Prostatic HyperplasiaNCT06091618
Laser Vaporization of the Prostate: Comparing Between Ejaculatory Preserving and Non-ejaculatory Preserving Technique
A study testing new technique of ejaculatory preserving laser prostatectomy and conventional technique of laser vaporization of the prostate in people with Prostatic Hyperplasia, run by Ain Shams University at 1 site in Egypt.
Trial summary
The present work aimed to compare between The Outcomes of conventional technique of laser prostatectomy versus the new ejaculatory sparing technique . Read more about this study
- Who is it for?
- Ages 45 years and older, men only
- Conditions the study is for
- Prostatic Hyperplasia
- What is being tested?
- new technique of ejaculatory preserving laser prostatectomy and conventional technique of laser vaporization of the prostate
- Type of treatment
- Pill or oral medicine, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 120 participants
- Where
- 1 siteEgypt
- Study dates
- 1 Aug 2022to 27 Apr 2024
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 45 years and older
- Men only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age >45 years old, clinical diagnosis of BOO by medical history and physical examination (including digital rectal examination)
- International prostate symptoms score (IPSS) >14 points
- Normal PSA (PSA<4 ng / ml or free/ total PSA >0.25)
- Prostate size < 80 gm
- Men with recurrent urinary retention (drug-refractory), urinary infection, or haematuria who had failed standard medical therapy (alpha-blockers, 5-alpha reductive inhibitors)
- Patients were also required to have an active and healthy sexual life, the ability to ejaculate and a desire to preserve ejaculation
Who cannot join
- Major psychiatric and somatic diseases and the use of drugs that affect sexual function
- Patients with ejaculatory dysfunction or no ejaculation
- Patients with documented or suspected prostate cancer
- Patients with neurogenic bladder, voiding dysfunction, urethral strictures, and malignancies of the upper or lower urinary tract,
- Prostates sized more than 80 CC, severe comorbidities or high surgical risk patients.
Trial locations and contacts
1 site in 1 country.
Ahmed Emam, PHD contact
Egypt1 site, 1 recruiting
- Recruiting
Ain Shams University Hospital
Cairo, 11741
ahmed emam, doctorate, 01228770965
About this study
Official title: Laser Vaporization of the Prostate: Comparative Study Between Ejaculatory Preserving and Non-ejaculatory Preserving Technique
The present work aimed to compare between The Outcomes of conventional technique of laser prostatectomy versus the new ejaculatory sparing technique .
Read the detailed description
Benign prostate hyperplasia (BPH) is a histological diagnosis which is identified by non-malignant hyperplasia of prostatic tissue due to smooth muscle and epithelial cell proliferation in the prostate transition zone.
The prevalence of histologically diagnosed (BPH) increases from 8% in men aged 31 to 40 years old to 40-50% in men aged 51 to 60 years old. This increases to over 80% in men older than 80 years old.
Bladder outlet obstructions (BOO) are one of the major disorders in the aging male, The most common aetiology of BOO in elderly men above the age of 60 years is (BPH), but younger men (< 50 years old) can also experience infra vesical obstruction from a small but obstructive prostate.
Ejaculation is one of the fundamental domains of male sexual function An almost inevitable adverse event of the conventional TURP is the loss of antegrade ejaculation, seen in 65%-80% of patients.
The use of alpha receptor antagonists is also known to cause a loss in antegrade ejaculation. Aside from peri- and postoperative morbidities, such as bleeding and TURP syndrome, the loss of ejaculation represents a major reason for the avoidance of surgical treatment. This is a particular issue among young people who hesitate to agree to the TURP procedure due to the fear of loss of ejaculation. Losing the ability to ejaculate often leads to a subsequent decrease in sexual pleasure, which has psychosocial implications but can also impact on aspects related to their cultural background, desire for children, and sexual life.
According to the current theory of ejaculation, the loss of antegrade ejaculation is attributed to the loss of bladder neck function after resection.
Even though TURP has a high success rate, the perioperative morbidity and operative safety specially in relation to bleeding pose serious concerns In addition to bleeding, retrograde ejaculation and TURP syndrome due to irrigant absorption are also relevant to intra and postoperative complications.
