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Introduction: Water vapor thermal therapy (WVTT; REZUM™; Boston, USA) offers symptom relief with reduced risks of complications in patients with lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). WVTT therapy has been validated in the pivotal study in men with smaller prostates (< 80 cc). Yet, its feasibility for larger prostates (≥ 80 cc) remains underexplored. Methods: This retrospective study assessed WVTT efficacy and safety in 131 patients with symptomatic BPH treated between January 2022 and March 2024. Patients were categorized based on prostate size: smaller prostates (SP) (< 80 cc) and larger prostates (LP) (≥ 80 cc). Baseline characteristics, treatment specifics, and post-procedure outcomes—including retreatment rates, symptom scores, and adverse events (AEs)—were recorded. All patients who required surgical retreatment underwent Holmium laser enucleation of the prostate (HoLEP). Statistical analyses compared results between groups over 6- and 12-month follow-up periods. Results: Among the 131 patients, 48 (37%) had LP, with a median volume of 93 cc (Interquartile range (IQR) 88–110). Patients with LP experienced more non-serious AEs, primarily hematuria (p = 0.001), although serious AEs were similar across groups and limited to urinary retention (p = 0.35). At 6 months postoperatively, LP patients had a higher PVR (42 mL(IQR 21–75) vs. 21 mL (IQR2-40); p = 0.032), though this resolved by 12 months. No significant differences were observed between the groups in IPSS, maximum flow rate (Qmax), or erectile function (IIEF-5) scores at either follow-up point. Medical retreatment rates at 12 months were similar (LP: 4% vs. SP: 7%; p = 0.39), as were surgical retreatment rates (LP: 2% vs. SP: 2%; p = 0.51). Ejaculatory function was largely preserved in both groups (LP: 96%, SP: 95%). Conclusion: WVTT therapy in LP is associated with a higher risk of minor post-operative AEs, with similar functional outcomes at one year compared to SP. Longer follow-up studies are needed to compare the durability of treatment in LP. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to compare the results of radiofrequency (RF) thermotherapy and transurethral resection of the prostate (TURP) in patients who required benign prostatic obstruction (BPO) surgery and had storage symptoms. Methods: The results of patients who had undergone TURP and RF thermotherapy procedures between December 2019 and 2022 were compared before and after the procedure. Patients' International Prostate Symptom Scores, maximum flow rate (Qmax), postvoiding residues, and overactive bladder validated 8 scores (OAB-V8) at 3 and 6 months were analyzed. Results: While the preprocedural OAB-V8 in the RF thermotherapy group was 25.85, this score decreased to 18.12 (P<0.001) at the postprocedural 3rd month and 16.42 (P<0.001) at the postprocedural 6th month. While the preprocedural OAB-V8 score in TURP group was 23.26, it decreased to 20.17 (P<0.001) at the postprocedural 3rd month and 19.84 at the postprocedural 6th month, and there was no significant difference between the 3rd-month and 6th-month values (P=0.328). The proportion of de crease in the OAB-V8 scores was 30% at the 3rd month and 36% at the 6th month in the RF thermotherapy group, whereas it was 13% at the 3rd month and 15% at the 6th month in TURP group. Conclusions: It was determined that RF thermotherapy was 2.35 times more effective than TURP on OAB-V8 scores. In addition to its acceptable effect on Qmax, its continued effect on storage symptoms at 6 months may be a significant advantage over the TURP. As a minimally invasive method, RF thermotherapy can be offered as a suitable option for BPO patients with storage symptoms. [ABSTRACT FROM AUTHOR]

Objective: To test for differences in recovery of lower urinary tract symptoms (LUTS) between patients with storage‐positive vs ‐negative symptoms after laser enucleation of the prostate (LEP). Patients and methods: Consecutive storage‐positive (severe storage symptoms, International Prostate Symptom Score [IPSS] storage subscore >8) vs storage‐negative patients treated with LEP (November 2017–September 2022) within our tertiary‐care database were identified. Mixed linear models tested for changes in IPSS and quality of life (QoL) at 1, 3 and 12 months after LEP. Multiple linear regression models tested for LUTS and QoL recovery risk factors at 1, 3 and 12 months. Results: Of 291 study patients, 180 (62%) had storage‐positive symptoms. There were no differences between storage‐positive and ‐negative patients in mean adjusted total IPSS, IPSS‐storage, IPSS‐voiding and QoL at 12 months after LEP. In multiple linear regression models, storage‐positive status was identified as a risk factor for higher IPSS at 1 month (β coefficient 2.98, P = 0.004) and 3 months (β coefficient 2.24, P = 0.04), as well as for more unfavourable QoL at 1 month (β coefficient 0.74, P = 0.006) and 3 months (β coefficient 0.73, P = 0.004) after LEP. Conversely, at 12 months there were no differences between storage‐positive vs ‐negative patients. Conclusion: Storage‐positive patients appear to experience similar long‐term benefits from LEP compared to storage‐negative patients. However, significant storage symptoms are associated with higher total IPSS and less favourable QoL at 1 and 3 months after LEP. These findings advocate for the consideration of LEP also in storage‐positive cases with the need for thorough patient education especially in the initial post‐LEP period. [ABSTRACT FROM AUTHOR]

Introduction: Benign prostatic obstruction (BPO) is one of the most common causes of male lower urinary tract symptoms. Some institutions routinely perform BPO surgeries in ambulatory setting, while others elect for overnight hospitalization. With the COVID-19 pandemic limiting resources and hospital space for elective surgery, we investigated the time trend of ambulatory BPO procedures performed around the COVID-19 outbreak. Methods: We identified BPO surgeries from the California State Inpatient and State Ambulatory Surgery Databases between 2018 and 2020. Our primary outcome was the proportion of procedures performed in ambulatory settings with a length of stay of zero days. Univariable and multivariable analyses were performed to analyze factors associated with ambulatory surgery around the COVID-19 outbreak. Spline regression with a knot at the pandemic outbreak was performed to compare time trends pre- and post-pandemic. Results: Among 37,148 patients who underwent BPO procedures, 30,067 (80.9%) were ambulatory. Before COVID-19, 80.1% BPO procedures were performed ambulatory, which increased to 83.4% after COVID-19 outbreak (p < 0.001). In multivariable model, BPO procedures performed after COVID-19 outbreak were 1.26 times more likely to be ambulatory (OR 1.26, 95% CI 1.14–1.40, p < 0.0001). Spline curve analysis indicated significantly different trend of change pre- and post-pandemic (p = 0.006). Conclusions: We observed a rising trend of BPO surgeries performed in ambulatory setting post-pandemic. It remains to be seen if the observed ambulatory transition remains as we continue to recover from the pandemic. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the impact of anterior fibromuscular stroma preserved enucleation (AFSPE) of the prostate on serum testosterone levels in patients with benign prostatic obstruction (BPO) and to explore age‐related differences in postoperative testosterone elevation. Methods: In a retrospective analysis, 304 patients from a pool of 560 who underwent AFSPE at Linkou Chang Gung Memorial Hospital between January 2018 and December 2021 were evaluated. Patients were stratified based on preoperative testosterone levels into low (<3.5 ng/mL) and normal (≥3.5 ng/mL) groups. Serum testosterone levels were measured preoperatively, at 1.5 and 3–6 months postoperatively. Age and other demographic data were analyzed as potential factors influencing testosterone changes. Results: The low‐testosterone group (n = 90) showed significant testosterone increases, from an average of 2.61 ng/mL preoperatively to 3.3 ng/mL at 1.5 months and 3.59 ng/mL at 3–6 months postoperatively (p < 0.0001). The normal‐testosterone group (n = 214) maintained stable testosterone levels at 1.5 months but exhibited a significant rise to 6.06 ng/mL by 3–6 months (p = 0.0079). Older age was inversely associated with postoperative testosterone elevation in both groups. Improvements in nocturia were notable in both groups. Conclusions: AFSPE of the prostate significantly elevates serum testosterone levels in men with BPO, particularly benefiting those initially with low levels. Age is a crucial factor influencing postoperative testosterone changes, indicating that younger patients may benefit more from this intervention. AFSPE offers a promising approach for improving hormonal health in BPO patients, alongside alleviating urinary symptoms. [ABSTRACT FROM AUTHOR]

