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Objective: The aim of this study was to investigate whether urinary glycosaminoglycans (GAG) levels reflect clinical status in men with lower urinary tract symptoms and if they could be used as a marker in management of overactive bladder (OAB). Methods: A total of 34 patients were recruited who were admitted with LUTS and diagnosed as having clinically bladder outlet obstruction (BOO) due to prostate enlargement. These newly diagnosed, never treated patients underwent routine investigation, consisting of history, physical examination, PSA, ultrasound, uroflowmetry, assessment of symptoms scored by both International Prostate Symptom Score (IPSS) and Marmara- Overactive Bladder Questionnaire (M-OBQ). The patients were divided into two groups as those with an initial M-OBQ score < 12 (group 1) and ≥ 13 (group 2). Alfa blocker was initiated in eligible patients. Further evaluations included prostate volume measurement, pre- and post-treatment urinary GAG levels, IPSS and M-QAOB values and maximum urine flow rate (Qmax). Results: Before treatment, urinary GAG level was 21.5 mg/gCr (6.1-45.5) in Group 1, and 23.35 mg/gCr (15.6-32.6) in Group 2 (p =0.845). After the treatment, the GAG level in Group 1 and Group 2 were found to be 19.8 mg/gCr (7.4-70.5) and 18 (7.6- 41.7), respectively (p = 0.511). No difference in GAG levels was found in subgroup analysis for patients with or without OAB. Conclusions: In recent years, there have been many studies investigating the relationship between LUTS and urinary markers. However, in our prospective study, no relationship was found between pre- and post- treatment urinary GAG levels in patients with LUTS with or without OAB. [ABSTRACT FROM AUTHOR]

Simple Summary: The contrast-enhanced ultrasound (CEUS) allows the evaluation of the vascularization of an organ, using contrast agents composed of gas microbubbles, such as sulfur hexafluoride. Prostate perfusion is increased in dogs with benign prostatic hyperplasia (BPH), due to the stimulation of dihydrotestosterone (DHT). In the present study, CEUS is applied for monitoring dogs with BPH, receiving osaterone acetate (OSA). Fifteen intact adult dogs are referred for BPH. A CPSE assay and B-mode ultrasound confirm the diagnosis. CEUS is performed before OSA treatment (D0) and highlights the rapid diffusion times of the contrast agent (length of the wash-in and wash-out phases). Prostatic cysts and parenchymal alteration are also detected. After treatment (D1), the CPSE and prostate volume are significantly reduced, while CEUS detects a significant increase in wash-in and wash-out times and a reduction in parenchymal abnormalities. These findings confirm the decrease in prostatic perfusion after OSA treatment and, although preliminary, are promising for the broader use of CEUS for the diagnosis and monitoring of dogs with BPH. The prostate is the only sexual gland of the male dog, and dihydrotestosterone (DHT) regulates its growth. In intact dogs, constant DHT stimulation results in benign prostatic hyperplasia (BPH) that can be treated with osaterone acetate (OSA). This study describes the effects of OSA treatment, detected by contrast-enhanced ultrasonography (CEUS), highlighting prostatic vascularization with a contrast agent composed of gas microbubbles. Fifteen dogs (2–8 years) of different sizes and breeds (4–30 kg) diagnosed with BPH are involved in the study. Before treatment (D0), CPSE is measured (294.05 ± 115.97 ng/mL), and a B-mode ultrasound is performed (Vratio = 2.80 ± 1.85), confirming BPH. CEUS highlights the length of the wash-in (11.93 ± 2.08 s) and wash-out (42.20 ± 6.99 s) phases of the contrast agent in the prostate and the presence of cysts and parenchymal alteration. Dogs are treated with OSA (0.5 mg/kg for 7 days) and reassessed after 21 days (D1): CPSE and prostate volume are significantly (p < 0.001) reduced. The length of the wash-in (14.73 ± 2.54 s) and wash-out (51.13 ± 6.03 s) phases are significantly (p < 0.001) increased. The results confirm the effectiveness of the treatment, particularly the reduction in prostatic perfusion, confirmed by the increase in diffusion times of the contrast. Although preliminary, these findings are promising for the use of CEUS in monitoring dogs with BPH. [ABSTRACT FROM AUTHOR]

Numerous animal models have demonstrated that caloric restriction (CR) is an excellent tool to delay aging and increase the quality of life, likely because it counteracts age-induced oxidative stress and inflammation. The aging process can affect the prostate in three ways: the onset of benign prostatic hyperplasia, prostatitis, and prostate cancer. In this study, we used 14 aged male Sprague Dawley rats, which were allocated into two groups, at the age of 18 months old. One group was fed ad libitum (a normal diet (ND)), and the other group followed a caloric restriction diet with a 60% decrease in intake. The rats were sacrificed at the age of 24 months. By immunohistochemical (IHC) and Western blot (WB) analyses, we studied the variations between the two groups in immune inflammation and fibrosis-related markers in aged prostate tissues. Morphological examinations showed lower levels of prostatic hyperplasia and fibrosis in the CR rats vs. the ND rats. The IHC results revealed that the prostates of the CR rats exhibited a lower immune proinflammatory infiltrate level and a reduced expression of the NLRP3 inflammasome pathway, together with significantly reduced expressions of mesenchymal markers and the profibrotic factor TGFβ1. Finally, by WB analysis, we observed a reduced expression of ERα, which is notoriously implicated in prostate stromal proliferation, and increased expressions of SOD1 and Hsp70, both exerting protective effects against oxidative stress. Overall, these data suggest that CR brings potential benefits to prostatic tissues as it reduces the physiological immune–inflammatory processes and the tissue remodeling caused by aging. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is a multifactorial disease in which abnormal growth factor activation and embryonic reawakening are considered important factors. Here we demonstrated that the aberrant activation of transforming growth factor β (TGF-β)/Rho kinase 1 (ROCK1) increased the stemness of BPH tissue by recruiting mesenchymal stem cells (MSCs), indicating the important role of embryonic reawakening in BPH. When TGF-β/ROCK1 is abnormally activated, MSCs are recruited and differentiate into fibroblasts/myofibroblasts, leading to prostate stromal hyperplasia. Further research showed that inhibition of ROCK1 activation suppressed MSC migration and their potential for stromal differentiation. Collectively, our findings suggest that abnormal activation of TGF-β/ROCK1 regulates stem cell lineage specificity, and the small molecule inhibitor GSK269962A could target ROCK1 and may be a potential treatment for BPH. [ABSTRACT FROM AUTHOR]

Background The Qianlie Shule capsule is a classical Chinese medicine compound preparation frequently used in therapeutic settings to alleviate astringent pain in the urethra, prostatic hypertrophy, and chronic prostatitis or urinary frequency. However, a comprehensive analysis of the chemical composition of Qianlie Shule capsules has not been reported. Objective To establish a quick and effective analytical method based on hybrid quadrupole-orbitrap mass spectrometry ultrahigh-performance liquid chromatography (UPLC-Q-Orbitrap-MS/MS) for the identification and characterization of chemical components in Qianlie Shule capsules. Method Using ultrahigh-performance liquid chromatography with hybrid quadrupole-orbitrap mass spectrometry and data post-processing, the samples of Qianlie Shule capsules were examined. First, the whole extract of the Qianlie Shule capsules was separated using a UPLC machine, and the fragmentation data were collected in both positive and negative ion mode. The target molecule is then quickly identified by comparing the fragmentation information of the neutral loss (NLs) and characteristic fragments (CFs) reported in the literature. Results A total of 145 chemical components were identified. It includes flavonoids, triterpenoids, phenylpropanoids, organic acids, alkaloids, phenylethanoids, iridoids, and anthraquinones. Conclusions This study is a method for the rapid qualitative analysis of the chemical composition of Qianlie Shule capsules, which provides a method for the rapid, sensitive, and high-throughput identification of the prescription components of Chinese medicine. Highlights Systematic identification of the chemical composition of QLSL capsules provides a theoretical basis for studying the substance basis of QLSL capsules and the improvement of the quality control level. [ABSTRACT FROM AUTHOR]