Despite technical advancements in TURP, blood transfusion rates are still 2 % to 7 %, TUR syndrome occurs in 2 %, stress urinary incontinence in 2 %, retrograde ejaculation in 65 % to 70.0%, urethral strictures in 4 %, bladder neck contractures in 4 % and early revision rates are 3 % to 5 %. These, along with prolonged catheterization time, advocate for alternatives to this treatment modality that offer similar clinical results but fewer complications
Laser vaporization of prostate is one of these methods. Lasers generate different effects in tissues, like coagulation and vaporization. Different types of laser like potassium-titanyl phosphate (KTP), holmium, diode and thulium are available. Of these, those gaining more popularity are the photoselective vaporization of the prostate (PVP) using the KTP laser, and holmium laser enucleation of the prostate (HOLEP).
The semiconductor diode laser is thought to be the best in relation to its haemostatic properties, but due to postoperative dysuria, pain, and storage urinary symptoms, it was less acceptable , A newly introduced diode laser, operating on the wavelength of 980 nm, is different in terms of its new fiber design, greater ablative properties of tissues, and efficient haemostasis due to its significant simultaneous absorption in water and Haemoglobin
The conventional technique of laser prostatectomy is traditionally performed with careful vaporization of apical tissue around the verumontanum.
To preserve the antegrade ejaculation, the paracollicular and the situated tissue, which is located 1 cm proximal to the verumontanum should not be vaporized. This is mainly related to the importance of the musculus ejaculatorius and verumontanum for ejaculation.
Based on this clearer understanding of the process of ejaculation, a new technique of trans urethral laser vaporization of the prostate , termed ejaculation-preserving technique was developed with the overarching aim of preserving antegrade ejaculation with comparable functional outcome for micturition parameters to regular technique.
- Conditions
- Prostatic Hyperplasia
- Being tested
- new technique of ejaculatory preserving laser prostatectomy, conventional technique of laser vaporization of the prostate
- Keywords
- ejaculatory preserving, laser vaporization of the prostate
- Medical subject headings
- Prostatic Hyperplasia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
new technique of ejaculatory preserving laser prostatectomyProcedure or surgery
laser will be employed to preform vaporization. The ejaculatory preserving procedure will be done in the following steps:
Setting a mark cut 1 cm proximal of the verumontanum as orientation. Complete resection of the middle lobe to the abovementioned mark. Vaporization of lateral lobes to the capsule and the ventral side to the level of the verumontanum with avoidance of paracollicular digging.
Circular resection of the internal bladder neck. Apical resection utilizing the colliculus seminalis as a distal resection border and maintaining a 1cm safety area for preservation of ejaculation.
Total removal of prostate cuts and final check to confirm that there are no obstructive components.
conventional technique of laser vaporization of the prostateProcedure or surgery
conventional laser vaporization of the prostate
| Study group | Role | What they receive |
|---|---|---|
| new technique of ejaculatory preserving laser vaporization prostatectomy | Active comparator | laser will be employed to preform vaporization. The ejaculatory preserving procedure will be done in the following steps:
1. Setting a mark cut 1 cm proximal of the verumontanum as orientation.
2. Complete resection of the middle lobe to the abovementioned mark.
3. Vaporization of lateral lobes to the capsule and the ventral side to the level of the verumontanum with avoidance of paracollicular digging.
4. Circular resection of the internal bladder neck.
5. Apical resection utilizing the colliculus seminalis as a distal resection border and maintaining a 1cm safety area for preservation of ejaculation.
6. Total removal of prostate cuts and final check to confirm that there are no obstructive components. Receives: Procedure: new technique of ejaculatory preserving laser prostatectomy |
| conventional technique laser vaporization prostatectomy | Active comparator | non ejaculatory preserving laser vaporization of the prostate Receives: Procedure: conventional technique of laser vaporization of the prostate |
What is being measured
The primary outcome is the main question the study is designed to answer.