Aims: To address how invasive therapies for benign prostatic obstruction (BPO) have been evaluated, what their effect is on BPO, if they can prevent progression to BPO and how new therapies need to be evaluated before implementation into clinical practice. Methods: The think tank conducted a literature review and looked at the previous and current American Urological Association, European Association of Urology and the International Consultation on Urological Diseases guidelines to see what procedures have been used to treat BPO. They then assessed whether trials have been conducted before implementation of the procedures and whether they have been compared to a "gold" standard treatment. The use of urodynamics has also been addressed in the think tank in relation the clinical trials as well as terminology. Results: Guidelines vary in the use of terminology when it comes to BPO with some continuing to use the term benign prostatic hyperplasia (BPH). There are several procedures for example, TUNA, which have become obsolete although continues to be mentioned in the guidelines until recently. Majority of procedures have been introduced without comparing to "gold" standard treatment and without any long‐term data. There continues to be many unknowns with regard to the success of some of the BPO procedures and why some of the adverse events develop. Conclusion: There needs to be more robust long‐term clinical trials conducted of new BPO therapies, with men who have both lower urinary tract symptoms and urinary retention, before introduction into clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). Methods: We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. Results: We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. Conclusion: HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery. [ABSTRACT FROM AUTHOR]

Purpose of Review: As novel approaches for treating bladder outlet obstruction due to benign prostatic hyperplasia proliferate, it is critical for urologists to have accurate information regarding the durability of these procedures as they counsel patients. We summarize the available data examining the rate and time course of treatment failure for common contemporary procedures. Recent Findings: There is significant clinical variability between procedures for benign prostatic hyperplasia with lack of long-term evidence for several newer procedures. Summary: While numerous surgical approaches for benign prostatic hyperplasia are endorsed by the most recent AUA guidelines, the most durable treatments remain the most invasive. Clinicians should consider the tradeoffs between expected patient lifespan, surgical candidacy, and durability of treatment. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In the treatment and follow-up of patients with Benign Prostatic Obstruction (BPO), uroflowmetry and evaluation of post voiding residual urine volume (PVR) are of great importance. Methods such as urethral catheter and suprapubic ultrasonography are generally used to measure PVR. In this study, we aimed to compare the accuracy of urethral catheter and suprapubic ultrasonography methods in detecting PVR. METHODS: We included patients who underwent catheterisation for various clinical reasons. A total of 103 patients were included in the study. All patients were evaluated by suprapubic ultrasonography (USG) in the supine position to confirm that their bladders were empty. After 200 ml of saline was injected into the bladder with the help of a urethral catheter, the catheter was removed and the patients were instructed to urinate into a graduated cup.PVR was calculated by subtracting the volume voided by the patient from the volume injected into the bladder (200 ml).Abdominal USG was performed again within 5 minutes after voiding. Finally, the PVR values obtained were compared. RESULTS: The accuracy of urethral catheter measurements was higher than suprapubic ultrasonography (p= 0.028). The sensitivity and specificity of suprapubic ultrasonography were found to be 100% (1.000 (0.904-1.000)) and 94% (0.940 (0.856-0.977)), respectively.. DISCUSSION AND CONCLUSION: Conclusions: USG demonstrating high specificity and sensitivity in assessing postvoid residual urine volume.

Introduction Several ‘ultra-minimally-invasive’ surgical treatments (uMISTs) have been developed, aiming to relieve benign prostatic obstruction (BPO) and spare ejaculatory function; however, such techniques do not always ensure substantial improvements in uroflowmetry parameters. The aim of the present study was to evaluate the 2-year functional outcomes of thulium laser transurethral incision of the prostate (ThuIP) as an alternative to uMISTs. Material and methods Data of consecutive patients affected by BPO with indication to surgical intervention and a strong will to spare ejaculatory function were collected on a dedicated prospectively maintained database. A specific “trifecta” was identified as the contemporary presence of: (1) post-operative Qmax ≥15 ml/s; (2) absence of early (within 90 days) complications; and (3) preserved antegrade ejaculation. Results 120 patients underwent ThuIP and were analysed. Median catheterisation time was 2 days (IQR 2-2). Significant improvements in IPSS and IPSS-QoL scores and uroflowmetry parameters were observed at all follow-up times. At the last follow-up visit (24 months) the median ΔIPSS was -12 (-17; -9), median ΔIPSS-QoL was -3 (-4; -2), median ΔQmax was +7.7 ml/s (+5.2; +11.0), and median ΔPVR was -50 ml (-100; 0) (all p-values <0.001). Fourteen patients reported postoperative absence of antegrade ejaculation (11.7%). Overall, trifecta was achieved in 86 patients (71.7%) at 6 months, in 79 patients (65.8%) at 12 months, and in 75 patients (62.5%) at 24 months. Conclusions ThuIP allows for a significant improvement in uroflowmetry parameters and patient-reported outcomes at 2-year follow-up. Moreover, antegrade ejaculation is preserved in approximately 90% of cases. [ABSTRACT FROM AUTHOR]

The treatment of non-neurogenic lower urinary tract symptoms (LUTS) has changed significantly in recent years. This applies to both medical and surgical therapy options. Although surgical treatment of benign prostatic obstruction (BPO) is now used much less frequently than several decades ago, there is still a certain subset of patients who have absolute or relative indications for surgery. Traditionally, transurethral resection of the prostate (TURP) has been and remains the gold standard against which all newer minimally invasive surgical methods are compared. Although in recent decades new surgical methods based on various forms of energy have been introduced into practice with the aim of reducing the duration of the postoperative period, complications, and consequently the cost of surgery, only a small part of these methods have become widespread. The technique of TURP itself has also changed significantly with the introduction of bipolar TURP (B-TURP). Furthermore, B-TURP has made it possible to introduce a completely different technique of performing the operation - prostate enucleation. Its main advantage is the ability to completely remove the prostate regardless of its size, and studies show that this operation is safe and effective for any gland volume. Numerous comparative studies have shown that prostate enucleation likely reduces the frequency of TUR syndrome, blood transfusion, the frequency of repeat surgeries, and improves functional outcomes. This could make B-TURP prostate enucleation the new "gold standard" for endoscopic prostate surgery. Another important direction in prostate surgery is laser enucleation. It has been actively developing in recent years, and its share is constantly increasing. Laser enucleation makes it possible to radically transform the surgical technique, moving from cutting the prostate into pieces to the principle of anatomical enucleation, where the gland is removed as a single block. This technique has raised the safety and effectiveness of the operation to a new level, competing with classical prostatectomy. This has led to a reduction in hospital stay, the frequency of repeat surgeries, and a decrease in the risk of such a severe complication as vascular thrombosis. Thus, the introduction of new methods of surgical treatment for BPO allows for safer surgery, better functional outcomes, and treatment of complex patients for whom classical TURP is too risky. [ABSTRACT FROM AUTHOR]

Background: The selection of suitable patients for the surgical treatment of benign prostatic obstruction (BPO) is a challenge in persons ≥75 years of age. Methods: After a systematic literature search of PubMed, 22 articles were included in this review. Clinical and functional parameters were evaluated statistically. Results: The mean age of the patients was ≥79 years. The mean duration of postoperative catheterization ranged between 2 (d) (ThuLEP, thulium laser enucleation of the prostate) and 4.4 days (TURP, transurethral resection of the prostate). Complication rates ranged between 6% (HoLAP, holmium laser ablation of the prostate) and 34% (PVP, photoselective vaporization of the prostate); the maximum rate of severe complications was 4% (TURP). The mean postoperative maximal urinary flow (Qmax) in mL/sec. ranged between 12.9 mL/sec. (HoLAP) and 19.8 mL/sec (Hol-TUIP, holmium laser transurethral incision of the prostate). The mean quality of life (QoL) score fell from 4.7 ± 0.9 to 1.8 ± 0.7 (HoLEP), from 4.1 ± 0.4 to 1.9 ± 0.8 (PVP), from 5.1 ± 0.2 to 2.1 ± 0.2 (TURP), and from 4 to 1 (ThuVEP, thulium laser vapoenucleation of the prostate). Pearson's correlation coefficient (r) revealed a positive linear correlation between age and inferior functional outcome (higher postoperative International Prostate Symptom Score (IPSS) [r = 0.4175]), higher overall complication rates (r = 0.5432), and blood transfusions (r = 0.4474) across all surgical techniques. Conclusions: This meta-analysis provides the summary estimates for perioperative and postoperative functional outcome and safety of endoscopic treatment options for BPO in patients ≥ 75 years of age. Of particular importance is that all surgical techniques significantly improve the postoperative quality of life of patients in this age group compared to their preoperative quality of life. [ABSTRACT FROM AUTHOR]

