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Introduction: BPH/male LUTS is a prevalent condition in the aging male population with multifactorial pathophysiology. Pharmacotherapy remains the cornerstone of treatment in patients who fail conservative treatment. 5-α-Reductase inhibitors (5-ARIs) are the only class of medication shown to reduce the risk of acute retention and BPH-related surgery and, thus, are commonly used along with other "short acting" medications in combination treatments. Areas covered: Combination treatments with α-blockers and 5-ARIs have been investigated extensively in high quality trials that prove the long-term efficacy of such treatments with acceptable rates of side effects. Combination treatments involving 5-ARIs and other classes of medications (anticholinergics, b3 agonists, PDEI) have been shown to be beneficial in the short term and but studies with longer follow-up periods are required to fully establish their role. Expert opinion: A-blocker/5-ARI combination treatment is a reasonable approach for patients with male LUTS/BPH who are at increased risk of disease progression or have incomplete response to monotherapies. Other combination treatments with 5-ARIs and PDEI or anticholinergics/β-3 agonists can be tried based on predominant symptoms or side effect profile, but patients should be informed about the lack of long-term data. [ABSTRACT FROM AUTHOR]

Introduction: Benign prostatic hyperplasia (BPH) is a prevalent urological condition leading to lower urinary tract symptoms. Minimal invasive surgical treatment (MISTs) such as Rezūm System are emerging aiming to relieve symptoms. We present results from a single centre prospective study. Methods: We prospectively followed patients undergoing Rezūm between 2021 and 2023 from a single centre. International Prostate Symptom Score (IPSS), functional outcomes (maximum urinary flow rate (Qmax) and post-void urinary residual (PVR) and International Index of Erectile Function-5 (IIEF-5) were assessed at 3, 6, 12 and 24 months. Anterograde ejaculation was assessed at 12 months follow up. Linear mixed-effects models (LMMs) for repeated measures were applied to assess differences in the IPSS, maximum flow rate (Qmax), PVR, and International Index of Erectile Function-5 (IIEF-5) from baseline (t0) to 3, 6, 12 and 24 months. Results: After adjusting for prostate volume and symptoms severity, significant differences were observed at 3, 6, 12 and 24 months for IPSS (p < 0.001), Qmax (p < 0.001), PVR (p < 0.001) and IPSS-QoL (p < 0.001) from baseline. No statistically significant changes were found in the IIEF-5 scores at 3, 6, 12 and 24 months from baseline. Anterograde ejaculation remained in 98% of patients after treatment. Conclusions: In conclusion, the study's findings indicate that patients undergoing Rezūm treatment experience sustained improvements in IPSS, Qmax, PVR and IPSS-related quality of life up to 24 months following the intervention. Anterograde ejaculation remained in 98% of patients after treatment. [ABSTRACT FROM AUTHOR]

Objectives: Benign Prostatic Hyperplasia (BPH) is the most common cause of the Lower Urinary Tract Symptoms (LUTS) in ageing men. TURP is still the gold-standard procedure for the treatment of LUTS-BPH, however new minimally invasive modalities like Urolift procedure has been introduced. Methods: Patients with prostate size up to 100 g were offered both treatment modalities. Hundred patients were included in the study, 100 in TURP group (group A) and 100 in Urolift group (group B). International Prostate Symptom Score (IPSS) was used at initial contact and for evaluation of response to treatment. Group A underwent TURP under regional anaesthetic, while group B underwent Urolift under sedation. Results: The mean age in both groups was 66.4 years. The IPSS score improvement among both groups is attached in the diagram. Group B patients had less hospital stay, better erectile and ejaculatory function compared to group B, and no stress incontinence was detected in group B while 6.7% of the patients in group A suffered some stress incontinence. Conclusion: Urolift has the benefit of preserving the ejaculatory function and less complications. Nevertheless, it has size limitations and the IPSS score improvement is less satisfactory when compared to TURP. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is a prevalent urinary system disorder. Despite evidence of a significant genetic component from previous studies, the specific pathogenic genes and biological mechanisms are still largely unknown. The study utilized the FinnGen R10 dataset, encompassing 177,901 individuals (36,601 cases and 141,300 controls), and the GTEx v8 EQTLs files to conduct single-tissue and cross-tissue transcriptome-wide association studies (TWAS). FUSION method was utilized to validate the findings in specific tissues. Gene Analysis and Multi-marker Analysis of Genomic Annotation (MAGMA) were used to identify potential susceptibility genes. The intersection genes of the above results were analyzed by Mendelian randomization (MR), summary data-based MR (SMR) and colocalization studies. Fine-mapping of causal gene sets (FOCUS) software was employed to accurately locate risk genes. Gene Expression Omnibus (GEO) analysis explores the differential expression of genes. Finally, The GeneMANIA tool was utilized to further understand the functional roles of these susceptibility genes. The cross-tissue TWAS analysis revealed 28 genes associated with BPH susceptibility. Single-tissue TWAS and MAGMA further refined eight genes, and subsequent MR, SMR, FOCUS and colocalization analysis pinpointed INO80B as the key gene. The differential expression of this result was verified by GEO. INO80B may help prevent excessive prostatic cell proliferation by regulating cell cycle-related gene expression. Our research identified the INO80B gene, whose predicted expression is associated with BPH risk and hence provided a new insight into the genetic basis of this disease. However, further functional studies are necessary to elucidate the potential biological activity of these significant signals. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the efficacy of Transurethral Holmium Laser of the Prostate (HoLEP) with Double-n Technology in the treatment of benign prostatic hyperplasia (BPH), with a focus on preserving sexual function postoperatively. Methods: Conducted as a multicenter, prospective, single-blind randomized controlled trial, this study enrolled sexually active male patients with BPH. Participants were randomized into three groups: standard HoLEP (Group A), single-n technology (Group B), and innovative double-n technology (Group C), which emphasizes the preservation of the urethral mucosa and nearby structures. The primary endpoints included maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF). Results: Of the 180 initial participants, 139 completed the study. All groups showed significant improvements in Qmax and IPSS. Initial declines in IIEF scores were noted across all groups, stabilizing to baseline by 3 months without further improvement. Group A had modest antegrade ejaculation rates, starting at 15.4% at 3 months and reaching 23.1% at 12 months. Group B showed a significant improvement, with AE rates rising from 31.8% at 3 months to 45.5% at 12 months, significantly higher than Group A (p < 0.05). Group C had the highest AE rates, starting at 57.8% at 3 months and reaching 77.8% at 12 months, significantly surpassing both Group A and B (p < 0.05). Regarding semen reduction, Group A had 100% reduction at 3 months, which decreased to 77.8% at 12 months. Group B followed a similar trend, from 100% at 3 months to 68.2% at 12 months. Group C showed a more pronounced decline, starting at 84.6% at 3 months and dropping to 37.1% at 12 months, with values significantly lower than both Groups A and B (p < 0.05). Conclusions: The double-n HoLEP technique shows promising results in improving urinary symptoms while better preserving ejaculatory function and sexual quality of life in BPH patients. This technique could offer a significant advancement in the surgical management of BPH, particularly for sexually active patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Chronic inflammation is a key factor in prostatic diseases, such as prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer (PCa). This study explored the role of human papillomavirus (HPV) infection in these conditions by analyzing the expression of specific microRNAs (miRNAs) linked to various cellular processes involved in cancer. We identified 284 miRNAs associated with PCa by performing in silico analysis; these were found to be involved in cancer development and progression. Notably, a subset of these miRNAs exhibited dysregulated expression in HPV-positive tissues, suggesting their role in promoting a pro-oncogenic environment. These findings identify potential miRNA biomarkers for improving the diagnosis and treatment of prostatic diseases. Background/Objectives: Chronic inflammation is a critical factor in the development of prostatic diseases, including prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer (PCa). Although this is recognized as a significant risk factor, the molecular mechanisms underlying these conditions remain unclear. Studies have shown that human papillomavirus (HPV) can infect the prostatic epithelium; however, its role in prostatic pathologies is not fully understood. This study aimed to evaluate the expression profiles of miRNAs involved in inflammation, proliferation, cell cycle regulation, apoptosis, angiogenesis, migration, invasion, and metastasis in HPV-positive and HPV-negative prostatic tissues. Methods: Using bioinformatics analyses, including interactomic and functional enrichment analyses, miRNAs associated with PCa and their potential roles in key cellular processes related to tumor progression were identified. Subsequently, some of these miRNAs were selected to evaluate their expression profiles in biopsies from patients with BPH/prostatitis and PCa, including HPV-positive and HPV-negative samples. Results: Our results revealed that 67.2% of benign lesions and 93.4% of cancer samples were HPV-positive. Interactomic analysis identified 284 miRNAs associated with PCa, with key miRNAs such as let-7c, miR-21, miR-34a, miR-126, miR-18a, miR-145, miR-221, miR-106a, miR-222, and miR-143 highlighted. Dysregulated expression of miRNAs was observed in HPV-positive tissues: miR-34a, miR-143, and miR-145 were downregulated in BPH/prostatitis, while miR-221 was upregulated. In HPV-positive PCa, additional miRNAs, including let-7c, miR-126, and miR-106a, showed altered expression. Complementarily, the functional enrichment analysis revealed that these miRNAs are associated with key biological processes that are crucial to cancer, such as cell cycle regulation, apoptosis, immune response, angiogenesis, metastasis, and tumor suppressor pathways. This finding is consistent with the predicted target genes of the evaluated miRNAs and their potential roles in processes related to cancer development and progression. Conclusions: The differential expression of HPV-induced miRNAs suggests their potential as biomarkers for diagnosing, prognosing, and treating prostatic diseases. These findings offer new insights into the molecular mechanisms linking HPV to prostatic pathologies. [ABSTRACT FROM AUTHOR]