compare between The Outcomes of conventional technique of laser prostatectomy versus the new ejaculatory sparing technique regarding semen volume
decreased,vanished or the same
Measured: one year
maximum flow rate of the urine after the procedure (Qmax )
maximum flow rate increased or decreased or the same Qmax Interpretation * is higher than 15ml/sec Normal 10-15ml/sec Equivocal is lower than 10ml/sec Obstruction or weak detrusor
Measured: one year
international prostate symptoms score (IPSS)
Score: 1-7: Mild 8-19: Moderate 20-35: Severe
- Incomplete Emptying How often have you had the sensation of not emptying your bladder? 0 1 2 3 4 5
- Frequency How often have you had to urinate less than every two hours? 0 1 2 3 4 5
- Intermittency How often have you found you stopped and started again several times when you urinated? 0 1 2 3 4 5
- Urgency How often have you found it difficult to postpone urination? 0 1 2 3 4 5
- Weak Stream How often have you had a weak urinary stream? 0 1 2 3 4 5
- Straining How often have you had to strain to start urination? 0 1 2 3 4 5 None 1 Time 2 Times 3 Times 4 Times 5 Times
- Nocturia How many times did you typically get up at night to urinate? 0 1 2 3 4 5
Measured: one year
post voiding residual urine
Post-void residual urine (PVR) is the amount of urine that remains in the bladder after urinating. It can be estimated by ultrasound or measured by catheterization1. A small amount of PVR is normal, but a high amount can indicate a urinary obstruction or other problems
Measured: 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Oct 2023
- Study start1 Aug 2022
- Primary completion27 Mar 2024 (estimated)
- Study completion27 Apr 2024 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Prostatic HyperplasiaStudies of the same condition, open and under way.
- More trials run by Ain Shams UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- prospective, randomized clinical study. Exclusion criteria * Major psychiatric and somatic diseases and the use of drugs that affect sexual function * Patients with ejaculatory dysfunction or no ejaculation * Patients with documented or suspected prostate cancer * Patients with neurogenic bladder, voiding dysfunction, urethral strictures, and malignancies of the upper or lower urinary tract, * Prostates sized more than 80 CC, severe comorbidities or high surgical risk patients.
- Masking
- None (open label)
- Enrolment
- 120 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Ain Shams University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06091618
- Sponsor's protocol ID
- ejaculatory sparing laser turp
- Status last verified
- Sep 2023
- First submitted
- 26 Sep 2023
- Last updated
- 20 Mar 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Elshazly M, Sultan S, Shaban M, Zanaty F. Evaluation of a novel technique of bladder neck and supramontanal sparing ejaculatory preserving transurethral prostatectomy. World J Urol. 2021 Nov;39(11):4215-4219. doi: 10.1007/s00345-021-03752-z. Epub 2021 Jun 6.
PubMed 34091741Brant A, Cho A, Posada Calderon L, Te A, Kashanian J, Chughtai B. Ejaculatory Hood-Sparing Vaporization of the Prostate and Its Impact on Erectile, Ejaculatory, and Sexual Function. Urology. 2020 Oct;144:177-181. doi: 10.1016/j.urology.2020.06.072. Epub 2020 Jul 23.
PubMed 32711008
Study at a glance
From the registry record, last updated by the sponsor on 20 Mar 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Laser Vaporization of the Prostate: Comparative Study Between Ejaculatory Preserving and Non-ejaculatory Preserving Technique
- ClinicalTrials.gov ID
- NCT06091618
- Acronym / sponsor ID
- ejaculatory sparing laser turp
- Conditions
- Prostatic Hyperplasia
- Keywords
- ejaculatory preserving, laser vaporization of the prostate
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 120 participants (estimated)
- Lead sponsor
- Ain Shams UniversityUniversity, hospital or other
- Study start
- 1 Aug 2022 (actual)
- Primary completion
- 27 Mar 2024 (estimated)
- Study completion
- 27 Apr 2024 (estimated)
- First posted
- 19 Oct 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The present work aimed to compare between The Outcomes of conventional technique of laser prostatectomy versus the new ejaculatory sparing technique .
Detailed description
Benign prostate hyperplasia (BPH) is a histological diagnosis which is identified by non-malignant hyperplasia of prostatic tissue due to smooth muscle and epithelial cell proliferation in the prostate transition zone.
The prevalence of histologically diagnosed (BPH) increases from 8% in men aged 31 to 40 years old to 40-50% in men aged 51 to 60 years old. This increases to over 80% in men older than 80 years old.
Bladder outlet obstructions (BOO) are one of the major disorders in the aging male, The most common aetiology of BOO in elderly men above the age of 60 years is (BPH), but younger men (< 50 years old) can also experience infra vesical obstruction from a small but obstructive prostate.
Ejaculation is one of the fundamental domains of male sexual function An almost inevitable adverse event of the conventional TURP is the loss of antegrade ejaculation, seen in 65%-80% of patients.