Aim: To assess the feasibility, efficacy and safety of performing photoselective vaporisation of the prostate (PVP) as a day‐surgery procedure for patients with benign prostatic obstruction. Patients and Methods: A prospective single‐arm observational study was performed involving patients with benign prostatic obstruction (BPO) who received PVP between 2017 and 2021. Data were collected on demographics, prostate volume by transrectal ultrasonography, mean peak flow rate (Qmax), post‐void residual urine volume, International Prostate Symptom Score (IPSS) with quality‐of‐life (QoL) index, length of stay, success in weaning off catheter on the day of operation and complications. Results: PVP was performed successfully in all 37 men between 2017 and 2021. Their mean age was 67 years. The mean prostate volume was 54 mL. The mean duration of operation was 80 min. The mean peak urinary flow rate improved from 9.14 to 16.8, 17.3 and 15.4 mL/s at post‐operative 1, 3 and 12 months, respectively (P =.001). The mean IPSS score improved from 19.5 to 8.94, 6.40 and 5.63 at post‐operative 1, 3 and 12 months, respectively (P <.001). The mean QoL index improved from 4.07 to 2.43, 2.25 and 1.81 at post‐operative 1, 3 and 12 months, respectively (P =.001). The mean duration of catheterisation after PVP was 5.81 h. Thirty‐three (89.2%) patients were discharged on the same day. Overall, the 30‐day complication rate was 27%. The most common complication was haematuria (6 patients, 16.2%). Five patients (13.5%) required readmission and inpatient care. There was one Clavien–Dindo grade III and IV complication (2.6%), respectively. Conclusion: This study demonstrated the feasibility of performing PVP as a day‐surgery procedure with good short‐ and medium‐term functional outcomes and safety profiles. [ABSTRACT FROM AUTHOR]

Abstract Background Standard surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) requires anaesthesia and hospitalization. Transperineal laser ablation (TPLA) is a novel minimally invasive treatment for BPO, which has been performed using local anaesthetics and conscious sedation. Objectives The aim of this study is to assess safety, feasibility and functional outcomes of TPLA for the treatment of LUTS in men fit also for standard surgery. Methods This prospective, multicentre, interventional pilot study included 20 patients. Eligible patients were men ≥40 years of age, with urodynamically proven bladder outlet obstruction, a peak urinary flow of 5–15 mL/s and a prostate volume of 30–120 cc. All subjects underwent Soractelite™ TPLA using the Echolaser® X4 system. Two to four fibres were placed in the prostate, whereafter laser light induced coagulative necrosis. Twelve months of follow‐up included uroflowmetry, an ultrasound of the prostate and PROMs (IPSS and IIEF). Results Twenty patients were treated with TPLA using local anaesthetics and optional sedation. Sixteen patients were treated in an outpatient setting, using only local anaesthetics in 12 of them; four were treated in the operating room, whereof two under general anaesthesia. No device related adverse events occurred, nor did any grade ≥3 adverse events during follow‐up. Post‐TPLA, 10 men continued spontaneous voiding, and 10 men developed a urinary retention treated by a temporary indwelling catheter for 15.2 ± 3.5 days. At 12 months, Qmax improved from 9.7 ± 3.5 to 14.9 ± 6.0 (p = 0.015), IPSS improved from 21.3 ± 5.2 to 10.9 ± 5.5 (p

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Background: Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention. Objective: To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO. Design, setting, and participants: The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed. Surgical procedure: AFS-preserved EEP starts at the 12 o'clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved. Measurements: Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed. Results and limitations: The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches. Conclusions: The preserved AFS provides a nice landmark at the 12 o'clock position during EEP. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the reliability of transperineal interstitial laser ablation of the prostate (TPLA) in preserving antegrade ejaculation compared to transurethral resection of the prostate (TURP). Patients and Methods: In this single‐centre, prospective, randomized, open‐label study, consecutive patients with indication for surgical treatment for benign prostatic obstruction (BPO) were enrolled between January 2020 and September 2021 (NCT04781049). Patients were randomized to one of two treatment arms: Group A: TPLA (experimental group) and Group B: TURP (reference standard group). The primary endpoint was change in ejaculatory function (assessed by the Male Sexual Health Questionnaire – Ejaculatory function domain [EJ‐MSHQ]) at 1 month after surgery. Secondary endpoints included comparison of visual analogue scale (VAS) scores, changes in sexual function (assessed using the five‐item International Index of Erectile Function [IIEF‐5]), change in International Prostate Symptom Score [IPSS], change in quality of life score, and maximum urinary flow rate [Qmax] improvement at 1–6 months, as appropriate. Results: Fifty‐one patients (26 TPLA vs 25 TURP) were analysed. No differences in the perception of pain assessed by VAS and no differences in IIEF‐5 score were found between the groups. The distribution of ejaculatory function assessed by the EJ‐MSHQ remained unmodified after TPLA (P = 0.2), while a median 30% decrease in EJ‐MSHQ score was observed after TURP (P = 0.01). Absence of antegrade ejaculation was reported in one patient in the TPLA group (vs 18 patients in the TURP group). A statistically significant difference between the treatment groups was found in terms of postoperative Qmax (TPLA vs TURP: 15.2 [interquartile range 13.5–18.3] mL/s vs 26.0 [interquartile range 22.0–48.0] mL/s; P < 0.001). Both treatments significantly improved Qmax, with a mean 23.9 mL/s improvement after TURP (95% confidence interval [CI] 17.1–30.7) vs 6.0 mL/s after TPLA (95% CI 5.0–7.0), and IPSS, with a mean decrease of 11.6 (95% CI 9.7–13.5) vs 5.8 after TPLA (95% CI.2–9.6) with respect to baseline. Conclusion: In our study, TPLA preserved ejaculatory function in 96% of cases in addition to providing significant relief from BPO. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the rate of revision surgery following commonly performed procedures for benign prostatic hyperplasia (BPH) is hyperplasia of both glandular and stromal components of prostate especially in periurethral transitional gland, using real‐world data from Medicare Australia. Methods: Prospection is a Healthcare Data Analytics firm that has negotiated access with the Medicare Benefits Schedule (MBS) to provide longitudinal data on the use of specific procedural item codes. We identified patients over the age of 40 years who had undergone primary transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP) or photoselective vaporization of the prostate (PVP) between 2005 and 2010 using MBS item numbers 37203, 37207 and 36854, respectively. Using longitudinal MBS data, primary outcomes included need for revision surgery at 5‐years follow‐up (2015). The release of these data was approved by Medicare Australia upon application. Data analysis was conducted using chi‐squared tests and statistical significance was defined at P < 0.05. Results: The distribution of primary surgical procedures performed between 2005 and 2010 was: TURP 5579 (90%), TUIP 345 (6%) and PVP 258 (4%). TURP was also the most prevalent procedure for treatment of lower urinary tract symptoms in men with BPH requiring revision surgery (75%). At 5‐year follow‐up the rate of revision surgery for TURP (573/5579), TUIP (47/345) and PVP (30/258) was 10.3%, 13.6% and 11.6%, respectively. The difference was not statistically significant (P = 0.12). There was no significant change (P = 0.59) observed over the years in number of men requiring revision surgery. Conclusion: This study indicates that TURP and PVP have a similar durability after 5 years of follow‐up. [ABSTRACT FROM AUTHOR]

To the Editor, Our study aimed to investigate a possible relationship between benign prostatic obstruction (BPO) and Peyronie's disease (PD) and to characterize the psychological profile of patients affected by Peyronie's disease, with or without concomitant BPO. In this study, we have investigated whether there is a relationship between the two diseases. The typical symptoms of PD are as follows: penile deformation, local pain, erectile dysfunction (ED), and anxious depressive state. Benign prostatic hyperplasia (BPH) causes symptoms only in the case of urinary obstruction (benign prostatic obstruction/BPO). BPO is an emotionally stressful condition, but any type of treatment, such as surgery, by significantly decreasing LUTS, can significantly improve the general well-being of the affected patient (1). We performed a retrospective analysis of the clinical database of a single uro-andrology clinic. From the database, we considered two separate cohorts of patients observed between January 2013 and February 2023. The first cohort included 539 patients diagnosed with Peyronie's disease. As a comparator population, we considered a cohort of 2208 outpatients referred to our clinic for any disease, but not Peyronie's disease. [...]