Objective: Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) has been adopted to treat a wide range of prostate anatomies including glands up to 150 cc. Patients with recurrence of LUTS after previous BPH procedure often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and feasibility of aquablation in patients with previous BPH surgical history. Patients and Methods: A prospectively managed single institution database of aquablation patients with BPH/LUTS was queried from August 2020 to December 2022 for patients who failed previous BPH procedures. Patients were divided into two groups: those with and without previous BPH procedure. Primary outcomes were intraoperative and 90-day complications. Secondary outcomes included operative time (OT), number of Aquabeam passes, estimated blood loss, hospital length of stay, and catheter duration. Outcomes were assessed using chi-squared, Wilcoxon rank sum tests, and logistic regression. Results: A total of 200 patients with BPH/LUTS were treated with aquablation. We identified 26 patients with a history of previous BPH procedures. Patients who underwent previous BPH procedures had smaller prostate volumes (60 cc) compared with treatment-naïve (88 cc) patients, p = 0.016. There was no difference in perioperative and 90-day complications (29% for treatment-naïve vs 17% in the retreatment group, p = 0.32). Most secondary outcomes were the same including OT, but the retreatment group had fewer Aquabeam passes (2 [1–2] vs 2 [2–2] treatment-naïve, p = 0.037) and more additional procedures at follow-up (30% vs 8.3% treatment-naïve, p = 0.005). Conclusion: Patients with previous BPH interventions remain excellent candidates for aquablation, with similar perioperative and 90-day postoperative outcomes compared with intervention-naïve patients. Aquablation demonstrates efficient tissue ablation without the risk of increased injury or significant blood loss after prior failed BPH procedures. [ABSTRACT FROM AUTHOR]

Purpose of Review: Prostate cancer and benign prostate hyperplasia (BPH) are two ubiquitous pathologies that may coexist. A significant percentage of patients with different stages of prostate cancer suffer lower urinary tract symptoms (LUTS) due to associated BPH. We aimed to review the literature regarding the role of transurethral surgeries in the management of prostate cancer patients and the different available management options. Recent Findings: The evidence in literature for the use of BPH surgeries in prostate cancer patients is based mainly on low-quality retrospective studies. In patients on active surveillance, BPH surgeries are beneficial in relieving LUTS without oncological risk and can eliminate the contribution of adenoma to PSA level. In patients with advanced prostate cancer, palliative BPH surgery can relieve LUTS and urinary retention with unclear oncological impact; however some reports depict that the need for BPH surgery in advanced prostate cancer is associated with poorer prognosis. In patients receiving radiotherapy, various studies showed that transurethral resection of prostate (TURP) is associated with increased radiotoxicity despite some recent reports encouraging the use of Holmium Laser Enucleation of the Prostate (HoLEP) to improve urinary symptom scores before radiotherapy. The most commonly reported techniques utilized are TURP, photoselective vaporization of prostate (PVP) and HoLEP. Summary: The use of BPH surgery is justified for relieving LUTS in selected prostate cancer patients on active surveillance or in advanced stages, however the use in the pre-radiotherapy settings remains controversial. Future prospective and randomized controlled trials are required for validating the benefits and assessing potential hazards. [ABSTRACT FROM AUTHOR]

Purpose: In patients with prostate cancer (PCa), focal therapy with High-Intensity Focused Ultrasound (HIFU) combined with benign prostatic hyperplasia (BPH) surgery has been used to improve immediate post-operative voiding symptoms. Our study aimed to evaluate the functional outcomes of patients undergoing simultaneous holmium laser enucleation of the prostate (HoLEP) + HIFU and compare them to those who underwent HoLEP for bladder outlet obstruction secondary to BPH. Methods: We performed retrospective review of patients who underwent HoLEP + HIFU or HoLEP between June 2017 and May 2024. The nearest neighbor method with age and prostate volume were used to propensity match HoLEP + HIFU patients with HoLEP only patients in a 1:2 ratio. Demographics, functional characteristics, and complications of patients who underwent HoLEP + HIFU were compared with patients undergoing only HoLEP for BPH. Results: A total of 99 patients were analyzed, of which 33 patients underwent combined HIFU with HoLEP. Patients undergoing HIFU + HoLEP experienced higher rates of acute urinary retention (p = 0.016) and transient urinary incontinence, along with a delayed recovery of full continence, compared to those who underwent HoLEP alone. Postoperative urinary tract infection (UTI), urethral stricture, bladder neck stenosis (BNS), and continence rate were similar between the groups. Conclusion: Patients undergoing HoLEP + HIFU seems to have a higher risk of post-operative acute urine retention and delayed recovery from transient urinary incontinence, compared to HoLEP alone. The addition of HIFU to HoLEP does not influence the rate of UTI, urethral stricture, BNS, or improvement of voiding parameters up to one year follow up. [ABSTRACT FROM AUTHOR]

Objective: We aim to evaluate the association of composite dietary antioxidant index (CDAI) and Benign Prostatic Hyperplasia (BPH) in a large population in the United States using a cross-sectional design. Methods: Data was retrieved from the National Health and Nutrition Examination Survey (NHANES) 2003–2008 and 2013–2020 datasets. Univariate and multivariate logistic regression were performed to explore the association between CDAI and BPH. The restricted cubic spline (RCS) model was also conducted to investigate the potential linear relationship. Sub-group analyses were also conducted. Results: Totally, this study included 13,419 participants with 1085 BPH patients among them. The higher continuous CDAI value was significantly related to higher BPH risk (OR = 1.05, 95%CI: 1.02, 1.08). Besides, individuals with the highest quartile (Q4) CDAI possessed 1.87 times risk of BPH than the lowest quartile (Q1, OR = 1.87, 95%CI: 1.41, 2.50). The RCS curve also showed a positive linear dose-response relationship between CDAI and BPH (cut-off = -0.64). The P for interaction in any subgroup was > 0.05, indicating that the main outcome was not affected by other covariates. The limitation of this study was the lack of data on the relationship between CDAI and the severity of BPH symptoms. Conclusions: This study reveals that an elevated CDAI may be associated with a linear higher risk of BPH. We do not recommend intentional or excessive antioxidant diet to prevent BPH based on the current results. [ABSTRACT FROM AUTHOR]

Introduction: Since contact laser vaporization of the prostate (CVP) was approved by the Japanese insurance system in 2016, the use of a 980 nm diode laser system for CVP has become widespread for treating benign prostate hyperplasia (BPH) patients. Our institute has been implementing CVP for BPH since 2018, treating a total of 93 patients, including 28 with a risk of hemorrhage. This study examines the safety and efficacy of CVP treatment for BPH patients with a hemorrhagic risk. Patient and Methods: A total of 93 BPH patients with lower urinary tract symptoms (LUTS) underwent CVP between February 2018 and September 2022. All patients were on medications for BPH and were refractory to these medications. The median (mean ± SD) age was 72 (72.9±6.27), and the prostate volume was 64 (68.9±32.5). IPSS, QOL index, and OABSS scores for patients not requiring catheterization were 22 (22.1±6.38), 5 (5.24±0.74), and 6 (7±3.29), respectively. The CVP treatment was performed using a 980 nm diode laser. Of the 93 patients, 28 (30.1%) had a hemorrhage risk. This group included 13 (14.0%) who were continuously receiving anticoagulant and/or antiplatelet agents, 13 (14.0%) who temporarily stopped these medications, and 2 (2.1%) who had a hemorrhage risk due to low platelet counts (< 5.0 × 104/μL). Results: Postoperatively, 15 (16.1%) patients, including 11 who were catheterized preoperatively, needed temporary catheterization after CVP treatment. Of these, 14 had their catheters successfully removed. The IPSS score significantly decreased from 22 (22.1±6.38) to 8 (9.02±6.07) (p < 0.0001). In patients with hemorrhagic risk on anticoagulant and/or antiplatelet agents, the change in hemoglobin level before and after surgery was 0.6 g/dL, a difference that was not significant. Two of the 15 patients with hemorrhagic risk experienced hemorrhage 23 and 26 days postoperatively and underwent transurethral coagulation. Other perioperative complications classified as Clavien–Dindo Grade 2 or higher occurred in 4 (4.3%) patients. Conclusion: CVP treatment appears to be acceptable for BPH patients with hemorrhagic risk. In this study, late‐onset hemorrhage occurred approximately 1 month postoperatively. Close postoperative follow‐up is required. [ABSTRACT FROM AUTHOR]

