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Cheng, Y. Zhou, X. Chu, S. Huang, X. Zheng, H. Zheng" "autores" => array:6 [ 0 => array:2 [ "nombre" => "W." "apellidos" => "Cheng" ] 1 => array:2 [ "nombre" => "Y." "apellidos" => "Zhou" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Chu" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Huang" ] 4 => array:2 [ "nombre" => "X." "apellidos" => "Zheng" ] 5 => array:2 [ "nombre" => "H." 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Jue, Jean-Francois Eid" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Joshua S." "apellidos" => "Jue" "email" => array:1 [ 0 => "jjue@northwell.edu" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jean-Francois" "apellidos" => "Eid" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, USA" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Advanced Urological Care, PC, New York, USA" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are common health conditions in aging males. LUTS are commonly attributed to benign prostatic hyperplasia (BPH) in men over the age of 50 years, with autopsy evidence showing the presence of BPH in 70% of sexagenarians.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Erectile dysfunction increases in prevalence with age and age-independent medical comorbidities, which has led to estimates of ED to be as high as 200 million men by 2025.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Increasing evidence also suggests an age-independent association between LUTS and ED, with metabolic syndrome potentially being a common potentiator of both conditions.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Sexual health, including ejaculatory and erectile dysfunction are well described adverse effects of both medical and surgical therapies for BPH. Prospective evidence has shown that daily single and combination drug therapy can significantly worsen sexual desire, erectile function, and ejaculatory function.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Surgical therapies can also significantly worsen ejaculatory and erectile function in men with normal preoperative function.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Although ejaculatory dysfunction is better described, capsular perforation adjacent to the neurovascular bundles and thermal injury have been theorized to contribute to erectile dysfunction after BPH surgeries.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">While ED after BPH therapies has been well investigated, the treatment of BPH after ED therapies yields different considerations. Transurethral surgery after inflatable penile prosthesis (IPP) placement is often more difficult, due to decreased scope mobility within the prostatic urethra. IPP reservoirs are usually placed in the space of Retzius, adjacent to the anterolateral portion of the prostate.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> A capsular perforation during BPH surgery can inadvertently damage the IPP reservoir, due to the reservoir’s close proximity to the lateral lobe of the prostate.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> These injuries may be severe enough to result in complete device malfunction and require IPP removal and replacement, which has occurred after the prostatic urethral lift procedure.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Longitudinal data from 2 large randomized controlled trials suggest that Rezūm™ offers similar LUTS improvement compared to combination drug therapy, but with significantly less negative impact on sexual function.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,10</span></a> With Rezūm™ showing promising LUTS and sexual function results, we sought to evaluate the safety and efficacy of this therapy in IPP patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This was a retrospective review of patients with erectile dysfunction who consecutively underwent Rezūm™ System water vapor thermal therapy (Boston Scientific, Malborough, MA, USA) by a single surgeon from January 1st 2021 to December 31st 2021. Patients with erectile dysfunction refractory to medical therapy underwent placement of a three-piece inflatable Coloplast (Minneapolis, MN, USA) penile prosthesis through a penoscrotal approach using the No-Touch technique.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a> LUTS were treated with alpha(1) adrenergic receptor antagonists, 5-alpha-reductase inhibitors, beta(3) adrenergic receptor agonists, and phosphodiesterase-5 inhibitors at the discretion of the surgeon. Herbal remedy use for LUTS, such as saw palmetto, was also recorded. All pharmacotherapy used to treat LUTS were collectively referred to as BPH medications.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patient age, presence of IPP, date of IPP placement, date of Rezūm™, date of most recent follow up, number of BPH medications, prior prostatic urethral lift, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Q<span class="elsevierStyleInf">max</span>), and uroflowmetry average flow rate (Q<span class="elsevierStyleInf">avg</span>) before and after Rezūm™ were obtained. The preoperative IPSS, QOL, Q<span class="elsevierStyleInf">max</span>, and Q<span class="elsevierStyleInf">avg</span>, were obtained from the visit immediately prior to Rezūm™ surgery. The postoperative IPSS, QOL, Q<span class="elsevierStyleInf">max</span>, and Q<span class="elsevierStyleInf">avg</span>, were obtained from the most recent visit. Patient age, follow-up time after Rezūm™, and time between IPP placement and Rezūm™ were calculated as medians with interquartile ranges. Independent two-sample T-tests were used to compare the baseline demographics and clinical characteristics between patients with and without an IPP. Independent two-sample T-tests were also used to compare the postoperative IPSS, QOL, Q<span class="elsevierStyleInf">max</span>, and Q<span class="elsevierStyleInf">avg</span> between patients with and without an IPP.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Among all patients with erectile dysfunction, linear regression was performed to determine if the number of BPH medications, preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> were associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span>. Linear regression was also performed in only patients with an IPP to determine if the number of BPH medications, preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> were associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span>. Type-I error rate was set to 5%, where P values <0.05 were considered statistically significant. All statistical analyses were computed using IBM SPSS Statistics Version 26.0 (Armonk, NY: IBM Corp).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 17 patients with erectile dysfunction who underwent Rezūm™ from January 1st 2021 to December 31st 2021 were identified. The median follow-up after Rezūm™ was 65 days (interquartile range [IQR]: 19–86). 