who underwent HoLEP between January 2018 and December 2022 were enrolled in this prospective database study. Patients were divided into DUA (bladder contractility index [BCI] <100) and non‐DUA (BCI ≥100) groups. Objective (maximum urinary flow rate [Qmax], post‐void residual urine volume [PVR]) and subjective outcomes (International Prostate Symptom Score [IPSS], Overactive Bladder Symptom Score [OABSS], satisfaction with treatment question [STQ], overall response assessment [ORA], and willingness to undergo surgery question [WUSQ]) were compared between the two groups before surgery, and at 3 and 6 months after HoLEP.ResultsA total of 689 patients, with a mean (standard deviation [SD]) age of 69.8 (7.1) years, were enrolled. The mean (SD) BCI in the non‐DUA (325 [47.2%]) and DUA (364 [52.8%]) groups was 123.4 (21.4) and 78.6 (14.2), respectively. Both objective (Qmax and PVR) and subjective (IPSS, IPSS‐quality of life, and OABSS) outcomes after surgery significantly improved in both groups. The Qmax was lower in the DUA than in the non‐DUA group postoperatively. At 6 months postoperatively, the total IPSS was higher in the DUA than in the non‐DUA group. There were no significant differences in surgical complications between the two groups. Responses to the STQ, ORA, and WUSQ at 6 months postoperatively demonstrated that the patients were satisfied with the surgery (90.5% in the DUA group; 95.2% in the non‐DUA group), their symptoms improved with surgery (95.9% in the DUA group; 100.0% in the non‐DUA group), and they were willing to undergo surgery again (95.9% in the DUA group; 97.9% in the non‐DUA group). There were no significant differences in the responses to the STQ and WUSQ between the two groups.ConclusionOur midterm results demonstrated that patients with BPH and DUA showed minimal differences in clinical outcomes after HoLEP compared to those without DUA. The overall satisfaction was high in the DUA group.

PURPOSE:To examine efficacy and safety of ReMEEX implantation in patients with female stress urinary incontinence (SUI) associated with detrusor underactivity (DU), recurrence, or intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS:Retrospective cohort study included 303 females who underwent ReMEEX system (March 2008 to May 2021). Patients were stratified into three groups by purpose of surgery (SUI with DU, reoperation, and SUI with ISD) and evaluated with following criteria: cure (absence of subjective complaint of leakage and objective leakage in the stress test), improvement (rare leakage subjectively, but satisfaction regardless of stress test), and failure. Primary outcome was success rate of surgery assessed through patient interviews and a stress test. Surgical outcomes and complications were evaluated. RESULTS:Mean follow-up was 34.4 months (range, 6.0-145.0 months). At the final follow-up visit, 42.9% and 49.2% of patients were cured and improved. Twenty-one point five percent required tension readjustment (mean number, 1.2). The total complication rate was 19.5% (none for grade ≥4). Preoperative Qmax was significantly higher in the ISD group (p<0.001) and preoperative total International Prostate Symptom Score (IPSS) score was significantly higher in the DU group (p=0.044). Moreover, at postoperative 1 year, both total IPSS score and IPSS quality of life score were significantly higher in the DU group (both p=0.001). CONCLUSIONS:The success rate of ReMEEX system was 92.1% at mean follow-up of 34.4 months in female SUI with DU, reoperation, or ISD. It also enabled postoperative readjustment of sling tension, as needed, up to 130 months after surgery.

BackgroundAlthough organs are preserved and quality of life is improved, insufficient evidence is available for the oncologic safety of partial cystectomy in patients with colorectal cancer with suspected bladder invasion. Therefore, we aimed to compare partial and total cystectomy outcomes in patients with pathologically confirmed or clinically suspected bladder invasion.MethodsPatients with colorectal cancer with suspected bladder invasion who underwent R0 resection from 2000 to 2020 were evaluated. Long-term outcomes were determined in patients with histologically confirmed bladder invasion.ResultsOf the 151 consecutive patients, 96 (64.6%) had histologically confirmed bladder involvement, and 105 (69.5%) underwent partial cystectomy. Operative time, estimated blood loss, and reoperation rate in ≤30 days were significantly worse in the total cystectomy group than in the partial cystectomy group. The overall recurrence rate was significantly higher in the total cystectomy group than in the partial cystectomy group (39.1% vs 21.9%; P = .046). Five-year overall survival (75.8% vs 53.2%; P = .006) rates were higher in the partial cystectomy group than in the total cystectomy group; however, disease-free survival (60.8% vs 41.6%; P = .088) rates were similar in patients with suspected bladder invasion. In patients with histologically confirmed bladder invasion, 5-year overall survival rates (78.1% vs 52.1%; P = .017) were higher in the partial cystectomy group than in the total cystectomy group; however, disease-free survival rates (53.4% vs 41.2%; P = .220) did not differ significantly.ConclusionR0 resection is associated with favorable long-term outcomes in patients with locally advanced colorectal cancer. If R0 resection is possible, partial cystectomy is considered safe.