Objectives: To study the functional and oncological results of minimally invasive treatment methods: cryoablation, brachytherapy, and high-intensity focused ultrasound (HIFU) therapy of localized prostate cancer in a single hospital. Methods: One hundred sixty patients with localized prostate cancer were treated with minimally invasive methods (53, 52, 55 patients with cryoablation, brachytherapy and HIFU therapy, respectively). Prostate-specific antigen and evaluation of post-procedure biopsies were used as an assessment. The review of functional indicators and quality of life was made with International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL) questionnaires. Results: Patients after cryoablation showed worse results of oncological control according to positive repeat biopsies, best indicators were observed after brachytherapy. When considering the IPSS results, there were statistically significantly worse scores in the brachytherapy group in the early postoperative period, these differences do not reach statistical significance in the late period in the brachytherapy and cryoablation groups. Patients in the cryoablation group showed worse indicators of IIEF-5; in the early postoperative period; in the late follow-up period, the indicators of erectile function in patients in the cryoablation group did not statistically significantly differ from those in patients after brachytherapy. Patients after HIFU therapy showed fewer cases of de novo erectile dysfunction during the follow-up period of 3 years, higher average IIEF-5 scores, lower IPSS scores and better QoL results. Conclusion: The recurrence of prostate cancer was statistically significantly higher in the International Society of Urological Pathology (ISUP) 3 grade group. HIFU therapy had better urination indicators compared to other groups, that can be associated with the laser enucleation of prostatic hyperplasia. The advantage was noted in patients after HIFU therapy when comparing the parameters to the IIEF-5 thus, HIFU treatment had a better impact on patients' QoL with localized prostate cancer. [ABSTRACT FROM AUTHOR]

Androgen deprivation therapy for prostate cancer was pioneered by Charles Huggins, laureate of the Nobel Prize in Medicine in 1966. The authors tried to understand the scientific context and how previous findings paved Huggins way to his discoveries. With the help of summary or review articles on androgen deprivation therapy, the authors identified key publications and used his Nobel Prize speech as a basis to understand his discoveries. Furthermore, they used a recording of the laboratory‐talk interview he gave about his findings to guide them to relevant publications. The authors found that the basis for Huggins' discoveries was the isolation of testosterone in 1935, not long before Huggins' 1941 hallmark publication. Huggins' work follows major experiments in the 19th century in orchiectomy done as a treatment for prostate hypertrophy. Researching the etiology of idiopathic hydrocele, Huggins analyzed the composition of prostate fluid. Further research led to the discovery of the influence of castration, testosterone, and estrogen on acid phosphatase. Recently developed methods facilitated the measurement of the phosphatases. He, therefore, had a biomarker for metastatic prostate cancer to measure treatment response. Very early on, he reported clinical improvements after castration in metastatic patients. Although the effect of orchiectomy on prostate hypertrophy was already known, Huggins was the first to show that testosterone stimulated and estrogen decreased the activity of prostate cancer. Huggins also established phosphatases as a tumor marker to measure disease response. Charles Huggins won the Nobel Prize in Medicine in 1966 for his discovery of the effect of castration on prostate cancer. The authors elucidate how he arrived at his findings and the contributions of prior researchers. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to forecast the core targets of formononetin through network pharmacology and to assess its potential anti-benign prostatic hyperplasia (BPH) effects using molecular docking and animal experimentation. Active compounds were filtered from the Swiss ADME database, while drug targets were extrapolated from TTD, GeneCards, and DrugBank databases. Targets overlapping between drug and disease were pinpointed, and PPI networks were subsequently developed. Both GO and KEGG enrichment analyses were executed. The AutodockVina software facilitated molecular docking to examine formononetin's estrogen activity. Mice diagnosed with BPH were grouped into control, TP, 2.5 mg/kg, 5 mg/kg, 10 mg/kg, 5 mg/kg + fulvestrant (20 mg/kg/week), and 10 mg/kg + fulvestrant (20 mg/kg/week) groups. Pathological deviations were discerned through H&E and Masson staining. Estrogen receptor and cell cycle gene expressions were quantified by qPCR. Our findings pinpointed 35 potential protein targets bridging formononetin and BPH, with ER-α, EGFR, ER-β, CYP19A1, AChE, and PPARA being the focal targets. The GO and KEGG enrichment analyses indicated that formononetin's targets predominantly revolved around cellular responses to estradiol stimulation, estrogen biosynthesis, steroid hormone receptor activity, steroid binding, and other related processes. These extended to pathways like steroid hormone biosynthesis and estrogen signaling. Molecular docking deduced a stronger affinity of formononetin for ER-β than for ER-α. Examination of pathological sections in formononetin-treated BPH mice demonstrated its significant inhibitory effect on BPH. Concurrently, the estrogen receptor inhibitor, fulvestrant, markedly dampened formononetin's therapeutic efficacy. qPCR assessments revealed that formononetin effectively curtailed ER-β expression within hyperplastic prostate tissues. Moreover, post-formononetin treatment led to a decline in expression levels of cell cycle-related genes, such as CDK1, cyclin A2, CDK2, and cyclin B1. However, this trend was notably stunted with the introduction of an estrogen receptor inhibitor. In summation, through the combined insights of network pharmacology and animal testing, we ascertained that formononetin mitigated cell cycle progression via the estrogen receptor when addressing prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

Background: Lower urinary tract symptoms commonly occur in the elderly population and seriously constrain the quality of life. Glandular fibrosis is an important pathobiological process in benign prostatic hyperplasia and is also a main inducing factor for benign prostatic hyperplasia-associated lower urinary tract symptoms. Cistanches species is an important herbal medicine resource and is traditionally used in ameliorating renal and prostatic defects. Methods: This study was to investigate the potential protective function of echinacoside (a bioactive compound from Cistanches) against prostatic fibrosis in mice and human benign prostatic hyperplasia epithelial-1 cell models. Results: It was found that echinacoside attenuated testosterone-induced prostatic hyperplasia and collagen deposition in mice, relieved prostate local inflammation and oxidative damage, and ameliorated prostatic epithelial-mesenchymal transition. Additionally, echinacoside inhibited the activation of the MKK6/MK2 signaling pathway both in vivo and in vitro. Conclusion: This study added new evidence for the anti-fibrotic function of echinacoside on the prostate and provided new insights for understanding its possible pharmacological mechanisms. [ABSTRACT FROM AUTHOR]

Background: To assess the value of tripartite magnetic resonance imaging model based on T2-weighted imaging (T2-WI), diffusion-weighted imaging (DWI) as well as dynamic contrast-enhanced imaging (DCE) for the diagnosis of prostatitis, prostatic hyperplasia and prostate cancer. Materials and Methods: A total of 100 patients with prostatic diseases were selected from our hospital from January 2020 to December 2022. All patients underwent T2-WI, DWI and DCE examination. Results: Among the 100 suspected patients, 40 were diagnosed with prostate cancer, 30 were prostatitis, and 30 were prostate hyperplasia. Apparent diffusion coefficient (ADC) value was reduced in prostate cancer patients compared to the prostatic hyperplasia as well as prostatitis groups (P<0.05). No difference was discovered in ADC value between the prostatic prostatic hyperplasia and prostatitis groups (P>0.05). Moreover, the diagnosis efficacy of the tripartite magnetic resonance imaging model was higher compared to those of prostate imaging reporting and data system version 2 (PI-RADS V2). Conclusion: The tripartite magnetic resonance imaging model based on T2-WI, DWI, as well as DCE has high diagnostic accuracy in prostatic diseases, with high sensitivity and low misdiagnosis rate, which might be valuable in clinical application. [ABSTRACT FROM AUTHOR]

Our aim was to investigate which features were associated with clinical successes at short- and mid-terms following prostate artery embolization (PAE) for symptomatic benign prostate hypertrophy (BPH). All adults treated by PAE for BPH at our referral center between January 2017 and March 2021, with pre-treatment MRI, technical success, and follow-up at 3 months and 2 years were included in this single-center retrospective study. Radiologists reviewed the prostatic protrusion index (PPI), adenomatous dominant BPH (adBPH), and Wasserman classification on pre-treatment MRI. Radiomics analysis was achieved on the transitional zone on pre-treatment T2-weighted imaging (WI) and ADC, and comprised reproducibility assessment, unsupervised classifications, and supervised radiomics scores obtained with cross-validated Elasticnet regressions. Eighty-eight patients were included (median age: 65 years), with 81.8% clinical successes at 3 months and 60.2% at 2 years. No feature was associated with success at 3 months, except the radiomics score trained on T2-WI and ADC (AUROC = 0.694). Regarding success at 2 years, no radiomics approaches provided significant performances; however, Wasserman type-1 and change in international prostate symptom score (IPSS) at 3 months ≤ −35% were associated with success in multivariable analysis (OR = 5.82, p = 0.0296, and OR = 9.04, p = 0.0002). Thus, while radiomics provided limited interest, Wasserman classification and early IPSS changes appeared predictive of mid-term outcomes. [ABSTRACT FROM AUTHOR]

