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Purpose of review: The most definitive treatment for urethral stricture disease is urethroplasty, a procedure that has demonstrated great efficacy and durability in creating a patent urethral lumen. Criteria for success after urethroplasty have evolved over time, now with growing recognition of the importance of the patient experience. Recent Findings: Despite good surgical outcomes, patient reported metrics demonstrate that some patients have persistent urinary symptoms that impact satisfaction rates. Achieving success in patient reported outcomes after urethroplasty may require repeat intervention or addressing alternative etiologies including benign prostatic hypertrophy, overactive bladder, and underactive bladder. Summary: For patients who do not achieve symptom resolution after urethroplasty, evaluation should include addressing common complications, evaluating for recurrence, and consideration and treatment of additional causes of urinary bother. [ABSTRACT FROM AUTHOR]

To examine (i) if depression and anxiety are prospectively associated with subsequent lower urinary tract symptoms (LUTS) and (ii) if LUTS are prospectively associated with subsequent depression. The study is based on data from parous middle-aged women from the Avon Longitudinal Study of Parents and Children. LUTS were assessed using the Bristol Female LUTS Questionnaire and the International Consultation on Incontinence Questionnaire on Female LUTS. Depression was assessed using the Edinburgh Postnatal Depression Scale and anxiety was assessed using the Crown Crisp Experiential Index. We used multivariable logistic regression to examine (i) associations between depression and anxiety at baseline in 2002–04 and subsequent LUTS at follow-up in 2011–2012 (n = 5291) and (ii) associations between LUTS at baseline in 2002–04 and subsequent depression at follow-up in 2010–11 (n = 6147). Analyses were adjusted for age, socioeconomic factors, stressful life events, social support, smoking, weekly alcohol consumption, BMI, physical activity, obstetric/reproductive factors, and menopausal status. We found evidence of prospective associations between depression and subsequent mixed urinary incontinence [odds ratio = 1.97, 95 % confidence interval = 1.16, 3.33], any urinary incontinence [1.68 (1.21, 2.31)], and urgency [1.90 (1.28, 2.83)]. Anxiety was only associated with subsequent nocturia [1.84 (1.04, 3.26)]. Only stress urinary incontinence was associated with subsequent depression [1.37 (1.03, 1.83)]. We find evidence that mental health problems could be contributing factors, as well as consequences, of LUTS. Research is needed to determine if these observed associations are causal and to identify underlying mechanisms. • Bidirectional relationships exist between affective symptoms and urinary incontinence. • Depression was prospectively associated with incontinence at follow-up. • Anxiety was prospectively associated with subsequent nocturia. • Stress UI was associated with subsequent depression at follow up. [ABSTRACT FROM AUTHOR]

BPH is a common urological pathology that affects 2480 per 100,000 men worldwide. With a rising population and increased age expectancy, the prevalence of benign prostatic hyperplasia (BPH) is increasing (Awedew et al. in Lancet Healthy Longev 3(11), 2022). There are many surgical management options for BPH with LUTS, including open simple prostatectomy (OSP), holmium laser enucleation of the prostate (HoLEP), transurethral resection of prostate (TURP), and transurethral electro vaporization of the prostate (TUVP) (Cho et al. in Int Neurourol J 24(1), 2020). However, these options often have a steep learning curve and increasing complexity with larger prostates. Robot-assisted simple prostatectomy (RASP) offers an alternative approach for large and very large glands for those already trained in robotic-assisted radical prostatectomy (RARP), particularly as robotic surgery continues to increase in popularity and is steadily becoming the standard of care in the management of prostate disease (Madersbacher et al. in Gerontology 65(5), 2019). The aim of this study was to demonstrate the surgical outcomes for men undergoing RASP for bothersome LUTs and/or acute urinary retention (AUR) secondary to BPH. A retrospective study was performed which included 105 patients who underwent RASP for the treatment of BPH causing lower urinary tract symptoms or acute urinary retention. This study reviews the pre-operative, (age, PSA, weight, prostate size) operative (duration, histology, estimated blood loss and hospital length of stay) and post-operative (duration of indwelling catheter, trial of void outcome, complications and post-operative PSA) outcomes, to evaluate the effectiveness of RASP for the management of BPH with LUTS. Data were analyzed using standard descriptive measures and multivariate logistic regression for comparison of continuous variables, significance was set to a CI of 95%. The median age of patients was 75 years (IQR 70–78) with a median prostate size of 135.5 cc (IQR 112.25–162.25). Patient demographic and pre-operative LUTS assessments are summarized in Table 1. Median operative time was 60 min (IQR 50–80), estimated blood loss was 350 ml (IQR 200–563), specimen weight was 98.5 g (IQR 69.5–120). Prostate size on imaging directly impacted operative duration (CI 0.07–0.2, p = < 0.001). Eleven (10.5%) of the patients involved in the review had a post-operative complication, two (1.9%) considered major complications Clavien–Dindo grade ≥ 3. There was a statistically increased risk of complications associated with advanced age and prostate size (p = 0.043 and p = 0.001). This study, although limited by its retrospective nature, demonstrates the safety and utility of robotic simple prostatectomy in the context of large and very large prostate volumes. In particular, it offers a safe alternative for men with large prostates who otherwise may not be suitable for endoscopic management. Further prospective and randomized control trials are needed to reinforce the efficacy of RASP to assess its functional and cost effectiveness long term. [ABSTRACT FROM AUTHOR]

Introduction: Mirabegron is available for treatment of overactive bladder (OAB). However, mechanisms underlying symptom improvements and long-term effects on bladder smooth muscle cells are uncertain. Contractility and growth of bladder smooth muscle contribute to OAB, and depend on smooth muscle phenotypes, and on muscarinic receptor expression. Here, we examined prolonged exposure to mirabegron (20–48 h) on phenotype markers, muscarinic receptor expression, and phenotype-dependent functions in human bladder smooth muscle cells (hBSMC). Methods: Expression of markers for contractile (calponin, MYH11) and proliferative (MYH10, vimentin) phenotypes, proliferation (Ki-67), and of muscarinic receptors were assessed by RT-PCR. Proliferation, viability, actin organization and contractions in cultured hBSMC were examined by EdU, CCK-8, phalloidin staining and matrix contraction assays. Results: Calponin-1 mRNA decreased with 100 nM and 150 nM mirabegron applied for 20 h (0.56–0.6 fold of controls). Decreases were resistant to the β3-AR antagonist L-748,337 (0.34–0.55 fold, 100–150 nM, 20 h). After 40 h, decreases occured in the presence of L-748,337, but not without L-748,337. MYH11 mRNA increased with 150 nM mirabegron (40 h, 1.9 fold). This was partly preserved with L-748,337, but not observed after 20 h mirabegron exposure. Vimentin mRNA reduced with 150 nM mirabegron after 20 h, but not after 40 h, with and without L-748,337 (0.71–0.63 fold). MYH10 mRNA expression remained unaffected by mirabegron. Exposure to 150 nM mirabegron increased Ki-67 mRNA after 20 h in the presence of, but not without L-748,337, and after 40 h without, but not with L-748,337. Proliferation rates and actin organization were stable with 50–150 nM mirabegron (24 h, 48 h). Viability increased significantly after mirabegron exposure for 20 h, and by trend after 40 h, which was fully sensitive to L748,337. M2 mRNA was reduced by 20 h mirabegron, which was resistant to L-748,337. Carbachol (3 µM) enhanced time-dependent contractions of hBSMC, which was inhibited by mirabegron (150 nM) in late phases (24 h), but not in early phases of contractions. Conclusion: Mirabegron induces dynamic phenotype alterations and M2 downregulation in hBSMC, which is paralleled by time-shifted anticontractile effects. Phenotype transitions may be involved in improvements of storage symptoms in OAB by mirabegron. [ABSTRACT FROM AUTHOR]