Background: Benign prostatic hyperplasia (BPH) is a common issue among older men. Diagnosis of BPH currently relies on imaging tests and assessment of urinary flow rate due to the absence of definitive diagnostic markers. Developing more accurate markers is crucial to improve BPH diagnosis. Method: The BPH dataset utilized in this study was sourced from the Gene Expression Omnibus (GEO). Initially, differential expression and functional analyses were conducted, followed by the application of multiple machine learning techniques to identify key diagnostic markers. Subsequent investigations have focused on elucidating the functions and mechanisms associated with these markers. The ssGSEA method was employed to evaluate immune cell scores in BPH samples, facilitating the exploration of the relationship between key diagnostic markers and immune cells. Additionally, molecular docking was performed to assess the binding affinity of these key markers to therapeutic drugs for BPH. Tissue samples from BPH patients were collected for experimental validation of the expression differences of the aforementioned genes. Result: A total of 185 differential genes were identified, comprising 67 up-regulated and 118 down-regulated genes. These genes are implicated in pathways that regulate extracellular matrix tissue composition and cellular responses to transforming growth factor beta stimulation, as well as critical signaling pathways such as AMPK and mTOR. Through the application of various machine learning techniques, DACH1, CACNA1D, STARD13, and RUNDC3B were identified as key diagnostic markers. The ssGSEA algorithm further corroborated the association of these diagnostic genes with diverse immune cells. Moreover, molecular docking analysis revealed strong binding affinities of these markers to tamsulosin and finasteride, suggesting their potential as drug targets. Finally, experimental validation confirmed the expression differences of DACH1, CACNA1D, STARD13, and RUNDC3B in BPH tissues. Conclusion: This study introduces novel immune-related diagnostic markers for BPH and highlights their promise as new drug targets, providing a valuable approach for predictive diagnosis and targeted therapy of BPH. [ABSTRACT FROM AUTHOR]

The brown planthopper (BPH; Nilaparvata lugens Stål) is the most significant insect pest compromising rice production globally. Phytohormones, which are small organic compounds produced by plants, play a crucial role in regulating plant growth and development. Nevertheless, extensive research has established that phytohormones are essential in modulating plant defense against BPH. Plants can achieve equilibrium between growth and defense by utilizing the intricate network of phytohormone signaling pathways to initiate optimal and efficient defensive responses to insects. In this review, we primarily address the roles of phytohormones in conferring resistance against BPH, with a focus on hormone cross-talk. We also discuss the potential value of integrating hormones with other agricultural practices to enhance plant defense and agricultural yield, which highlights the significance of novel approaches for environment-friendly insect pest management. [ABSTRACT FROM AUTHOR]

Objective: The objective of our study was to assess the efficacy of Rezum, a minimally invasive surgical treatment, for patients with lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) in real‐world clinical practice at a single institution in Japan. Materials and Methods: We conducted a prospective study involving 100 patients who underwent the Rezum procedure between October 2022 and February 2024. We analyzed patient backgrounds that are compliant with Japanese regulations and assessed descriptive outcomes such as symptom scores, peak flow in uroflowmetry, post‐void residual (PVR) volume, and prostate volume (PVol). These data were collected at 1 and/or 3 months postoperatively. Results: On average, 4.7 water vapor injections were administered during the Rezum procedures, with a mean operative time of 6.3 min. Patients experienced significant relief in symptoms, with reductions of 55% in International Prostate Symptom Score, 53% in quality of life score, and 30% in Overactive Bladder Symptom Score. There was also a significant decrease in mean PVR volume (50% reduction) and PVol (27% reduction). Among the subgroup of 23 pre‐interventional catheter‐dependent patients, 91% achieved catheter independence. Conclusion: Our single‐center analysis demonstrates that Rezum is an effective and safe minimally invasive therapeutic option for patients with BPH. This promising novel technique can be particularly beneficial for patients at an augmented risk of bleeding or those considered high risk for anesthesia. [ABSTRACT FROM AUTHOR]

Purpose: Lower urinary tract symptoms (LUTS) consist of voiding and storage symptoms. While the therapeutic efficacy of current LUTS medications is limited, and with more than 20% of patients suffering from mixed symptoms, current guidelines offer nothing more than combining monotherapies. An individualized approach is urgently warranted, and phytomedicines have become an integral part of patient-empowerment in therapeutic shared-decision making processes. Therefore, we aimed to investigate patients' preference of phytomedicines and treatment adherence at the dawn of an era leaving α1-blocker monotherapies behind. Patients and Methods: A questionnaire was prepared, and patients at our tertiary referral center were given the opportunity to voluntarily participate in our survey. We collected questionnaires from 300 patients during their visits from January 2022 to December 2022. Results: With 73% (218/300), most of our study cohort had either taken one or more or were currently on prescription medication for LUTS/BPH. Patients were prescribed α1-blockers (72%), followed by 5α-reductase inhibitors (21%), and phosphodiesterase-5-inhibitor (5%), while antimuscarinics and β3-agonists were rarely prescribed. However, 41% (89/218) of our patients, who were taking medication for LUTS, had taken or were currently taking phytomedicines, making this the second most common drug class in our patient cohort. Patients scored the efficacy of phytomedicines at a mean in the lower third, but 87% of patients attributed excellent tolerability, and only 9% experienced side effects. While 43% of patients recommended phytomedicines for other patients, two-thirds of patients thought phytomedicines should be covered by statutory health insurance. Conclusion: We found that phytomedicines were the second most common drug class taken by LUTS patients at our hospital. Reasons may be easy availability as over the counter medication and a superior safety profile with less bothersome side effects than commonly prescribed drug classes. Taken together, phytomedicines may be able to bridge an important gap in LUTS pharmacotherapy to provide sufficient treatment adherence where prescription drug classes fail, and ultimately, adequate improvement of symptoms. However, patients need to be counseled on potentially limited efficacy. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is highly prevalent and associated with a significant impact on individuals’ well-being. Initial management involves various medications, but their benefits can be limited by side effects, particularly concerning young people. In this context, novel and better-tolerated therapeutic strategies have been proposed, thus including the modulation of the gut microbiome through probiotic ingestion. We aimed to examine the available evidence linking the urinary microbiome to lower urinary tract symptoms (LUTS) and to evaluate the possible usefulness of probiotic supplementation as a novel treatment option for LUTS/BPH. A narrative review design was preferred to fulfill our purpose. The search strategy included a range of terms, e.g., “microbiome,” “microbiota,” “urobiome,” AND/OR “probiotics” AND “benign prostatic hyperplasia,” “benign prostatic enlargement,” “lower urinary tract symptoms.” A range of studies aimed to investigate the possible impact of urinary microbiome on BPH. Gut and/or urinary dysbiosis can alter the gut permeability and initiate/maintain inflammatory and oxidative processes in the prostate, which may contribute to the cell-hyper-proliferation leading to BPH. The modulation of the urinary and/or gut microbiome through probiotic supplementation seems to provide levels of clinical effectiveness in the management of BPH. Although different probiotics have been tested, a combination of B. Longum and F. Psychaerophilum seems to be particularly promising due to their capability of modulating both the inflammatory pathway and the intestinal barrier permeability. Gut and/or urinary microbiome dysbiosis is most likely contributing to the BPH pathogenesis. Even though only scarce evidence on the potential usefulness of probiotic supplementation in the management of BPH is currently available, the available studies seem to provide encouraging results. Further prospective trials are warranted in order to confirm these findings and to clarify which probiotic strains are more suitable for supplementation in this setting. [ABSTRACT FROM AUTHOR]

Introduction. Benign prostate hyperplasia (BPH) is an enlargement of the prostate due to abnormal proliferation or apoptosis failure of the epithelial or stroma tissues.Objective. To compare the prostate volume, IPSS score (LUTS scale), and uroflowmetry of BPH patients with type 2 diabetes mellitus.Materials & Methods. The medical records of BPH patients from 2011 to 2015 were assessed with an analytical retrospective study based on the prostate volume, IPSS score (LUTS scale), and Q max using uroflowmetry. The data were analyzed using the chi-square test by online statistical analysis.Results. Among 62 patients recorded, 11 patients were diabetic, while the rest were non-diabetic. No notable differences were observed between the two groups (p > 0.05) in prostate volume, IPSS score, and Q max.Conclusion. No significant differences in prostate volume, IPSS score (LUTS scale), and uroflowmetry between diabetic and non-diabetic BPH patients.