11 of these patients had undergone IPP placement prior to undergoing Rezūm™. The median time between IPP placement and Rezūm™ was 30 months (interquartile range [IQR]: 17–94). The median age of all ED patients and in patients with an IPP was 68 years (interquartile range [IQR]: 63–78 and 59–79, respectively). There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. One patient with an IPP had a prior prostatic urethral lift with persistence of lower urinary tract symptoms. The full comparison of baseline patient demographics and characteristics are displayed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A comparison of postoperative characteristics found that there was no significant difference between IPSS and QOL scores between patients with and without an IPP. However, postoperative Q<span class="elsevierStyleInf">max</span> (10.9 mL/s vs 9.8 mL/s, p = 0.04) and Q<span class="elsevierStyleInf">avg</span> (7.5 mL/s vs 6.0 mL/s, p = 0.03) were significantly higher in patients with an IPP compared to patients without an IPP (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Among all ED patients, the number of BPH medications, preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> were not associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> (Supplemental Tables 1a and 1b). In the subset of patients with an IPP, the number of BPH medications, preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> were also not associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> (Supplemental Tables 2a and 2b).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Two patients without an IPP went into urinary retention within 4 weeks of undergoing Rezūm™, which required urethral catheterization and resumption of preoperative BPH medications. No complications were encountered in patients with an IPP. There were no infectious or IPP device malfunction complications.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">This is the first study to evaluate the safety and efficacy of Rezūm™ in patients with an IPP. Our results suggest that Rezūm™ is a safe procedure in IPP patients that may result in greater uroflowmetry flow rate compared to the general ED population. No preoperative clinical characteristics were predictive of postoperative outcomes. Urinary retention was the only complication after Rezūm™, which only occurred in 2 patients without an IPP.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Overall, the results observed in this study are similar to those observed in the randomized controlled study that evaluated Rezūm™. In the controlled study, 12-month follow-up IPSS was 10.3,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> which is in between the postoperative IPSS of 14.7 in IPP patients and 9.8 in patients without an IPP in this study. The 12-month follow-up Q<span class="elsevierStyleInf">max</span> in the controlled study was 15.5 mL/s,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> while the postoperative Q<span class="elsevierStyleInf">max</span> was 10.9 mL/s in IPP patients and 9.8 mL/s in patients without an IPP. Although these posttreatment flow rates may seem low in comparison, the preoperative flow rates were also substantially lower compared to the controlled study. Baseline Q<span class="elsevierStyleInf">max</span> was 10.0 mL/s in the controlled study,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> while approximately 8.5 mL/s in patients with or without an IPP. The absolute change in Q<span class="elsevierStyleInf">max</span> may be substantially less in our cohort, but the proportional change is more similar to the trial data. ED patients appear to have subjective and objective improvements in voiding function after Rezūm™, which may not be as pronounced in comparison to the general population.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Although uroflowmetry rates improved in all ED patients, IPP patients appeared to have more marked improvements compared to patients without an IPP. There were no significant differences in preoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> between the two patient groups; however, IPP patients had significantly greater postoperative Q<span class="elsevierStyleInf">max</span> and Q<span class="elsevierStyleInf">avg</span>. The Rezūm™ randomized controlled study mean baseline IIEF-EF was 22.7, which indicates the general absence of ED in this cohort.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The mean IIEF-EF did not significantly change until four years postoperatively, which decreased to a mild ED score of 20.8.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Very few patients with ED were included in the Rezūm™ study, which did not specify how many patients would be classified with ED by baseline IIEF-EF score.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> There is little inclusion of ED patients within high quality studies evaluating the efficacy of bladder outlet procedures, making the uroflowmetry observation in IPP patients both novel and difficult to contextualize. The mechanism of increased uroflowmetry after IPP is difficult to propose, since the entirety of the device is located outside of the prostate and urethra. The use of phosphodiesterase-5 inhibitors would likely improve uroflowmetry in patients without an IPP, rather than patients with an IPP. Overall, this uroflowmetry difference is unlikely to be clinically significant, but should be evaluated in future studies that include large ED patient populations with and without IPPs.</p><p id="par0065" class="elsevierStylePara elsevierViewall">While this is one of the first studies to compare the efficacy of a bladder outlet procedure in ED patients with and without IPPs, this study has several limitations. The absence of any objective assessment of prostate volume suggests that some patients that did not respond well to the treatment may not have been properly selected for this procedure. There was also an insufficient number of patients and complications to identify patient demographics or clinical characteristics that were associated with complications. Although Rezūm™ is just one of many bladder outlet procedures, the Rezūm™ needle is substantially smaller than the prostatic urethral lift needle, so perforation of the IPP reservoir is probably less likely. However, direct comparisons of Rezūm™ with other bladder outlet procedures are needed to adequately compare safety and efficacy. Nevertheless, the number of general ED and IPP patients who undergo Rezūm™ should continue to grow, which will allow for the continued surveillance of IPP device safety. Future studies should focus on identifying factors associated with complications and greater subjective/objective treatment response in ED patients with and without IPPs.