Introduction The International Prostate Symptoms Score (IPSS) may be used to measure the severity of lower urinary tract symptoms. To assess baseline patient pain, IPSS uses a seven-point questionnaire with a maximum total possible score of 35. IPSS is also used to monitor a patient's symptom improvement. Materials and Procedures: The current prospective investigation was carried out at our tertiary care hospital's Department of General surgery and department of radiodiagnosis. The research lasted six months, from January to June 2022. At 95% confidence interval and 5% acceptable margin of error, a sample size of 100 was computed. The research included patients with lower urinary tract complaints. Transabdominal ultrasonography was performed on all patients to determine prostate size/volume. The current research divides study participants into three groups based on the severity of their symptoms as determined by the IPSS score. 22% of the patients had mild symptoms, 40% had moderate symptoms, and 28% had severe symptoms. Prolate ellipsoid formula Antero-posterior x Transverse x Cranio-caudal x 0.52 was used to determine prostate volume. 12% of patients had a prostatic volume of 20 cc, 26% had a prostatic volume of 21-30 cc (Grade I), 34% had a prostatic volume of 31-50 cc (Grade II), 21% had a prostatic volume of 51-80 cc (Grade III), and 7% had an 80 cc (Grade IV). Conclusion We concluded from the current research that there was no association between age and international prostate symptom score, nor was there any correlation between prostate volume or prostate enlargement grade and IPSS score. [ABSTRACT FROM AUTHOR]

Background: Primary urothelial carcinoma in the prostate (UCP) is extremely rare and occurs most frequently in the bladder. There are only dozens of primary cases reported in the literature. Here, we describe a rare case of primary UCP and review the literature. Case presentation: A 67-year-old widowed male, was referred to our hospital due to the frequency, and urgency of dysuria. Magnetic resonance imaging (MRI) examination revealed prostate size was about 57 mm x 50 mm x 54 mm, increased prostatic transitional zone, and surrounding of prostatic duct indicate bar isointense T1, short T2, hyperintense DWI, and hyposignal ADC (PI-RADS 3); posterior of peripheral zone indicate patchy isointense T1, short T2, hyperintense DWI, and hyposignal ADC (PI-RADS 5). Subsequently, the patient underwent a transrectal prostate biopsy. Histopathological and immunohistochemical (IHC) assessments showed prostatic high-grade urothelial carcinoma with benign prostatic hyperplasia. Finally, the patient underwent laparoscopic radical prostatectomy. Four months after surgery, CT plain and enhanced scan revealed thickening of the bladder wall. On further workup, cystoscopy revealed lymphoid follicular changes in the cut edge of the radical prostatectomy, and cystoscopic biopsies showed the malignant tumor. Conclusions: Prostatic urothelial carcinoma should always be considered if the patient with severe lower urinary tract symptoms or hematuria, PSA, and digital rectal examination without abnormalities, without a personal history of urothelial cancer, but contrast-enhanced MRI showed the lesion located in the prostate. As of right now, radical surgical resections remain the most effective treatment. The effectiveness of neoadjuvant or adjuvant chemotherapy is still controversial. [ABSTRACT FROM AUTHOR]

Bisphenol AF (BPAF) represents a common environmental estrogenic compound renowned for its capacity to induce endocrine disruptions. Notably, BPAF exhibits an enhanced binding affinity to estrogen receptors, which may have more potent estrogenic activity compared with its precursor bisphenol A (BPA). Notwithstanding, the existing studies on BPAF-induced prostate toxicity remain limited, with related toxicological research residing in the preliminary stage. Our previous studies have confirmed the role of BPAF in the induction of ventral prostatic hyperplasia, but its role in the dorsal lobe is not clear. In this study, BPAF (10, 90 μg/kg) and the inhibitor of nuclear transcription factor-κB (NF-κB), pyrrolidinedithiocarbamate (PDTC, 100 mg/kg), were administered intragastrically in rats for four weeks. Through comprehensive anatomical and pathological observations, as well as the assessment of PCNA over-expression, we asserted that BPAF at lower doses may foster dorsal prostatic hyperplasia in rats. The results of IHC and ELISA indicated that BPAF induced hyperplastic responses in the dorsal lobe of the prostate by interfering with a series of biomarkers in NF-κB signaling pathways, containing NF-κB p65, COX-2, TNF-α, and EGFR. These findings confirm the toxic effect of BPAF on prostate health and emphasize the potential corresponding mechanisms. [ABSTRACT FROM AUTHOR]

Introduction: Urolift is an established intervention for symptoms of bladder outflow obstruction caused by benign prostate enlargement. Reported advantages include its minimally invasive profile, short learning curve and feasibility as a day case procedure. Our aim was to use a national registry as a means to evaluate the nature of complications and device failures that have been documented to occur. Methods: Retrospective review was performed of the US Manufacturer and User Facility Device Experience (MAUDE) database, a prospective register, which contains voluntarily submitted adverse events associated with surgical devices. Information collected include event timing, underlying cause, procedural completion, complications and mortality status. Results: Between 2016 and 2023, 103 device failures, 5 intra-operative complications and 165 post-operative complications (early: 151, late: 14) were registered. The commonest device problem (56%, n = 58) was failure of the implant to deploy with subsequent requirement for complete replacement. There were 50 cases of documented urosepsis. 62 patients with post operative haematuria were registered including 12 that underwent emergency embolisation. Other complications included stroke (n = 5), pulmonary embolism (n = 3) and necrotising fasciitis (n = 1). Twelve ITU admissions were registered. In the reports, 22 cases were filed that recorded a hospital stay of 7 days or more. Eleven deaths were captured in the database over the study period. Conclusion: While urolift is recognised as less invasive intervention compared to alternatives such as transurethral resection of the prostate, serious adverse events have been reported to occur including death. Our findings can provide learning points for surgeons and allow for improved patient counselling and treatment planning accordingly. [ABSTRACT FROM AUTHOR]

Purpose: To identify expert laser settings for BPH treatment and evaluate the application of preventive measures to reduce complications. Methods: A survey was conducted after narrative literature research to identify relevant questions regarding laser use for BPH treatment (59 questions). Experts were asked for laser settings during specific clinical scenarios. Settings were compared for the reported laser types, and common settings and preventive measures were identified. Results: Twenty-two experts completed the survey with a mean filling time of 12.9 min. Ho:YAG, Thulium fiber laser (TFL), continuous wave (cw) Tm:YAG, pulsed Tm:YAG and Greenlight™ lasers are used by 73% (16/22), 50% (11/22), 23% (5/22), 13.6% (3/22) and 9.1% (2/22) of experts, respectively. All experts use anatomical enucleation of the prostate (EEP), preferentially in one- or two-lobe technique. Laser settings differ significantly between laser types, with median laser power for apical/main gland EEP of 75/94 W, 60/60 W, 100/100 W, 100/100 W, and 80/80 W for Ho:YAG, TFL, cwTm:YAG, pulsed Tm:YAG and Greenlight™ lasers, respectively (p = 0.02 and p = 0.005). However, power settings within the same laser source are similar. Pulse shapes for main gland EEP significantly differ between lasers with long and pulse shape modified (e.g., Moses, Virtual Basket) modes preferred for Ho:YAG and short pulse modes for TFL (p = 0.031). Conclusion: Ho:YAG lasers no longer seem to be the mainstay of EEP. TFL lasers are generally used in pulsed mode though clinical applicability for quasi-continuous settings has recently been demonstrated. One and two-lobe techniques are beneficial regarding operative time and are used by most experts. [ABSTRACT FROM AUTHOR]