Abstract Benign prostatic hyperplasia (BPH) is a condition commonly observed in aging males. Inflammatory and metabolic factors are pivotal in the development and progression of BPH. The degree to which the effects of 91 inflammation-related proteins on BPH are mediated by 1400 plasma metabolites remains ambiguous. Our research analyzed the impact of these traits utilizing genetic evidence.Two-sample Mendelian randomization (MR) and multivariable MR (MVMR) were utilized in our study to infer the genetic causal effect of inflammation-related proteins on BPH, with metabolites serving as mediators. Increased levels of IL-2 were linked to a heightened incidence of BPH (β = 0.071, OR:1.074, 95% CI [1.002–1.152], p = 0.045), whereas lower concentrations of N6,N6-dimethyllysine were associated with decreased risk (β1=-0.127, p = 0.02; β2=-0.039, p = 0.008). The mediation effect was 0.005 (95% CI [0.0004, 0.012], OR: 1.005, 95% CI [1.000, 1.012]), accounting for 7.04% of the total effect. subsequently, we examined the phenotypic co-localization of the two pairings independently, revealing that the posterior probability of rs145516501 associated with IL-2 and BPH was 80.7%, whereas the posterior likelihood of rs4917820 linked to N6,N6-dimethyllysine levels and BPH was 95.9%. The research indicated that N6,N6-dimethyllysine levels seem to influence the causative relationship between IL-2 and BPH. These results elucidate the complex interplay between inflammation-related proteins and metabolism in the context of BPH, offering novel diagnostic and therapeutic avenues and enhancing our comprehension of the disease’s etiology for prospective research.

Background Benign prostatic hyperplasia (BPH) is one of the causes of lower urinary tract symptoms (LUTS) in men above 50 years of age. It is known that the severity of LUTS (degree of bladder outlet obstruction) does not correlate with the size of the prostate gland in BPH. Severity of LUTS due to BPH can be assessed using the internationally validated international prostate symptom score (IPSS). There are some concerns that the IPSS is subjective and may pose some challenges to the poorly educated patients in our environment during administration. Intravesical prostatic protrusion may be an objective index of degree of bladder outlet obstruction in men with BPH measured using abdominopelvic ultrasound. So the objective of this study is to evaluate for any correlation between IPP and IPSS in men with symptomatic BPH. Objective The objective of the study is to assess the correlation between IPP and IPSS. Patients and Methods A hospital based cross-sectional study of new patients with symptomatic LUTS of BPH, who presented to the Urology clinics of University of Nigeria Teaching Hospital Ituku-Ozalla Enugu. Ethical approval was obtained from the ethical committee of the hospital and informed consent from patients. After evaluation (including IPSS, PSA, and FBC, S/E/Ur/Cr, Urinalysis and M/C/S), participants had abdominopelvic ultrasonography measurement of IPP and midline sagittal image of the prostate (at bladder Volume of > 100mls) using Prosound model SSD 3500 with an abdominal probe frequency of 3.5MHz (Versana Essentials) IPP was divided into three grades (Grade I: 0-4.9mm; Grade II: 5.0-9.9mm; Grade III: 10.0mm and above). Data was analyzed using SPSS Version 20 (IBM, SPSS, Chicago, IL, USA). The Pearson correlation was used to assess correlation where necessary. P- value

Zhi-Bo Gu, Lei Qiu, Hua Zhu, Ming Lu, Jian-Gang Chen Department of Urology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu Province, 226200, People’s Republic of ChinaCorrespondence: Jian-Gang Chen, Department of Urology, Affiliated Hospital 2 of Nantong University, No. 666 Victory Road, Chongchuan District, Nantong, Jiangsu Province, 226200, People’s Republic of China, 226200, Tel +862115996558081, Email jiangang_chenC1@126.comObjective: To compare low- vs high-power HoLEP effects on coagulation in patients on antiplatelet (AP) therapy via thromboelastography (TEG).Methods: 210 patients was retrospectively analyzed and stratificated into three discrete groups, specifically: Group A (AP therapy, high-power HoLEP, n = 72); Group B (AP therapy, low-power HoLEP, n=73); Group C (no AP therapy, low-power HoLEP, n = 65). Baseline characteristics and coagulation profiles via TEG were compared. Univariate and multivariate analyses were conducted to identify independent risk factors associated with hematuria. Furthermore, parameters such as IPSS, Qmax, post-void residual volume V2 and PSA levels were recorded during 1year follow-up.Results: No differences in terms of baseline characteristics across all groups. Significant differences were observed in the duration of enucleation, morcellation, bladder irrigation, post-operative catheterization, length of hospital stay and the extent of hemoglobin reduction (F = 54.06, 8.54, 6.68, 9.24, 17.06, 5.97, p 0.05). Univariate and multivariate analyses revealed that prostate volume emerged as an independent risk factor for hematuria (OR 1.080, 95% CI: 1.007– 1.158, p = 0.031). Clinical outcomes including Qmax, IPSS, V2, and PSA demonstrated significant enhancement during 1 year follow-up.Conclusion: Compared to HP-HoLEP, LP-HoLEP effectively reduces surgical and subsequent processing times, decreases hospital stay duration, and diminishes hemoglobin decline, offering a viable option without discontinuing AP therapy.Keywords: anti-platelet therapy, BPH, high power, HoLEP, low power

Abstract Autophagy is a cellular homeostatic mechanism characterized by cyclic degradation. It plays an essential role in maintaining cellular quality and survival by eliminating dysfunctional cellular components. This process is pivotal in various pathophysiological processes. Benign prostatic hyperplasia (BPH) is a common urological disorder in middle-aged and elderly men. It frequently presents as lower urinary tract symptoms due to an increase in epithelial and stromal cells surrounding the prostatic urethra. The precise pathogenesis of BPH is complex. In recent years, research on autophagy in BPH has gained significant momentum, with accumulating evidence indicating its crucial role in the onset and progression of the disease. This review aims to outline the various roles of autophagy in BPH and elucidate potential therapeutic strategies targeting autophagy for managing BPH.

Background: One of the late complications of transurethral resection of the prostate (TURP) is urethral stricture. This is a disturbing problem more so in a resource-poor Black African community. We sought to prospectively study some of the implicated risk factors in literature. PATIENTS AND METHODS: This was a prospective, observational study carried out at 82 Division Military Hospital, Enugu, Nigeria from 2015 to 2022. Results: One hundred and ninety-four patients that had TURP for BPH were studied. The mean age of the participants was 66.28 years (standard deviation = 8.19). Ten patients (5.15%) had urethral stricture after the surgery. None of the factors studied which include age, previous prostate surgery, preoperative urethral catheter duration, resection time, resected prostate size, the presence of diabetes mellitus, and postoperative urinary tract infection was found to have a significant risk for the development of urethral stricture post-TURP. Conclusion: More studies are required to unravel significant risk factors for urethral stricture following a TURP. It is probably due to the interplay of many factors.

Purpose: Bipolar TURP is regarded as the gold standard for treatment of BPH. Historically, when compared to HOLEP, bTURP has been found to have shorter operative times and is considered more efficient. We sought to compare the efficiency, efficacy, and safety of current era HOLEP with MOSES 2.0 technology (MOLEP) and bTURP. Methods: We performed a retrospective review of patients who underwent bTURP or MOLEP at our institution between 2018 and 2023. Preoperative, intraoperative, and postoperative characteristics were collected for analysis. Analysis was done with SPSS software with significance defined as p < 0.05. Results: We identified 195 bTURPs and 918 MOLEPs performed at our institution. Men undergoing MOLEP had significantly higher pre-op prostate volume and resected weight (61 ml v 123 ml and 15 g v 70 g, p < 0.001, respectively) when compared to bTURP patients. MOLEP was completed in significantly less OR and procedure time compared to bTURP (66 min vs. 73 min, p < 0.001; 90 min vs. 111 min, p = 0.026, respectively). These results remained significant when controlling for age and prostate volume. At a mean follow up of 3.7 months, HOLEP patients were significantly more likely to be medication (0 vs. 35.84% p < 0.001) and catheter free post-operatively (0.95% vs. 5.68%, p < 0.001) compared to bTURP. Conclusion: In our contemporary cohort, MOLEP is faster and more efficient than bTURP. These findings remained significant despite being performed on larger prostates and in patients more likely to be anticoagulated. Furthermore, MOLEP patients are more likely to remain catheter and medication free at follow-up when compared to bTURP. [ABSTRACT FROM AUTHOR]

Introduction: Advances in health care have resulted in an increasing octogenarian population in the United States. The prevalence of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in this subgroup exceeds 70%. This study attempts to evaluate perioperative outcomes of different transurethral techniques in octogenarians and define their utilization trends from 2011 to 2022. Methods: We extracted data from the American College of Surgeons NSQIP for octogenarian patients who underwent prostatectomy for BPH. Procedures were categorized using CPT codes, and outcomes included postoperative complications, readmission, 30-day reoperation, and utilization trends from 2011 to 2022. Results: A total of 21,314 octogenarians were included. TURP was the most performed procedure (53.13–71.17%), followed by PVP and HoLEP. HoLEP utilization increased reaching up to 19% by year 2022. Higher American Society of Anesthesiologists (ASA) scores were observed more frequently in the TURP group. HoLEP consistently exhibits the longest operative times. Initially relatively higher transfusion rates for HoLEP decreased to 0% by 2022. Urinary tract infection rates did not significantly differ among the procedures most years. Results: TURP remained the most performed modality for BPH management in octogenarians amongst NSQIP-participating institutions. However, from 2011 to 2021, the utilization of HoLEP increased nearly by 2.5 folds, from 2.5 to 6.4%. [ABSTRACT FROM AUTHOR]

