https://www.ascopost.com/News/59392

Article from 2018 published out of the STAMPEDE group. Low metastatic burden was defined as lymph node or axial bone mets

https://www.europeanurology.com/article/S0302-2838(19)30265-9/fulltext

Thanks to @Durdi_uro for sending me such a cool article.

Will be interesting to see further research done on this

A retrospective review of 88 patients with a focus on risk factors for post operative urinary incontinence. Predicted Summary: Patients with incontinence prior to surgery were more likely to have it after. And this persisted as a risk factor for up to 12 months after surgery. Unpredicted Summary: Patients with a high detrusor voiding pressure on UDS had an increased of risk of incontinence post operatively, but this increased risk did not persist beyond 6 weeks.

Source: Predictors of Postoperative Urinary Incontinence After Holmium Laser Enucleation of the Prostate: 12 Months Follow-Up. – PubMed – NCBI

ASCO GU 2019 darolutamide, ARAMIS study darolutamide in non-metastatic castration-resistant prostate (nmCRPC), Karmin Fizazi, MD, the efficacy and safety of ODM-201 in high-risk nmCRPC patients.
— Read on www.urotoday.com/conference-highlights/asco-gu-2019/asco-gu-2019-prostate-cancer/110279-sco-gu-2019-efficacy-and-safety-data-of-the-aramis-study-darolutamide-in-nonmetastatic-castration-resistant-prostate-cancer-patients.html

ASCO GU 2019 ARCHES trial, metastatic hormone-sensitive prostate cancer (mHSPC), Andrew Armstrong, MD, XTANDI® (enzalutamide) significantly improved radiographic progression-free survival in men with metastatic hormone-sensitive prostate cancer, androgen deprivation therapy with enzalutamide or placebo, ENZA plus ADT, improved rPFS.
— Read on www.urotoday.com/conference-highlights/asco-gu-2019/asco-gu-2019-prostate-cancer/110267-asco-gu-2019-phase-3-study-of-androgen-deprivation-therapy-adt-with-enzalutamide-enza-or-placebo-pbo-in-metastatic-hormone-sensitive-prostate-cancer-mhspc-the-arches-trial.html

https://www.liebertpub.com/doi/10.1089/cren.2018.0057?utm_source=sfmc&utm_medium=email&utm_campaign=CREN+OA+August+31+2018&d=8%2F31%2F2018&mcid=1803417478#.W4lpABwmN4c.email

Cool report from Dr Chi about using an abdominal u/s probe to help visualize the adenoma while morcellating. Good improvisation!

Review article published in the Journal of Endourology. Dr. El Tayeb looked at this in 2015 and did not find any difference.

I haven’t figured out yet why some dissections are more difficult than others. I do think that the older men that I operate on have poorer tissue quality and thus the “surgical capsule” is not as robust. In these cases, I find that I do not stay in my correct plane as often. When I get out of the correct plane, I spend more time cutting through tissue  and also correcting my mistakes. I think that this prolongs my enucleation time.

Maintaining the correct plane is also more difficult in small prostates (enucleations < 10-15 grams). The value of HoLEP in these settings is debatable and a conversation for another day. In my opinion, I still think that it does.

http://online.liebertpub.com/doi/abs/10.1089/end.2017.0734

@marawaneltayeb

http://rdcu.be/GxI4

phase 3 clinical trial on a new injectable medication for BPH. the medication had a reduced need for BPH intervention and acute urinary retention.

Sounds exciting!

Will have to review this paper further to look at improvement in symptom scores, which appear modest at first glance, as well as quantitative measures of improvement like flow rate.

Post Void Dribbling

Are you leaking a little just after you go to the bathroom? It can be an annoying and sometimes embarrassing problem. With a little education on why the problem occurs, you can find an easy fix.

Why am I dribbling? I just went to the bathroom.

For the majority of men, there is nothing seriously wrong. It may just have to do with how you are urinating. To better understand what is going on, lets talk about some anatomy.

When you urinate, your bladder squeezes to push the urine out. The urine then travels through your prostate,  external sphincter, and penile urethra. Looking at the picture above, you’ll notice that your penis does not end where it attaches to your scrotum, it actually ends further back, behind your testicles and close to your anus. That area of your urethra (the bulbar urethra) is where urine can collect and if you do not get it out before you zip up your pants, you can have some leakage.

What can I do about it?

The first thing to do is change the way you urinate. When you pull your penis out, are your underwear or pants pressing up on the base of your penis? Are your fingers pressing up against  your urethra? Although your stream can still be strong when you are doing either of these things, at the end of urination when your bladder is no longer squeezing, it can be hard to get that remaining urine out when there is any amount of resistance against your urethra.

Try instead to urinate without anything pressing against your penis. Hold down the front of your underwear or pants while you urinate. If that is difficult, try pulling your penis and scrotum out and resting the underwear underneath.

If you are still dripping, gently shake the penis until no more urine drips out.

If you need to, you can “strip” the urethra to push it out. The best way to do this is to use two fingers to compress the urethra and push the urine out. Start in the area between your scrotum and anus and move your fingers forward. Then do the same thing along the under surface of the penis from the penoscrotal junction to the tip.

Another thing to try is contracting your pelvic floor muscles to displace the inner urethra’s contents. The bulbocavernosus muscle lies just underneath your bulbar urethra. When it contracts it compresses the urethra. By actively squeezing the pelvic floor muscle by using 3-5 quick pulsations, the last few drops will be directed into the toilet and not your pants. Here is a video that can teach you how to do this.

Of course the final thing that you can do is wrap some toilet tissue around the tip of the penis to soak up any residual urine.

When to See a Doctor?

If you have some difficulty with urination, including a slow or weak stream, a sensation of incomplete emptying, straining to urinate, urinary urgency, urinary frequency, blood in the urine, severe burning with urination, or recurrent urinary tract infections, these might be signs of something else going on.

Very rarely, pooling of urine can be the result of a urethral diverticulum. If your problem is severe or you have some other symptoms, a urologist can evaluate you for this problem with a retrograde urethrogram or cystoscopy.

Best of luck!

Tillman Hudson, MD

Thank you to Adam Siegel, MD, for providing some information on this posting.

For information on how to strengthen your pelvic floor after prostate surgery, click here

Kegel Exercises