Jens Sønksen

Prospective, Randomized, Multinational Study of Prostatic Urethral Lift Versus Transurethral Resection of the Prostate: 12-month Results from the BPH6 Study

BACKGROUNDnTransurethral resection of the prostate (TURP) is considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, TURP may lead to sexual dysfunction and incontinence, and has a long recovery period. Prostatic urethral lift (PUL) is a treatment option that may overcome these limitations.nnnOBJECTIVEnTo compare PUL to TURP with regard to LUTS improvement, recovery, worsening of erectile and ejaculatory function, continence and safety (BPH6).nnnDESIGN, SETTING, AND PARTICIPANTSnProspective, randomized, controlled trial at 10 European centers involving 80 men with BPH LUTS.nnnINTERVENTIONnPUL or TURP.nnnOUTCOME MEASUREMENTS AND STATISTICAL ANALYSISnThe BPH6 responder endpoint assesses symptom relief, quality of recovery, erectile function preservation, ejaculatory function preservation, continence preservation, and safety. Noninferiority was evaluated using a one-sided lower 95% confidence limit for the difference between PUL and TURP performance.nnnRESULTS AND LIMITATIONSnPreservation of ejaculation and quality of recovery were superior with PUL (p<0.01). Significant symptom relief was achieved in both treatment arms. The study demonstrated not only noninferiority but also superiority of PUL over TURP on the BPH6 endpoint. Study limitations were the small sample size and the inability to blind participants to enrollment arm.nnnCONCLUSIONSnAssessment of individual BPH6 elements revealed that PUL was superior to TURP with respect to quality of recovery and preservation of ejaculatory function. PUL was superior to TURP according to the novel BPH6 responder endpoint, which needs to be validated in future studies.nnnPATIENT SUMMARYnIn this study, participants who underwent prostatic urethral lift responded significantly better than those who underwent transurethral resection of the prostate as therapy for benign prostatic hyperplasia with regard to important aspects of quality of life.nnnTRIAL REGISTRATIONnClinicalTrials.gov NCT01533038.

Prevalence and Predicting Factors for Commonly Neglected Sexual Side Effects to Radical Prostatectomies: Results from a Cross‐Sectional Questionnaire‐Based Study

INTRODUCTIONnAltered perception of orgasm, orgasm-associated pain, penile sensory changes, urinary incontinence (UI) during sexual activity, penile shortening (PS), and penile deformity following radical prostatectomy (RP) have received increasing attention from researchers.nnnAIMnThe aim of this study is to describe the prevalence and predictors of the above-mentioned side effects.nnnMETHODSnThis was a cross-sectional questionnaire-based study among men who had undergone RP between 3 and 36 months prior to study inclusion. Predicting factors were identified through logistic regression analyses.nnnMAIN OUTCOME MEASURESnThe primary outcome measures were prevalence rates of the above-mentioned side effects.nnnRESULTSnOverall, 316 questionnaires were available for analyses. Of the sexually active patients (nu2009=u2009256), 12 (5%) reported anorgasmia, whereas 153 (60%) reported decreased orgasm intensity. Delayed orgasms were reported by 146 (57%). Twenty-three patients (10%) had experienced pain during orgasm. UI during sexual activity were reported by 99 patients (38%). Out of the whole population, 77 patients (25%) reported sensory changes in the penis. A total of 143 patients (47%) reported a subjective loss of penile length of >1u2009cm. An altered curvature of the penis was reported by 30 patients (10%). Patients had increasing risk of UI during sexual activity (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.10-1.25) and orgasmic dysfunction (OR 1.09; 95% CI 1.01-1.16) with increasing International Consultation on Incontinence Questionnaire scores. Erectile dysfunction (OR 1.81; 95% CI 1.07-3.10) and a high body mass index (OR 1.10; 95% CI 1.02-1.19) increased the risk of PS after RP. Nerve-sparing (OR 0.32; 95% CI 0.16-0.95) reduced the risk of PS.nnnCONCLUSIONSnOrgasm-associated problems, UI during sexual activity, penile sensory changes, PS, and penile deformity are common side effects to RP. Daytime UI, erectile dysfunction, and nerve-sparing status can help identify patients at risk.

Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study

To compare prostatic urethral lift (PUL) with transurethral resection of the prostate (TURP) with regard to symptoms, recovery experience, sexual function, continence, safety, quality of life, sleep and overall patient perception.

Studies on Varicocele and Subfertility – an Ongoing Debate

The possible link between varicoceles and male subfertility has been a matter of debate for more than six decades. In 1952 Tulloch [1] reported a case of varicocele repair in a patient with azoospermia who subsequently was able to impregnate his wife. This case report sparked intense research into the possible benefits of varicocele repair for male subfertility. In the first issue of Scandinavian Journal of Urology and Nephrology Fritjofsson and Ahr en [2] presented their case series of 40 men with clinical varicoceles of whom 35 underwent varicocele repair for male subfertility. Following varicocelectomy 62.5% and 50% of the patients experienced improvement in sperm density and sperm motility respectively while 17% of the couples achieved conception. The authors concluded that improved fertility could be expected in at least half of operated men. Without a control group this was somewhat overstated especially given the discrepancy between the number of men with improved semen parameters and the number of men who subsequently were able to father a child. However, this highlights some of today’s controversies in varicoceles and male subfertility namely that improvements of semen parameters do not always correspond to improved fertility and that far from all men with varicoceles are infertile. Although overstating their conclusion Fritjofsson and Ahr en [2] discuss this dilemma noting that several unknown factors may contribute to the man’s subfertility and that female factors should always be taken in to account. It is remarkable how these considerations are still highly relevant half a century later. Today varicocele repair for male subfertility is only advised in cases of otherwise unexplained couples infertility in which the man presents with a clinical varicocele and affected semen parameters [3]. Using these criteria varicocelectomy may have beneficial effects on male subfertility as shown by a recent well conducted randomized controlled trial by Abdel-Meguid et al. [4]. A total of 145 men from infertile couples with clinical varicoceles were randomized to either varicocelectomy or no treatment. After 12 months follow-up semen parameters improved significantly compared to baseline in the treatment group and these improvements were statistically significant better compared to the control group. In addition varicocelectomy was associated with and odds ratio for achieving a spontaneous pregnancy of 3.04 (95% confidence interval 1.33 to 6.95). Similar findings have been made in the latest Cochrane review [5] on the subject. Although still a matter of debate it seems that the rather bold conclusion made by Fritjofsson and Ahr en [2] 50 years ago has some merit today. However, varicoceles and subfertility is likely a subject of debate for many years to come.

Erectile function after radical prostatectomy: Do patients return to baseline?

Abstract Objective: The aim of this study was to assess postprostatectomy erectile function compared to preoperative status by subjective patient perception and the abbreviated International Index of Erectile Function (IIEF-5) questionnaire. Materials and methods: The study used data from a prospectively collected database and a cross-sectional, questionnaire-based study in patients following radical prostatectomy. Erectile function was assessed with the IIEF-5 and the question “Is your erectile function as good as before the surgery (yes/no)”. Patients were included if they were sexually active before surgery and had at least 1 year of follow-up. The main outcome measure was the proportion of patients returning to self-perceived baseline erectile function. Secondary outcome measures included the proportion of patients returning to baseline erectile function according to the IIEF-5 and predictors of return to baseline function. Results: Questionnaires from 210 patients were available. Overall, 14 patients (6.7%) reported that their erections were as good as before surgery. Bilateral nerve-sparing was the only significant predictor of a return to baseline erectile function (pu2009=u20090.004). Forty-three patients (20.5%), who did not report use of erectile aids, showed no decline in IIEF-5 score. When including patients who used erectogenic aids, 69 (32.9%) maintained their preoperative IIEF-5 score. On multivariate analysis a low preoperative IIEF-5 score was a significant predictor of return to baseline IIEF-5 score (pu2009<u20090.0001). Conclusions: Return to subjective baseline erectile function following radical prostatectomy is rare. The IIEF-5 questionnaire may not adequately reflect patients’ experience. This should be considered in preoperative patient counselling.

Thermal injury affecting the small bowel without evidence of bladder perforation following transurethral resection of bladder tumour

Abstract Thermal bowel injury following transurethral bladder tumour resection is a rare but potentially lethal complication. This article reports a case of isolated bowel perforation without concomitant bladder perforation. Although rare, clinicians should be aware of this complication, so that the diagnosis can be made promptly.