Introduction: Sexual dysfunction affects a couple's relationship and quality of life of the patient and the partner irrespective of age. In Lower urinary tract symptoms (LUTS) with benign prostatic hyperplasia (BPH), sexual dysfunction is highly prevalent. This study aims to evaluate prevalence of sexual dysfunction in patients having LUTS with BPH and effect of various treatment on it. Materials and methods: The study is hospital based prospective cross-sectional study. Total 106 patients were included in this study. Fifty-six patients underwent medical treatment and 50 patients underwent transurethral resection of prostate (TURP) according to lower urinary tract symptom score along with grades of prostate. We measured prevalence of lower urinary tract symptoms, erectile dysfunction (ED), ejaculatory dysfunction (EJD).We compared the pre and post treatment ED, EJD scores in both medical and TURP group. Result: In our study, 11 (10.4%) patients had very mild ED, 12 (11.3%) had mild ED, 54 (50.9%) had moderate ED and 23 (21.7%) had severe ED. In our study, 11 (10.4%) patients had very mild EJD, 7 (6.6%) had mild EJD, 28 (26.4%) had moderate EJD and 2 (1.9%) had severe EJD. In medical group, ED pre-treatment versus ED post treatment was statistically significant (p = 0.0046), treatment of LUTS improves ED. EJD pre-treatment versus EJD post treatment was not statistically significant (p = 0.8368), treatment of LUTS associated with deterioration of EJD. In TURP group association of ED pre-treatment versus ED post treatment was statistically significant (p = 0.0319). Post TURP patients shows improvement in ED Association of EJD pre-treatment versus EJD post-treatment was statistically significant (p = 0.03000). Post TURP EJD deteriorate. Conclusion: We concluded that the severity of sexual dysfunction correlates with severity of LUTS. Ejaculatory function deteriorates after treatment of TURP compared to medical. [ABSTRACT FROM AUTHOR]

Objectives: To establish the current practice of urologists in Scotland with regard to venous thromboembolism (VTE) prophylaxis following transurethral resection of the prostate (TURP). Methods: An electronic survey was distributed to all practicing urology consultants and trainees in Scotland. Participants were asked questions regarding their current practice with regard to peri-operative VTE prophylaxis and were offered free-text responses. Findings were compared with a previous UK-wide study from 2002, and with current European Association of Urology (EAU) guidelines. Results: 56/113 (49.6%) of urologists responded to the survey. Overall, 71.4% of responding urologists prescribed pharmacological VTE prophylaxis following TURP. No urologists routinely prescribe VTE prophylaxis on discharge. 94.6% of responding urologists utilise mechanical prophylaxis in the form of thromboembolic deterrent (TED) stockings, with 35.7% of urologists discharging patients with TED stockings. No urologists reported a death from uncontrollable bleeding after TURP in the previous 10 years, whereas 10% of respondents had a patient whom had suffered a death or serious complication from a thromboembolic event following TURP in the past 10 years. A range of free-text responses were given. Conclusion: Our national audit has identified a wide variation between practice and current published guidance. These results contrast dramatically with a previous UK wide audit from 2002, which found 14% of urologists utilised pharmacological prophylaxis, 50% utilised mechanical prophylaxis only and 23% used no thromboprophylaxis at all. Recent guidance from the EAU recommends against using pharmacological prophylaxis due to the increased bleeding risk. Given that current practice does not marry with published recommendations; we believe that further research is required in this area for stronger evidence-based guidelines to be developed. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the correlations between the obstructive and irritative domain scores of the total AUA-SI and the uroflowmetric peak flow rate (Qmax) in Thai patients suspected of having benign prostatic hyperplasia (BPH). Methods: A retrospective observational study was conducted on 510 patients who presented with lower urinary tract symptoms (LUTSs) and were suspected of having BPH at the Urology Outpatient Department of King Chulalongkorn Memorial Hospital, Thailand. A self-administered AUA-SI score was used to determine the severity of symptoms, and uroflowmetry was conducted to determine parameters, including flow rate variable. Results: A significant correlation was observed between the AUA-SI score and uroflowmetric peak flow (Qmax). The AUA-SI and its obstructive domain had weak negative Pearson correlations with uroflowmetric peak flow (r = −0.164 and −0.185, respectively; P < 0.01). The irritative domain was inversely associated with Qmax (r = 0.097, P = 0.028). However, when patients in each subgroup with mild (AUA-SI = 0 - 7), moderate (AUA-SI = 8–19), and severe symptoms (AUA-SI = 20–35) were considered, the relationship was found to be not significant. Conclusion: The study revealed a significant weak negative correlation between the AUA-SI score and Qmax, but no significant correlations were found between the obstructive and irritative domains and Qmax in the subgroup analysis. [ABSTRACT FROM AUTHOR]

Purpose of Review: Researchers have examined how telemedicine affects endourological patients. This review analyzes the literature to determine telemedicine's benefits and limitations in endourology. Recent Findings: Many studies were devoted to describing the effect of telemedicine on endourological patient satisfaction, optimization of the clinical decision-making among patients with kidney and ureteric stones, the effectiveness of telemedicine in the management of patients with indications for PCNL, follow-up for patients with urolithiasis and describing financial effectiveness for the patients after BOO surgery. The authors describe phone calls, video calls, and online booking platforms as used as telemedicine technology. However, several concerns also exist, such as the necessity of internet connections and appropriate devices, different receptivity among certain subgroups, data safety, and different regulatory environments among countries. Summary: Telemedicine offers the potential to reduce patient travel time, expedite decision-making, and save costs in endourology. However, its everyday implementation is challenging due to various obstacles faced by patients and providers, hindering the realization of its full potential and necessitating a systematic approach to problem-solving. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is a condition commonly observed in aging males. Inflammatory and metabolic factors are pivotal in the development and progression of BPH. The degree to which the effects of 91 inflammation-related proteins on BPH are mediated by 1400 plasma metabolites remains ambiguous. Our research analyzed the impact of these traits utilizing genetic evidence.Two-sample Mendelian randomization (MR) and multivariable MR (MVMR) were utilized in our study to infer the genetic causal effect of inflammation-related proteins on BPH, with metabolites serving as mediators. Increased levels of IL-2 were linked to a heightened incidence of BPH (β = 0.071, OR:1.074, 95% CI [1.002–1.152], p = 0.045), whereas lower concentrations of N6,N6-dimethyllysine were associated with decreased risk (β1=-0.127, p = 0.02; β2=-0.039, p = 0.008). The mediation effect was 0.005 (95% CI [0.0004, 0.012], OR: 1.005, 95% CI [1.000, 1.012]), accounting for 7.04% of the total effect. subsequently, we examined the phenotypic co-localization of the two pairings independently, revealing that the posterior probability of rs145516501 associated with IL-2 and BPH was 80.7%, whereas the posterior likelihood of rs4917820 linked to N6,N6-dimethyllysine levels and BPH was 95.9%. The research indicated that N6,N6-dimethyllysine levels seem to influence the causative relationship between IL-2 and BPH. These results elucidate the complex interplay between inflammation-related proteins and metabolism in the context of BPH, offering novel diagnostic and therapeutic avenues and enhancing our comprehension of the disease's etiology for prospective research. [ABSTRACT FROM AUTHOR]

Background: Benign prostatic hyperplasia (BPH) is a growing issue due to an ageing population. Our study investigated the possible associations between BPH and ageing hallmarks, including the telomere length (TL) and mitochondrial genome copy number (mtDNA CN), along with genetic variations in the TP53 gene and mtDNA. Methods: Prostate tissue samples were obtained from 32 patients with BPH, together with 30 blood samples. As a healthy control group, age-matching blood DNA samples were used. For the comparison of mtDNA sequence data, 50 DNA samples of the general Latvian population were used. The full mtDNA genome was analyzed by using Next-Generation Sequencing (NGS), the TP53 gene by Sanger sequencing, and the mtDNA copy number (mtDNA CN) and telomere length (TL) byqPCR assay. Results: The results showed that in BPH patients, telomeres in the prostate tissue were significantly longer than in blood cells, while the TL in blood cells of the healthy controls was the shortest. Also, the mtDNA amount in the prostate tissue of BPH patients was significantly greater in comparison with blood cells, and controls had the smallest mtDNA CN. We did not find any mutations in the TP53 gene that could be linked to BPH; however, in mtDNA, we found several unique mutations and heteroplasmic changes, as well as genetic changes that have been previously associated with prostate cancer. Conclusions: In conclusion, prolonged telomeres and changes in the mtDNA amount might be involved in the molecular mechanisms of BPH. Some of the heteroplasmic or homoplasmic mtDNA variants might also contribute to the development of BPH. Additional studies are needed to substantiate these findings. [ABSTRACT FROM AUTHOR]