Objective:Previous studies showed that nocturia has a negative effect on patients’ sleep quality. However, studies that focused on the sleep quality of patients’ partners are limited. In this study, we evaluated the impact of nocturia on sleep quality in patients with benign prostatic obstruction (BPO) and their female partners.Materials and Methods:We included 50 BPO patients with nocturia (group 1), 50 patients without nocturia (group 2) and their female partners. Lower urinary tract symptoms of the patients were evaluated by international prostate symptom score, serum prostate-specific antigen, uroflowmetry and urinary ultrasonography. The sleep quality of the patients and their partners were assessed by Pittsburgh sleep quality index (PSQI). The demographic and evaluation outcomes of the participants were recorded.Results:The mean age of the patients and their partners were 63±7.9 and 57.4±8.5 years, respectively, with no statistical significance. The patients and their partners in group 1 had significantly higher global PSQI compared with those in group 2. The percentage of poor sleep in patients and partners in group 1 was higher than that in group 2.Conclusion:Nocturia negatively affects the sleep quality of patients with BPO and their partners.

Introduction The aim of this study was to compare peri-operative and mid-term outcomes of patients who underwent robot-assisted simple prostatectomy (RASP) vs holmium laser enucleation of the prostate (HOLEP). RASP and HOLEP are the treatments of choice for men with symptomatic benign prostatic obstruction (BPO) and a prostate =80 g, achieving comparable short and mid-term efficacy. No randomized controlled studies have proved the superiority of one technique over the other. Material and methods The prospectively maintained databases of the participating institutions were queried for patients with a prostate volume (PV) =80 g, who underwent surgery for BPO between 2011 and 2021. The study population was divided into two subgroups based on surgical approach. Demographics, baseline characteristics, and 12 months outcomes were compared between groups: χ2 and Student t-tests were used for categorical and continuous variables, respectively. The Trifecta composite outcome (post-operative Q-max >15 ml/sec, International Prostate Symptom Score (IPSS) <8 and absence of complications) was used to define surgical quality and the two groups were compared accordingly. Logistic regression analyses investigated predictors of Trifecta achievement. Results We included 97 patients with comparable pre-operative features (all p >0.30): 43 underwent RASP, 54 HOLEP. Median PV was 102 g (IQR 89-120) and Q-max was 7.2 ml/s (IQR 5.4-9.0). The Trifecta rate was 43% overall, higher in the RASP subgroup (56% vs 33%; p = 0.02). The endoscopic approach was its only independent predictor (OR 0.5; 95% CI 0.28-0.88; p = 0.016). Conclusions At univariable regression analysis, surgical approach was the only independent predictor of Trifecta achievement, which was significantly higher in the RASP group compared to HOLEP. [ABSTRACT FROM AUTHOR]

Introduction: Water vapor intraprostatic injection (Rezum procedure) for benign prostatic hyperplasia (BPH) is one of the most promising minimally invasive surgical treatments. Five-year outcomes from the multicenter randomized controlled trial (RCT) demonstrated significant and durable urinary and sexual function results in selected patients. We compared the sexual and urinary outcomes of this procedure in patients satisfying inclusion criteria of the RCT with unselected patients. Materials and Methods: We prospectively followed all patients with symptomatic BPH who underwent Rezum therapy at eight institutions and analyzed the functional results. Patients were divided into two groups: patients who matched the 5-year RCT inclusion criteria (Group A) and patients who did not (Group B). The pre- and postoperative data, complications, presence of antegrade ejaculation, and urinary and sexual outcomes were periodically recorded. Results: A total of 426 patients were eligible for the study (232 in Group A and 194 in Group B). Patients in Group B had a higher American Society of Anesthesiologists score, prostate volume, and postvoid residual measurement. No difference was found in terms of preoperative International Prostate Symptom Score, International Index of Erectile Function, maximum urinary flow, and prostate-specific antigen. Longer operative time and higher number of vapor injections were required in Group B, with no differences in hospital stay, injection density, and complication rates. All the urinary and sexual outcomes improved with no differences between the two groups. The reintervention rate at the latest follow-up visit was 2.6% in Group A and 3.1% in Group B. Conclusions: In our large multicenter series, water vapor intraprostatic injections showed a safe and effective profile regardless of the prostate size, presence of indwelling catheter, antiplatelet/anticoagulant medications, and patients' comorbidities. [ABSTRACT FROM AUTHOR]

Objective: To investigate if treatment with transurethral enucleation of the prostate (TUEP) during the learning curve is as efficient and safe in the short term as transvesical open prostate enucleation (OPE), in patients with benign prostatic obstruction (BPO) > 80 ml in a population in Sweden. Methods: 54 patients with ultrasound verified BPO > 80 ml and indication for surgery underwent TUEP or OPE between 2013 and 2019. Peri- and postoperative outcome variables regarding voiding efficiency and morbidity from 20 OPE at Skåne University Hospital (SUS) and from the first 34 TUEP performed at SUS and Ystad Hospital were retrospectively assembled. Follow-up data from the first 6 postoperative months were collected by chart review. Results: Intraoperative bleeding during TUEP was less than in OPE (225 ml vs. 1,000 ml). TUEP took longer surgery time than OPE (210 vs. 150 min.). Within 30 days postoperatively, bleeding occurred less often after TUEP (23% vs. 40%), requiring one fourth of the blood transfusions given after OPE. After TUEP, patients had shorter hospitalisation (3 days vs. 7 days) and catheterisation time (3 days vs. 12 days). During the 6-month follow-up period, incontinence and UTI defined as symtomatic significant bacteriuria (urinary culture) were observed as main complications after TUEP and OPE. Functional outcome data availability (International Prostate Symptom Score [IPSS] questionnaire, uroflowmetry, residual urine) were limited. Conclusions: Treatment with TUEP during the learning curve led to less bleeding, shorter hospitalisationand catheterisation time than treatment with OPE. However, surgery time was shorter with OPE. There were no major differences between the groups concerning mid-term functional outcomes, with the reservation of an inconsistent follow-up. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted simple prostatectomy (RASP) proved to be a sound and effective procedure for bladder outlet obstructive symptoms relief. Routinely, the transvesical (Freyer) or transcapsular (Millin) techniques are performed. A novel approach of near-infrared fluorescence imaging (NIFI)-guided urethra-sparing robot-assisted prostatectomy (Madigan) was recently introduced. Objectives: The aim of our study was to evaluate the long-term functional outcomes between the Millin, Freyer, and Madigan RASP. Design: This is a single-center, retrospective evaluation of a prospectively maintained Institutional Review Board–approved database. Methods: Data from patients who have undergone RASP in our center were prospectively collected. Demographics, prostate size, and preoperative flowmetry parameters were assessed. Questionnaires such as International Index of Erectile Function (IIEF), and International Consultation on Incontinence Questionnaire (ICIQ), International prostatic symptoms score (IPSS) with its quality of life (QoL) score, Male Sexual Health Questionnaire (MSHQ), Overactive bladder questionnaire (OABQ) were administered to every patient preoperatively and during follow-up. We tested composite outcomes (trifecta) defined as a combination of postoperative Q-max >15 ml/s, IPSS score < 8, and absence of complications. We also tested a pentafecta which keeps in account the persistence of antegrade ejaculation (MSHQ > 0) and the erectile function maintenance (∆IEEF < 6). Results: Median follow-up was 36 months. Millin, Madigan, and Freyer procedures were performed in 37 (51%), 18 (25%), and 17 (24%) cases, respectively. Trifecta was achieved in 43 (60%) patients. Preoperative ICIQ, postoperative IPSS, postoperative OABQ, and QoL were significantly different between groups (all p < 0.02). Pentafecta was achieved by 14 (20%) patients. The pentafecta group showed a statistically significant advantage in terms of postoperative IPSS and MSHQ (p < 0.01). Conclusion: RASP provides an effective and durable relief of obstructive symptoms at longterm follow-up, regardless of the technique, achieving the trifecta in the majority of the patients. The Madigan technique is significantly related to the pentafecta achievement. [ABSTRACT FROM AUTHOR]

