Impact of COVID-19 vaccination on lower urinary tract (LUTS) in benign prostatic hyperplasia (BPH) patients

Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization

To evaluate the relationship between prostate volume (PV) and diabetes mellitus (DM) in geriatric benign prostatic hyperplasia (BPH) patients. One hundred and seventeen geriatric patients with BPH were retrospectively studied between 2008 and 2009. Patients were divided into two groups: BPH and BPH with DM group. The effects of indexes of DM, including fasting blood glucose (FBG), 2-h postprandial blood glucose, glycosylated hemoglobin (HbA1c), fasting insulin (FINS), insulin resistance (IR) index, prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS), and lower urinary tract symptoms (LUTS) were evaluated. The values of PV (P = 0.005), PSA (P = 0.013), and IPSS (P = 0.01) in the BPH patients with DM group were significantly higher than in the BPH group. The values of PV (P = 0.002) and PSA (P = 0.006) in the BPH patients with elevated FBG were significantly higher than in the BPH patients with normal FBG. BPH patients with elevated HbA1c had significantly higher PV than BPH patients with normal HbA1c (P = 0.046). BPH with hyperinsulinemia group showed significantly higher PV (P = 0.017) and longer duration of LUTS (P = 0.031) than BPH patients with normal FINS. Similarly, BPH patients with IR had higher PV (P = 0.004) and longer duration of LUTS (P = 0.036) than BPH patients without IR. The logistic regression analysis showed that FBG and FINS were the risk factors for BPH. Our study demonstrates that PV is closely correlated with diabetes and diabetes has a direct effect on the occurrence and development of BPH.

The guest editors of this special issue, both members of the European Association of Urology Guidelines Office dealing with male lower urinary tract symptoms and benign prostatic hyperplasia (BPH), have been asked by the editorial board of the World Journal of Urology to collect and publish a series of articles on BPH to document the latest developments of this disease. Next to this issue solely dealing with the treatment of BPH, another special issue on basic science, epidemiology, and assessment of BPH is already in preparation and anticipated to be published later in 2010. Both special issues contain a mixture of original scientific as well as review articles on BPH and summarize the latest knowledge of the BPH disease. We thank all authors who have followed our invitation and shared their professional inside information with us. As all articles have been peer-reviewed, we would also like to thank all reviewers for their valuable time, work, and suggestions. BPH is the term used only to describe benign growth of epithelial, muscular, and/or fibrotic cells in the prostate. Microscopic changes increase with ageing and approximately 40, 70, 80, and 90% of men are affected in their sixth, seventh, eighth, and ninth decade, respectively [1]. Based on the prevalence data, BPH appears to be a physiological ageing process. BPH becomes a disease when benign prostatic enlargement (BPE), benign prostatic obstruction (BPO), or lower urinary tract symptoms (LUTS) appear. No strict correlations between these components have been found so far and, therefore, each component of the BPH disease has to be assessed and treated separately. It is estimated that one-third to one-half of men with BPH develop BPE, approximately half of men with BPH–LUTS have BPO, and up to 40% of men in a community have LUTS. LUTS is the most frequent cause of annoyance and decreased life quality in patients with BPH and associated with health-seeking behavior [2]. Although in most cases not life-threatening, BPH–LUTS has a tremendous socio-economic impact. Data from the Integrated Health Care Information Solutions National Managed Care Benchmark Database which included more than 30 health care plans between July 1997 and January 2003 and covered 25 million men aged 50 years or older demonstrated that BPE–LUTS is the fifth most commonly treated disease in the US, following cataracts, hypertension, osteoarthritis, and bursitis [3]. It was calculated from this database that medical costs of BPE–LUTS are among the seven most costly diseases. The chance of developing a significant clinical event (defined as acute urinary retention or need for prostate surgery) within 12 months after initiating medical treatment was the second highest of all diseases. Inpatient treatment of BPE–LUTS was responsible for 40% of the total costs which were only higher for cataracts, coronary artery diseases, osteoarthritis, and arrhythmias. It was concluded that improvement of the understanding of BPE (BPO or LUTS) would have the potential to significantly decrease costs. However, it is expected that the number of patients will dramatically increase as the average life expectancy increases worldwide, and therefore, further improvements in assessment and treatment of BPE, BPO, and LUTS will help in decreasing the cost related to BPH-related conditions. Assessment and treatment of BPH, BPE, BPO, or male LUTS has been and will be the “bread and butter” of urologists not only because of the pure amount of patients, but also because of the special skills necessary to treat these patients. Urology would definitely not exist as a separate specialization without BPH and BPH-specific treatments. Amazingly, the importance of this disease is not reflected by the amount of publications in peer-reviewed journals or abstracts of major urology congresses. Of 536 published articles in European Urology in 2009, only 12 articles (2.2%) dealt with BPH or male LUTS. Therefore, the number one topic of urology is clearly underrepresented in the current literature. The guest editors of this issue of the World Journal of Urology are therefore grateful to have the opportunity to draw more attention to the most frequent urological disease. We wish our readers a joyful and interesting time reading the following articles on medical or surgical treatment of clinical BPH. Yours,