Background: The pathogenesis of benign prostatic hyperplasia (BPH) has not been fully elucidated. Ras homology family member A (RhoA) plays an important role in regulating cell cytoskeleton, growth and fibrosis. The role of RhoA in BPH remains unclear. Methods: This study aimed to clarify the expression, functional activity and mechanism of RhoA in BPH. Human prostate tissues, human prostate cell lines, BPH rat model were used. Cell models of RhoA knockdown and overexpression were generated. Immunofluorescence staining, quantitative real time PCR (qRT-PCR), Western blotting, cell counting kit-8 (CCK-8), flow cytometry, phalloidine staining, organ bath study, gel contraction assay, protein stability analysis, isolation and extraction of nuclear protein and cytoplasmic protein were performed. Results: In this study we found that RhoA was localized in prostate stroma and epithelial compartments and was up-regulated in both BPH patients and BPH rats. Functionally, RhoA knockdown induced cell apoptosis and inhibited cell proliferation, fibrosis, epithelial-mesenchymal transformation (EMT) and contraction. Consistently, overexpression of RhoA reversed all aforementioned processes. More importantly, we found that β-catenin and the downstream of Wnt/β-catenin signaling, including C-MYC, Survivin and Snail were up-regulated in BPH rats. Downregulation of RhoA significantly reduced the expression of these proteins. Rho kinase inhibitor Y-27632 also down-regulated β-catenin protein in a concentration-dependent manner. However, overexpression of β-catenin did not affect RhoA-ROCK levels, suggesting that β-catenin was the downstream of RhoA-ROCK regulation. Further data suggested that RhoA increased nuclear translocation of β-catenin and up-regulated β-catenin expression by inhibiting its proteasomal degradation, thereby activating Wnt/β-catenin signaling. Overexpression of β-catenin partially reversed the changes in cell growth, fibrosis and EMT except cell contraction caused by RhoA downregulation. Finally, Y-27632 partially reversed prostatic hyperplasia in vivo, further suggesting the potential of RhoA-ROCK signaling in BPH treatment. Conclusion: Our novel data demonstrated that RhoA regulated both static and dynamic factors of BPH, RhoA-ROCK-β-catenin signaling axis played an important role in the development of BPH and might provide more possibilities for the formulation of subsequent clinical treatment strategies. [ABSTRACT FROM AUTHOR]

Objectives: To find out the frequency of Electrolytes derangement (increase or decrease in serum sodium, potassium and chloride level) in patients who underwent TURP for enlarged prostate. Materials and Methods: This was a cross sectional descriptive study from 11-02-2020 to 11-08-2020 on 142 patients. After taking approval from ethical committee of the hospital. Informed consent was taken from the patients by explaining the patients. Detail physical examinations were performed and all necessary investigation was done. Preoperatively serum electrolyte levels were noted. Results: In this study, 142 patients with patient's benign prostate enlargement undergoing TURP had observed, in which 83(58.5%) patients have prostate volume have less than or equal to 15gm and 59(41.5%) patients have more than 15gm. Electrolyte derangement among patients presenting with benign prostatic enlargement after TURP was 69(48.59%). Conclusion: Electrolyte serum levels were decreased after TURP procedure. Pre and post-surgery electrolyte should be fully monitored to prevent TURP complications. [ABSTRACT FROM AUTHOR]

Background: Male breast cancer (MBC) is one of the rare malignancies that account for less than 1% of all malignancies in males. However, the clinicopathological characteristics of MBC are not entirely similar to female breast cancer; but still, it is treated in line with the female breast cancer protocols. Aims: To retrospectively analyse trends in MBC as to its distribution, presentation, treatment, and outcome. Material and method: A total of 106 patients with MBC from 1991 to 2020 were analysed retrospectively. Frequency distribution analysis of the demographic and clinicopathological data and treatment variables was done. Results: Median age of presentation was 57 years; ranging from 30 to 86 years. Either of the sides was almost equally affected with an R: L ratio of 1.2:1. The average duration of complaint was 26.2 months (range 1-240 months). History of gynaecomastia was noted in 18 patients, significant benign prostate hypertrophy in 13, and hypertension needing medical treatment in 14 patients. The majority of the patients were smokers (72/106) and alcoholics (43/106). Five patients reported positive family history. 21 patients had metastatic disease at presentation and received palliative treatment. Stage II was seen in 36.8%, stage III in 43.4%, and stage IV in 19.8% of patients. Node positives were 63.2%. Pathology was invariably (90.5%) infiltrative ductal carcinoma. Radiation was administered in 85.8% of the patients, chemotherapy in 72.6% of patients, and hormonal treatment was given in 47.2% of patients. The median overall survival (OS) was 78 months. OS at 5 and 10 years was 78% and 58% respectively. Conclusion: Despite the possibility of MBC being apparent at an early stage, patients present with locally advanced disease. Radical surgery with adjuvant/neoadjuvant chemotherapy and adjuvant radiotherapy remains the gold standard. Cancer education campaigns must be run to catch the early disease and to radically treat the disease. [ABSTRACT FROM AUTHOR]

Introduction: Transurethral resection of the prostate (TURP) is the gold-standard for the treatment of benign prostate enlargement (BPE) associated with lower urinary tract symptoms (LUTS), after failure of conservative therapy. At present, only resection-rate (grams of prostate resected over time) is regarded as an efficiency parameter to evaluate the skill of the operator and to assess the outcome of the procedure. Materials and methods: Five surgeons performed TURP using a Gyrus-type bipolar system in 123 patients with BPE/LUTS who came to our observation from June 2016 to December 2019. The amount of irrigation fluid used during the procedure was registered and correlated to the operating time, resection-rate, prostate adenoma weight, post-operative bladder irrigation time, intraoperative bleeding and days of catheterization. Results: We found an inverse correlation between the amount of irrigation fluid used during TURP and the resection-rate recorded for all operators, according to Spearman's Correlation (r = -0.78, p = 0.002); a direct correlation was also found between the amount of irrigation fluid and the adenoma weight. Finally, we also found a direct correlation with intraoperative bleeding and the duration and amount of bladder irrigation during and after TURP. Conclusions: The amount of irrigation fluid used is proposed as a reliable parameter to estimate the efficiency of the endoscopic procedure as well to assess the skill of the operator and shortterm results. The observed data encourage the possibility of applying this new efficiency indicator to all endoscopic maneuvers. [ABSTRACT FROM AUTHOR]

Background:Prostatic lesions account for the major afflictions in the geriatric population worldwide. Prostate specific antigen can be used for screening but histopathology remains the gold standard for differentiating benign and malignant prostatic enlargements and definite diagnosis. Furthermore, a precise pathologic evaluation of the prostatectomy specimen can provide additional prognostic factors including pathological stages and surgical margin status. Methods: A systematic search identified 306 prostatic specimens submitted in the department over a time period of three years (January 2019-December 2021). Relevant clinical data, PSA level and H&E stained sections were examined for microscopic details and diagnosis. Results: Benign Prostate Hypertrophy (BHP) was the most common prostatic lesion and accounted for 83% of all cases. The age range was 49 to 90 years with a peak age group between 6th-7th decade. BPH associated with prostatitis and basal cell hyperplasia was seen in 57.8% and 3.3% cases respectively. A single case of non-specific granulomatous prostatitis was seen. Malignant tumours constituted 15.7% of all prostatic specimen. Adenocarcinoma was the histopathological subtype in all primary tumours. A single case of metastatic deposits from bladder tumour was recorded. Gleason score 7 was the most frequent (38.2.8%) in occurrence. Most adenocarcinomas were moderately differentiated (55.3%). Prostate Intraepithelial neoplasia (pre malignant lesion) was seen in 1.3 % of cases. Conclusion: Benign Prostate lesions occur more frequently when compared to malignant ones. Major proportion of benign lesions was contributed by Benign prostate hypertrophy. A pathologist's awareness of the benign mimics is important for the diagnosis of Prostate carcinoma. [ABSTRACT FROM AUTHOR]

Purpose: Evaluate the therapeutic effect of a tomato lipidic extract (STE) in combination with selenium (Se) on rats with prostatic hyperplasia (PH) and to observe its possible mechanisms of action and synergism versus finasteride. Materials and methods: 54 male Wistar rats of nine weeks old were divided in Control (C), PH, Finasteride (F), STE, Se, F + STE, F + Se, STE + Se and F + STE + Se with testosterone enanthate (except C). After 4 weeks of treatment administration, prostate weight, bladder weight, diuresis, prooxidant and antioxidant activity, dihydrotestosterone (DHT), androgen receptor (AR) expression and anatomopathological analysis were determined. Results: STE + Se decreased prostate weight 53.8% versus 28% in F group, also STE + Se decreased significatively glandular hyperplasia, prooxidant activity, DHT and AR expression and increased diuresis and antioxidant activity versus finasteride which increased MDA in prostate. Conclusions: These results demonstrate a greater therapeutic and beneficial effect of tomato lipidic extract in combination with Se in young rats with PH with respect to finasteride without increase prooxidant activity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Superior mesenteric artery (SMA) syndrome, a rare condition in which the SMA and aorta occlude the third duodenal portion, can cause serious complications. We present the case of an 83-year-old Japanese man who presented with shock because of massive gastric dilatation due to SMA syndrome and developed multi-organ ischemia. CASE REPORT: The day before admission, the patient had visited the emergency department with abdominal pain and was sent home following spontaneous symptom resolution, but experienced abdominal pain flare-up. His history included diabetes mellitus, hypertension, gastric ulcer, prostatic hypertrophy, esophageal hiatal hernia, and esophageal cancer. Plain computed tomography showed gastric dilatation and obstruction of the duodenal third portion by the SMA, leading to SMA syndrome diagnosis. Since a nasogastric tube could not be manually inserted into the stomach and the gastric dilatation could not be decompressed, the tube was inserted endoscopically. Endoscopy revealed mechanical obstruction of the gastric cardia and gastric mucosal ischemia. He was admitted to intensive care, and blood pressure was maintained with vasopressors and blood transfusion. The next day, contrast-enhanced computed tomography performed for persistently elevated lactate levels revealed extensive ischemia affecting multiple gastrointestinal organs. Surgery and other treatments were considered too risky due to the patient’s advanced age and condition. Best supportive care was administered after discussion with the family, and he died on the second day of hospitalization. CONCLUSIONS: SMA syndrome with extensive ischemia and infarction is rare. Given this, clinicians should remain vigilant for its potential complications. [ABSTRACT FROM AUTHOR]