Prostatic artery embolization (PAE) is a minimally invasive technique with proven safety and efficacy to treat lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) or benign prostatic hyperplasia (BPH). In this review, we discuss the required level of evidence to implement and adopt treatment options for patients with LUTS due to BPO/BPH. Focus is given on the long-term (>3 years) data after PAE with reported outcomes including cohort sizes, follow-up times, reintervention rates (repeat PAE and prostatectomy), need for LUTS/BPO medical therapy, and improvements in International Prostate Symptom Score/quality of life score, peak flow rate (Qmax), postvoid residual, prostate volume, and prostate-specific antigen. The durability of treatment effects after PAE and need for prostatic reinterventions need to be taken into consideration when discussing treatment options with patients and referring colleagues from other medical specialties. Developments in medical devices used for PAE have allowed for a continuous drop in unilateral PAE rates over the last 12 years and will probably play a role in optimizing technical and thus clinical outcomes for patients with LUTS due to BPH/BPO. [ABSTRACT FROM AUTHOR]

Purpose: Robot-assisted simple prostatectomy (RASP) for benign prostatic hyperplasia (BPH) is a recently described surgical approach, but comparison with open simple prostatectomy (OSP) lack in the literature. We compared perioperative outcomes of OSP versus RASP. Methods: Patients who underwent simple prostatectomy between 2017 and 2020 were included in this retrospective study. OSP was performed by the transvesical technique and RASP was performed with a DaVinci Xi robot, using the transvesical extraperitoneal approach. Perioperative and postoperative data were compared and complications risk factors for complications were identified. Results: and limitations. Overall, 103 patients were included (median age 72 years [IQR = 67–76]). Forty-seven underwent RASP and 56 OSP. The median volume of the prostate gland was 130 mL [IQR = 100–180] in the RASP group and 126 mL [IQR = 100–160] in the OSP group. RASP was associated with a significant reduction in blood loss (median 200 vs. 400 mL; p < 0.001), shorter hospital stay (5 vs. 10 days; p < 0.001) and median catheterisation time (4 vs. 9 days; p < 0.001). In the RASP group, there were fewer grade ≥ 2 complications (2 (4.3%) vs. 13 (23.2%); p = 0.005) and less need for transfusions (0 vs. 6 (11%), p = 0.005). Preoperative prostate volume was a risk factor for complications (OR = 1.2 [95% CI 1.1–1.5]; p = 0.01) while robot-assisted surgery was a protective factor (OR 0.3 [95% CI 0.05–0.9]; p = 0.05). Functional outcomes between the two groups were identical at 12 months follow up. Conclusion: RASP is a safe and effective procedure. When compared with OSP, RASP was associated with decreased morbidity as well as reduced hospital stay and catheterisation time. Functional outcomes were comparable to the open approach. [ABSTRACT FROM AUTHOR]

Objective: To identify whether men aged ≥40 years with bladder stones (BS) benefit from treatment of benign prostatic obstruction (BPO). Patients and methods: A regional, retrospective study of patients undergoing BS surgery between January 2011 and December 2018 was performed using a prospectively collected database. The primary outcome was BS recurrence after successful removal. Kruskal–Wallis and chi‐squared statistical tests were used. Results: A total of 174 patients underwent BS removal and 71 (40.8%) were excluded due to BS formation secondary to causes other than BPO. Hence, 103 men aged ≥40 years had BS successfully removed, of which 40% had a history of upper tract urolithiasis. These men were divided into three groups: those undergoing contemporaneous medical, surgical, or no BPO treatment. Age, diabetes, previous urolithiasis and previous BPO surgery were well matched between the BPO treatment groups. In all, 18 of these men (17%) had BS recurrence after 46 months follow‐up. Recurrences were significantly lower following BPO surgery; one of 34 (3%) men versus five of 28 (18%) with no BPO treatment (P = 0.048) and 12 of 41 (29%) with medical BPO treatment (P = 0.003). Recurrences after medical and no BPO treatment were similar (P = 0.280). In all, 34 men (33%) had BPO complications that were similar between groups (P = 0.378). Conclusion: This is the largest reported cohort of men, with the longest follow‐up after BS removal. Most men aged ≥40 years with BS benefit from BPO surgery. However, the study findings also support a multifactorial aetiology for BS, which questions the dogma that BS are an 'absolute indication' for BPO surgery, as is stated in the Non‐neurogenic Male Lower Urinary Tract Symptoms European Association of Urology Guideline. Assessment and management of all causative factors is likely to enable selection of which men will benefit from BPO surgery and to reduce BS recurrence rates. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia is a prevalent condition leading to male lower urinary tract symptoms (mLUTS), particularly in aging populations. Current management strategies-spanning watchful waiting, pharmaceutical therapy, and surgical interventions such as transurethral resection of the prostate-face significant limitations, including side effects, low adherence, and patient hesitancy toward invasive treatments. First-line interventional therapy (FIT) emerges as a novel paradigm bridging the gap between medications and surgery. FIT aims to provide effective, minimally invasive symptom relief with rapid recovery, minimal side effects, and preserved treatment adaptability. Recent advancements in minimally invasive surgical therapies (MISTs) highlight potential; yet existing MIST procedures often fall short of meeting the FIT criteria. An ideal FIT would integrate outpatient feasibility, durability, and patient-centered outcomes, addressing both urologist and patient expectations. By reimagining treatment pathways, FIT has the potential to revolutionize mLUTS management, shifting the standard of care toward early, effective, and patient-friendly interventions, ultimately improving quality of life and long-term bladder health. PATIENT SUMMARY: In this report, we explored new treatment options for men with urinary symptoms caused by an enlarged prostate. We found that many men avoid surgery due to its risks and side effects, while medications often have limited success and unwanted effects. We suggest a new type of treatment, called first-line interventional therapy, which could provide faster symptom relief with fewer risks and quicker recovery, offering a better option for many patients., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: The aim was to propose initial and pre-therapeutical assessment of lower urinary tract symptoms in adult men through a systematic review and clinical practice guidelines Methods: These guidelines were based on a systematic review performed between January 2011 and November 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The protocol was registered in the International Prospective Register of Systematic Reviews database (CRD42022336418). The recommendations and the methodology of elaboration were prospectively validated by the French Health Authority (Haute Autorité de Santé - HAS)., Results: In total, 1662 publications were screened for eligibility and 311 met the inclusion criteria, 167 studies were retained among them 17 guidelines from French, European or International institutions. Perform on initial evaluation: identification of cardiovascular risk factors, metabolic syndrome, current medication, urinary and sexual symptoms (by structured interview or validated self-questionnaires), physical examination (lumbar fossa, pelvis, prostate, genitalia), urinalysis (dipstick or microscopy), abdominal ultrasound of the urinary tract (kidneys, bladder, prostate), post-void residual urine measurement (by ultrasound or automated measurement; under physiological conditions). Micturition flowmetry is recommended (except for general practitioners). Update and complete initial assessment before medication, interventional or surgical treatment if too old or incomplete. Perform a preoperative assessment (bleeding risk, infectious risk, geriatric risk). Urodynamic assessment, endorectal ultrasound and cystoscopy should not be systematically performed (only if additional information is needed). Perform urodynamics and urethrocystoscopy in case of failed interventional or surgical treatment. Following the initial workup, it is recommended to refer the patient to a urologist in case of: macroscopic hematuria, recurrent urinary tract infection or persistent perineal and/or suprapubic pain, persistent microscopic hematuria or leukocyturia in absence of urinary tract infection, predominant storage-phase symptoms, abnormal examination of the genitals or suspected prostate cancer, urinary retention, urinary tract stones, ureterohydronephrosis or morphological abnormalities of the prostate or the urinary tract., Conclusion: These guidelines aimed to define the recommended investigation for LUTS in adult men at diagnosis, before medical treatment and before surgical and interventional treatments, in order to better personalize management and avoid unnecessary and/or invasive examinations., (Copyright © 2024. Published by Elsevier Masson SAS.)