Introduction Urinary incontinence (UI) is a prevalent condition among postmenopausal women, seriously impacting their sexual health and quality of life. In the postmenopausal period, multiple hormonal and structural changes occur in female body. These conditions can lead to psychosomatic disorders, causing shame, social withdrawal, and negatively affecting sexual health. Loss of bladder control creates discomfort during sex, reducing satisfaction for both women and their partners. Management strategies for UI in postmenopausal women include pelvic floor training, medications, and surgical options. Addressing the psychosocial aspects of urinary incontinence through counseling and education is essential for empowering women to seek support. Aim of the study The article discusses urinary incontinence in postmenopausal women, highlighting its impact on sexual health. It discusses the hormonal and physiological changes related to this condition and aims to present effective diagnostic and treatment strategies. Materials and methods We searched the following databases: PubMed, Web of Science, clinical trial registry platforms, and Google Scholar, using key terms such as "urinary incontinence," "postmenopausal women," "sexual health," "lower urinary tract symptoms (LUTS).” Conclusion UI is a serious problem affecting many postmenopausal women. It is crucial to elevate the understanding of both patients and medical staff about diagnosis, effective treatment options, and the importance of mental support. By taking this approach, we can create a healthcare environment that is more informed and compassionate.

BackgroundStudies on lower urinary tract symptoms (LUTS) in women, especially in relation to different modes of delivery, are limited. The relationship between the emergence of LUTS and the decline of pelvic muscle function after childbirth remains uncertain.Study designThis observational study was carried out at the Peking University First Hospital over a time span of 2019–2022. A total of 2,462 women were recruited and surveyed 6 weeks after delivery, utilizing questionnaires for data collection. Additionally, gynecological physical examinations and pelvic floor muscle screenings were conducted as part of the study. To assess individual LUTS and the level of discomfort caused by these symptoms, a modified Chinese version of the Bristol Female Lower Urinary Tract Symptoms questionnaire was employed. Data analysis methods such as descriptive statistics, χ2 tests, one-way ANOVAs, and multivariate logistic regressions were used to thoroughly examine the collected data.ResultsA high prevalence of LUTS was observed in the study participants, with 70.6% experiencing any symptoms. Storage symptoms were reported by 65.4%, while voiding symptoms were reported by 23.0%. Nocturia was the most commonly reported symptom (35.4%), followed by frequency (25.6%) and urgency (25.3%). Stress urinary incontinence (SUI) was reported by 20.8% of women. Interestingly, nocturia and frequency were generally perceived as less troublesome, with only a minority rating them as problematic. In contrast, urinary incontinence (UI) was frequently reported as highly bothersome, with SUI and urge urinary incontinence (UUI) accounting for significant proportions. Vaginal delivery (VD) and forceps delivery (FD) were identified as significant predictors of LUTS, with statistical significance observed (P

Medical management and lifestyle changes rather than surgical interventions, are used for many urological problems. This was also the case in the past. The use of herbal medication for urinary symptoms in the nineteenth century is reviewed as well as the acceptance of herbal medicine at that time. The place of conservative therapy is studied in context of the global management of lower urinary tract symptoms during the nineteenth century. During this time period, lower urinary tract symptoms were still mainly managed with herbal treatments, despite the advances in science and chemistry; anything resembling a modern pharmacopeia postdated the nineteenth century.

With no lysine/K kinases (WNKs) promote vasocontraction and vascular smooth muscle cell proliferation. In the prostate, smooth muscle contraction and growth may be critical for the development and medical treatment of voiding symptoms in benign prostatic hyperplasia. Here, we examined the effects of isoform‐specific WNK silencing and of the WNK inhibitor WNK463 on growth‐related functions and contraction in prostate stromal cells, and in human prostate tissues. Impacts of WNK silencing by transfection of cultured stromal cells with isoform‐specific siRNAs were qualitatively and quantitatively similar for each WNK isoform. Effects of silencing were largest on cell death (3–5 fold increase in annexin V‐positive/7‐AAD‐positive cells), on proliferation rate, Ki‐67 mRNA expression and actin organization (reduced around two‐thirds). Contraction in matrix contraction assays and viability were reduced to a lower degree (approximately half), but again to a similar extent for each WNK isoform. Effects of silencing were quantitatively and qualitatively reproduced by 10 μM WNK463, while 1 μM still induced cell death and breakdown in actin organization, without affecting proliferation or viability. Using 500 nM and 10 μM, WNK463 partly inhibited neurogenic and U46619‐induced contractions of human prostate tissues (around half), while inhibition of α1‐adrenergic contractions (around half) was limited to 10 μM. All four WNK isoforms suppress cell death and promote proliferation in prostate stromal cells. WNK‐driven contraction of stromal cells appears possible, even though to a limited extent. Outcomes of isoform‐specific WNK silencing can be fully reproduced by WNK463, including inhibition of smooth muscle contraction in human prostate tissues, but require high concentrations. [ABSTRACT FROM AUTHOR]

IntroductionMirabegron is available for treatment of overactive bladder (OAB). However, mechanisms underlying symptom improvements and long-term effects on bladder smooth muscle cells are uncertain. Contractility and growth of bladder smooth muscle contribute to OAB, and depend on smooth muscle phenotypes, and on muscarinic receptor expression. Here, we examined prolonged exposure to mirabegron (20–48 h) on phenotype markers, muscarinic receptor expression, and phenotype-dependent functions in human bladder smooth muscle cells (hBSMC).MethodsExpression of markers for contractile (calponin, MYH11) and proliferative (MYH10, vimentin) phenotypes, proliferation (Ki-67), and of muscarinic receptors were assessed by RT-PCR. Proliferation, viability, actin organization and contractions in cultured hBSMC were examined by EdU, CCK-8, phalloidin staining and matrix contraction assays.ResultsCalponin-1 mRNA decreased with 100 nM and 150 nM mirabegron applied for 20 h (0.56–0.6 fold of controls). Decreases were resistant to the β3-AR antagonist L-748,337 (0.34–0.55 fold, 100–150 nM, 20 h). After 40 h, decreases occured in the presence of L-748,337, but not without L-748,337. MYH11 mRNA increased with 150 nM mirabegron (40 h, 1.9 fold). This was partly preserved with L-748,337, but not observed after 20 h mirabegron exposure. Vimentin mRNA reduced with 150 nM mirabegron after 20 h, but not after 40 h, with and without L-748,337 (0.71–0.63 fold). MYH10 mRNA expression remained unaffected by mirabegron. Exposure to 150 nM mirabegron increased Ki-67 mRNA after 20 h in the presence of, but not without L-748,337, and after 40 h without, but not with L-748,337. Proliferation rates and actin organization were stable with 50–150 nM mirabegron (24 h, 48 h). Viability increased significantly after mirabegron exposure for 20 h, and by trend after 40 h, which was fully sensitive to L-748,337. M2 mRNA was reduced by 20 h mirabegron, which was resistant to L-748,337. Carbachol (3 µM) enhanced time-dependent contractions of hBSMC, which was inhibited by mirabegron (150 nM) in late phases (24 h), but not in early phases of contractions.Conclusion: Mirabegron induces dynamic phenotype alterations and M2 downregulation in hBSMC, which is paralleled by time-shifted anticontractile effects. Phenotype transitions may be involved in improvements of storage symptoms in OAB by mirabegron.