In alternative medicine, Saw palmetto is used in the treatment of many diseases, as it is effective in treating urinary system diseases through anti-androgen effects and effects on involuntary receptors in the lower urinary tract, in addition to being used in the treatment of patients with benign prostatic hyperplasia and cancer Prostatitis, chronic prostatitis (CP) and erectile dysfunction (ED). Scientific research has proven that Saw palmetto is considered a herbal remedy because it contains 3 phytosterols, 14 fatty acids, and SRM3251 contains 3 phytosterols, 17 fatty acids, β-carotene, and γ-tocopherol. It also played an important role as an anti-androgen as 5a-dihydrotestosterone (DHT) is converted from testosterone by the action of 5a-reductase, and this helps in the development of male sexual characteristics, transcription of androgen-regulating genes, prostate enlargement. Also, it affects on enzymes and chemokines that effect on the inflammatory process. Saw palmetto is used in the treatment of Chronic Prostatitis (CP) and Chronic Pelvic Pain Syndrome (CPPS). In this review, the phytochemical content of Saw palmetto will be highlighted and the pharmacological effect on male hormones, urinary system diseases and infections will be studied. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia. Material and methods: Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination. Results: A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively. Conclusions: The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development. [ABSTRACT FROM AUTHOR]

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by pain and stiffness around the shoulders and hip girdles, an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) and a dramatic response to corticosteroids. It is usually seen in adults aged over 50 years; about 30% also have giant cell arteritis. Its etiology is unknown. A 72-year-old male received water vapor therapy, a novel, minimally invasive therapy for benign prostate hypertrophy (BPH). On postoperative day 1, he developed severe shoulder pain and weakness, with difficulty with lifting his arms above his head, and hip pain and weakness, with difficulty getting out of a bed or chair. Laboratory results showed elevated ESR and CRP, but a normal creatine kinase level. The patient received low-dose prednisone and had prompt symptom relief. This case illustrates that a diagnosis of PMR after water vapor therapy can be easily overlooked. [ABSTRACT FROM AUTHOR]

Virtual Touch Tissue Quantification (VTTQ) is a promising new implementation of the acoustic radiation force pulsed ultrasound technique that has gained popularity in recent years. The present study compares the performance of the VTTQ technique in distinguishing between prostate cancer (PCa) and benign prostatic hyperplasia (BPH). VTTQ was performed on 91 prostate nodular lesions in 72 patients with BPH and suspected PCa prior to a prostate histopathologic examination, while 35 healthy volunteers were included in the study as controls. The mean shear wave velocity (SWV) values of the central and peripheral prostate zone were measured in the healthy volunteers, with the SWV at each nodular lesion quantified through the implementation of an acoustic radiation force impulse (ARFI). The performance of VTTQ in discriminating between PCa and BPH was compared, and the diagnostic value of VTTQ for PCa was evaluated in terms of sensitivity, specificity and cut-off value. Histopathological examinations detected PCa in 21 of the 91 nodular lesions and BPH in 70. The SWV values (m/s) were significantly higher in prostate cancer than in the BPH and central-peripheral prostate zones (3.85±0.78, 2.29±1.03, 1.65 ±0.95, 1.14±0.56). The mean SWV values of the central-peripheral prostate zones were found to be significantly different from each other. We determined an SWV cut-off value of 3.09 m/s for differentiating between benign and malignant nodules, with a sensitivity and specificity of 90.5% and 80%, respectively. VTTQ can effectively determine the stiffness of prostate nodular lesions, with significantly higher performance discrimination between PCa and BPH. [ABSTRACT FROM AUTHOR]

Benign prostatic hypertrophy (BPH) is a noncancerous enlargement of the prostate gland that develops from hyper-proliferation of the stromal and epithelium region. Activation of pathways involving inflammation and oxidative stress can contribute to cell proliferation in BPH and tumorigenesis. Agricultural-waste-derived extracts have drawn the attention of researchers as they represent a valid and sustainable way to exploit waste production. Indeed, such extracts are rich in bioactive compounds and can provide health-promoting effects. In particular, extracts obtained from pomegranate wastes and by-products have been shown to exert antioxidant and anti-inflammatory effects. This study focused on the evaluation of the anti-angiogenic effects and chemopreventive action of a pomegranate extract (PWE) in cellular models of BPH. In our experimental conditions, we observed that PWE was able to significantly (p < 0.001) reduce the proliferation and migration rates (up to 60%), together with the clonogenic capacity of BPH-1 cells concomitantly with the reduction in inflammatory cytokines (e.g., IL-6, PGE2) and pro-angiogenic factor (VEGF-ADMA) release. Additionally, we demonstrated the ability of PWE in reducing angiogenesis in an in vitro model of BPH consisting in transferring BPH-1-cell-conditioned media to human endothelial H5V cells. Indeed, PWE was able to reduce tube formation in H5V cells through VEGF level reduction even at low concentrations. Overall, we confirmed that inhibition of angiogenesis may be an alternative therapeutic option to prevent neovascularization in prostate tissue with BPH and its transformation into malignant prostate cancer. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of transurethral plasma prostate enucleation (TUKEP; Transurethral plasma enucleation of the prostate) on IPSS, QoL score, and in patients with prostatic hyperplasia. Methods 100 patients with Phyperplasia admitted to our hospital from January 1,2017 to September 1,2021 were selected as the subjects of this study・ According to the different treatment methods adopted by patients, 50 cases of observation group and control group, the control group underwent transurethral electric resection of the prostate (TURP; Transurethral electrical resection of the prostate), the observation group underwent transurethrfd plasma enucleation of the prostate, observe and compare the surgical conditions of the two groups (intraoperative blood loss, operation time, quality of prostate resection, bladder washing time, indwlling catheter time, etc.), residual urine volume before and after treatment (PVR; postvoid residual), international prostate symptom score (IPSS), patient quality of life (QoL; quality of life) score, maximum urinary flow rate (Q彌;Maximum urinary flow rate), postoperative complications. Results Hie operation time, bladder irrigation time, indwelling catheter time, and intraoperative blood loss of the observation group were (106・ 45 ± 18・ 29) min, (58・ 24 ± 17・ 23) mL, (3・ 53 ±0・ 92) d, and (19・ 45 ± 1.62) h respectively, and significantly shorter than the control group (132.76 ±32.11) min, (120,05 ±26.79) mL, (5.73 ±1.13) d, (27-74 ±4.12) h. Tlie excised tissue weight (55.76 ±16.43) g was higher than that of the control group (48・27 ±24・ 89) g, the difference was statistically significant (P <0・ 05); 3 months after the operation, the two groups of patients were improved to a certain extent, and the IPSS score, RUV value of the observation group were (5.95±l・08), (21.38 土2.12) mL was significantly lower than the control group (7・ 10 ± 0.94), (24.01 ± 2.31) mL, Q却 value (20・ 57 土 0・ 97) mL/s. It was significantly higher than the control group (17・ 88 ± 1.16) mL/s, and the difference was statistically significant (P <0.05). There was no significant difiference in the QoL score between the two groups after operation (P >0・ 05). Hie incidence of complications in the observation group was 5. 00% (3/50) was significandy lower than 16.00% (8/50) of the control group, and the difiference was statistically significant (P <0,05)・ Condusion Transurethral plasma enucleation of the prostate has a significant therapeutic effect on patients with benign prostatic hyperplasia. It can effectively improve IPSS, QoL scores and, with fewer postoperative complications and higher safety. [ABSTRACT FROM AUTHOR]