Although designed for in-office use, water vapor thermal therapy (Rezum™) remains a painful procedure, and oral±intravenous sedation is often required. Schelin Catheter® (ProstaLund AB, Lund, Sweden) is an innovative bladder catheter that delivers local anesthesia to the prostate in a sterile transurethral way. We aimed to evaluate the safety and feasibility of Rezum™ for male lower urinary tract symptoms due to benign prostatic obstruction (LUTS/BPO) with local anesthesia delivered with Schelin® catheter, and to report its first step-by-step video description. A total of 15 patients were enrolled, and 14 analyzed. Median pain numeric rating scale at catheter insertion, anesthetic injection, Rezum™ insertion, Rezum™ treatment, and at 2-h postoperatively were 3 (2-5), 3 (2-5), 1 (0-3), 3.5 (2-6), and 0 (0), respectively. In 1 patient local anesthesia protocol failed and intravenous sedation was used. All Rezum™ therapies were performed successfully. Local anesthesia with Schelin® catheter opens up new possibilities for ultra-minimally invasive surgery for LUTS/BPO., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Double-J stent is well known for relieving urinary tract obstruction, but still, some patients might develop double-J stent-related urinary tract infection (UTI), lower urinary tract symptoms (LUTS), lower abdominal pain, and hematuria. This study aims to compare alpha-blockers and antimuscarinics for the treatment of double-j stent-related lower urinary tract symptoms. Methodology: Patients planned for double-J stent insertion undergoing the urological procedure for ureteric stones were recruited and randomly allocated into two groups. One group was labeled as the tamsulosin (T), and the other was labeled as the solifenacin succinate (S) group. Group" T" patients were prescribed tamsulosin 0.4 mg once at bedtime and solifenacin succinate 10mg once daily to group "S" for 2 weeks. Improvement in symptoms was checked by means of international prostate symptom score (IPSS)/ quality of life (QoL) score charts for LUTS in the out-patient clinic at baseline and at follow-up. Results: When comparing the absolute changes in IPSS/QoL for LUTS scores, both groups showed significant improvement in double-J stent-related lower urinary symptoms, body pain, generalized body weakness, and sexual function, which affect their quality of life (QoL). The mean index score of all domains in both groups was significantly less (p

Background: Lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO) and bladder tumors may co-exist, especially among elderly patients. Transurethral resection of bladder tumors (TURBT) and endoscopic surgery for benign prostatic obstruction in the same setting are avoided by many surgeons due to concerns for tumor cell seeding and recurrences in the prostatic urethra. Aim: The aim of this study was assess the effect of concomitant TURBT and endoscopic BPO surgery on oncological safety and patient quality of life via systematic review and meta-analysis. Methods: We searched the PubMed, Cochrane Library, EMBASE, Scopus, and Clinicaltrials.gov databases and sources of grey literature published before June 2021 for relevant studies. We performed a random-effects meta-analysis of odds ratios (ORs) or weighted mean differences (WMD) to compare concomitant TURBT and BPO surgery versus TURBT alone in terms of recurrence and progression rates. Accordingly, we undertook multiple subgroups and sensitivity analyses (PROSPERO: CRD42020173363). Results: Three randomized and twelve retrospective observational studies with 2421 participants were included. Across studies with good methodological quality, no statistically significant differences were demonstrated regarding overall bladder tumors recurrence rates between concomitant endoscopic BPO surgery and TURBT versus TURBT alone (OR: 0.81, 95% CI: 0.60–1.09, I2 = 42%). Similarly, no significant differences were observed in recurrences located at the bladder neck and/or prostatic urethra (OR: 1.06, 95% CI: 0.76–1.47, I2 = 0%), time to first recurrence (WMD: −0.2 months, 95% Cl: −2.2–1.8, I2 = 48%), and progression rate (OR: 1.05, 95% CI: 0.67–1.64, I2 = 0%). Subgroup analyses based on tumor grade, number of tumors, and utilization of single-instillation chemotherapy post-TURBT did not detect any significant differences in overall bladder tumor recurrence. The level of evidence was estimated as low for all outcomes. Concomitant surgery improved lower urinary tract symptoms. Conclusion: Concomitant endoscopic BPO surgery and TURBT are oncologically safe and improve LUTS-related quality of life. [ABSTRACT FROM AUTHOR]

Background: The postoperative bleeding complications associated with laser surgery of the prostate and transurethral resection of the prostate (TURP) were compared. Methods: We used the Taiwan National Health Insurance Research Database to conduct an observational population-based cohort study. All eligible patients who received transurethral procedures between January 2015 and September 2018 were enrolled. Patients who received laser surgery or TURP were matched at a ratio of 1:1 by using propensity score matching, and the association of these procedures with bleeding events was evaluated. Results: A total of 3302 patients who underwent elective transurethral procedures were included. The multivariable Cox regression analysis revealed that diode laser enucleation of the prostate (DiLEP) resulted in significantly higher emergency room risks within 90 days after surgery due to clot retention than the Monopolar transurethral resection of the prostate (M-TURP) (Hazard Ratio: 1.52; 95% Confidence Interval [CI], 1.06–2.16, p = 0.022). Moreover, GreenLight photovaporization of the prostate (PVP) (0.61; 95% CI, 0.38–1.00 p = 0.050) and thulium laser vaporesection of the prostate (ThuVARP) (0.67; 95% CI, 0.47–0.95, p = 0.024) resulted in significantly fewer rehospitalization due to clot retention than did M-TURP. No significant increase in blood clots were observed in patients using comedications and those with different demographic characteristics and comorbidities. Conclusions: Among the investigated six transurethral procedures for Benign prostatic hyperplasia, PVP and ThuVARP were safer than M-TURP because bleeding events and clot retention were less likely to occur, even in patients receiving anticoagulant or antiplatelet therapy. However, DiLEP and holmium laser enucleation of the prostate (HoLEP) did not result in fewer bleeding events than M-TURP. [ABSTRACT FROM AUTHOR]

Objective: Previous studies showed that nocturia has a negative effect on patients' sleep quality. However, studies that focused on the sleep quality of patients' partners are limited. In this study, we evaluated the impact of nocturia on sleep quality in patients with benign prostatic obstruction (BPO) and their female partners. Materials and Methods: We included 50 BPO patients with nocturia (group 1), 50 patients without nocturia (group 2) and their female partners. Lower urinary tract symptoms of the patients were evaluated by international prostate symptom score, serum prostate-specific antigen, uroflowmetry and urinary ultrasonography. The sleep quality of the patients and their partners were assessed by Pittsburgh sleep quality index (PSQI). The demographic and evaluation outcomes of the participants were recorded. Results: The mean age of the patients and their partners were 63±7.9 and 57.4±8.5 years, respectively, with no statistical significance. The patients and their partners in group 1 had significantly higher global PSQI compared with those in group 2. The percentage of poor sleep in patients and partners in group 1 was higher than that in group 2. Conclusion: Nocturia negatively affects the sleep quality of patients with BPO and their partners. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the functional and urodynamic outcome of Aquablation in patients with acute urinary retention (AUR) on catheters. Methods: Men aged 50–70 who failed medical treatment of BPO with AUR failing to wean off urethral catheter were recruited to undergo Aquablation. Individuals were assessed pre-operatively and at 3 and 6 months after surgery. The primary outcome was defined by the success rate of weaning off catheter. Secondary outcomes were measured by a change in prostate size, symptom scores and urodynamic parameters. Results: Twenty patients underwent Aquablation between June 2019 and September 2020. Mean duration of the urethral catheter in-situ was 5.9 ± 4.9 weeks and mean prostate size of the cohort pre-operatively was 60.8 ± 15.8 cc. A second pass Aqaublation treatment was performed in 14 patients. Five patients failed to wean off the catheter on the first attempt after surgery, requiring another attempt 1 week later which were all successful. At 3 months after the operation, a significant reduction in prostate volume was observed (60.8 ± 15.8 cc vs 24.9 ± 10.3 cc, p < 0.001). No change in international index of erectile function (IIEF) was found (baseline: 16.1 ± 5.8; 3-month: 14.9 ± 6.4; p = 0.953). Mean bladder outlet obstruction index was 14.2 ± 23.0 at 6 months upon urodynamic assessment with 75% of patients had a resolution of detrusor overactivity. Reduction in prostate length was found to be more significant than a reduction in width and height after Aquablation (R = 0.693, p = 0.039). Conclusion: From the early data of a single centre, Aquablation was shown to provide a consistent improvement in symptoms, uroflowmetry and urodynamic parameters in patient with a urethral catheter. Results from our study suggest that improvement from Aquablation is reproducible in patients with AUR. [ABSTRACT FROM AUTHOR]