Background: Lower urinary tract symptoms (LUTS) are a complex and widespread problem among women, resulting in serious problems in both physical, mental, and social health and occupational activity. Methods: A self-administered survey questionnaire was conducted among 100 women diagnosed with LUTS via Google Forms. Among other things, the level of knowledge and self-assessment of existing knowledge about the condition among affected women and the preventive activities undertaken were assessed. Results: The respondents' level of knowledge varied widely. The average score reached was 66.67% (64.48 ± 24.63%). The study demonstrated that women under 35 years of age (U = 772.5; p = 0.005) and those with higher education (U = 615.5; p < 0.001) had significantly higher levels of knowledge. Conclusions: Women's age and education affect knowledge of incontinence prevention. The common occurrence of lower urinary tract symptoms requires the development of a system of preventive, educational and therapeutic activities. Multilevel cooperation is important to increase the effectiveness of therapy.

Background: Saw palmetto extract (SPE) is one of the most widely used supplements for benign prostatic hyperplasia (BPH) due to its pharmacological effects. ß-sitosterol-enriched saw palmetto oil (VISPO™) contains more than 3% ß-sitosterol and 85% total fatty acids and has been shown to improve symptoms in patients with BPH. Lower urinary tract symptoms (LUTS) require primary preventive measures in countries with accelerated population aging, including Japan. VISPO™ is expected to be effective against the early symptoms of LUTS. However, the effect of VISPO™ on urinary function in healthy individuals has not been elucidated. Objective: This clinical study evaluated the efficacy and tolerability of VISPO™ in the management of urinary complaints among healthy middle-aged and older men who did not require treatment. Methods: We conducted a randomized, double-blind, placebo-controlled trial that included 54 male participants who were assigned to consume VISPO™ or placebo (olive oil) capsules for 12 weeks. Biometric data, uroflowmetry results, and salivary hormone levels were assessed at weeks 1 and 12. Urinary function and quality of life were assessed at weeks 1, 4, 8, and 12 using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Core Lower Urinary Tract Symptom Score (CLSS), and WHOQOL-26. Results: Two-way analysis of variance revealed that IPSS and OABSS were significantly lower in the VISPO™ group that in the placebo group. However, there were no significant differences in urine volume, urinary flow rate, or salivary hormone levels. In addition, no participants reported adverse effects (diarrhea, abdominal pain, etc.). Conclusion: The results of the present study, which is the first randomized controlled trial of VISPO™ conducted among healthy participants, demonstrate the effectiveness of VISPO™ in the management of lower urinary tract complaints that do not require treatment. [ABSTRACT FROM AUTHOR]

Smooth muscle contraction by Pim kinases and ZIPK has been suggested, but evidence for lower urinary tract organs or using Pim-selective inhibitor concentrations is not yet available. Here, we assessed effects of the Pim inhibitors AZD1208 and TCS PIM-1 and the dual ZIPK/Pim inhibitor HS38 on contractions of human prostate and bladder tissues and of porcine interlobar arteries. Human tissues were obtained from radical prostatectomy and radical cystectomy and renal interlobar arteries from pigs. Contractions were studied in an organ bath. Noradrenaline-, phenylephrine- and methoxamine-induced contractions were reduced (up to > 50%) with 500-nM AZD1208 in prostate tissues and to lesser degree and not consistently with all agonists in interlobar arteries. A total of 100-nM AZD1208 or 500-nM TCS PIM-1 did not affect agonist-induced contractions in prostate tissues. Decreases in agonist-induced contractions with 3-µM HS38 in prostate tissues and interlobar arteries were of small extent and did not occur with each agonist. Carbachol-induced contractions in detrusor tissues were unchanged with AZD1208 (500 nM) or HS38. Electric field stimulation–induced contractions were not affected with AZD1208 or HS38 in any tissue, but slightly reduced with 500-nM TCS PIM-1 in prostate tissues. Concentration-dependent effects of Pim inhibitors suggest lacking Pim-driven smooth muscle contraction in the prostate, bladder, and interlobar arteries but point to organ-specific functions of off-targets. Procontractile functions of ZIPK in the prostate and interlobar arteries may be limited and are lacking in the detrusor. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore treatment options for chronic urinary retention (CUR) in men, including complications and consequences. Male patients diagnosed with a non-neurogenic, symptomatic and/or high-risk, CUR > 150 mL were included. Data for treatments, complications, and consequences were recorded and incidence rate ratios (IRRs) calculated. We enrolled 177 patients, most initially received a urethral catheter (74%) and some form of catheterization as final treatment (87%), 49 (28%) underwent de-obstructive prostate surgery. Catheterization was more likely to be stopped after surgery (16/49 patients), compared with non-surgical cases (8/128 patients) (IRR 4.18; p < 0.001). Urinary tract infection (IRR 3.68; p < 0.001) and macroscopic hematuria (IRR 5.35; p < 0.001) were more common with catheterization, but post-renal problems were more likely in patients without catheterization (IRR 25.36; p < 0.001). The lowest complication rate was with clean intermittent catheterization. In conclusion, most patients received catheterization for CUR, with clean intermittent catheterization preferred due to its comparatively lower complication risk. De-obstructive prostate surgery increases the chance of stopping catheterization. [ABSTRACT FROM AUTHOR]

Purpose: Prostate artery embolisation (PAE) is a key treatment for the management of symptomatic benign prostatic hyperplasia (BPH). Common cardiovascular risk factors might be associated with suboptimal outcomes and thus influence patient treatment selection. The aim of the study was to evaluate whether cardiovascular comorbidities affect PAE outcomes. Methods: Retrospective subset analysis of the UK Registry of Prostate Artery Embolisation (UK-ROPE) database was performed with patients who had a full documented past medical histories including hypertension, diabetes, coronary artery disease (CAD), diabetes and smoking status as well as international prostate symptom score (IPSS) at baseline and at 12 months. Multiple regression was performed to assess for any significant predictors. Results: Comorbidity data were available for 100/216 patients (mean age 65.8 ± 6.4 years), baseline IPSS 20.9 ± 7.0). Regression analysis revealed that the presence of hypertension (53.7% IPSS reduction vs. absence 51.4%, p = 0.94), diabetes (52.6% vs. absence 52.1%, p = 0.6), CAD (59.2% vs. absence 51.4%, p = 0.95), no comorbidities (49.8% vs. any comorbidity present 55.3%, p = 0.66), smoking status (non-smoker, 52.6%, current smoker, 61.5%, ex-smoker, 49.8%, p > 0.05), age (p = 0.52) and baseline Qmax (p = 0.41) did not significantly impact IPSS reduction at 12 months post-PAE. Baseline prostate volume significantly influenced IPSS reduction (≥ 80 cc prostates, 58.9% vs. < 80 cc prostates 43.2%, p < 0.05). Conclusion: The presence of cardiovascular comorbidities/smoking history does not appear to significantly impact PAE symptom score outcomes at 12 months post procedure. Our findings suggest that if the prostatic artery can be accessed, then clinical success is comparable to those without cardiovascular comorbidities. [ABSTRACT FROM AUTHOR]