The use of alpha receptor antagonists is also known to cause a loss in antegrade ejaculation. Aside from peri- and postoperative morbidities, such as bleeding and TURP syndrome, the loss of ejaculation represents a major reason for the avoidance of surgical treatment. This is a particular issue among young people who hesitate to agree to the TURP procedure due to the fear of loss of ejaculation. Losing the ability to ejaculate often leads to a subsequent decrease in sexual pleasure, which has psychosocial implications but can also impact on aspects related to their cultural background, desire for children, and sexual life.
According to the current theory of ejaculation, the loss of antegrade ejaculation is attributed to the loss of bladder neck function after resection.
Even though TURP has a high success rate, the perioperative morbidity and operative safety specially in relation to bleeding pose serious concerns In addition to bleeding, retrograde ejaculation and TURP syndrome due to irrigant absorption are also relevant to intra and postoperative complications.
Despite technical advancements in TURP, blood transfusion rates are still 2 % to 7 %, TUR syndrome occurs in 2 %, stress urinary incontinence in 2 %, retrograde ejaculation in 65 % to 70.0%, urethral strictures in 4 %, bladder neck contractures in 4 % and early revision rates are 3 % to 5 %. These, along with prolonged catheterization time, advocate for alternatives to this treatment modality that offer similar clinical results but fewer complications
Laser vaporization of prostate is one of these methods. Lasers generate different effects in tissues, like coagulation and vaporization. Different types of laser like potassium-titanyl phosphate (KTP), holmium, diode and thulium are available. Of these, those gaining more popularity are the photoselective vaporization of the prostate (PVP) using the KTP laser, and holmium laser enucleation of the prostate (HOLEP).
The semiconductor diode laser is thought to be the best in relation to its haemostatic properties, but due to postoperative dysuria, pain, and storage urinary symptoms, it was less acceptable , A newly introduced diode laser, operating on the wavelength of 980 nm, is different in terms of its new fiber design, greater ablative properties of tissues, and efficient haemostasis due to its significant simultaneous absorption in water and Haemoglobin
The conventional technique of laser prostatectomy is traditionally performed with careful vaporization of apical tissue around the verumontanum.
To preserve the antegrade ejaculation, the paracollicular and the situated tissue, which is located 1 cm proximal to the verumontanum should not be vaporized. This is mainly related to the importance of the musculus ejaculatorius and verumontanum for ejaculation.
Based on this clearer understanding of the process of ejaculation, a new technique of trans urethral laser vaporization of the prostate , termed ejaculation-preserving technique was developed with the overarching aim of preserving antegrade ejaculation with comparable functional outcome for micturition parameters to regular technique.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- prospective, randomized clinical study. Exclusion criteria * Major psychiatric and somatic diseases and the use of drugs that affect sexual function * Patients with ejaculatory dysfunction or no ejaculation * Patients with documented or suspected prostate cancer * Patients with neurogenic bladder, voiding dysfunction, urethral strictures, and malignancies of the upper or lower urinary tract, * Prostates sized more than 80 CC, severe comorbidities or high surgical risk patients.
| Arm | Type | Receives |
|---|---|---|
| new technique of ejaculatory preserving laser vaporization prostatectomy | Active comparator | Procedure: new technique of ejaculatory preserving laser prostatectomylaser will be employed to preform vaporization. The ejaculatory preserving procedure will be done in the following steps: 1. Setting a mark cut 1 cm proximal of the verumontanum as orientation. 2. Complete resection of the middle lobe to the abovementioned mark. 3. Vaporization of lateral lobes to the capsule and the ventral side to the level of the verumontanum with avoidance of paracollicular digging. 4. Circular resection of the internal bladder neck. 5. Apical resection utilizing the colliculus seminalis as a distal resection border and maintaining a 1cm safety area for preservation of ejaculation. 6. Total removal of prostate cuts and final check to confirm that there are no obstructive components. |
| conventional technique laser vaporization prostatectomy | Active comparator | Procedure: conventional technique of laser vaporization of the prostatenon ejaculatory preserving laser vaporization of the prostate |
Who may qualify
- Ages
- 45 years and older
- Sex
- Male only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (6 listed)