Objective: Analyzing the differences between collagen thicknesses in periurethral region from transurethral resection of the prostate (TURP) specimens of Benign Prostate Hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and of those with urinary retention. Material & methods: This was an observation analytic study on 30 patients who underwent TURP. Patients who met the inclusion criteria were divided into 2 groups: BPH patients with LUTS and those with urinary retention. Each group consisted of 15 people. The first TURP specimen of proximal verumontanum resection were examined in anatomic pathology using mass on strichrome staining as an examination of periurethral collagen thickness. Collagen will be stained as blue. Periurethral collagen thickness was measured from the basal membrane of transitional epithelium to fibromuscle tissue. Data were then statistically analyzed using independent t-test. Results: The average patient age was 66 ± 7 years old and there was no significant difference between age and periurethral collagen thickness with p=0.175 (p>0.05). The mean prostate volume was 47.19 ± 13.2 ml and there was no significant difference between prostate volume and periurethral collagen thickness with p=0.148 (p>0.05). Average periurethral collagen thickness in BPH patients with urinary retention was 146.67 ± 39.80 micrometers and while in those with LUTS was 205.33 ± 85.6 micrometers. There were no significant differences between periurethral collagen thickness and the occurrence urinary retention with retention of urine with p=0.063 (p>0.05). Conclusion: There were no significant differences between periurethral collagen thickness patients in BPH patients with LUTS and in those with urinary retention. This suggests that periurethral collagen thickness is not associated with the occurrence of urinary retention or LUTS in BPH patients.

Background: Incidence of symptomatic prostatic diseases increases with age. Nocturia disturbs sleep. We set out to determine the quality of sleep and severity of lower urinary tract symptoms (LUTS) and bother score in patients with benign prostatic hyperplasia (BPH) and carcinoma of the prostate (CAP).
 Methods: A cross-sectional study of new patients seen in the urology outpatient clinic with bladder outlet obstruction (BOO) from either BPH or CAP over a period of 18 months. Patients were interviewed using Pittsburgh Sleep Quality Index (PSQI) and International prostate symptoms score (IPSS) questionnaires. Data obtained were analyzed using SPSS version 23.
 Results:168 patients were interviewed. CAP patients were older than their BPH counterparts. About 45% of the patients had poor sleep quality. CAP patients (52.9%) were more of poor sleepers compared with BPH patients (40.0%). CAP patients (46.3%) had more severe IPSS than BPH patients (33.3%). Both CAP (70.6%) and BPH (76.0%) patients reported high bother score.
 Conclusion: CAP and BPH patients have high bother score, affirming need for early treatment. CAP patients had more severe lower urinary tract symptoms and poorer sleep quality than BPH patients.
 Keywords: IPSS, Sleep quality, LUTS, Bother score

In late 2019, an outbreak of pneumonia of unknown etiology was reported in Wuhan (China). The causative agent was quickly identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the impact of COVID-19 (coronavirus disease 2019) on various organs and symptoms has been studied, there is still a dearth of data regarding its effect on the genitourinary system. In this study, we investigated the impact of different COVID-19 strains on lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). A total of 69 patients who had previously been infected with COVID-19 from August 2021 to October 2021 and January 2022 to May 2022 were assessed. The two periods were purposively selected based on the dominant COVID-19 variant: the Delta strain for the first period and Omicron for the second, respectively. All patients had BPH and were followed up in two outpatient practices. Demographic information was collected, and LUTS were assessed using the international prostate symptom score (IPSS) questionnaires before and after COVID-19. Ultrasound examinations were performed to determine the prostate gland volume and the post-voided residual (PVR) in each patient. All patients affected by COVID-19 exhibited a worsening of LUTS. The degree of deterioration differed between those infected with different COVID-19 strains. Patients infected with the Delta strain had more severe LUTS than those with the Omicron strain. There is currently limited information available regarding the emerging pathophysiological processes in the urogenital system related to COVID-19. This present study serves as a preliminary investigation into the impact of COVID-19 on LUTS in BPH patients and could serve as a basis for more extensive multicenter studies leading to fundamental discoveries.