Abstract Background An evaluation of preoperative and postoperative 12th month Pelvic Organ Prolapse Quantification (POP-Q) and Lower Urinary Tract Symptoms (LUTS) changes in patients operated for the diagnosis of isolated anterior compartment defect (ACD) or Stress Urinary Incontinence (SUI). Method Patients who were diagnosed with isolated ACD or SUI were retrospectively analyzed at urogynecology unit of our tertiary referral center. All pelvic examinations were performed by the same experienced urogynecologist. Pre-operative and post-operative 12th month POP-Q scores and the responses to a detailed LUTS questionnaire in the unit were assessed. Results Of the 90 patients with isolated ACD or SUI, midurethral sling with mini-sling and retropubic transobturator tape methods was applied in 24, iliococcygeal fixation in 28, trapezoid repair in 9 patients, anterior bridge operation in 14, and plication of pubocervicovaginal fascia to the cervical ring in 15. We compared the POP-Q score and pre and post-operative 12th month LUTS. Between pre and post-operative 12th month, there was a statistically significant difference at Aa and Ba points (p

Urinary tract cells respond to bladder distension by releasing adenosine triphosphate (ATP). Patients with interstitial cystitis/bladder pain syndrome (IC/BPS) exhibit elevated urinary ATP levels compared to asymptomatic controls. This study aimed to evaluate the potential of urinary ATP as a non-invasive biomarker for IC/BPS and its correlation with symptom severity. We included 56 patients diagnosed with IC/BPS and 50 asymptomatic controls. Urine samples were collected from both groups. Urinary ATP levels were quantified using the luciferin-luciferase bioluminescence method. The severity of IC/BPS symptoms was assessed using the visual analogue score (VAS), Interstitial Cystitis Symptom Index (ICSI), and Interstitial Cystitis Problem Index (ICPI) from the O'Leary-Sant score. We specifically examined the correlation between symptom scores and urinary ATP levels in IC/BPS patients. Urinary ATP levels were significantly higher in IC/BPS patients compared to the control group (P < 0.0001). There was a significant positive correlation between urinary ATP concentrations and VAS, ICPI, and ICSI scores among IC/BPS patients (P < 0.0001). The threshold value for ATP concentration was set at 56.6 nM, with an area under the receiver operating characteristic (ROC) curve of 0.811 (95% CI 0.730 - 0.892). Our findings indicate that IC/BPS patients excrete elevated amounts of ATP in their urine. This suggests that urinary ATP might serve as a non-invasive biomarker for IC/BPS, with a predictive potential in terms of symptom severity.

We aimed to assess the feasibility of developing three-dimensional (3D) models of pelvic organs using cross-sectional MRI images of patients with uterine fibroids and urinary symptoms and of obtaining anatomical information unavailable in 2D imaging modalities. We also aimed to compare two image processing applications. We performed a feasibility study analysing MRI scans from three women, aged 30 to 58 years old, with fibroids and urinary symptoms. Cross-sectional images were used to render 3D models of pelvic anatomy, including bladder, uterus and fibroids, using 3D Slicer and OsiriX. Dimensions, volumes and anatomical relationships of the pelvic organs were evaluated. Comparisons between anatomical landmarks and measurements obtained from the two image processing applications were undertaken. Rendered 3D pelvic models yielded detailed anatomical information and data on spatial relationships that were unobtainable from cross-sectional images. Models were rendered in sufficient resolution to aid understanding of spatial relationships between urinary bladder, uterus and fibroid(s). Measurements of fibroid volumes ranged from 5,336 to 418,012 mm3 and distances between the fibroid and urinary bladder ranged from 0.10 to 83.60 mm. Statistical analysis of measurements showed no significant differences in measurements between the two image processing applications. To date, limited data exist on the use of 3D volume reconstructions of routine MRI scans, to investigate pelvic pathologies such as fibroids in women with urinary symptoms. This study suggests that post-MRI image processing can provide additional information over standard MRI. Further studies are required to assess the role of these data in clinical practice, surgical planning and training. Three-dimensional reconstruction of routine two-dimensional magnetic resonance imaging provides additional anatomical information and may improve our understanding of anatomical relationships, their role in clinical presentations and possibly guide clinical and surgical management. [ABSTRACT FROM AUTHOR]

Tamsulosin is a first-line drug for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Despite its high ratings for efficacy and safety, these parameters may vary due to genetic polymorphisms of CYP2D6 enzyme, which is involved in the metabolism of the drug. This variability may have great impact on the therapy of LUTS associated with BPH and may require an individualized approach to drug selection. The aim of the study was to assess the impact of genetic polymorphisms in CYP2D6 on the efficacy and safety of tamsulosin therapy in patients with LUTS associated with BPH. The study included 106 patients with LUTS/BPH (N40 according to ICD-10). All patients received monotherapy with tamsulosin 0.4 mg/day for at least 8 weeks. Depending on the severity of symptoms, all patients were divided into 2 groups based on the IPSS score: the first group of patients had moderate symptoms (n=57), and the second group of patients had severe symptoms (n=49). The results of treatment were assessed using the IPSS questionnaire with determination of quality of life (QoL), transrectal ultrasound of the prostate with determination of prostate volume and postvoid residual urine volume, and uroflowmetry. The carriage of allelic variants of CYP2D6 (*3, *4, *9, *10, and *41) were determined by polymerase chain reaction in all patients. In patients with moderate symptoms who was classified as «intermediate» metabolizers by CYP2D6, a statistically significant greater reduction in symptoms according to the overall IPSS scale at 8 weeks (p=0.046) and the obstructive symptom subscale starting from 4 weeks of treatment (p<0.05) was shown. Allelic variants of the CYP2D6 gene did not affect the frequency of adverse reactions to tamsulosin. The results of the study show that in patients with moderate LUTS associated with BPH who are «intermediate» metabolizers by CYP2D6, there is a better therapeutic effect of tamsulosin. [ABSTRACT FROM AUTHOR]

Background: Phospholipases A2 (PLA2) may be involved in α1‐adrenergic contraction by formation of thromboxane A2 in different smooth muscle types. However, whether this mechanism occurs with α1‐adrenergic contractions of the prostate, is still unknown. While α1‐adrenoceptor antagonists are the first line option for medical treatment of voiding symptoms in benign prostatic hyperplasia (BPH), improvements are limited, probably by nonadrenergic contractions including thromboxane A2. Here, we examined effects of PLA2 inhibitors on contractions of human prostate tissues. Methods: Prostate tissues were obtained from radical prostatectomy. Contractions were induced by electric field stimulation (EFS) and by α1‐adrenergic agonists in an organ bath, after application of the cytosolic PLA2 inhibitors ASB14780 and AACOCF3, the secretory PLA2 inhibitor YM26734, the leukotriene receptor antagonist montelukast, or of solvent to controls. Results: Frequency‐dependent contractions of human prostate tissues induced by EFS were inhibited by 25% at 8 Hz, 38% at 16 Hz and 37% at 32 Hz by ASB14780 (1 µM), and by 32% at 16 Hz and 22% at 32 Hz by AACOCF3 (10 µM). None of both inhibitors affected contractions induced by noradrenaline, phenylephrine or methoxamine. YM26734 (3 µM) and montelukast (0.3 and 1 µM) neither affected EFS‐induced contractions, nor contractions by α1‐adrenergic agonists, while all contractions were substantially inhibited by silodosin (100 nM). Conclusions: Our findings suggest presynaptic PLA2 functions in prostate smooth muscle contraction, while contractions induced by α1‐adrenergic agonists occur PLA2‐independent. Lacking sensitivity to montelukast excludes an involvement of PLA2‐derived leukotrienes in promotion of contractile neurotransmission. [ABSTRACT FROM AUTHOR]