- Age >45 years old, clinical diagnosis of BOO by medical history and physical examination (including digital rectal examination)
- International prostate symptoms score (IPSS) >14 points
- Normal PSA (PSA<4 ng / ml or free/ total PSA >0.25)
- Prostate size < 80 gm
- Men with recurrent urinary retention (drug-refractory), urinary infection, or haematuria who had failed standard medical therapy (alpha-blockers, 5-alpha reductive inhibitors)
Key exclusion criteria (5 listed)
- Major psychiatric and somatic diseases and the use of drugs that affect sexual function
- Patients with ejaculatory dysfunction or no ejaculation
- Patients with documented or suspected prostate cancer
- Patients with neurogenic bladder, voiding dysfunction, urethral strictures, and malignancies of the upper or lower urinary tract,
- Prostates sized more than 80 CC, severe comorbidities or high surgical risk patients.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| new technique of ejaculatory preserving laser prostatectomylaser will be employed to preform vaporization. The ejaculatory preserving procedure will be done in the following steps: Setting a mark cut 1 cm proximal of the verumontanum as orientation. Complete resection of the middle lobe to the abovementioned mark. Vaporization of lateral lobes to the capsule and the ventral side to the level of the verumontanum with avoidance of paracollicular digging. Circular resection of the internal bladder neck. Apical resection utilizing the colliculus seminalis as a distal resection border and maintaining a 1cm safety area for preservation of ejaculation. Total removal of prostate cuts and final check to confirm that there are no obstructive components. | Procedure or surgery | new technique of ejaculatory preserving laser vaporization prostatectomy |
| conventional technique of laser vaporization of the prostateconventional laser vaporization of the prostate | Procedure or surgery | conventional technique laser vaporization prostatectomy |
Primary outcome
compare between The Outcomes of conventional technique of laser prostatectomy versus the new ejaculatory sparing technique regarding semen volume
Time frame: one year
decreased,vanished or the same
maximum flow rate of the urine after the procedure (Qmax )
Time frame: one year
maximum flow rate increased or decreased or the same Qmax Interpretation * is higher than 15ml/sec Normal 10-15ml/sec Equivocal is lower than 10ml/sec Obstruction or weak detrusor
international prostate symptoms score (IPSS)
Time frame: one year
Score: 1-7: Mild 8-19: Moderate 20-35: Severe 1. Incomplete Emptying How often have you had the sensation of not emptying your bladder? 0 1 2 3 4 5 2. Frequency How often have you had to urinate less than every two hours? 0 1 2 3 4 5 3. Intermittency How often have you found you stopped and started again several times when you urinated? 0 1 2 3 4 5 4. Urgency How often have you found it difficult to postpone urination? 0 1 2 3 4 5 5. Weak Stream How often have you had a weak urinary stream? 0 1 2 3 4 5 6. Straining How often have you had to strain to start urination? 0 1 2 3 4 5 None 1 Time 2 Times 3 Times 4 Times 5 Times 7. Nocturia How many times did you typically get up at night to urinate? 0 1 2 3 4 5
post voiding residual urine
Time frame: 1 year
Post-void residual urine (PVR) is the amount of urine that remains in the bladder after urinating. It can be estimated by ultrasound or measured by catheterization1. A small amount of PVR is normal, but a high amount can indicate a urinary obstruction or other problems
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Mar 2024.
- Background: PubMed 34091741Elshazly M, Sultan S, Shaban M, Zanaty F. Evaluation of a novel technique of bladder neck and supramontanal sparing ejaculatory preserving transurethral prostatectomy. World J Urol. 2021 Nov;39(11):4215-4219. doi: 10.1007/s00345-021-03752-z. Epub 2021 Jun 6.
- Background: PubMed 32711008Brant A, Cho A, Posada Calderon L, Te A, Kashanian J, Chughtai B. Ejaculatory Hood-Sparing Vaporization of the Prostate and Its Impact on Erectile, Ejaculatory, and Sexual Function. Urology. 2020 Oct;144:177-181. doi: 10.1016/j.urology.2020.06.072. Epub 2020 Jul 23.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Ahmed Emam, PHD contact
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing new technique of ejaculatory preserving laser prostatectomy and conventional technique of laser vaporization of the prostate in people with Prostatic Hyperplasia, run by Ain Shams University at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 20 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact kirolos N habib, MD (01220357684, kirolos.nabil@med.asu.edu.eg), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
compare between The Outcomes of conventional technique of laser prostatectomy versus the new ejaculatory sparing technique regarding semen volume (time frame: one year). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06091618, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Mar 2024.