Current Laser Treatments for Benign Prostatic Hyperplasia

The latest technical improvements in the surgical armamentarium are remarkable. In particular, advancements in the urologic field are so exceptional that we could observe the flare-up of robot-assisted laparoscopic radical prostatectomy for prostate cancer and laser prostatectomy for benign prostatic hyperplasia (BPH). Photoselective vaporization of the prostate (PVP) and holmium laser prostatectomy are the most generalized options for laser surgery of BPH, and both modalities have shown good postoperative results. In comparison to transurethral prostatectomy (TURP), they showed similar efficacy and a much lower complication rate in randomized prospective clinical trials. Even in cases of large prostates, laser prostatectomy showed comparable efficacy and safety profiles compared to open prostatectomy. From a technical point of view, PVP is considered to be an easier technique for the urologist to master. Furthermore, patients can be safely followed up in an outpatient clinic. Holmium laser enucleation of the prostate (HoLEP) mimics open prostatectomy because the adenomatous tissue is peeled off the surgical capsule in both procedures. Therefore, HoLEP shows notable volume reduction of the prostate similar to open prostatectomy with fewer blood transfusions, shorter hospital stay, and cost reduction regardless of prostate size. Outcomes of laser prostatectomy for BPH are encouraging but sometimes are unbalanced because safety and feasibility studies were reported mainly for PVP, whereas long-term data are mostly available for HoLEP. We need longer-term randomized clinical data to identify the reoperation rate of PVP and to determine which procedure is the ideal alternative to TURP and open prostatectomy for each patient

Patients' experience with ambulatory urodynamics. A prospective study

OBJECTIVE: To assess emotional variables in patients who underwent ambulatory urodynamic monitoring (AUM). MATERIAL AND METHODS: A total of 33 females and 7 males aged 23-72 years with an overactive bladder who had undergone three consecutive AUM sessions were included in the study on a prospective basis. Patients completed a self-administered questionnaire before and immediately after each procedure. Answers were given using a visual analog scale. RESULTS: The pre-procedural level of anxiety did not differ significantly with respect to sex, age, education level or income. The degree of bother experienced by patients aged > or = 50 years was higher than for those aged 0.05). Only the subjective bother score influenced the examiner-rated degree of intolerance during AUM (p = 0.007). A total of 34 patients (85.0%) indicated that they would be willing to return for a further session of AUM. The degree of intolerance decreased at the second (p = 0.006) and third (p = 0.049) AUM sessions, whereas other parameters were not significantly different. CONCLUSION: Our results demonstrate that AUM is acceptable and well tolerated by patients with bladder dysfunction

Anticholinergics [corrected] in patients with overactive bladder: Assessment of ambulatory urodynamics and patient perception

AIMS: The aim of this study was to evaluate whether ambulatory urodynamic monitoring (AUM) may reflect patient perception of bladder condition and treatment benefit in patients with overactive bladder (OAB). METHODS: A total of 33 women and 7 men 23 to 72 years old who were undergoing AUM were included in this study. At baseline, patients were asked to complete the following information in the micturition chart for 3 consecutive days. Patients were given anticholinergics once daily for the 2 weeks. Two weeks after the treatment, all patients received an identical repeat study. RESULTS: Most parameters of AUM, micturition chart and patient perception were improved 2 weeks after treatment. However, when Spearman correlation coefficients were performed, all AUM parameters did not correlate with patient perception of bladder condition after treatment although some AUM parameters regarding incontinence were associated with patient perception of bladder condition at baseline. In addition, when patients were divided as the 'no or some benefit' group (n = 25) and the 'much benefit' group (n = 15), all AUM parameters except total voided volume (P = 0.004) were not significantly different in the two groups. CONCLUSIONS: Because patients with pelvic floor dysfunction have widely varying expectations from treatment, the patient's goal for treatment is highly subjective. Our findings suggest that AUM does not take into account the patient perception of disease severity, and correlations between the patient view of treatment outcome and objective measures are poor. Therefore, strategies for assessing OAB should incorporate self-perceived disease condition