Background: An evaluation of preoperative and postoperative 12th month Pelvic Organ Prolapse Quantification (POP-Q) and Lower Urinary Tract Symptoms (LUTS) changes in patients operated for the diagnosis of isolated anterior compartment defect (ACD) or Stress Urinary Incontinence (SUI). Method: Patients who were diagnosed with isolated ACD or SUI were retrospectively analyzed at urogynecology unit of our tertiary referral center. All pelvic examinations were performed by the same experienced urogynecologist. Pre-operative and post-operative 12th month POP-Q scores and the responses to a detailed LUTS questionnaire in the unit were assessed. Results: Of the 90 patients with isolated ACD or SUI, midurethral sling with mini-sling and retropubic transobturator tape methods was applied in 24, iliococcygeal fixation in 28, trapezoid repair in 9 patients, anterior bridge operation in 14, and plication of pubocervicovaginal fascia to the cervical ring in 15. We compared the POP-Q score and pre and post-operative 12th month LUTS. Between pre and post-operative 12th month, there was a statistically significant difference at Aa and Ba points (p < 0.00, 0.001). Comparative LUTS questionnaire showed statistically significant differences in stress urinary incontinence, frequency, urgency, abnormal emptying, nocturia, pelvic pain (p: <0.001, p < 0.001, p: <0.001, p:0.001, p:<0.001, p:0.003, respectively). Conclusion: Anatomical and symptomatic recovery is achieved with appropriate surgical intervention in women with isolated ACD or SUI. When LUTS were evaluated in terms of symptomatic recovery, they were found to be related not only to symptoms involving the anterior compartment, but also to symptoms involving other compartments. [ABSTRACT FROM AUTHOR]

How can nurses assess the self‐management of lower urinary tract symptoms (LUTS) in patients with cancer after radical prostatectomy (RP)? Patients with prostate cancer who have undergone RP experience multiple LUTS. This study aimed to develop a self‐management scale for LUTS in patients with cancer following RP (SMS‐LUTS‐RP), as well as to verify its reliability and validity. LUTS has physical, social, and psychological consequences for patients. As a result, patients are forced to self‐manage their LUTS and LUTS‐related issues. However, no indicators exist to assess self‐management of LUTS. A total of 246 individuals were surveyed. A 49‐item scale draft, whose content validity and face validity were confirmed, was used to develop a questionnaire for patients with LUTS after RP. The reliability and validity were determined using by item analysis, exploratory factor analysis, confirmatory factor analysis, and Cronbach's α coefficient. The exploratory factor analysis produced the following 18 items on five extracted factors: 'monitoring of urinary status,' 'coping with daily life difficulties due to LUTS,' 'collaboration with medical professionals,' 'continued training to improve LUTS,' and 'living with LUTS.' The goodness‐of‐fit‐index (GFI) for confirmatory factor analysis was 0.876, and the root mean square error of approximation was 0.075. Cronbach's α coefficient was 0.754–0.820. SMS‐LUTS‐RP has desirable psychometric properties and can assess the cognitive and behavioural aspects of self‐management of LUTS in patients with cancer who have undergone a RP. This scale can be used to provide individualized self‐management support according to living conditions. [ABSTRACT FROM AUTHOR]

Abstract Background To compare the efficacy and safety of bipolar transurethral vaporization of the prostate (B-TUVP) with holmium laser enucleation of the prostate (HoLEP) for moderate [prostate volume (PV) 30–80 ml] and large (≥ 80 ml) benign prostatic enlargement (BPE). Materials and methods Male patients with lower urinary tract symptom (LUTS) or urinary retention who underwent B-TUVP or HoLEP treatment in two regional centers were respectively enrolled. Patient characteristics and treatment outcomes were retrospectively compared between B-TUVP and HoLEP. Results In patients with moderate and large prostate volume,B-TUVP showed shorter operative time (P 80 ml.(P 80 ml.(P=0.08) The Incidence of postoperative stress incontinence(SUI) was higher in HoLEP than in B-TUVP for patients with moderate and large prostate volume. Conclusions There are few studies that investigated the short-term efficacy and safety of second-generation B-TUVP in comparison with HoLEP for moderate and large BPE. Improvement in LUTS and achievement of catheter-free status were predominant in HoLEP, and these outcomes were more prominent in patients with large BPE of PV > 80 ml. However, B-TUVP resulted in less blood loss, shorter operative duration, and less SUI suggesting that B-TUVP is also well-tolerated surgical modality.

Background: NUAKs promote myosin light chain phosphorlyation, actin organization, proliferation and suppression of cell death in non-muscle cells, which are critical for smooth muscle contraction and growth. In benign prostatic hyperplasia (BPH), contraction and growth in the prostate drive urethral obstruction and voiding symptoms. However, a role of NUAKs in smooth muscle contraction or prostate functions are unknown. Here, we examined effects of NUAK silencing and the presumed NUAK inhibitors, HTH01-015 and WZ4003 on contraction and growth-related functions in prostate stromal cells (WPMY-1) and in human prostate tissues. Methods: Effects of NUAK1 and -2 silencing, HTH01-015 and WZ4003 on matrix plug contraction, proliferation (EdU assay, Ki-67 mRNA), apoptosis and cell death (flowcytometry), viability (CCK-8) and actin organization (phalloidin staining) were examined in cultured WPMY-1 cells. Effects of HTH01-015 and WZ4003 on smooth muscle contraction were assessed in organ bath experirments with human prostate tissues. Results: Effects of silencing were most pronounced on proliferation and cell death, resulting in decreases of proliferation rate by 60% and 70% by silencing of NUAK1 and NUAK2 (compared to scramble siRNA-transfected controls), decreases in Ki-67 by 75% and 77%, while numbers of dead cells after silencing of NUAK1 and NUAK2 amounted to 2.8 and 4.9 fold of scramble-transfected controls. Silencing of each isoform was paralleled by reduced viability, breakdown in actin polymerization, and partial decreases in contractility (maximally 45% by NUAK1 silencing, 58% by NUAK2 silencing). Effects of silencing were mimicked by HTH01-015 and WZ4003, with numbers of dead cells amounting up to 16.1 fold or 7.8 fold with HTH01-015 or WZ4003, compared to solvent-treated controls. Using concentrations of 500 nM, neurogenic contractions of prostate tissues were inhibited partly by HTH01-015 and U46619-induced contractions were inhibited partly by HTH01-015 and WZ4003, while α1-adrenergic and endothelin-1-induced contractions remained unaffected. Using 10 μM, inhibition of endothelin-1-induced contractions by both inhibitors and inhibition of α1-adrenergic contractions by HTH01-015 added to effects seen by 500 nM. Conclusion: NUAK1 and -2 suppress cell death and promote proliferation in prostate stromal cells. A role in stromal hyperplasia appears possible in BPH. Effects of NUAK silencing are mimicked by HTH01-015 and WZ4003. [ABSTRACT FROM AUTHOR]

This review summarises the presentations during a workshop session entitled “The Use of Soluble Guanylate Cyclase Activators to Treat Benign Prostatic Hyperplasia, Obstruction and Fibrosis – Mechanistic Concepts and Clinical Implications” at the International Continence Society (ICS) 2021 Melbourne Virtual meeting. Benign prostatic hyperplasia (BPH) is a highly prevalent condition that can result in bladder outflow obstruction (BOO) and development of lower urinary tract symptoms (LUTS), and by 80 years of age is present in about 75% of men. Current pharmacological therapies include α-adrenoceptor antagonists, 5α-reductase inhibitors, and the phosphodiesterase type 5 (PDE5) inhibitor, tadalafil. The efficacy of tadalafil suggests a role for nitric oxide (NO•) through activation of soluble guanylate cyclase (sGC) and production of cyclic guanosine 3’5’-monophosphate (cGMP), a cyclic nucleotide that relaxes smooth muscle, reduces neurotransmitter release and also acts as an antifibrotic agent. Patient refractoriness to tadalafil may be, for example, due to sGC inactivation due to oxidative stress. The workshop discussed the superiority of cinaciguat, an sGC activator that functions even when the enzyme is oxidised, over PDE5 inhibitors, and potentially its use in combination with agents that reduce formation of reactive oxygen species.