To evaluate safety and efficacy of tadalafil on lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) in patients treated with standard medication. In this case-controlled randomized clinical trial, from November 2008 to August 2009, 132 patients with obstructive and irritative urinary tract symptoms due to BPH, IPSS ≥ 8, no indication for surgical intervention and that reached plateau levels of response to treatment were selected. These patients were randomly allocated in two groups (each containing 66 patients). The treatment group received standard treatment of BPH and tadalafil (10 mg nightly); the placebo group received only standard treatment of BPH. IPSS, maximum urinary flow rate (Qmax) and quality of life were assessed before and after a 3-month period of study. Before treatment, mean IPSS, Qmax and quality of life values in the treatment and placebo groups were 13.06 ± 4.37 and 13.66 ± 4.25, 8.92 ± 2.96 mL/s and 9.09 ± 2.91 mL/s, 2.93 ± 0.86 and 2.66 ± 0.78, respectively. After treatment, mean IPSS, Qmax, and quality of life values in treatment group were 7.66 ± 3.99, 9.99 ± 4.76 mL/s and 1.80 ± 0.98, respectively. These findings were compared to corresponding values of the placebo group (11.37 ± 3.64, 8.73 ± 2.22 mL/s and 2.19 ± 0.53, respectively): IPSS and quality of life were significantly different but Qmax didn't show a significant change. Tadalafil improves quality of life and urinary symptoms in patients with LUTS suggestive of BPH, but doesn't have any significant effect on Qmax. Therefore, this drug may be effectively used in combination with standard medical therapies for BPH.

Background: Benign prostatic hyperplasia is a common problem that affects men older than 50 years. Benign prostatic hyperplasia can lead to urinary retention, and often the presence of moderate-to-severe lower urinary tract symptoms could impact on patients’ quality of life. Aim: to assess the relation between the severity of lower urinary tract symptoms and quality of life among patients with benign prostatic hyperplasia. Research design: A descriptive correlational research design was utilized. Setting: Assiut University Urology Hospital. Sample: A targeted sample of sixty male patients with BPH who were experiencing lower urinary tract symptoms. Tools: tool I: A structured interview questionnaire, tool II: International Prostate Symptom Score, tool III: Benign prostatic hyperplasia -Specific Quality of life scale. Results showed that the mean age of studied patients was 51.97±4.94 years. 80% presented with grade II, according to severity of lower urinary tract symptoms, 3.30% had mild symptoms, 71.0 % had moderate symptoms, and 25.0% had severe symptoms. There was a statistically significant positive correlation between the severity of lower urinary tract symptoms and quality of life (P. value <0.01) Conclusion: The quality of life among patients with benign prostatic hyperplasia decreases with the increment in the severity of their lower urinary tract symptoms. Recommendation: Further studies are needed to study factors aggravating the severity of lower urinary symptoms among patients with benign prostatic hyperplasia and target interventions that burden its effect on patients’ quality of life.