The clinical guidelines for interstitial cystitis (IC) and bladder pain syndrome (BPS) have been revised by updating our previous guidelines. The symptoms of IC and BPS, collectively called as hypersensitive bladder (HSB) symptoms, are virtually indistinguishable between IC and BPS; however, IC and BPS should be considered as a separate entity of disorders. We define IC as a bladder disease with Hunner lesions, usually associated with HSB symptoms and bladder inflammation, and BPS as a condition with HSB symptoms in the absence of Hunner lesions and any confusable diseases. Pathophysiology totally differs between IC and BPS. IC involves immunological inflammation probably resulting from autoimmunity, while BPS is associated with the interaction of multiple factors such as neurogenic inflammation, exogenous substances, urothelial defects, psychological stress, and neural hyperactivity. Histopathology also differs between IC and BPS. IC is associated with severe inflammation of the whole bladder accompanied by plasma cell infiltration and urothelial denudation, while BPS shows little pathological changes. Management should begin with a differential diagnosis of IC or BPS, which would require cystoscopy to determine the presence or absence of Hunner lesions. The patients should be treated differently based on the diagnosis following the algorithm, although pain management would be common to IC and BPS. Clinical studies are also to be designed and analyzed separately for IC and BPS.

A voiding diary is commonly used in clinical practice to monitor urinary tract health. However, manual recording and use of a measuring cup can cause significant inaccuracy and inconvenience. Recently sound-based voided volume estimation algorithms such as proudP have shown potential to accurately measure the voided volumes of patients urination while overcoming these inconveniences. In order to validate the sound-based voided volume estimation algorithm, we chose bodyweight change after urination as a reference value. Total 508 subjects from the United States and Korea were enrolled. 584 data points that have matching bodyweights change data and urination sound data were collected, and fivefold cross validation was performed in order to evaluate the model on all data in the dataset. The mean voided volume estimated by the algorithm was 202.6 mL (SD: ± 114.8) while the mean bodyweight change after urination was 208.0 g (SD: ± 121.5), and there was a strong linear correlation with high statistical significance (Pearson’s correlation coefficient = 0.92, p-value < 0.001). Two paired t-test showed the equivalence with bodyweight change data with 10 mL margin. Additionally, a Bland–Altman plot shows a mean difference of − 5.5 mL with LoA (− 98.0, 87.1). The results support high performance of the algorithm across the large population data from multi-site clinical trials.

You have accessJournal of UrologyCME1 Apr 2023MP72-03 PROSPECTIVE RANDOMIZED TRIAL FOR POSTOPERATIVE VOIDING OUTCOME & PATIENT-CLINICIAN SATISFACTION IN RETROGRADE BLADDER FILLING PRIOR TO CATHETER REMOVAL AFTER TRANSURETHRAL PROSTATECTOMY Sang Hun Song, Jin Noh, Hae Sung Lee, Jun Hyun Nam, Byeongdo Song, Jung Kwon Kim, Jong Jin Oh, Sangchul Lee, Seong Jin Jeong, Sung Kyu Hong, Seok-Soo Byun, and Hakmin Lee Sang Hun SongSang Hun Song More articles by this author , Jin NohJin Noh More articles by this author , Hae Sung LeeHae Sung Lee More articles by this author , Jun Hyun NamJun Hyun Nam More articles by this author , Byeongdo SongByeongdo Song More articles by this author , Jung Kwon KimJung Kwon Kim More articles by this author , Jong Jin OhJong Jin Oh More articles by this author , Sangchul LeeSangchul Lee More articles by this author , Seong Jin JeongSeong Jin Jeong More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , and Hakmin LeeHakmin Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Awaiting initial trial without catheter for evaluation for adequacy of discharge can be a time and resource consuming process in both inpatient and outpatient settings, and retrograde bladder filling with normal saline or sterile water is often attempted to expedite the process. However, previous randomized clinical trials have produced statistically insignificant results, with limited literature on men with BPH or patients undergoing TURP. This study intends to compare and evaluate outcomes in patients undergoing removal of catheter after TURP by either retrograde fill (RF) or spontaneous voiding (SV). METHODS: Male patients undergoing TURP for BPH from January 2019 to October 2019 were randomized into either RF or SV methods. Perioperative outcomes and complications were assessed, and satisfaction with either technique was assessed with questionnaires for the patient as well as the clinician (nurse or physician) involved in removing the Foley catheter. Time to void and time to discharge was compared to assess facilitation of discharge. RESULTS: Total 54 patients randomized into two groups were included in final analysis, with 28 men in retrograde filling