A comparative study of patient experiences of conventional fluoroscopic and four-hour ambulatory urodynamic studies

We assessed several emotional variables in patients experiencing conventional urodynamic and ambulatory urodynamic monitoring (AUM) to verify the hypothesis that AUM is tolerated as well as conventional urodynamics. A total of 33 women and 7 men from 23 to 72 years of age who were undergoing both procedures were prospectively included in this study. Prior to and immediately after the procedures, each patient completed a self-administered questionnaire. Answers were given on a visual analogue scale. The degree of anxiety was higher for conventional urodynamics than for AUM (p = 0.045), while the degree of boredom experienced during AUM was higher than that during conventional urodynamics (p= 0.013). There was no significant difference in the degree of shame or bother experienced by the patients during the two procedures. In general, patients tolerated both examinations extremely well. The examiner-rated degree of intolerance during conventional urodynamics was influenced by the subjective pain score (p=0.001), while all other emotional variables except bother were not significantly related with the degree of intolerance during AUM (p=0.007). A total of 74.4% and 84.6% responded that they were willing to repeat conventional urodynamics and AUM, respectively, which were not significantly different. Although AUM produced a significantly higher level of boredom than conventional urodynamics, our data demonstrates that patients are as tolerant of AUM as they are of conventional urodynamic procedures

Factors influencing self-perceived disease severity in women with stress urinary incontinence combined with or without urge incontinence

AIMS: The aim of this study was to assess the impact of patient-perceived disease severity (PPDS) on the quality of life (QoL) of women with urinary incontinence (UI) and to identify factors predicting PPDS. METHODS: A total of 109 women (mean age 54.9; range 31-77) with stress UI combined with or without urge UI were included in the primary analyses. The incontinence quality of life (I-QoL) devised during the course of this study was used to assess the QOL impact of UI. RESULTS: PPDS of women with UI increased as I-QoL scores decreased (P25 g had a 4.7-fold higher risk of perceiving their symptoms were more severe than those with a pad test weight of <15 g. CONCLUSIONS: Our results suggest that the frequency of UI episodes and the volume of urine loss are associated with PPDS. In addition, the I-QoL scores deteriorated significantly as the PPDS of incontinence increased. Thus, PPDS may impact on the QoL of women with stress UI combined with or without urge UI

A different female partner does not affect the success of second vasectomy reversal

The aim of the study was to determine whether the pregnancy rate with the same female partner or younger partners was higher compared with different or older partners after undergoing repeated vasectomy reversal. A total of 44 patients were enrolled in the present study. The cause of reversal in patients with the same partner was the desire to have more children in 14 cases, the loss of a child in 7 cases, and the desire for a son in 7 cases. Patients were asked about pregnancy and childbirth during follow-up visits and by telephone or mail. Following microsurgical vasectomy reversal, patency was observed in 38 men (86.4%). Twenty-five of the couples (56.8%) achieved pregnancy without any artificial conception technique. We did not observe a significant difference in the pregnancy rate (57.1% vs 56.3%, P=.954) between patients with the same or a different female partner. In the multivariate model used, partner age was the only independent predictor for pregnancy. Patients with a partner less than 35 years old had a 4.1-fold greater chance (odds ratio, 4.13; 95% confidence interval, 1.06-16.10; P=.041) of pregnancy than those with a partner 35 years old or older. The area under the receiver operating characteristics curve for partner age was 73.0% (95% confidence interval 56.8-89.2, P=.011). Our findings suggest that repeat microsurgical vasectomy reversal still remains a reasonable choice for patients with different female partners. However, it should be considered that the likelihood of achieving pregnancy after repeat vasectomy reversal may decrease with advancing age of the female partner

Significance of pad test loss for the evaluation of women with urinary incontinence