Background: To compare the efficacy and safety of bipolar transurethral vaporization of the prostate (B-TUVP) with holmium laser enucleation of the prostate (HoLEP) for moderate [prostate volume (PV) 30–80 ml] and large (≥ 80 ml) benign prostatic enlargement (BPE). Materials and methods: Male patients with lower urinary tract symptom (LUTS) or urinary retention who underwent B-TUVP or HoLEP treatment in two regional centers were respectively enrolled. Patient characteristics and treatment outcomes were retrospectively compared between B-TUVP and HoLEP. Results: In patients with moderate and large prostate volume,B-TUVP showed shorter operative time (P < 0.001) and less hemoglobin decrease (P < 0.001) than in HoLEP. In uncatheterised patients, voiding symptoms and patients' quality of life improved after B-TUVP and HoLEP, but these improvement rates were consistently bigger in HoLEP than in B-TUVP. In catheterised patients, the rate of achieving catheter-free status after surgery was higher in HoLEP than in B-TUVP for patients with PV > 80 ml.(P < 0.001) The incidence of postoperative fever was higher in B-TUVP than in HoLEP for patients with PV 30–80 ml (P < 0.001) but not for those with PV > 80 ml.(P=0.08) The Incidence of postoperative stress incontinence(SUI) was higher in HoLEP than in B-TUVP for patients with moderate and large prostate volume. Conclusions: There are few studies that investigated the short-term efficacy and safety of second-generation B-TUVP in comparison with HoLEP for moderate and large BPE. Improvement in LUTS and achievement of catheter-free status were predominant in HoLEP, and these outcomes were more prominent in patients with large BPE of PV > 80 ml. However, B-TUVP resulted in less blood loss, shorter operative duration, and less SUI suggesting that B-TUVP is also well-tolerated surgical modality. [ABSTRACT FROM AUTHOR]

Interstitial cystitis is a disease of de bladder. At cystoscopy typical signs of inflammation can be seen, the so called Hunner lesions. Symptoms are high frequency voiding and pain or discomfort felt in the region of the bladder and urethra when the bladder fills. There is no curative treatment. Fulguration of Hunner lesions can give a temporarily relief. In the end fibrosis of the bladder can lead to a cripple bladder with hampered bladder capacity and sometimes secondary hydronephrosis. For a long time this diagnosis was mixed up with bladder pain syndrome because of same symptoms. We now consider IC as a distinct phenotype. The etiology of IC is most probably due to a disorder in the immune system. [ABSTRACT FROM AUTHOR]

We aimed to review the current evidence on surgical and functional outcomes of Transperineal Laser Ablation for LUTS due to BPH. A comprehensive review of the English-language literature was performed using the MEDLINE and Web of Science databases until 1 August 2022, aiming to select studies evaluating TPLA for the treatment of LUTS due to BPH. Additional records were found from Google Scholar. Data were extracted and summarized in Tables. An appropriate form was used for qualitative data synthesis. Seven studies were included in the review, with all being single arm, non-comparative studies. In all studies, functional outcomes were evaluated with uroflowmetry parameters and validated questionnaires, showing a promising effectiveness at short- and mid-term follow-up. There is a lack of standardized pathways for preoperative assessment of patients suitable for TPLA, and even the technique itself has been reported with a few nuances. A good safety profile has been reported by all the authors. Although promising results have been reported by different groups, selection criteria for TPLA and few technical nuances regarding the procedure were found to be heterogeneous across the published series that should be standardized in the future. Further research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives: To compare the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) and bipolar palsmakinetic enucleation of the prostate (BPEP) for patients with benign prostatic hyperplasia (BPH) and prostate volumes 50-120 mL. Methods: a total of 52 patients were prospectively randomized and enrolled in this study at Zagazig university hospitals. All patients were preoperatively evaluated using prostate volume measurement, the International Prostate Symptom Scores (IPSS) questionnaire, a quality-of-life (QoL) questionnaire and international index for erectile function-5 (IIEF-5). Measurement of maximum urinary flow rate (Qmax), post-void residual urine volume (PVR) and blood sample analysis for determination of prostate-specific antigen (PSA) and haemoglobin concentration. Patients were evaluated peri-operatively and postoperatively at 1, 3, 6 and 12 months with documentation of any complication. Results: Of 52 patients enrolled in this study, 47 patients completed 12 months of follow-up. There were statistically insignificant differences between both groups regarding the preoperative and intraoperative data. Perioperatively, bleeding, need for blood transfusion and hemoglobin drop were higher in the HoLEP group. There were no statistically significant differences in the post-operative follow-up data between both groups. Conclusion: In terms of surgical safety and efficacy BPEP is comparable to HoLEP for moderately to markedly enlarged prostates, with indication for surgical intervention. [ABSTRACT FROM AUTHOR]

Polypoid cystitis is a rare benign exophytic lesion affecting the bladder mucosa that clinically and radiologically resembles urothelial carcinoma. An adequate diagnosis of this pathology requires histological evaluation. Owing to the rare occurrence of this benign urinary bladder lesion, its prevalence is under-reported, with very few cases reported. Here, we report a case of polypoid cystitis in a young Indian female, who presented to the urology department with obstructive LUTS and a history of catheterization for urinary retention. The patient was evaluated and found to have a usual bladder mass that was clinically and radiologically suspected to be a carcinoma bladder, so TURBT of the mass was performed. The mass was completely resected and sent for HPE, which revealed features of polypoid cystitis. Polypoid cystitis should be considered in the differential diagnosis of urinary bladder masses presenting at a younger age with a history of dysuria, LUTS, multiple catheterizations for retention of urine along with no history of hematuria and negative familial history for carcinoma. One of the common factors in all cases of polypoid cystitis is a history of long-standing catheterization, which might predispose patients to such a benign lesion or vice versa. Adequate histopathological evaluation of these benign lesions is crucial for accurate diagnosis. Therefore, in young female/males without a familial history of bladder carcinoma or environmental carcinogen exposure, benign bladder lesions should be suspected first rather than malignant lesions, although malignant lesions of the bladder are far more common than benign lesions. • This is an usual presentation of benign bladder lesion which is itself unusual. • Clinical and radiological presentation of the case suggests of malignant lesion but turns out to be benign lesion. • Polypoidal cystitis can become aggressive and obstructive. • Its presentation in the young age group, females and with urethral involvement is uncommon. • Though benign but may require aggressive resection and treatment. [ABSTRACT FROM AUTHOR]

