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Re: A Valsalva Leak-Point Pressure of > 100 cmH2O is Associated with Greater Success in AdVance™ Sling Placement for the Treatment of Post-Prostatectomy Urinary Incontinence
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BENIGN PROSTATIC HYPERPLASIA
Re: A Valsalva Leak-Point Pressure of > 100 cmH2O is Associated with Greater Success in AdVanceTM Sling Placement for the Treatment of Post-Prostatectomy Urinary Incontinence J. Barnard, S. van Rij and A. M. Westenberg Department of Urology, Auckland Hospital, Auckland, New Zealand BJU Int, suppl., 2014; 114: 34e37.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.02.010 available at http://jurology.com/ Editorial Comment: What is the best way to determine sling candidates from artificial urinary sphincter candidates? Patient history regarding the number of pads required during a 24-hour period is the most commonly used measure of stress urinary incontinence (SUI) severity. But pad usage is subjective and does not account for level of activity or fastidiousness of the patient. Pad weights are similarly imperfect and more unwieldly. This report from New Zealand examines Valsalva leak point pressure (VLPP) as an indicator of success of sling surgery. Most men had either mild (1 to 2 pads) or moderate (3 to 5) SUI. VLPP is an objective measure that is urodynamically derived. The authors found a greater than 90% success rate with the AdVanceÔ sling in men with VLPPs greater than 100 cm H2O. They do not advocate VLPP assessment in all individuals with SUI, but suggest considering it for men with moderate SUI as an adjunctive test. Allen F. Morey, MD
Benign Prostatic Hyperplasia Re: Early Results from a United States Trial of Prostatic Artery Embolization in the Treatment of Benign Prostatic Hyperplasia S. Bagla, C. P. Martin, A. van Breda, M. J. Sheridan, K. M. Sterling, D. Papadouris, K. S. Rholl, J. B. Smirniotopoulos and A. van Breda Cardiovascular and Interventional Radiology Department, Inova Alexandria Hospital, Alexandria, Inova Research Center, Falls Church and Inova Health System, Springfield, Virginia, and Georgetown University School of Medicine, Washington, D.C. J Vasc Interv Radiol 2014; 25: 47e52.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.027 available at http://jurology.com/ Editorial Comment: Those of us who have been involved in investigative trials for new therapeutic interventions for benign prostatic hyperplasia have become a bit skeptical regarding the long-term viability of these new, miraculous cures. Too often initial data in a few select patients have not translated to more widespread efficacy and safety. A relatively new player has been prostatic artery embolization (PAE). It is noteworthy that the authors are interventional radiologists, which suggests that urologists will not be the driving force behind this technology, although, ironically, we are the major source of patient referrals. In this preliminary analysis a number of items stand out. First, only 20 of 72 men screened underwent the procedure, with exclusions ranging from, “I just do not want to do this” to opting for watchful waiting. However, the results demonstrate the disconnect between reduction in prostate volume and lower urinary tract symptoms. At 3 months there was a significant decrease in prostate volume (from 82.7 to 56.7 cm3). There was also a symptom score decrease of about 12 points. However, at 3 months most men still had moderate or significant symptoms and would have been eligible for entry into a clinical trial for benign prostatic hyperplasia. As the authors note, this was a small cohort with limited followup. If this technology continues to evolve, it will be interesting to see how clinical trials will be developed. To gain approval, one suspects
BENIGN PROSTATIC HYPERPLASIA
Re: A Valsalva Leak-Point Pressure of > 100 cmH2O is Associated with Greater Success in AdVanceTM Sling Placement for the Treatment of Post-Prostatectomy Urinary Incontinence J. Barnard, S. van Rij and A. M. Westenberg Department of Urology, Auckland Hospital, Auckland, New Zealand BJU Int, suppl., 2014; 114: 34e37.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.02.010 available at http://jurology.com/ Editorial Comment: What is the best way to determine sling candidates from artificial urinary sphincter candidates? Patient history regarding the number of pads required during a 24-hour period is the most commonly used measure of stress urinary incontinence (SUI) severity. But pad usage is subjective and does not account for level of activity or fastidiousness of the patient. Pad weights are similarly imperfect and more unwieldly. This report from New Zealand examines Valsalva leak point pressure (VLPP) as an indicator of success of sling surgery. Most men had either mild (1 to 2 pads) or moderate (3 to 5) SUI. VLPP is an objective measure that is urodynamically derived. The authors found a greater than 90% success rate with the AdVanceÔ sling in men with VLPPs greater than 100 cm H2O. They do not advocate VLPP assessment in all individuals with SUI, but suggest considering it for men with moderate SUI as an adjunctive test. Allen F. Morey, MD
Benign Prostatic Hyperplasia Re: Early Results from a United States Trial of Prostatic Artery Embolization in the Treatment of Benign Prostatic Hyperplasia S. Bagla, C. P. Martin, A. van Breda, M. J. Sheridan, K. M. Sterling, D. Papadouris, K. S. Rholl, J. B. Smirniotopoulos and A. van Breda Cardiovascular and Interventional Radiology Department, Inova Alexandria Hospital, Alexandria, Inova Research Center, Falls Church and Inova Health System, Springfield, Virginia, and Georgetown University School of Medicine, Washington, D.C. J Vasc Interv Radiol 2014; 25: 47e52.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.027 available at http://jurology.com/ Editorial Comment: Those of us who have been involved in investigative trials for new therapeutic interventions for benign prostatic hyperplasia have become a bit skeptical regarding the long-term viability of these new, miraculous cures. Too often initial data in a few select patients have not translated to more widespread efficacy and safety. A relatively new player has been prostatic artery embolization (PAE). It is noteworthy that the authors are interventional radiologists, which suggests that urologists will not be the driving force behind this technology, although, ironically, we are the major source of patient referrals. In this preliminary analysis a number of items stand out. First, only 20 of 72 men screened underwent the procedure, with exclusions ranging from, “I just do not want to do this” to opting for watchful waiting. However, the results demonstrate the disconnect between reduction in prostate volume and lower urinary tract symptoms. At 3 months there was a significant decrease in prostate volume (from 82.7 to 56.7 cm3). There was also a symptom score decrease of about 12 points. However, at 3 months most men still had moderate or significant symptoms and would have been eligible for entry into a clinical trial for benign prostatic hyperplasia. As the authors note, this was a small cohort with limited followup. If this technology continues to evolve, it will be interesting to see how clinical trials will be developed. To gain approval, one suspects