and 26 in SV. No significant differences in baseline characteristics including age, prostate volume, or perioperative uroflowmetry were observed. RF significantly facilitated time to void (67±63.2 min vs 144±78.7; p=0.001) and time to discharge (168.4±57.2 vs. 218.9±106.9; p=0.046). Immediate postoperative Clavien-Dindo grade≥3 complication and reintervention within a 3 month follow-up were comparable in both methods with no significant difference. Overall patient and medical staff satisfaction showed tolerable and similar response by either procedure. CONCLUSIONS: RF for catheter removal in urologic inpatient settings is a safe and satisfactory method that can facilitate void and time-to-discharge, decreasing length of unnecessary hospital stay. When feasible, the procedure can be undertaken in routine clinical practice. Larger trials with long-term follow-up are required to further validate our results. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1025 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sang Hun Song More articles by this author Jin Noh More articles by this author Hae Sung Lee More articles by this author Jun Hyun Nam More articles by this author Byeongdo Song More articles by this author Jung Kwon Kim More articles by this author Jong Jin Oh More articles by this author Sangchul Lee More articles by this author Seong Jin Jeong More articles by this author Sung Kyu Hong More articles by this author Seok-Soo Byun More articles by this author Hakmin Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract Background Obesity is associated with poor clinical outcomes in critically ill patients. However, under some clinical conditions, obesity has protective effects. Bloodstream infections (BSI) are one of the most common nosocomial infections associated with extracorporeal membrane oxygenation (ECMO) support. BSI during ECMO is associated with higher mortality rates and poorer clinical outcomes. This study analyzed whether body mass index (BMI) was associated with BSI during ECMO and in-hospital mortality. Methods All adult patients who had received ECMO support for >48 h were included in the analysis. The total duration of ECMO support, in-hospital mortality, and BSI were analyzed according to BMI categories. The Cox proportional hazards model was used to compare the risk of BSI according to different BMI categories.Figure 1.Study flow chart Results A total of 473 patients were enrolled in the study. The average age was 56.5 years old and 65.3% were men. The total ECMO duration was approximately 11.8 days with a mortality rate of 47.1 %. The incidence of bacteremia and candidemia were 20.5% and 5.5%, respectively. There was no significant difference in bloodstream infection rates (p=0.784) or mortality rate (p=0.253) among the five groups. The underweight group required ECMO for respiratory support, whereas the overweight and obese groups required cardiogenic support (p< 0.0001). However, there was no significant difference in the development of BSI during ECMO support or in-hospital mortality among any of the five groups. Conclusion Patients with higher or lower BMI did not show an increased risk of BSI or in-hospital mortality associated with ECMO support.Figure 2.Forest-plot for risk of bloodstream infection occurrence in different body-mass index categories.Figure 3.Kaplan-Meier analysis comparing the survival rate in different BMI groups. Disclosures All Authors: No reported disclosures

You have accessJournal of UrologyCME1 Apr 2023MP17-17 GERMLINE MUTATIONAL CARRIER FREQUENCY ANALYSIS IN KOREAN METASTATIC PROSTATE CANCER : A LARGE COHORT STUDY Sang Hun Song, Jin Noh, Hae Sung Lee, Jun Hyun Nam, Byeongdo Song, Jung Kwon Kim, Hakmin Lee, Jong Jin Oh, Sangchul Lee, Seong Jin Jeong, Sung Kyu Hong, and Seok-Soo Byun Sang Hun SongSang Hun Song More articles by this author , Jin NohJin Noh More articles by this author , Hae Sung LeeHae Sung Lee More articles by this author , Jun Hyun NamJun Hyun Nam More articles by this author , Byeongdo SongByeongdo Song More articles by this author , Jung Kwon KimJung Kwon Kim More articles by this author , Hakmin LeeHakmin Lee More articles by this author , Jong Jin OhJong Jin Oh More articles by this author , Sangchul LeeSangchul Lee More articles by this author , Seong Jin JeongSeong Jin Jeong More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , and Seok-Soo ByunSeok-Soo Byun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003237.