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Rezūm™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. Objective and subjective improvement in LUTS are observed in patients with and without an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1999079" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1713366" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1999078" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1713365" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-02-12" "fechaAceptado" => "2022-03-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1713366" "palabras" => array:5 [ 0 => "Erectile dysfunction" 1 => "Inflatable penile prosthesis" 2 => "Bladder outlet obstruction" 3 => "Benign prostatic hyperplasia" 4 => "Rezūm™" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1713365" "palabras" => array:5 [ 0 => "Disfunción eréctil" 1 => "Prótesis peneana inflable" 2 => "Obstrucción de la salida de la vejiga" 3 => "Hiperplasia prostática benigna" 4 => "Rezūm®" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This study evaluates the safety and efficacy of Rezūm™ in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective review of ED patients who underwent Rezūm™ by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Q<span class="elsevierStyleInf">max</span>), and uroflowmetry average flow rate (Q<span class="elsevierStyleInf">avg</span>) before and after Rezūm™ were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span>.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A total of 17 patients with ED who underwent Rezūm™ were identified, including 11 patients with an IPP. The median follow-up after Rezūm™ was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Q<span class="elsevierStyleInf">max</span> (10.9 mL/s vs 9.8 mL/s, p = 0.04) and Q<span class="elsevierStyleInf">avg</span> (7.5 mL/s vs 6.0 mL/s, p = 0.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Q<span class="elsevierStyleInf">max</span> or Q<span class="elsevierStyleInf">avg</span> on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Rezūm™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Este estudio evalúa la seguridad y eficacia del sistema Rezūm® en pacientes con disfunción eréctil (DE) con y sin prótesis peneana inflable (PPI).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se trata de una revisión retrospectiva de los pacientes con disfunción eréctil tratados con Rezūm® por un único cirujano durante 12 meses. De cada paciente se obtuvo la edad, la presencia de PPI, el número de medicamentos para la hiperplasia prostática benigna, la puntuación internacional de síntomas prostáticos (IPSS), el índice de calidad de vida (QOL) de la IPSS, la tasa de flujo máximo (Q<span class="elsevierStyleInf">max</span>) en la uroflujometría y la tasa de flujo promedio (Q<span class="elsevierStyleInf">avg</span>) en la uroflujometría antes y después del tratamiento con Rezūm®. Se utilizaron pruebas T para dos muestras independientes para comparar las características preoperatorias y postoperatorias entre los pacientes con y sin PPI. Se realizó una regresión lineal para identificar los factores asociados con el Q<span class="elsevierStyleInf">max</span> o Q<span class="elsevierStyleInf">avg</span> postoperatorio.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se identificaron un total de 17 pacientes con disfunción eréctil sometidos al sistema Rezūm®, incluyendo 11 pacientes con una PPI. La mediana de seguimiento tras el tratamiento con Rezūm® fue de 65 días. No hubo diferencias significativas en cuanto a los datos demográficos y las características clínicas basales entre los pacientes con y sin PPI. El Q<span class="elsevierStyleInf">max</span> postoperatorio (10,9 mL/s frente a 9,8 mL/s, p = 0,04) y el Q<span class="elsevierStyleInf">avg</span> (7,5 mL/s frente a 6,0 mL/s, p = 0,03) fueron significativamente mayores en los pacientes con PPI en comparación con los pacientes sin PPI. No hubo factores asociados con el Q<span class="elsevierStyleInf">max</span> o el Q<span class="elsevierStyleInf">avg</span> postoperatorio en la regresión lineal. Dos pacientes sin PPI resultaron en retención urinaria, mientras que en los pacientes con PPI no se produjeron complicaciones.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Rezūm® es un procedimiento seguro y eficaz para realizar en pacientes con DE, especialmente en aquellos con una PPI. Los pacientes con PPI pueden experimentar un incremento mayor en los parámetros de uroflujometría en comparación con los pacientes con DE sin PPI.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0085" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">IPP Present \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">IPP Absent \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (Standard Deviation)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.0 (10.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.0 (12.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of BPH medications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative IPSS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.4 (7.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.5 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative QOL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.5 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative Q<span class="elsevierStyleInf">max</span> (mL/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.6 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5 (4.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative Q<span class="elsevierStyleInf">avg</span> (mL/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.7 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3319345.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Baseline demographics and clinical characteristics among patients with and without IPP.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">IPP Present \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">IPP Absent \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (Standard Deviation)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative IPSS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.7 (12.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.8 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative QOL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.2 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative Q<span class="elsevierStyleInf">max</span> (mL/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.9 (8.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.8 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative Q<span class="elsevierStyleInf">avg</span> (mL/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.5 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3319344.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Postoperative clinical characteristics among patients with and without IPP.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 16809 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of benign prostatic hyperplasia: present knowledge and studies needed" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. 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