AIMS: The aim of this study was to determine whether the objective incontinence severity, as measured by the pad test, correlated with urethral parameters, and if the objective incontinence severity was differentiated by the incontinence types and also, if it influenced the patient's clinical outcome. METHODS: Two hundred seventy-four female patients who had undergone a tension-free vaginal tape procedure between March 1999 and May 2003 were retrospectively reviewed. The 1 hr pad test was carried out as recommended by the International Continence Society, with some modification. The mean patient age was 55.1 years (range: 28-80). Two hundred-one women (73.3%) that complained of stress urinary incontinence and another 73 women (26.7%) that had additional symptoms of urge incontinence were enrolled as study subjects. A cure for incontinence, after the tension-free vaginal tape procedure, was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress testing, and all other cases were considered failures. RESULTS: In linear regression analysis, the Valsalva leak point pressure (VLPP) was the only explanatory variable influencing the objective incontinence severity. The urine leakage was significant higher in the mixed urinary incontinence group than in the stress urinary incontinence group (39.7 +/- 7.5 g vs. 30.3 +/- 2.8 g, P < 0.05). For the total patients, the failure group had a more severe preoperative objective severity than the cure group (53.2 +/- 16.6 vs. 32.0 +/- 3.0, P < 0.05). Upon a subgroup analysis, a similar result was found in the stress urinary incontinence group (87.1 +/- 8.2 vs. 29.8 +/- 2.8, P < 0.05) but not in the mixed urinary incontinence group. CONCLUSIONS: Our findings suggest that the amount of urine leakage as measured during the pad test may be associated with the clinical outcome, after the anti-incontinence surgery

Green supercapacitor patterned by synthesizing MnO/laser-induced-graphene hetero-nanostructures on wood via femtosecond laser pulses

Abstract Eco-friendly next-generation energy storage devices with high energy density are required to meet the increasing demand for sustainable and green electronics. However, their manufacturing requires a lot of chemical precursors and is usually accompanied by chemical waste; it also involves laborious and time-consuming processes such as mixing, heat treating, casting, and drying. Here, we proposed that mass production of microsupercapacitors (MSCs) for green electronics can be achieved by embedding manganese monoxide (MnO) on wood-derived laser-induced-graphene (LIG) via femtosecond laser direct writing (FsLDW) technique. The direct synthesis of MnO/LIG hetero-nanostructures on wood was realized by drop-casting a small amount of precursor between the first and second FsLDW. The preceding FsLDW thermochemically converted wood into LIG while the following FsLDW converted the precursor into MnO, resulting in MnO/LIG hetero-nanostructures. As-fabricated MnO/LIG MSC exhibited enhanced areal capacitance (35.54 mF cm−2 at 10 mV s−1) and capacitance retention (approximately 82.31% after 10,000 cycles) with only a small inclusion of Mn sources (0.66 mg cm−2) and short production time (10 min cm−2), which attributes to operate light-emitting diodes, digital clocks, and electronic paper as well. This approach enables the green, facile, fast, and cost-effective fabrication of future sustainable energy storage devices from biomass for next-generation green electronics. Graphical Abstrac

Reusable Polystyrene-Functionalized Basic Ionic Liquids as Catalysts for Carboxylation of Amines to Disubstituted Ureas

A series of polystyrene (PS)-functionalized basic ionic liquids (BILs) were prepared and used as catalysts for synthesis of disubstituted ureas (DSUs) from amines and carbon dioxide (CO₂). The PS-BILs as prepared were characterized by scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and Fourier transform infrared (FT-IR) spectroscopy. For investigating the catalytic activities, all PS-BILs were tested in a model reaction of cyclohexylamine (CHA) and CO₂ to synthesize dicyclohexylurea (DCU). <b>Poly-2</b> having branched [bis-imidazolium]/[bis-bicarbonate] was found to show the highest activity for the DCU formation among all PS-BILs catalysts. For a comparison point of view, ceria (CeO₂) as a typical catalyst and original Merrifield’s resin (MR) was also applied for the reaction. Reaction conditions were optimized by varying reaction temperature, pressure, reaction time, and amount of catalyst used. Under optimized conditions, reactions of various amines with CO₂ to synthesize the corresponding diureas were carried out in the presence of the most active catalyst (<b>poly-2</b>). Furthermore, <b>poly-2</b> could be easily recovered and reused up to seven consecutive cycles with no significant loss of the catalytic activity