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Germline mutations in DNA-damage repair (DDR) genes such as BRCA2 have been associated with prostate cancer (PC) risk but has not been thoroughly evaluated for metastatic prostate cancer (mPC) in Asian men. This study attempts to evaluate frequency of DDR mutations in the largest cohort of Koreans. METHODS: We recruited 340 patients with mPC unselected for family history of cancer and compared to 495 controls. Whole genome sequencing was applied to assess germline pathogenic/likely pathogenic variants (PVs/LPVs) in 26 DDR genes and HOXB13, including 7 genes (ATM, BRCA1/2, CHEK2, BRIP1, PALB2, and NBN) associated with hereditary PC. Comparisons to published Caucasian and Japanese cohorts were performed. RESULTS: Total of 28 PVs/LPVs were identified in 30 (8.5%) patients; mutations were found in 13 genes, including BRCA2 (15 men [4.4%]), ATM (2 men [0.6%]), NBN (2 men [0.6%], and BRIP1 (2 men [0.6%]). Only one patient had HOXB13 mutation (0.3%). Compared with the germline variant frequency of previously reported mPC studies (8.5% and 11.8%), a slightly lower or similar rate was found in Korean mPC, but notably differed from Caucasian and geographically similar Japanese cohorts. PVs/LPVs in DDR genes tended to increase gradually with higher Gleason Scores (GS 7, 7.1%; GS 8, 7.5%; GS 9-10, 9.9%). CONCLUSIONS: We successfully identified 26 DDR and HOXB13-related deleterious variants in 30 Korean men with aggressive mPC. Germline PV/LPV profiles show comparable frequency of overall carriers (8.5%) but distinctly different distribution when contrasted to previous studies in European and even geographically nearby Japanese cohorts, with BRCA2 playing a dominant role. These results illustrate further evidence for population-based, ethnic-specific analyses for genetic testing as well as highlighting the potential differences that exist even in common East Asian ancestry. These findings may further emphasize the importance of genomic background in Korean PC. Future combinatory efforts must be made in larger, multiethnic trials to identify PVs of variable importance depending on ancestry. Source of Funding: This study was supported by the SNUBH Research foundation and KUOS © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e219 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sang Hun Song More articles by this author Jin Noh More articles by this author Hae Sung Lee More articles by this author Jun Hyun Nam More articles by this author Byeongdo Song More articles by this author Jung Kwon Kim More articles by this author Hakmin Lee More articles by this author Jong Jin Oh More articles by this author Sangchul Lee More articles by this author Seong Jin Jeong More articles by this author Sung Kyu Hong More articles by this author Seok-Soo Byun More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP76-15 EVALUATION OF THE EFFICACY OF TRANSURETHRAL ENUCLEATION WITH BIPOLAR USING SPATULA LOOP BY PROSTATE VOLUME IN BENIGN PROSTATE HYPERPLASIA PATIENTS Byeongdo Song, Jun hyun Nam, Hae sung Lee, Jin Noh, and Seong Jin Jeong Byeongdo SongByeongdo Song More articles by this author , Jun hyun NamJun hyun Nam More articles by this author , Hae sung LeeHae sung Lee More articles by this author , Jin NohJin Noh More articles by this author , and Seong Jin JeongSeong Jin Jeong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transurethral Enucleation with Bipolar (TUEB) using spatula loop has advantages for hemostasis during enucleation and tissue removal, giving a wide range of options. We compared the efficacy of TUEB using spatula loop according with prostate size. METHODS: We retrospectively evaluated 519 patients who underwent TUEB at a single tertiary hospital between August 2018 and March 2022. Patients who were not evaluated for the International Prostate Symptom Score (IPSS) before or after the surgery or not followed up for ≥6 months after surgery were excluded. We divided 125 patients into three groups according to estimated prostate volume (ePV): ≤40 mL (n=24), 40-80 mL (n=71) and ≥80 mL (n=30). The patient characteristics, IPSS, maximum flow rate (Qmax), post-void residual urine volume (PVR), and other data were compared before and after surgery in each group and between the groups. RESULTS: A total of 125 patients were included in this retrospective study. Operation time, enucleation time, enucleated tissue weight and enucleation efficacy increased along with ePVs (all p<0.05). Catheterization duration was higher in men with ePV ≥80 mL compared to other groups (p<0.001). Duration of hospital stay and rates of complications were comparable among groups. The IPSS, IPSS-quality of life, Qmax and PVR improved after TUEB in all groups (all p<0.001), but they did not differ according to ePV. In the multivariable logistic regression analysis, prostate volume was not associated with postoperative complications. Conversely, patient’s antiplatelet/anticoagulation usage was only independently associated with postoperative complications (Hazard ratio [HR], 13.112; confidence interval [CI], 1.895-90.730; p=0.009). CONCLUSIONS: TUEB using spatula loop could be an effective treatment for patients with a small prostate, even though the efficacy was greater in those with a larger prostate. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1097 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Byeongdo Song More articles by this author Jun hyun Nam More articles by this author Hae sung Lee More articles by this author Jin Noh More articles by this author Seong Jin Jeong More articles by this author Expand All Advertisement PDF downloadLoading ...