Purpose: Because of many unanswered questions regarding men's health, a literature review was performed to better understand the role of testosterone and testosterone replacement therapy (TRT) in the management of hypogonadism and aging related prostate gland diseases (ARPGD) including prostate cancer (PCa) and benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Methods: The PubMed database was screened for pertinent peer reviewed articles published during the last four decades that culminated in the positions and recommendations in this paper. Results: Hypogonadism seriously impacts men's health, and the diagnosis remains controversial. The incidence of ARPGD is projected to increase worldwide and treatment still has significant limitations. There is compelling evidence that lower, not higher, testosterone levels trigger the development of PCa and BPH through androgen receptor over-expression. TRT was found to be safe and effective in treating hypogonadism including in PCa survivors and those harboring PCa. There is also evidence that TRT might reduce the incidence and prevalence of ARPGD. Conclusions and recommendations: This review synthesizes a wide-ranging compendium of basic science and clinical research that strongly encourages altering the present approach to diagnosing and treating men with hypogonadism and ARPGD. These findings underscore the importance of avoiding significant testosterone decline and support the use of TRT. Ten recommendations are offered as a framework for the way forward. It is now time for clinicians, payers, researchers, funding agencies, professional associations, and patient advocacy groups to embrace this new paradigm to increase longevity and improve the quality of life. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is an increasingly common pathology in the adult male. BPH increases after the age of 40-45 years, and its management consumes an enormous amount of resources. The UroLift® System is an approved technology designed to treat lower urinary tract symptoms (LUTS) secondary to BPH and is used to perform the prostatic urethral lift (PUL) procedure. Various urology specialists in Spain with experience in PUL have prepared this consensus document. Endorsed by the Spanish Urology Association, its information is based on the most recent findings. The main objective of this document is to disseminate the consensus recommendations among all professionals treating patients with LUTS/BPH. Both primary care physicians and urologists can assess and offer PUL as an effective, minimally invasive treatment., (Copyright © 2024 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

BPH is a common urological pathology that affects 2480 per 100,000 men worldwide. With a rising population and increased age expectancy, the prevalence of benign prostatic hyperplasia (BPH) is increasing (Awedew et al. in Lancet Healthy Longev 3(11), 2022). There are many surgical management options for BPH with LUTS, including open simple prostatectomy (OSP), holmium laser enucleation of the prostate (HoLEP), transurethral resection of prostate (TURP), and transurethral electro vaporization of the prostate (TUVP) (Cho et al. in Int Neurourol J 24(1), 2020). However, these options often have a steep learning curve and increasing complexity with larger prostates. Robot-assisted simple prostatectomy (RASP) offers an alternative approach for large and very large glands for those already trained in robotic-assisted radical prostatectomy (RARP), particularly as robotic surgery continues to increase in popularity and is steadily becoming the standard of care in the management of prostate disease (Madersbacher et al. in Gerontology 65(5), 2019). The aim of this study was to demonstrate the surgical outcomes for men undergoing RASP for bothersome LUTs and/or acute urinary retention (AUR) secondary to BPH. A retrospective study was performed which included 105 patients who underwent RASP for the treatment of BPH causing lower urinary tract symptoms or acute urinary retention. This study reviews the pre-operative, (age, PSA, weight, prostate size) operative (duration, histology, estimated blood loss and hospital length of stay) and post-operative (duration of indwelling catheter, trial of void outcome, complications and post-operative PSA) outcomes, to evaluate the effectiveness of RASP for the management of BPH with LUTS. Data were analyzed using standard descriptive measures and multivariate logistic regression for comparison of continuous variables, significance was set to a CI of 95%. The median age of patients was 75 years (IQR 70-78) with a median prostate size of 135.5 cc (IQR 112.25-162.25). Patient demographic and pre-operative LUTS assessments are summarized in Table 1. Median operative time was 60 min (IQR 50-80), estimated blood loss was 350 ml (IQR 200-563), specimen weight was 98.5 g (IQR 69.5-120). Prostate size on imaging directly impacted operative duration (CI 0.07-0.2, p =  < 0.001). Eleven (10.5%) of the patients involved in the review had a post-operative complication, two (1.9%) considered major complications Clavien-Dindo grade ≥ 3. There was a statistically increased risk of complications associated with advanced age and prostate size (p = 0.043 and p = 0.001). This study, although limited by its retrospective nature, demonstrates the safety and utility of robotic simple prostatectomy in the context of large and very large prostate volumes. In particular, it offers a safe alternative for men with large prostates who otherwise may not be suitable for endoscopic management. Further prospective and randomized control trials are needed to reinforce the efficacy of RASP to assess its functional and cost effectiveness long term., Competing Interests: Declarations. Conflict of interest: In addition, the authors have no relevant financial or non-financial interests to disclose. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was given by SA Health Central Adelaide Local Health Network HREC, approval number 18842., (© 2024. Crown.)

Background Lower urinary tract symptoms (LUTS) refer to a group of symptoms related to the storage and voiding of urine that comprises storage, voiding, and post-micturition symptoms affecting the lower urinary tract, and the prevalence in men in our society is on the rise as a result of an increase in the life expectancy. This study investigates the relationship between lifestyle, health factors, and severity of LUTS amongst men living in the southeastern part of Nigeria. Method A cross-sectional study of 389 men aged 42-96 years was conducted. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Health factors such as diabetes mellitus, hypertension, age, prostate volume, prostate-specific antigen, body mass index, and others were examined using the chi-square test. Results Out of the 389 participants enrolled in the study, the mean age was 69.21 ± 9.683 years. Nocturia was the most reported symptom in 337 participants. Over half of the respondents (212) experienced severe symptoms, while 152 (39.1%) reported moderate issues, and 25 (6.4%) had mild symptoms. Mean values were as follows: prostate volume of 69.62 ± 34.82 g, post-void residual urine of 52.72 ± 14.96 mL, and prostate-specific antigen (PSA) of 23.42 ± 28.78 ng/mL. Using the chi-square test, significant associations were found between LUTS severity and age (x 2 =37.454; p≤0.001), diet (x 2 =16.341; p=0.003), BMI (x 2 =21.152; p=0.002), diabetes mellitus (x 2 =7.690; p=0.021), prostate volume (x 2 =22.001; p≤0.001), and post-void residual urine (x 2 =10.779; p=0.005). Conclusion This study highlights the importance of socio-demographic characteristics, lifestyle factors, and clinical parameters in predicting LUTS severity. These findings can inform prevention and management strategies for LUTS., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Health Research Ethics Committee of Federal Teaching Hospital Owerri issued approval FTH/OW/HREC/185. The Health Research Ethics Committee has reviewed your proposal on the "Relationship Between Lifestyle, Health Factors, and Severity of Lower Urinary Tract Symptoms Amongst Men Living in Southeast Nigeria." I am pleased to inform you that ethical approval has been granted for the conduct of your research. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chineme-Anyaeze et al.)

Background: Surgical management options for lower urinary tract symptoms due to benign prostatic hypertension have remained limited in prostates of large volume. The advent of the Aquablation has created a potential minimally invasive option for treatment in prostates of all volumes. Thus, this study aims to evaluate outcomes and complications of Aquablation in clinical practice based on prostate volume., Methods: Collected variables included adverse events with Clavien-Dindo classifications, transfusion rates, surgical retreatment rates, continued medication use postoperatively, and International Prostate Symptom Score (IPSS) with Quality-of-Life indicator. Aquablations were stratified by preoperative prostate volume., Results: One hundred seventy-four men were included in the study. The average postop decrease in IPSS was 10.28, with a 2.02 point decrease in Quality-of-Life at 1 year. Postop increase in peak urinary flow rate was 7.65 mL/s for an average of 16.44 mL/s. Hemoglobin drop average was 1.78 g/dL, but only 2.3% of patients required a transfusion. 12.9% of patients required surgical retreatment. Six months after Aquablation, 22.9% and 12.9% of patients continued taking Alpha-blockers and Androgen receptor inhibitors, respectively. Adverse events occurred in 33 patients (19.0%). Eighteen patients were excluded from secondary analysis due to unrecorded prostate volume, leaving 123 with volumes <150 mL and 33 with volumes ≥150 mL. Groups were comparable with respect to length of stay, adverse events, blood transfusion, IPSS with Quality-of-Life indicator preoperative and postoperative, postop peak urinary flow, and postop alpha-blocker use. Larger prostates had a higher rate of adverse events, retreatment, postop hemoglobin drop, and postop use of finasteride., Conclusions: Aquablation is a viable treatment option for benign prostatic hyperplasia. Efficacy, safety, subjective outcomes, and adverse event rates were not impacted by prostate volume. However, size does matter as prostates ≥150 mL had higher surgical retreatment rates and postop finasteride use., (© 2024 Wiley Periodicals LLC.)