Background: Most occurrences of prostatic disease are caused by benign prostatic hyperplasia (BPH), then prostatic cancer. An adult male with prostatic hyperplasia requires a thorough study because prostate cancer is the second most frequently diagnosed malignancy in males. Different prostatic lesions have the same clinical characteristics; however, identification is crucial because treatment and prognosis vary greatly. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Pathology, Government Medical College, Kadapa, Andhra Pradesh. Study Period: 1 year. Study population: This prospective study includes TURP specimens that were collected during the study period. Sample size: The study consisted of 100 cases. Sampling method: Simple random technique. Results: Foci of Prostatic Intra-Epithelial Neoplasia (PIN) were identified in 10% of all cases that were studied. 40% of the HG PIN lesions were identified in association with adenocarcinoma of prostate and the rest (60%) were found along with BPH. Highest incidence of PIN was noted in 7th decade followed by 6th decade. Atypical adenomatous hyperplasia was found in 4 (4%) of all cases. Conclusion: Malignant lesions are less frequent than benign ones. BPH is the most common type of prostatic lesion among the histopathological patterns. In order to recognise premalignant lesions, proliferative activity, and degree of inflammation, it is required to examine all prostate biopsies (TURP and needle core). [ABSTRACT FROM AUTHOR]

To perform a systematic review of the literature on plant-based and plant-forward diets and the prevention/treatment of the following common men's health conditions: prostate cancer (PCa), erectile dysfunction (ED), and benign prostatic hyperplasia (BPH). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system criteria were utilized to search PubMed and Medline databases for the following search terms: "Diet (Mesh)" OR "Diet Therapy (Mesh)" AND "Prostatic Hyperplasia (Mesh)" OR "Prostatic Neoplasm (Mesh)" OR "Erectile Dysfunction (Mesh)." Articles in English published from 1989 to 2022 using human participants were analyzed, data summarized, and assessed for bias. Studies reporting on plant-based or vegetable-forward diets (Mediterranean) as an intervention were included. Cohort and cross-sectional studies using food frequency questionnaires or diet classification indices to quantify plant-based food intake patterns were included in the study. Ultimately, 12 PCa articles, 4 BPH articles, 6 ED articles, and 2 articles related to both BPH and ED were reviewed. Overall, the literature suggests plant-forward diets confer a protective effect on the men's health conditions reviewed. Evaluation of the literature on the impact of plant-forward diets on urologic conditions includes a heterogenous range of dietary patterns and study designs. The greatest amount of research has evaluated the application of plant-forward diets for PCa. While there is currently a lack of high-quality evidence for the use of plant-forward diets as prevention and/or treatment for PCa, ED, or BPH, reported outcomes suggest a consistent small beneficial impact alongside well-established benefits for common chronic conditions. [ABSTRACT FROM AUTHOR]

Tissue changes and the enlargement of the prostate, whether benign or malignant, are among the most common groups of diseases that affect men and can have significant impacts on length and quality of life. The prevalence of benign prostatic hyperplasia (BPH) increases significantly with age and affects nearly all men as they grow older. Other than skin cancers, prostate cancer is the most common cancer among men in the United States. Imaging is an essential component in the diagnosis and management of these conditions. Multiple modalities are available for prostate imaging, including several novel imaging modalities that have changed the landscape of prostate imaging in recent years. This review will cover the data relating to commonly used standard-of-care prostate imaging modalities, advances in newer technologies, and newer standards that impact prostate gland imaging. [ABSTRACT FROM AUTHOR]

Background: There are many ways to treat prostatic hyperplasia; these are currently more inclined to minimally invasive treatment. We mainly compared the differences between two treatment methods， ultrasound-guided transperineal laser ablation (US-TPLA) and prostatic artery embolization (PAE). Purpose: To evaluate the efficacy and safety of US-TPLA and PAE in the treatment of benign prostatic hyperplasia (BPH). Material and Methods: The clinical information for 40 patients with BPH admitted to our hospital between June 2018 and January 2021 were retrospectively analyzed. The changes in International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate volume (PV), and the incidence of complications were compared between groups. Results: The IPSS (P < 0.001; P < 0.001), QoL (P < 0.001; P < 0.001), Qmax (P < 0.001; P < 0.001), PVR (P < 0.001; P < 0.001), and PV (P < 0.001; P < 0.001) at three and six months after US-TPLA and PAE improved with respect to those before surgery. There was no significant difference in IPSS (P = 0.235; P = 0.151), QoL (P = 0.527; P = 0.294), Qmax (P = 0.776; P = 0.420), PVR (P = 0.745; P = 0.607), and PV (P = 0.527; P = 0.573) between the groups at three and six months after surgery. No serious complications occurred in either group. Conclusion: US-TPLA and PAE seem to have a similar short-term efficacy. The efficacy of the two procedures is comparable, and neither is associated with serious complications. US-TPLA and PAE are both effective complementary measures for the treatment of BPH. [ABSTRACT FROM AUTHOR]

Introduction: The Butterfly Prostatic Retraction device is a novel transurethral implant designed to dilate the prostatic urethra and treat lower urinary tract symptoms. We assessed its safety, efficacy and impact on urinary flow, ejaculation, and quality of life. Materials and Methods: We included 64 men, treated for benign prostate hyperplasia for at least 1 year. All patients had Qmax≤ 13 mL/s and IPSS >12. Insertion of the device was performed via cystoscopy. Follow-up visits were performed at 2 weeks, 1, 3, 6, and 12 months and included uroflowmetry, IPSS, QoL, and sexual function questionnaires. Cystoscopy was performed on 3 and 12 months. Results: Patients age was 50–83 years. 28 patients completed a 1-year follow-up with an intact device. Mean Qmax improved by 2 mL/s (25%), IPSS median drop was 10 points (40%), and QoL score was 1.5 points (38%). Sexually active patients reported antegrade ejaculation. On cystoscopy, gradual coverage of the devices with urethral mucosa was observed. In 1 patient, the device was repositioned. In 19 patients, the device was removed. 12 patients returned to alpha-blocker therapy and 7 patients underwent TURP. One patient developed a bulbar urethral stricture. Conclusions: We demonstrated feasibility and good tolerability of the Butterfly device. [ABSTRACT FROM AUTHOR]

Several pollutants can alter neonatal prostatic development predisposing this gland to diseases. The toxicity and endocrine disrupting potential of aluminum has been reported in many organs, but little is known about its effects on the prostate. This study aimed to evaluate the effects that aluminum neonatal exposure can cause in the male ventral prostate and in the female prostate of adult and senile gerbils. Male and female pups were treated orally with aluminum chloride (10 mg/kg) from the 1st to the 14th day life. After treatment, the animals were aged until they reached 90 days or 1 year of life. The prostate glands were dissected out and submitted to morphological, immunohistochemical and ultrastructural analyses. Ventral prostates of adult males showed moderate hyperplasia and increased epithelial proliferation not associated with androgen receptor (AR) deregulation. On the other hand, senile males showed intense prostatic hyperplasia, and increased cell proliferation and epithelial AR regulation. Additionally, at both ages, there was a reduction in the prostate secretory function. The morphological changes observed in the female prostate were like those found in males. However, in adult females, prostatic hyperplasia was accompanied by a lower regulation of AR and estrogen receptor alpha, while in senile females, intense hyperplastic growth was associated with an increase in estrogen receptor alpha and a reduction in stromal AR. These results demonstrate that aluminum chloride neonatal exposure alters the hormonal regulation of the male and female prostate, inducing tissue damage that occurs in adulthood and intensifies during aging. [ABSTRACT FROM AUTHOR]

This article discusses the use of lasers in endourology, specifically for treating urinary tract conditions. The holmium: yttrium–aluminium-garnet (Ho:YAG) laser has been the main tool for these procedures, but new high-power Ho:YAG machines and Thulium lasers have entered the market. The Moses™ technology improves laser fragmentation, while the Thulium: yttrium–aluminum-garnet (Tm:YAG) laser offers better cutting and specimen quality. The Thulium fibre laser (TFL) provides increased cutting efficiency and reduced carbonization. However, there is no consensus on preferred laser settings, and the choice depends on various factors. The article aims to provide insights into proper laser use and the latest advances in laser endoscopic urological procedures. [Extracted from the article]