Purpose We compared success rates of 3 surgical techniques (holmium laser enucleation of the prostate [HoLEP], transurethral resection of the prostate [TURP], and photoselective laser vaporization prostatectomy [PVP]) for treatment of benign prostatic obstruction (BPO). We aimed to identify preoperative clinical variables and urodynamic parameters that predict surgical success. Methods A total of 483 patients who underwent surgical treatment for BPO at Samsung Medical Center between 2006 and 2017 were retrospectively analyzed; of these 361, 81, and 41 patients underwent HoLEP, TURP, and PVP, respectively. Prostate-specific antigen, prostate volume, urodynamic parameters, and International Prostate Symptom Score (IPSS)/quality of life (QoL) index were evaluated preoperatively; uroflowmetry, postvoid residual urine, and IPSS/QoL index were measured 6 months postoperatively. Surgical success was defined based on IPSS, maximum flow rate, and QoL index and predictive factors were identified using multiple logistic regression analyses. Results Success rates of HoLEP, TURP, and PVP were 67.6%, 65.4%, and 34.1%, respectively, and the HoLEP and TURP groups were not significantly different. Regression analysis revealed prostate volume ≥50 mL and bladder outlet obstruction index (BOOI) ≥40 to be independent factors predicting HoLEP success. Only high preoperative QoL could predict the success of TURP, whereas other urodynamic parameters remained unrelated. Conclusions Patients treated with HoLEP and TURP displayed equivalent efficacies, but PVP was relatively less efficient than both. Preoperative variables of prostate volume ≥50 mL and BOOI ≥40 were independent predictive factors for the success of HoLEP but not of TURP.

Abstract Introduction The recommended treatment for bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) after the failure of behavioral therapy and fluid modification includes pharmacological, minimally invasive interventional, and surgical approaches. Each option has different risk and benefit profiles, and the urologist must be aware of the unique characteristics of each option in order to be able to accurately counsel the patients based on their individual values and preferences. We provide a comparative review of the commonest pharmacological and most widely performed interventional/surgical treatments for BPO, discussing the evidence for the treatment characteristics that are most useful for the practicing urologist. Methods A search of the PubMed database was performed for articles reporting on the following treatments for LUTS due to BPO: α‐blockers, 5α‐reductase inhibitors, phosphpdiesterase‐5 inhibitors, prostatic urethral lift (Urolift), convective radiofrequency water vapor thermal therapy (Rezum), Temporary implantable Nitinol Device (iTIND), prostate artery embolization (PAE), transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), Aquablation, and anatomical endoscopic enucleation of the prostate (AEEP). We performed a narrative review focussing on the following outcomes: efficacy, safety, durability, duration of catheterization, length of stay, re‐treatment rate, efficacy in special situations (enlarged median lobe, prostate size, urinary retention, and anticoagulant use), and sexual adverse events. Results AEEP offers the greatest long‐term improvement in maximum flow rate, IPSS, and prostate volume reduction, with lowest re‐treatment rate, followed by PVP, TURP, and Aquablation. Urolift, Rezum, and PAE have similar efficacy for prostate volume up to 80cc, and all are more effective than the pharmacological treatment. Urolift offers the lowest rate of sexual dysfunction, followed by Rezum, and both can be performed as a day case under local anesthesia. Conclusion Several treatment options exist to treat voiding LUTS due to BPO. Newer minimally invasive treatments reduce the hospital stay and postoperative complications, whereas AEEP provides the greatest long‐term symptom improvement at the expense of higher morbidity and sexual dysfunction. Men should be counseled regarding all suitable treatment options as some may favor reduced efficacy in association with reduced side effects.

ObjectiveTo compare the perioperative morbidity of robotic-assisted simple prostatectomy (RASP), anatomical endoscopic enucleation of the prostate (AEEP) and open simple prostatectomy (OSP) for the treatment of benign prostatic obstruction (BPO). MethodsThe national surgical quality improvement program database was queried for AEEP, RASP, and OSP procedures. Clavien-Dindo-graded complications, length of hospital stay (LOS), and operative time were compared among the procedures. To control for the potentially confounding variables, we first conducted a multivariate backward conditional logistic regression, and then resorted to propensity score matching. ResultsWe identified 2867 AEEP, 234 RASP, and 1492 OSP procedures. After matching, the risk of pulmonary, renal, infectious, and thromboembolic adverse events was lower after AEEP but not RASP in comparison with OSP (P < 0.05). In comparison with RASP, AEEP had lower cardiac and thromboembolic events (P < 0.05). When compared with OSP, AEEP had reduced odds of Clavien-Dindo grade I (OR = 0.12; 95% CI 0.10 to 0.16) and II (OR = 0.38; 95% CI 0.24 to 9.58) complications. Also, AEEP had lower odds for grade I and II as well as grade IV complications (OR = 0.30; 95% CI 0.19 to 0.48, and OR = 0.05; 95% CI 0.01 to 0.24, respectively) compared with RASP. ConclusionAEEP and RASP were associated with fewer perioperative adverse events, a shorter LOS and a reduced risk of transfusion compared with OSP. AEEP was associated with overall lower complication rates than RASP and OSP.

Level of evidence: 5 [ABSTRACT FROM AUTHOR]

Objective: This study examined bacterial resistance to antibiotics administered for prophylaxis in rectal swaps taken before biopsy in patients who underwent transrectal ultrasound-guided prostate biopsy (TRUS). Materials and Methods: This prospective study evaluated 251 patients who underwent TRUS in the clinic between January 2015 and December 2016. The patients were administered ciprofloxacin one day before the biopsy, the day of the biopsy, and five days after the biopsy. Urinalysis of patients was performed before biopsy and those with active infection were excluded from the study. Swap samples of patients were taken from the rectal mucosa before the biopsy. These samples were cultivated in blood agar and EMB growth medium. E. coli and Klebsiella reproductions were assessed. Antibiogram tests were studied in terms of resistance/sensitivity after identifying these bacterial subgroups. Results: In the comparison of resistance and sensitivity of microorganism-independent antibiotics, the highest resistance was detected in amoxicillin (70%). The resistance to ciprofloxacin was 41.8%. The highest sensitivity was detected for fosfomycin (97.6%) and ceftazidime (91.6%). Extended spectrum beta-lactamase (ESBL) positivity was detected based on the bacterial species (p=0.001). The study found that ESBL positivity did not affect prostatitis development (p=0.447). The study also found that prostatitis development was not based on ciprofloxacin sensitivity/resistance in the rectal swap (p=0.803). A total of 105 patients showed resistance to ciprofloxacin. Prostatitis development was observed in 5 (4.8%) of these patients. Prostatitis development was observed in 11 (4.3%) of 251 patients. Conclusion: According to the results of this study, antibiotic prophylaxis for rectal swab culture taken before TRUS does not affect prostatitis development after the biopsy. Although rectal swap guided goal-oriented prophylaxis does not reduce infective complications, it may be beneficial so as not to administer additional antibiotics to patients. [ABSTRACT FROM AUTHOR]