RNAs, especially non-coding RNAs (ncRNAs), are crucial players in regulating cellular mechanisms due to their ability to interact with and regulate other molecules. Altered expression patterns of ncRNAs have been observed in prostate cancer (PCa), contributing to the disease's initiation, progression, and treatment response. This study aimed to evaluate the ability of a specific set of RNAs, including long ncRNAs (lncRNAs), microRNAs (miRNAs), and mRNAs, to discriminate between PCa and the non-neoplastic condition benign prostatic hyperplasia (BPH). After selecting by literature mining the most relevant RNAs differentially expressed in biofluids from PCa patients, we evaluated their discriminatory power in samples of unfiltered urine from 50 PCa and 50 BPH patients using both real-time PCR and droplet digital PCR (ddPCR). Additionally, we also optimized a protocol for urine sample manipulation and RNA extraction. This two-way validation study allowed us to establish that miRNAs (i.e., miR-27b-3p, miR-574-3p, miR-30a-5p, and miR-125b-5p) are more efficient biomarkers for PCa compared to long RNAs (mRNAs and lncRNAs) (e.g., PCA3, PCAT18, and KLK3), as their dysregulation was consistently reported in the whole urine of patients with PCa compared to those with BPH in a statistically significant manner regardless of the quantification methodology performed. Moreover, a significant increase in diagnostic performance was observed when molecular signatures composed of different miRNAs were considered. Hence, the abovementioned circulating ncRNAs represent excellent potential non-invasive biomarkers in urine capable of effectively distinguishing individuals with PCa from those with BPH, potentially reducing cancer overdiagnosis. [ABSTRACT FROM AUTHOR]

Autophagy is a cellular homeostatic mechanism characterized by cyclic degradation. It plays an essential role in maintaining cellular quality and survival by eliminating dysfunctional cellular components. This process is pivotal in various pathophysiological processes. Benign prostatic hyperplasia (BPH) is a common urological disorder in middle-aged and elderly men. It frequently presents as lower urinary tract symptoms due to an increase in epithelial and stromal cells surrounding the prostatic urethra. The precise pathogenesis of BPH is complex. In recent years, research on autophagy in BPH has gained significant momentum, with accumulating evidence indicating its crucial role in the onset and progression of the disease. This review aims to outline the various roles of autophagy in BPH and elucidate potential therapeutic strategies targeting autophagy for managing BPH. [ABSTRACT FROM AUTHOR]

Introduction/background: Holmium laser enucleation of the prostate (HoLEP) is an increasingly popular size-independent technique of treating male voiding dysfunction due to benign prostatic hypertrophy. Some patients after HoLEP may develop clinically significant prostate cancer and opt for definitive treatment with external beam radiation therapy (EBRT). Little is known about the safety of EBRT after HoLEP and how it may functionally impact voiding after HoLEP has altered the anatomy of the prostate. Our study aimed to assess patient-reported voiding outcomes following EBRT after HoLEP with a focus on incontinence related patient outcomes. Methods/materials: This study was conducted with approval from our hospital's institutional review board. Patients that underwent HoLEP followed by EBRT were identified and data were collected in a retrospective nature from a single surgeon HoLEP cohort over the past 4 years (2019–2023). Patient demographics, disease and radiation therapy characteristics, radiation therapy, and baseline voiding symptoms were recorded. Current functional voiding outcomes were also collected via phone-call or portal communication in a cross-sectional manner with questions pertaining to type of incontinence, IPSS quality of life score, and administration of the Michigan incontinence symptom index (M-ISI). Adverse events encountered during follow-up were recorded. Results: 24 patients were identified who received RT for prostate cancer after HoLEP with an average age of 73.6 (± 5.3). One third of patients reported no incontinence whatsoever after radiation and of those who experienced incontinence, the majority felt that it was not worsened after radiation. Median IPSS QoL score following radiation was 1 (range 0–6), median M-ISI Severity Score was 4 out of a maximum of 32, and median M-ISI bother score was 0 out of a maximum of 8. One patient developed a bladder neck contracture (BNC) approximately 1 year following his radiation therapy (approximately 18 months after HoLEP) causing bothersome incontinence and LUTS. Conclusions: In our cohort most patients who received RT after HoLEP reported a high urinary-symptom related quality of life and a low rate of urinary incontinence. One patient who received SBRT suffered a BNC which is a known adverse event with RT but given our small sample size it remains unclear if the risk is higher in patients receiving RT after HoLEP. Larger studies should focus on examining the rate of bladder neck contracture in patients receiving RT after HoLEP, particularly focusing on whether the degree of dose fractionation may impact their development. [ABSTRACT FROM AUTHOR]

Patients undergoing transurethral resection of the prostate (TURP) surgery can develop TURP syndrome and post-TURP bleeding. Post-TURP bleeding can be surgical, from arteries or venous sinuses, or non-surgical, due to coagulopathy preventing clot formation. Non-surgical post-TURP bleeding may be due to high concentrations of urokinase and tissue plasminogen activator (tPA) in the urine that cause fibrinolytic changes and increase bleeding risk. Urine urokinase and tPA may have both local and systemic fibrinolytic effects that may prevent blood clot formation locally at the site of surgery, and cause fibrinolytic changes systemically through leaking into the blood stream. Another post-TURP complication that may happen is TURP syndrome, due to absorption of hypotonic glycine fluid through the prostatic venous plexus. TURP syndrome may present with hyponatremia, bradycardia, and hypotension, which may be preceded by hypertension. In this case report, we had a patient with benign prostatic hyperplasia (BPH) who developed both TURP syndrome and non-surgical post-TURP bleeding. These complications were transient for one day after surgery. The local effect of urine urokinase and tPA explains the non-surgical bleeding after TURP by preventing clot formation and inducing bleeding. Coagulation studies showed fibrinolytic changes that may be explained by urokinase and tPA leakage into the blood stream. In conclusion, non-surgical bleeding after TURP can be explained by the presence of fibrinolytic agents in the urine, including urokinase and tPA. There is a deficiency in existing studies explaining the pathophysiology of the fibrinolytic changes and risk of bleeding after TURP. Herein, we discuss the possible pathophysiology of developing fibrinolytic changes after TURP. More research effort should be directed to explore this area to investigate the appropriate medications to treat and prevent post-TURP bleeding. We suggest monitoring patients' coagulation profiles and electrolytes after TURP because of the risk of developing severe acute hyponatremia, TURP syndrome, fibrinolytic changes, and non-surgical bleeding. In our review of the literature, we discuss current clinical trials testing the use of an antifibrinolytic agent, Tranexamic acid, locally in the irrigation fluid or systemically to prevent post-TURP bleeding by antagonizing the fibrinolytic activity of urine urokinase and tPA. [ABSTRACT FROM AUTHOR]

Transurethal Urethral Resection of the Prostate (TURP) is a surgical procedure to treat Benign Prostate Hyperplasia (BPH) by removing tissue from the side of the prostate zone. Surgery will cause pain and one way to relieve pain is the Benson relaxation technique. Benson relaxation is a relaxation technique that combines deep breathing relaxation and beliefs that can relax and reduce pain. This research design uses the Case Study method. The sampling method used is purposive sampling. The samples taken were 2 respondents, namely postoperative TURP patients with BPH who were hospitalized at Vita Insani Hospital, Pematangsiantar. The results showed that the pain experienced by post TURP surgery patients in BPH sufferers decreased as seen on the pain scale. Mr. H, moderate pain scale (6) to mild pain (2) and Mr. P, moderate pain scale (5) to mild pain (1) Benson relaxation therapy was effective in post-TURP surgery cases in reducing pain intensity. Nurses are expected to be able to accompany patients to apply Benson relaxation therapy in an effort to reduce pain in postTURP surgery patients. [ABSTRACT FROM AUTHOR]