Background Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths worldwide. Serum psa, a glycoprotein and a serine protease, which is increased in all prostatic diseases but markedly elevated levels are indicative of carcinoma prostate. The present study was done to evaluate the histopathologyof carcinoma of prostate in trus guided prostatic biopsy specimens and correlate serum psa levels with gleason score and grade groups. Methods A hundred patients presented with luts and suspicious of carcinoma prostate underwent trus guided 16 core prostatic biopsy. Histopathological examination, gleason scores and grades of biopsies were obtained. Based on the gleason scores, patients with carcinoma of the prostate were divided into five-grade groups. Mean serum psa levels were calculated and correlated with gleason score and grade groups. Results Malignancy was found in 69 per cent of cases, of which 68 patients were found to have adenocarcinoma of the prostate, one patient found to have undifferentiated carcinoma of the prostate. The total number of patients in each gleason grade groups were obtained, and the mean serum psa levels of these patients in each group were calculated. Mean serum psa levels in each group are group 1 (21.3 ng/ml), group 2 (58.4 ng/ml), group 3 (73.6 ng/ml), group 4 (118.4 ng/ml), group 5 (96.3 ng/ml). Conclusion Serum psa is a highly sensitive tumour marker with low specificity, and its levels are increased in many benign and iatrogenic conditions. Psa has a high negative predictive value which is essential in ruling out malignancy. In our study, higher serum psa levels were correlated with higher gleason score and grades.

Background: Lower urinary tract symptoms (LUTS) are common non-motor symptoms but are often overlooked in Parkinson's disease (PD). The prevalence of LUTS in PD is inconsistent among diffierent studies. Objective: To estimate the prevalence of LUTS, urinary incontinence, and urinary retention in PD patients, then, investigate potential sources of inconsistency in prevalence estimation. Methods: We searched PubMed, EMBASE, and Web of Science databases from inception to May 2022. Studies reporting the prevalence of LUTS or LUTS subtypes in PD were included. Pooled prevalence of LUTS, LUTS subtypes, urinary incontinence, and urinary retention was calculated via random-effects models. Meta-regression and subgroup analyses were performed. Results: Of 7,358 studies after duplicate removal, a total of 73 studies comprising 14,937 PD patients were included. The pooled prevalence of LUTS was 61% (95% CI 53-69; 27 studies; n = 5,179), while the pooled prevalence of storage symptoms and voiding symptoms was 59% (44-73; 9 studies; n = 798) and 24% (14-33; 11 studies; n = 886), respectively. The pooled prevalence of urinary incontinence, retention and post-void residual (PVR) volume ≥ 100ml were 30% (95% CI 22-39; 21 studies; n = 6,054), 27% (17-37; 14 studies; n = 1,991), and 4% (1-7; 5 studies; n = 439), respectively. The prevalence of LUTS, urinary incontinence, or urinary retention was significantly associated with diagnostic methods. Conclusion: LUTS and its subtypes present in a significant proportion of PD patients. It is necessary to use standardized and validated methods to detect and screen LUTS and its subtypes. [ABSTRACT FROM AUTHOR]

Purpose: Assess long-term outcomes of prostatic artery embolization (PAE) for patients with benign prostatic hyperplasia (BPH). Materials and Methods: Single centre retrospective study from 2009–2019 including 1072 patients who received PAE and had available follow-up. Patients were evaluated yearly at 1–10 years post PAE using the International Prostate Symptom Score (IPSS) and quality of life (QoL), prostate volume (PV), prostate-specific antigen (PSA), peak urinary flow rate (Qmax) and postvoid residual (PVR) volume. The need for prostatic medication, re-intervention rates, repeat PAE and prostatectomy rates were assessed with Kaplan–Meier survival analysis and compared between different embolic agents using Cox regression analysis. Results: Mean follow-up time was 4.39 ± 2.37 years. At last follow-up visit, mean IPSS and QoL improvements were − 10.14 ± 8.34 (p <.0001) and − 1.87 ± 1.48 (p <.0001) points, mean PV reduction was − 6.82 ± 41.11 cm3 (p = 0.7779), mean PSA reduction was − 1.12 ± 4.60 ng/mL (p = 0.9713), mean Qmax increase was 2.72 ± 6.38 mL/s (p = 0.0005), mean PVR reduction was − 8.35 ± 135.75 mL (p = 0.6786). There were 335 patients (31.3%) needing prostatic medication after PAE. Re-intervention rates were 3.4% at 1 year, 21.1% at 5 years and 58.1% at 10 years. Repeat-PAE rates were 2.3% at 1 year, 9.5% at 5 years and 23.1% at 10 years. Prostatectomy rates were 1.1% at 1 year, 11.6% at 5 years and 35.0% at 10 years. No significant differences were found between polyvinyl alcohol particles, Bead Block, Embospheres and Embozenes. Conclusion: PAE induces durable long-term LUTS relief, with re-intervention rates of 20% in the first 5 years and 30%–60% > 5 years post-PAE. [ABSTRACT FROM AUTHOR]

The increasing incidence of urinary bladder carcinoma is alarming. Approximately seventy percent of these patients are non-muscle invasive bladder cancer (NMIBC). Restage transurethral resection of bladder tumor (TURBT) is the current recommendation for any T1 and or high-grade non muscle invasive bladder cancers (NMIBC) to accurately stage the malignancy. The question whether a second surgery is always required as a restage procedure is still unanswered. The patient's concern about completeness, morbidity, and financial considerations of a major surgery cannot be overlooked. Moreover, it also puts a strain on the already overburdened healthcare system. To answer this question, whether it is oncologically sound to omit a second resection, the current study evaluated the outcomes of patients undergoing restage TURBT, and analyzed the preoperative factors predicting a change in the staging of this malignancy. The study design was a prospective observational including NMIBC patients from September 2018 to February 2020. A total of 72 patients underwent restage TURBT. Their demographic data, imaging and cystoscopic findings, and histopathological data were recorded. The objective was to study the clinico-pathological correlations and factors predicting recurrence and upstaging of tumor in NMIBC patients undergoing restage TURBT. A total of 101 patients were found eligible for restage TURBT. Eventually, 72 underwent restage TURBT. Twelve (16.7%) patient had recurrence at restage while 3(4.16%) were upstaged to T2. Presence of lower urinary tract symptoms (LUTS) was independently associated with the risk of recurrence of same stage compared to no recurrence (p-0.025, OR-8.793, 95% CI-1.316–98.773). Chemical exposure (p-0.042) was also significantly associated with the same. Presence of lymphadenopathy on CT was independently associated with the risk of upstaging compared to no recurrence (p-0.032, OR-18.25, 95% CI-1.292–257.85). The study concluded that in the presence of a well-performed and adequate initial TURBT, restage TURBT could be skipped for further management. However, in small subgroup of patients with lymphadenopathy on preoperative imaging having a higher risk of tumor recurrence and upstaging, and patients with a history of chemical exposure and previous lower urinary tract symptoms having a high risk of recurrence alone, restage TURBT should still be performed to accurately stage the disease. Further studies with large patient cohort are needed to confirm and reinforce the facts proposed. [ABSTRACT FROM AUTHOR]