Purpose: To compare the safety and efficacy of n-butyl cyanoacrylate glue (NBCA) versus microspheres for prostatic artery embolization (PAE) in patients with benign prostatic obstruction (BPO). Materials and Methods: This institutional review board-approved, single-centre, retrospective study included consecutive patients undergoing PAE from September 2017 to July 2020. Age, medical history, previous treatment, pre- and post-PAE prostatic volumes and International Prostate Symptom Scores (IPSSs) were systematically analysed. Procedural duration, dosimetry, immediate and delayed complications were recorded. Patients at the beginning of the study were treated with microspheres and patients at the end of the study with NBCA. The main outcome measures were the absolute and relative changes in IPSS at 3 months. Statistical analyses comprised unpaired t-tests, Wilcoxon tests, Chi-2 tests, uni- and multivariate linear regressions. Results: Sixty-two patients were included (median age: 65.9 years). Thirty-two patients were treated with microspheres and 30 with NBCA. There were no significant baseline differences between the two groups except for the baseline PSA (P = 0.0251). Average procedural and fluoroscopy times, and radiation exposure were significantly lower in the NBCA group versus the microspheres group (80.7 ± 22.5 versus 112 ± 42.1 min [P = 0.0011], 24.2 ± 9.6 min versus 42.1 ± 20.2 min [P = 0.0001], 12,004.6 ± 6702 uGy.m2 versus 25,614.9 ± 15,749.2 uGy.m2 [P = 0.0001], respectively). Immediate complications were all minor, and there were no significant differences between the two groups (4/32 [12.5%] with microspheres versus 7/30 [23.3%] with NBCA, P = 0.4335), nor for delayed complications (P = 1). No association was found between the PAE techniques and the absolute change in IPSS at 3 months (−10.2 ± 7.9 with microspheres versus −9.5 ± 7.6 with NBCA, P = 0.7157). Conclusion: PAE using NBCA was safe and effective for symptomatic BPO, with faster procedures, lower radiation exposure and similar safety and efficacy compared to microspheres. Operator learning curve could have biased the procedural times and radiation exposure between groups favouring NBCA. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of mirabegron in the treatment of erectile dysfunction concomitant with lower urinary tract symptoms in benign prostatic obstruction patients. Methods: In this randomized controlled trial, 55 sexually active lower urinary tract symptoms/benign prostatic obstruction patients with concomitant erectile dysfunction were randomly allocated in two groups: the first received mirabegron 50 mg plus doxazosin 2 mg once daily (mirabegron group) and the second received tolterodine 4 mg plus doxazosin 2 mg (tolterodine group) for 12 weeks. The evaluation was based on the International Index of Erectile Function questionnaire, Erection Hardness Score questionnaire, International Prostate Symptom Score, quality of life, uroflowmetry and post‐voiding residual. The therapeutic outcomes were assessed at 4 and 12 weeks compared with the baseline. Results: Only the mirabegron group achieved significant improvement in sexual functions after 4 and 12 weeks. By using ≥5 points difference from the baseline as a cut‐off point of change, there was a significant difference in change of direction of the International Index of Erectile Function‐15 total score in favor of the mirabegron group; after 12 weeks, the International Index of Erectile Function‐15 total score decreased in 0%, was unchanged in 8.3% and improved in 91.7% in the mirabegron group compared with 8.7%, 65.2% and 26.1%, respectively, in the tolterodine group (P < 0.001). Regarding the urinary characteristics, both groups showed significant improvement in the International Prostate Symptom Score, quality of life, and post‐voiding residual after 4 and 12 weeks, with no significant difference among them. Conclusion: Mirabegron improves urinary characteristics and the associated sexual dysfunction in patients with lower urinary tract symptoms/benign prostatic obstruction. [ABSTRACT FROM AUTHOR]

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Purpose: The present study introduces a modified surgical procedure, extraperitoneal laparoscopic simple prostatectomy (LSP) with urethra preservation using urethral initiation as the entry point, and evaluates its feasibility, safety, and efficacy in the treatment of benign prostatic obstruction (BPO). Materials and methods: A total of 50 patients with BPO underwent modified LSP from January 2018 to December 2020. The main surgical procedures performed were as follows: transversely incision of prostate surgical capsule at the urethral initiation; creating of the subcapsular plane and the space between urethra and adenoma; removal of lobes with preservation of urethra followed by suturing of capsule. Preoperative, perioperative, follow-up parameters, and complications were recorded and analyzed. Results: Operative time was (106.34 ± 28.00) min and intraoperative blood loss was (98.80 ± 130.58) ml. Continuous bladder irrigation (CBI) was not performed routinely, catheterization duration was (5.26 ± 2.99) days, and postoperative hospital stay was (5.42 ± 1.62) days. Significant improvements were observed in functional outcomes, whereas no retrograde ejaculation, urinary incontinence, and urethral stricture occurred. Urethral rupture was not significantly influenced by operative time, intraoperative blood loss, and prostate volume. However, it prolonged CBI duration, drainage tube retention time, catheterization duration, and postoperative hospital stay. Operative time decreased with an increase in the number of cases, and the surgeon achieved proficiency level after handling 21–25 cases. Conclusion: Extraperitoneal LSP with urethra preservation using urethral initiation as the entry point is a feasible, repeatable, safe, and effective surgical procedure, which is suitable for treating BPO. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the safety and feasibility of magnetic resonance imaging (MRI)‐guided transurethral ultrasound ablation (TULSA) for the treatment of benign prostatic obstruction (BPO). Patients and methods: An investigator‐initiated, prospective, registered (NCT03350529), phase I study enrolled men with lower urinary tract symptoms due to benign prostatic hyperplasia in need of surgical intervention. Patients were followed for 12 months after TULSA. Uroflowmetry, prostate‐specific antigen (PSA) level, and a comprehensive set of functional questionnaires including the Expanded Prostate cancer Index Composite‐26, International Prostate Symptom Score (IPSS) and five‐item version of the International Index of Erectile Function were obtained at baseline and every 3 months afterwards. MRI was obtained at baseline, and at 3 and 12 months after TULSA. Medication use before and after TULSA were recorded. Adverse events (AEs) were reported using the Clavien–Dindo classification. Results: A total of 10 men underwent TULSA with no severe AEs encountered. The baseline median (interquartile range [IQR]) age and prostate volume were 68 (63–72) years and 53 (45–66) mL, respectively. At baseline, six patients were moderately symptomatic and four patients severely symptomatic. Nine patients at baseline were on BPO medication. The median (IQR) improvement in the IPSS was 82%, from 17.5 (15.3–23.0) at baseline to 4.0 (2.3–6.3) at 12 months. Similarly, the median maximum urinary flow rate improved by 101%, from a median (IQR) of 12.4 (8.8–17.6) mL/s at baseline to 21.8 (17.6–26.5) mL/s at 12 months. Improvements were already seen at 3 months. The median prostate volume and PSA reduction at 12 months were 33% and 48%, respectively. There were no changes in continence, sexual, erectile or bowel functions. At 12 months, five out of six men with normal ejaculatory function before TULSA reported normal antegrade ejaculations. All patients taking BPO medication before TULSA discontinued medication after TULSA. Conclusion: TULSA appears to be a safe and effective treatment for BPO, with promising 12‐month follow‐up outcomes. Further studies with larger cohorts are needed to confirm the observed results. [ABSTRACT FROM AUTHOR]

Objective: Photoselective vaporization of the prostate (PVP) is a widely performed surgical procedure for benign prostatic obstruction. This approach has become particular favoured for men on anti-platelet and anticoagulation agents such as clopidogrel and warfarin but there is minimal published experience in the setting of novel oral anticoagulants (NOACs). This study was to examine the perioperative outcomes in men on NOACs undergoing PVP, with particular reference to perioperative morbidity. Methods: A retrospective analysis of PVP datasets was undertaken from three centres in Sydney (Australia), Toulouse (France) and Boston (USA). Subjects who had been treated whilst on NOACs without discontinuation or bridging were identified. Perioperative outcomes and treatment parameters were examined and morbidity recorded according to Clavien-Dindo (CD) classification. Results: There were a total of 20 subjects who had undergone PVP whilst NOACs had been continued during the perioperative period. The mean age was 77±6.5 years. The mean prostate volume, energy utilization and vaporisation time was 94±56 mL, 301±211 kJ, and 35±21 min respectively. The mean postoperative duration of catheterization and duration of hospitalization was 2.2±2.4 days and 2.4±2.4 days respectively. There was a single episode of urinary tract infection and four subjects required re-catheterisation for non-hematuric retentions. Conclusions: This study supports the safety of men on NOACs undergoing PVP. Whilst this study represents the largest experience of PVP in these men, larger studies are necessary to confirm the safety of PVP in this group of men undergoing BPH-related surgery.