• Brown Planthopper is a serious threat to rice crop, posing a significant risk to food security. • To combat the damage, molecular breeding stands as an efficient approach by utilizing resistance genes. • Accordingly, a sophisticated marker assisted breeding technique was employed with SSRs and SNPs to introduce BPH genes from M229 and 10–3 donors into susceptible Telangana Sona. • Five backcross lines (BC 1 (a)−14, BC 1 (a)−19, BC 1 (b)−2, BC 1 (b)−4, BC 1 (b)−5) from both the crosses were identified as potential materials, displaying grain characteristics similar to Telangana Sona. Brown Planthopper (BPH) is one of the most destructive insect pests of rice that threatens food security. Molecular breeding through the use of resistance genes per se would be an economic and efficient way to combat the damage caused by BPH. Telangana Sona (TS) is an elite, popular and a high yielding rice variety susceptible to the infestation of BPH causing severe yield losses. In the current investigation, a marker-assisted backcross breeding approach using gene-specific Simple Sequence Repeats (SSRs) and designed Single Nucleotide Polymorphisms (SNPs) was employed to incorporate BPH resistance genes from the donor lines, M229 and 10–3 into TS. Foreground selection using gene-specific SSRs pinned down one plant (BC 1 (a)-19) from TS//TS/M229 cross with qBph-3–1 and Bph33(t) genes/QTLs, while, six plants of TS//TS/10–3 cross had Bph33(t) gene. Validation of BC 1 F 1 plants with designed SNPs altogether identified three (BC 1 (a)-14, BC 1 (a)-18, BC 1 (a)-19) from TS//TS/M229 and three lines (BC 1 (b)-2, BC 1 (b)-4, BC 1 (b)-5) from TS//TS/10–3 cross positive for snpOS00915, snpOS00922 and snpOS00923. All these lines were also found to be phenotypically resistant to BPH as screened using a modified mass tiller screening method. Altogether, foreground selection coupled with stringent phenotypic selection and agro-morphological evaluation led to the identification of two backcross lines (BC 1 (a)-14 and BC 1 (a)-19) from TS//TS/M229 and three (BC 1 (b)-2, BC 1 (b)-4, BC 1 (b)-5) from TS//TS/10–3 that had grain type characteristics similar to TS that can be potentially used as breeding material for further backcrossing and advancing for near isogenic lines development. The study demonstrates the potential efficacy of marker-assisted selection deployed with both SSRs and SNPs that can be employed in breeding for BPH-resistant varieties. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study was to assess the predictive factors associated with transient urine incontinence (TUI) following holmium laser enucleation of the prostate (HoLEP). Materials and Methods: A retrospective analysis was conducted on a prospectively maintained database containing the first 149 consecutive HoLEP cases between June 2022 and December 2023. The study recorded several patient characteristics, and preoperative data such as IPSS score, total gland volume, preoperative catheterization, Qmax, and PVR volume were collected. During the operation, data on total operating time, enucleation time, morcellation time, and weight of enucleated tissue were recorded. Finally, postoperative data were also documented. TUI refers to a patient's complaint of urine leakage, irrespective of type. Univariate and multivariate logistic regression analyses were performed to determine factors that predict TUI. Results: The study included 119 patients with BPH. Nineteen (15.96%) of them experienced postoperative TUI. Of those 19 patients, 15 (78.94%) recovered within three months from the date of the surgery. In the multivariate regression analysis, increased age (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.56~7.78; p = 0.002), prostate volume ≥ 100 mL (OR 1.86; 95% CI 1.54–2.13; p = 0.001), preoperative PVR volume ≥ 250 mL (OR 1.22; 95% CI 1.10–1.32; p = 0.02), preoperative catheterization (OR, 0.56; 95% CI 0.34–0.78; p = 0.003), increased operation time (OR, 3.87; 95% CI 1.62–4.19; p = 0.002), and resected tissue weight ≥ 40 g (OR, 1.032; 95% CI, 1.015–1.048; p = 0.002) were found to be independent predictors of TUI. Conclusions: The incidence of TUI following HoLEP was found to be 15.96% in patients, with a recovery rate of 78.94% within three months post-surgery. Predictive factors for TUI included age at surgery, prostatic volume, preoperative catheterization, high PVR, longer operative time, and resected tissue weight. [ABSTRACT FROM AUTHOR]

BackgroundNational guidelines recommend obtaining prostate gland volume (PGV) prior to benign prostate hyperplasia (BPH) surgery. Measurement of PGV with handheld ultrasound (HUS) probes shows promise.ObjectiveTo compare the reliability of two HUS probes (Butterfly iQ and Clarius C3) to the BPH guideline-recommended imaging (GIm) for both prostate and bladder volumetrics.MethodsMale patients with GIm were randomized to undergo transabdominal HUS PGV with one of the two probes. A subset underwent voided volume measurements with one of the two HUS and a conventional bladder scanner (BS). The reliability of the volume measurements was assessed for each probe via intraclass correlation coefficients (ICCs). We utilized the following standard criteria: ICC < 0.5: poor reliability; 0.5 ≤ ICC < 0.75: moderate reliability; and ICC ≥ 0.75: good reliability.ResultsA total of 78 men in the prostate arm (38 Butterfly, 40 Clarius) and 45 in the bladder arm (24 Butterfly, 21 Clarius) were randomized and included in this study. The mean prostate volume based on GIm was larger in the Clarius group (p = 0.044). Other baseline characteristics were similar between groups (p > 0.05). The ICCs were 0.78 (95% CI: 0.62, 0.88) and 0.71 (95% CI: 0.51, 0.83) for the Butterfly and Clarius probes, respectively. Regarding bladder volumetrics, the ICCs were 0.82 (95% CI: 0.19, 0.95), 0.72 (95% CI: 0.44, 0.88), and 0.69 (95% CI: 0.13, 0.87) for the Butterfly, Clarius, and bladder scanner, respectively.ConclusionsThe Butterfly iQ demonstrated good reliability for PGV and voided volume measurements, in comparison to moderate reliability for Clarius C3.

BackgroundBenign prostatic hyperplasia (BPH) is a common issue among older men. Diagnosis of BPH currently relies on imaging tests and assessment of urinary flow rate due to the absence of definitive diagnostic markers. Developing more accurate markers is crucial to improve BPH diagnosis.MethodThe BPH dataset utilized in this study was sourced from the Gene Expression Omnibus (GEO). Initially, differential expression and functional analyses were conducted, followed by the application of multiple machine learning techniques to identify key diagnostic markers. Subsequent investigations have focused on elucidating the functions and mechanisms associated with these markers. The ssGSEA method was employed to evaluate immune cell scores in BPH samples, facilitating the exploration of the relationship between key diagnostic markers and immune cells. Additionally, molecular docking was performed to assess the binding affinity of these key markers to therapeutic drugs for BPH. Tissue samples from BPH patients were collected for experimental validation of the expression differences of the aforementioned genes.ResultA total of 185 differential genes were identified, comprising 67 up-regulated and 118 down-regulated genes. These genes are implicated in pathways that regulate extracellular matrix tissue composition and cellular responses to transforming growth factor beta stimulation, as well as critical signaling pathways such as AMPK and mTOR. Through the application of various machine learning techniques, DACH1, CACNA1D, STARD13, and RUNDC3B were identified as key diagnostic markers. The ssGSEA algorithm further corroborated the association of these diagnostic genes with diverse immune cells. Moreover, molecular docking analysis revealed strong binding affinities of these markers to tamsulosin and finasteride, suggesting their potential as drug targets. Finally, experimental validation confirmed the expression differences of DACH1, CACNA1D, STARD13, and RUNDC3B in BPH tissues.ConclusionThis study introduces novel immune-related diagnostic markers for BPH and highlights their promise as new drug targets, providing a valuable approach for predictive diagnosis and targeted therapy of BPH.

Background: Transurethral resection of the prostate (TURP) is widely recognized as the gold standard surgical treatment for patients experiencing bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH). An essential consideration in TURP is determining the amount of tissue resection necessary to achieve a clinical improvement of lower urinary tract symptoms. Objectives: To develop a model for predicting resected prostate weight (RPW) for TURP. Materials and Methods: This was a cross-sectional study involving 187 patients who underwent TURP between January 2016 and July 2017 in a Nigerian hospital. Results: The mean age of the patients was 66.13 years (SD = 8.02). The mean post-void residual urine volume (PVR) was 192.74 mL (SD = 241.88), while the mean transrectal ultrasound scan (TRUS) estimated prostate weight (EPW) was 44.24 g (SD = 18.40). The mean RPW was 27.01 g (SD = 10.80), and the mean International Prostate Symptom Score (IPSS) score was 25.88 (SD = 5.12). A statistically significant positive correlation was observed between RPW and TRUS EPW (r = 0.636, P < 0.001) as well as between RPW and PVR (r = 0.359, P < 0.001). A weak positive correlation was found between RPW and pre-treatment IPSS (r = 0.191, P = 0.023). In a regression model, only TRUS EPW and PVR were significant predictors of the RPW (P < 0.05). Conclusion: It is essential to develop a model for predicting the RPW for TURP. This could significantly aid in surgical planning before the procedure.

Objective Methods Results Conclusion To compile and evaluate the heritability and inheritance patterns of lower urinary tract symptoms (LUTS) in adult cohorts.Searches of five databases (PubMed, Embase, APA PsycInfo, Global Health, and OVID Medline) commenced on 6 July 2024, resulting in 736 articles retrieved after deduplication. Studies evaluating heritability patterns, gene frequencies, and familial aggregation of symptoms were included for review. Screening and predefined eligibility criteria produced 34 studies for final review. A descriptive analysis of synthesised data was performed, adhering to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The Cochrane Risk of Bias in Non‐Randomised Studies of Interventions (ROBINS‐I) tool and the Johanna Briggs Institute checklist were used to evaluate these studies.Ten of the 34 studies (29%) described general LUTS, 14 (41%) described symptoms due to benign prostatic enlargement (BPE), nine (26%) described urinary incontinence (UI; urge UI [UUI], stress UI [SUI] and mixed UI [MUI]), four (12%) described nocturia alone, two (6%) described overactive bladder (OAB), and four (13%) described other specific symptoms (frequency, postvoid residual urine volume). BPE symptoms, UI (MUI and UUI), nocturia alone, and frequency alone were associated with genetic predisposition, whilst OAB and SUI had more modest inheritance.The pathogenetic and pharmacological mechanisms fundamental to LUTS manifestation are highly heterogeneous. Further work is required to evaluate the inheritance patterns of LUTS more extensively. [ABSTRACT FROM AUTHOR]