Background: Patients with prostate enlargement have an increased risk of recurrent urinary tract infections. This study determined the resistance profile of bacteria causing urinary tract infection (UTI) and the magnitude of multidrug-resistant (MDR) bacteria among patients with symptomatic prostate enlargement in a tertiary hospital in Dar es Salaam. Methods: This cross-sectional study was conducted at Muhimbili National Hospital between August 2021 and January 2022. Male patients aged 40–90 years with symptomatic enlarged prostate, confirmed by digital rectal examination, were enrolled consecutively. We used conventional biochemical methods and analytical profile index (API) 20-E & API 20-NE to identify the uropathogens. In addition, antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method. Results: A total of 422 participants were enrolled, of whom 196 (46.4%) had laboratory-confirmed UTI. In total, 203 bacterial pathogens were isolated. Gram-negative bacteria (GNB) were the predominant uropathogens accounting to 165/203 (81.3%). The prevalent isolates were E. coli 49 (24.1%), followed by K. pneumoniae 40 (19.7%). Most, 157 (77.3%) pathogens were MDR, of which 33 (21.0%) were resistant to all tested antibiotic classes. The proportion of methicillin-resistant Staphylococcus aureus was 75.8%, while 45.5% of S. aureus were inducible clindamycin resistant. Among Enterobacterales, 98 (70.5%) were Extended-spectrum beta-lactamases (ESBL) producers, and 33 (20.0%) were carbapenem resistant. Four of forty-one (9.6%) non-ESBL producers were class C β-lactamase producers. Conclusions: There is a relatively high proportion of MDR strains of uropathogens, which limits treatment options for UTI among men with prostate enlargement. These findings call for the revision of the current UTI treatment guidelines and continuous antimicrobial resistance surveillance to monitor antibiotic resistance and guide treatment options within the hospital. [ABSTRACT FROM AUTHOR]

Background: Ablative surgery has been the go-to method for treating benign prostatic hyperplasia (BPH), for the better part of the past 60 years. Recent discoveries in incidence and pathogenesis as well as physiology of prostatic hyperplasia, while conventional management guidelines are put to reconsider by urologists due to recent endocrine and urology studies, which have served as the foundation for diagnosis and therapy in the past. Objective: Review literature about management options of benign prostatic hyperplasia. Methods: We scoured scholarly papers and databases including PubMed, Google Scholar, and Science Direct for information on benign prostatic hyperplasia and management between December 1999 and July 2022. However, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references taken from similar books. Documents written in languages other than English have been overlooked because of lack of funding to translate them. Unpublished articles, oral talks, conference abstracts, and dissertations were all generally agreed upon to not constitute valid scientific investigation. Conclusion: Over the course of the past ten years, a number of innovative approaches to the treatment of symptomatic BPH have come into existence. The number of possible treatments has increased, the spectrum of therapeutic choices, from careful waiting to open surgery, has broadened thanks to minimally invasive surgical techniques (MIST), novel drugs, and novel combinations of medical treatments. The range of possible symptoms is matched by the breadth of available therapies. Since deaths from BPH are uncommon, treatment typically centres on maintaining or enhancing quality of life. [ABSTRACT FROM AUTHOR]

It is well-established that the beneficial properties of single phytonutrients can be better attained when they are taken with the complex of the molecules present in their natural milieu. Tomato, the fruit providing the most comprehensive complex of prostate-health-preserving micronutrients, has been shown to be superior to its single-nutrient counterparts in decreasing the incidence of age-related prostate diseases. Herein, we describe a novel tomato food supplement enriched with olive polyphenols, containing cis-lycopene concentrations far exceeding those present in industry-produced tomato commodities. The supplement, endowed with antioxidant activity comparable to that of N-acetylcysteine, significantly reduced, in experimental animals, the blood levels of prostate-cancer-promoting cytokines. In prospective, randomized, double-blinded, placebo-controlled studies performed on patients affected by benign prostatic hyperplasia, its uptake significantly improved urinary symptoms and quality of life. Therefore, this supplement can complement and, in some cases, be an alternative to current benign prostatic hyperplasia management. Furthermore, the product suppressed carcinogenesis in the TRAMP mouse model of human prostate cancer and interfered with prostate cancer molecular signaling. Thus, it may offer a step forward in exploring the potential of tomato consumption to delay or prevent the onset of age-related prostate diseases in high-risk individuals. [ABSTRACT FROM AUTHOR]

Objective: Unusual or unexpected effect of treatment Background: The removal of concurrent ureteral and renal stones within a single procedure has always been a challenge for urological surgeons. The incorporation of single-use digital flexible ureteroscopes into laparoscopic ureterolithotomy procedures has demonstrated effective removal of concurrent stones with a good clearance rate and decreased risk of bleeding and trauma. We report the successful removal of a unilateral upper ureteral stone and a smaller renal stone with this procedure. Case Report: A 60-year-old man visited the outpatient clinic with an ultrasonography report that revealed a large proximal ureteral stone with moderate hydronephrosis, accompanied by bilateral renal stones and prostatic hyperplasia. He had been experiencing urinary urgency for a year and was determined to undergo lithotomy. Due to his longstanding history of coronary artery disease and myocardial ischemia, the urologists decided that concurrent stone removal within an operation would be the best treatment. A preoperative computed tomography urogram measured the left ureteral and renal stones to be 2.0×0.8 cm and 0.6 cm, respectively. Both stones were successfully removed by laparoscopic ureterolithotomy using a single-use digital flexible ureteroscope. The patient had an uneventful recovery and remained well 1 month post-operation. Conclusions: The application of single-use digital flexible ureteroscopes for laparoscopic ureterolithotomy has demonstrated safety, efficiency, and cost-effectiveness. The authors believe that it is a safe alternative for the removal of concurrent ureteral and renal stones, especially in patients with multiple comorbidities. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) describes the non-malignant enlargement of the prostate. It is both common and growing in incidence. Treatment is multimodal, involving conservative, medical, and surgical interventions. This review aims to examine the evidence base for phytotherapies, specifically analyzing their role in treating lower urinary tract symptoms (LUTS) attributable to BPH. A literature search was completed, specifically looking for randomized control trials (RCTs) and systematic reviews involving phytotherapy treating BPH. Specific emphasis was placed on exploring substance origin, the proposed mechanism of action, evidence of efficacy, and the side-effect profile. Several phytotherapeutic agents were evaluated. These included serenoa repens, cucurbita pepo, and pygeum Africanum, among others. For most of the reviewed substances, only modest effectiveness was reported. Generally, though, all treatments were tolerated well with minimal side effects. None of the treatments discussed in this paper form part of the recommended treatment algorithm in either European or American guidelines. We, therefore, conclude that phytotherapies, in the treatment of LUTS attributable to BPH, do provide a convenient option for patients, with minimal side effects. At present, however, the evidence for the usage of phytotherapy in BPH is inconclusive, with some agents having more backing than others. This remains an expansive field of urology whereby there is still more research to be done. [ABSTRACT FROM AUTHOR]

Prostatic hyperplasia (PH) is an androgen-dependent condition associated with increased prostatic size that is common in intact dogs, and similar to the condition in men. In dogs, the increase in prostatic size is most prominent the first years, and after approximately four years (in beagles), a plateau is reached, and further growth is slower. Why the prostate continues to grow more in some individuals is not clear. Most testosterone in the circulation is bound to albumin or sex hormone binding globulin (SHBG) and only a minor part is unbound and biologically active. The binding to SHBG has higher affinity than that to albumin. In addition, SHBG has own biological functions, modifying testosterone action. The aim of the present study was to investigate if there is an association between relative prostatic size and the variables total testosterone concentration, SHBG concentration, an estimation of bioavailable testosterone: the ratio between testosterone and SHBG (free androgen index, FAI), estradiol concentration, the estradiol/testosterone ratio, dog age and dog weight. Hormone concentrations were measured in serum from 79 intact male dogs aged ≥ four years, weighing ≥ five kg. The size of the prostate was estimated using ultrasonography, and relative prostate size, S rel , was calculated as the estimated size related to the normal size for a 4-year-old dog of the same weight. There as a negative correlation between testosterone concentration and age (ρ = −0.27, P = 0.018) and a positive correlation between age and S rel (ρ = 0.27, P = 0.016) and between SHBG and weight (ρ = 0.38, P = 0.001). The FAI was negatively correlated with dog weight (ρ = −0.32, P = 0.004). There were no significant correlations between S rel and SHBG or FAI or between estradiol or estradiol/testosterone and S rel , age or weight. A multiple regression analysis showed significant associations between log S rel and log testosterone concentration, log age and log weight of the dog, with an adjusted R2 of 9.5%. Although the variables total testosterone concentration, age and weight of the dog were all significantly associated with S rel , the coefficient of determination was low, indicating that they only explained a minor part of the prostatic size. The results support the analysis of total testosterone in studies of prostatic growth in the dog. • Large dogs have relatively larger prostates - relative size increases with weight. • The prostatic size is positively associated with testosterone concentrations. • Factors other than age, weight and testosterone are important for prostatic size. • Analysis of total testosterone gives useful information. [ABSTRACT FROM AUTHOR]