Purpose: Prostatic urethral lift has been an effective ejaculation sparing treatment for benign prostatic hypertrophy. The aim of this study was to evaluate the effect on male semen parameters. Methods: Between July 2014 and January 2022, 20 young men with urinary symptoms of BPH, unresponsive to drug treatment and motivated to preserve ejaculation for eventual paternity, underwent UroLift. Semen analysis was performed before and 6 month after surgery with evaluation of pH, volume, sperm concentration, total motility, vitality and morphology according to WHO 2011. All underwent digital rectal examination, transrectal prostate ultrasound to measure prostate volume, PSA, uroflowmetry, cystoscopy and urodynamics test if necessary. Objective and subjective urinary function was scheduled at 1, 3, 6, 12 month than yearly with UFM, IPSS, IIEF-5, and MSHQ-EjD-SF. Results: At a mean follow-up of 36 month (range 12 to 63), no retroejaculation or changes in seminal parameters occurred. Mean age was 44.5 (range 36.5 to 48) years. Mean operative time was 15 (range 10 to 20) min and 2.5 (range 2 to 4) implants per patients were used. At 6 month there were no difference in terms of total sperm count, volume, pH, motility, vitality, morphology, liquefaction, leucocytes (p = 0.9; p = 0.8; p = 0.7; p = 1; p = 1; p = 1; p = 0,2; p = 0.5). At last, Q-max increased by 64.4% (p = 0.001), post-void residual volume decreased by 66.6% (p = 0.016), and IPSS decreased by 60% (p < 0.001). IIEF and MSHQ-EjD-SF were preserved (p = 0.14, p = 0.4). Conclusions: UroLift appears safe technique to correct LUTS from BPH in young men desirous to preserve seminal analysis. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of our study is to compare the perioperative and functional outcomes of a multimodal approach combining thulium laser vaporization, bipolar TURP, and bipolar plasma vaporization (TLP) with bipolar TURP in a matched-pair analysis. Methods: A nonrandomized, observational, retrospective, and matched-pair analysis was performed on two homogeneous groups of 60 patients who underwent TLP versus bipolar TURP at our center between March 2018 and December 2021. The American Society of Anesthesiologists (ASA) score and prostate volume (PV) were the main parameters used to match patients between the two groups. Follow-up was evaluated at 3, 6, 12, and 24 months after surgery. Results: There was a shorter operative time in favor of TLP (42 versus 45 min, p = 0.402). Median hemoglobin drop (−0.3 versus −0.6, p < 0.001) and median sodium drop (−0.3 versus −0.7, p < 0.001) after surgery were statistically significantly lower in TLP compared to bipolar TURP. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were significantly lower, and the maximum urinary flow rate was higher in the TLP group. The median PSA decrease 2 years after surgery was 73.92% in the TLP group versus 76.17% in the bipolar TURP group (p = 0.578). The complication rate was lower in the TLP group (20% versus 21.67%, p = 1). Conclusions: The results show that both procedures are equally effective and safe in the treatment of symptomatic BPH with some advantages regarding the TLP technique. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the early learning curve of BipolEP (Bipolar Enucleation of the Prostate). Subjects/patients and methods: We conducted a retrospective, multicenter analysis of surgical and functional outcomes of patients treated with BipolEp for BPO (benign prostatic obstruction). We evaluated the first 20 cases of BipolEp performed by four different surgeons in three different countries. The following baseline parameters were obtained: age, IPSS, indwelling catheter, transrectal measured prostate volume, post void residual volume (PVR) and uroflowmetry. The learning curve was analysed based on perioperative parameters and the influence of perioperative parameters was correlated with the sequence of BipolEp cases. Results: 84 BipolEp operations performed by 4 different surgeons in their early learning curve were studied. Mean prostate volume was 75 ml, 39% of cases had an indwelling catheter and the average operating time was 101 min. Three out of four surgeons performed at least 50% of successful operations according to Trifecta (complete enucleation and morcellation < 90 min., no conversion to TUR-P). Conversion rate to TURP was 11.9% in total which however was driven by a single surgeon with an almost 50% conversion rate. Mean enucleated prostate was 33.3 gr (18-54.5). Intraoperative complications and reported stress incontinence ranged from 0 to 38.1%. At six-weeks review, the IPPS improved by 12.5 (8–16) points and Qmax by 208% (109.8-266.7). Uroflowmetry outcomes correlated with the sequence of cases with a linear improvement during 20 consecutive cases (p = 0.018) in all centres. Major complications (Clavien Dindo ≥ 3) were rare (4.8%) and comparable between the groups. Conclusion: Surgeons starting to learn BipolEp can expect to be able to achieve a linear improvement in Uroflow at the six-week postoperative evaluation after 20 consecutive cases. BipolEp can be successfully performed during the early learning curve with an acceptable rate of conversion to standard TUR-P. [ABSTRACT FROM AUTHOR]

Introduction: Botulinum toxin A (BoNT-A) injections in the prostate gland have been used as a minimally invasive option for treating bladder outlet obstruction (BOO). However, the efficacy of transurethral BoNT-A injections for BOO is not well established in the literature. The aim of this study is to collect evidence on the efficacy of transurethral BoNT-A injections for the treatment of BOO. Materials and methods: This systematic review and meta-analyses was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A systematic literature search was performed till December 2022. The study population consisted of adult patients diagnosed with BOO, who underwent transurethral injections of BoNT-A for the treatment of BOO. Evidence synthesis: Out of 883 records, we identified seven studies enrolling 232 participants, of which only one nonrandomized controlled trial was found. Four prospective studies and two retrospective studies. Three studies included patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) and were included in the meta-analysis. Three studies included patients with urethral sphincter hyperactivity. One study included patients with primary bladder neck disease (PBND). All studies showed significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR) at 3 and 6 months. The adverse events were mild in all studies. Hematuria, UTI, and urinary retention were reported across all studies. Conclusion: In conclusion, transurethral BoNT-A injections have been shown to improve LUTS, QoL, and urodynamic parameters of individuals with BOO at 3 and 6 months after injections, and no serious adverse effects have been reported. However, data on the long-term benefits of this treatment are scarce, and more prospective, randomized studies with larger samples examining various injection techniques, dosages, and extended follow-up of recurrent injections are needed. [ABSTRACT FROM AUTHOR]

Objective/background: Benign prostatic hyperplasia (BPH) is increasing substantial burden on health care systems. Men with high body mass index (BMI) have bigger prostate volumes (PV) with subsequent increase in lower urinary tract symptoms (LUTS) than men with normal BMI. The purpose of this research was to investigate the correlation between Obesity and PV in patients with BPH. Method: The study included 560 patients (50–80 years) with BPH. Weight and height measured to calculate BMI. TRUS was used to measure PV. Patient demographics such as IPSS score and prostate specific antigen (PSA) were also noted. Results: Patients in the study had a mean age of 65.3 ± 9.45 years and the mean BMI was 23.97 ± 4.89 kg/m2. The mean PV of each BMI group were 37.45 ± 0.81, 57.89 ± 1.52 and 77.94 ± 2.17 (ml) for normal, overweight and obese groups, respectively, and the average PV score was 57.76 ± 1.50 ml. The mean PSA score was 3.26 ± 0.94 (ng/dl) with a range of 0.6–10.4. There was significant correlation between BMI and PV (p = 0.001) as well as between BMI with PSA and IPSS (p = 0.02, 0.001, respectively). Conclusion: The results showing strong correlation between BMI and PV also BMI with PSA and IPSS. Therefore reducing weight may lead to a lower prostate volume in the elderly stage, making LUTS less noticeable and improving quality of life. [ABSTRACT FROM AUTHOR]

Objectives: Rezum (Boston Scientific) water vapour therapy is an effective day case minimally invasive surgical treatment (MIST) for men with troublesome lower urinary tract symptoms (LUTSs) due to benign prostatic obstruction. The potential place for MISTs in the treatment of patients with urinary retention or permanent catheter dependence is currently unclear. Patients and Methods: A total of 48 patients presenting with retention of urine (out of a total of 524 patients) over a 4-year period from 2017 underwent Rezum treatment. All patients were followed up at 3, 6 and 12 months after the procedure. At each visit, flow rate, post void residual urine, and patient reported outcome measures (PROMs) including International Prostate Symptom Score (IPSS) were recorded. Results: A total of 34 patients had an indwelling catheter prior to treatment and 14 were self-catheterising. The mean age was 67 years (standard deviation (SD) = 3) with a mean prostate volume of 56 mL (SD = 6). The average number of injections per case was 8 (SD1), which included median lobe (ML) treatment in one man. 75% of the patients passed their post treatment trial without catheter (TWOC). IPSS improved to 6 (p = 0.001) in 12 months. Conclusion: The results from this cohort of patients are encouraging. Further evaluation with longer follow-up is required. The addition of MISTs to the portfolio of options for men with retention of urine may offer a streamlined and efficient alternative to the conventional treatments, and help therefore to reduce the national waiting list, and allow men a more rapid solution avoiding prolonged catheterisation. Level of evidence: Not applicable. [ABSTRACT FROM AUTHOR]