Enlarged prostate, either in benign prostatic hyperplasia or prostate cancer is the predominant urological disease affecting older men. Metabolic syndrome including high blood glucose was considered to take part in the development of prostate enlargement, although their association is still unclear. This study aims to investigate the correlation between blood glucose with prostatic-related parameters. A cross-sectional study was conducted involving 91 men with prostate enlargement from Urology Polyclinic, Tabanan Hospital, Bali Province, Indonesia. Prostatic-related parameters collected include patient’s international prostate symptoms score using the questionnaire, prostate-specific antigen and random blood glucose analysis from serum blood sample, and prostate volume determined with transabdominal ultrasonography. Patient’s mean age was 65.4 ± 10 years, mean prostate volume 52.7 ± 26 ml, mean prostate-specific antigen (PSA) 9.2 ± 17 ng/ml, mean international prostatic symptoms score (IPSS) 14.31 ± 7.1, mean random blood glucose 121.1 ± 40.5 mg/dl. This study found weak positive correlation between random blood glucose and prostate volume (r=0.269; p=0.01). PSA and prostate volume showed moderate positive correlation (r=0.365; p<0.001). No correlation between random blood glucose with PSA or IPSS was found in this study. This study found random blood glucose has positive correlation with prostate volume. We recommend enhancing blood glucose control to prevent the progress of prostate enlargement. [ABSTRACT FROM AUTHOR]

Background: Transurethral resection of the prostate (TURP) is one of the best available treatments for benign hypertrophy of the prostate. Many of the complications in TURP are associated with the absorption of irrigation fluid. In BIPOLAR TURP, normal saline is used as an irrigant which is more physiological. Aims and Objectives: Our aim of the study is to evaluate the correlation between post-operative electrolyte changes to perioperative factors in bipolar TURP. Materials and Methods: One hundred and ten patients enrolled in this study who were admitted to Meenakshi Mission Hospital, Madurai, Tamil Nadu, India. Results: Mean age of the participants was 65.68 (±8.50) years with a median of 66 years. mean hemoglobin drop was 1.21 (±1.36) g/dl. The mean serum sodium drop was 1.55 (±3.01) mEq/L. The mean serum potassium change was 0.06 (±0.74) mEq/L. There was a significant positive association between operative time and serum sodium drop (P<0.001). There was no significant correlation between any of the other parameters prostate size, resection time, resected volume were noted, and post-operative electrolyte April 2019-March 2021. Patient pre-operative changes and hemoglobin drop is observed. Correlation is assessed with Spearman Rho. Conclusion: Our study concluded that as operative time increases sodium drop and hemoglobin drop significantly increases. Resected and preoperative prostatic volumes do not affect electrolyte and hemoglobin levels. [ABSTRACT FROM AUTHOR]

Objective and design: Prostatic inflammation is the driving force in benign prostatic hyperplasia (BPH). This work investigated the potential modulatory effect of COX-2 inhibition on ADAM-17/EGFR/ERK1/2 axis. Materials or subjects: Adult male Wistar rats were used. Treatment: Celecoxib (10 and 20 mg/kg; i.p.) was injected i.p. daily for three weeks. Testosterone (TST) (3 mg/kg; s.c.) was used to induce BPH. Methods: Prostatic inflammation and hyperplasia were assessed by organ weight and histopathology. Inflammatory mediators were measured using ELISA technique. Protein analysis was performed using western blotting and immunohistochemistry. Gene expression analysis was performed using qRT-PCR. Statistical analyses included one-way ANOVA and Tukey's multiple comparison test. Results: Testosterone-treated rats had a marked increase in COX-2, prostate weight, and index. Moreover, TST-induced COX-2 was inferred from cytoskeletal changes and was attributable to the overexpression of PGE2, NF-κB (p65), and IL-6. COX-2-derived PGE2 increased the activity of ADAM-17, TGF-α, and TNF-α. Consequently, EGFR–ERK1/2 pathway was over-activated, disrupting anti-apoptotic Bcl-2, cyclin D1, and pro-apoptotic Bax. Celecoxib reversed these effects. Conclusion: COX-2 stimulates the ERK1/2 pathway via PGE2–ADAM-17-catalyzed shedding of TGF-α in testosterone-induced BPH. The results indicate a functional correlation between inflammation and hyperplasia in BPH. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is an age-related non-neoplastic disease of the prostate gland in men that has become a global health issue in recent years. Due to the side effects of conventional treatment options, attention is now focused on phytotherapeutics for its management. We investigated the possible protective effect of Saccharomyces cerevisiae var. boulardii in a rat model of testosterone propionate (TP) induced BPH. Rats were divided into five groups: Gr. I, untreated control group; Gr. II, TP group; Gr. III, TP + finasteride; Gr. IV, TP + S. cerevisiae var. boulardii; and Gr. V, S. cerevisiae var. boulardii group. Treatments were given daily for 28 days. At the end of the experiment, all rats were weighed and the prostatic indices, prostate specific antigen, serum testosterone concentration as well as the histological and histomorphometric changes were evaluated. Saccharomyces cerevisiae var. boulardii significantly (P <0.05) reduced prostate weight, prostatic index, serum prostate specific antigen, prostatic epithelial thickness and increased luminal diameter. Thus, the results of this study suggest that S. cerevisiae var. boulardii is a potential pharmacological candidate for management of benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer is a public health problem and increasingly diagnosed in men under 50 years of age. This cancer occurs much more in subjects of advanced age, generally over sixty. The aim of the study was to describe the epidemiological, clinical and histopathological aspects of prostate cancer in men under the age of 50 in Togo. Methods: It was a retrospective descriptive, cross-sectional study of histologically confirmed cases of prostate cancer in young adults at the Pathological Laboratory of Lomé over a period of 10 years (2011–2020). Results: In total, 29 cases of prostate cancer in patients under 50 years of age. The proportion of prostate cancers in men under 50 was 0.7% of all prostate cancers, The average age of the patients was 45 years with extremes of 35 and 49 years. Twelve patients had a family history of prostate cancer, with a statistically significant relationship between the existence of a family history of prostate cancer and the age of onset of the cancer (p-value = 0.03). The dominant clinical information was prostatic hypertrophy (40.37%), followed by acute urine retention (20.69%) and micturition disorders (17.27%). The median Prostate Specific Antigen (PSA) was 188 ng/ml with extremes of 20 ng/ml and 2100 ng/ml. A large proportion of patients had a PSA between 100 and 500 ng/ml. Histologically, they were all prostatic acinar adenocarcinomas. These adenocarcinomas were well differentiated (48%) and moderately differentiated (38%). The predominant histoprognostic grade was ISUP (International Society of Urological Pathology) grade 1 which was noted in 65.52%, followed by grade 2 in 20.69%. Conclusion: Prostate cancer in men under 50 years of age is relatively rare in Togo, sometimes occurring in the context of a family history of prostate cancer. Hence the importance of raising awareness among the male population, especially with a family history of prostate cancer, to start screening early, around the age of 40. [ABSTRACT FROM AUTHOR]

Background: Medical therapy of prostatic symptoms and reduce study on benign prostatic hyperplasia (BPH) recently demonstrated a link between histological prostatic inflammation and prostate enlargement or symptoms scores. Aims and Objectives: Prognostication of symptoms of lower urinary tract based on pathological diagnosis following transurethral resection of prostate (TURP). Materials and Methods: This was a prospective observational study. A total of 60 BPH patients who underwent TURP were studied; 30 patients in each group, BPH without inflammation (Group I), and BPH with inflammation (Group II). Pre-operative and post-operative international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), and uroflowmetry were compared in both groups. Chronic prostatic inflammation was assessed by the grade (lymphocyte density), extent (lymphocyte distribution), and location of inflammation. Results: The prostate volume was significantly higher in Group II as compared to Group I (53.2±1.29 vs. 50.87±1.48). The improvement in IPSS and OABSS in each group, before and after surgery, was significant but the between-group difference was not significant. The post-operative voided volume (in ml) in Group I was 273.27±52.34 and in Group II, it was 289.47±34.25 (P=0.03). The post-operative post-void residual volume (in ml) was 21.97±2.55 in Group I and 13.28±2.11 in Group II (P=0.017). The post-operative Qmax (ml/s) in Group I was 15.41±2.1 and in Group II it was 19.28±2.11. (P=0.041). Conclusion: Surgical resection of the prostate helps in a higher degree of improvement in post-operative clinical parameters in BPH patients with inflammation. [ABSTRACT FROM AUTHOR]