Purpose: To investigate the efficacy and adverse effects of escalating the dose of tamsulosin in Korean benign prostate hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS). Materials & methods: From March, 2010 to February, 2011, we prospectively enrolled 120 BPH patients who complained of LUTS. We evaluated the prostate specific antigen (PSA) levels, transrectal ultrasonograms (TRUS), International Prostate Symptom Scores (IPSS), International Index of Erectile Dysfunction Questionnaire-5 (IIEF-5) responses, uroflowmetry measurements and post-voided residuals (PVR) of these patients. At first, tamsulosin 0.2 mg was prescribed for 8 weeks. After 8 weeks, we prescribed tamsulosin 0.4 mg for a further 8 weeks to those patients who had not responded to tamsulosin 0.2 mg. After another 8 weeks we re-evaluated the variables, and assessed side effects. Patients prescribed tamsulosin 0.4 mg were divided into two groups; those whose total IPSS were reduced by more than 3 were assigned to the responder group (n=31), those whose total IPSS were reduced by less than 3 were assigned to the non-responder group (n=29). We then compared the variables and frequencies of adverse effects in the two groups. Results: 60 patients completed the study. Mean age, prostate volume and PSA were 67.3±7.9 years, 31.0±7.7 ml and 1.8±2.3 ng/ml, respectively. Baseline prostate volume, maximal urine flow rate and IPSS score were higher in the responder group (p<0.05). There was no significant difference in baseline PVR or IIEF-5 between the two groups. Maximal urine flow rate increased in both groups but PVR did not improve in the non-responder group, and IIEF-5 scores decreased slightly in the non-responder group but not in the responder group. Numbers of adverse effects such as orthostatic hypotension, ejaculatory dysfunction, erectile dysfunction, dizziness and gastrointestinal discomfort were not significantly different in the two group (n=5 vs. 8, p=0.430). Conclusions: Dose escalation of tamsulosin is effective in improving the urinary symptoms of patients with large prostate volumes and high IPSS scores. The incidence of adverse effects is unaffected by tamsulosin dose escalation.

Prostate cancer (PCA) is a leading cause of cancer death in men. Underlying immunosuppressive mechanisms in benign prostate hyperplasia (BPH) and PCA patients are not fully clarified. We analyzed homeostatic proliferation of CD8+ T cells upon stimulation with common receptor γ chain IL-2, IL-7 and IL-15 cytokines in PCA as compared to BPH patients. CD8+ T cells exhaustion was assessed by evaluating Programmed Death-1 (PD-1) receptor and its ligand PD-L1 expression in PBMC and tissue infiltrating CD8+ T cells from PCA and BPH patients. 57 BPH and 76 PCA patients were enrolled. Gene expression was quantified by Real-Time PCR. T cell proliferation was evaluated by CFSE dilution. CD132, CD122, PD-1 and PD-Ll expression were assessed by flow cytometry. IL-2, IL-7 and IL-15 gene expression were quantified in PCA (n=57) and BPH (n=32) tissues. IL-7 and IL-15 gene expression were significantly increased in PCA tissues as compared to BPH (p=0.024; p=0.031). No significant differences were observed for IL-2 gene expression. CD8+ cells from BPH (n=17) and PCA (n=21) patients showed a significantly decreased responsiveness to IL-7 and IL-15 (p=0.021; p=0.015) as compared to healthy donors (n=9). Response to IL-2 was similar. A trend towards a lower response to IL-15 in PCA as compared to BPH patients was detectable. Percentage of CD8+ T cells expressing the common γ chain (CD132) of homeostatic cytokines receptor is significantly decreased in PCA (n=13) and BPH (n=16) patients as compared to healthy donors (n=8) (p= 0.024; p&amp;lt;0.001). Percentage of CD8+ T cells expressing the common β chain (CD122) is significantly decreased in PCA patients as compared to healthy donors (p=0.035). No significant differences were noticed for the expression of the α chain of homeostatic cytokine receptor. Urged by these findings, we addressed the expression of PD-1 and its ligand in CD8+ T cells from BPH and PCA patients. In BPH (n=7) and PCA (n=7), %CD8+PD-1+ and %CD8+PD-L1+ T cells are increasing upon culture with homeostatic cytokines. In freshly isolated CD8+ cells, a highly significant increase in the %CD8+PD-1+ cells was observed in PCA (n=32) and BPH (n=22) as compared to healthy donors (p&amp;lt;0.001; p&amp;lt;0.001). In contrast, PD-L1 expression in CD8+ cells was similar in BPH and PCA patients and in healthy donors. A large majority of CD8+ cells infiltrating BPH or PCA tissues (83±22% for BPH, n=9; 88±17% for PCA, n=7) were PD-1+, whereas PD-L1 was expressed in 51±43% and 37±39% of infiltrating CD8+ T cells in BPH and PCA, respectively. Taken together these data indicate that both BPH and PCA patients display a decreased responsiveness to IL-7 and IL-15 homeostatic cytokines. Interestingly, high percentages of peripheral blood CD8+ T cells express PD-1 in BPH and PCA patients. Notably, PD-1 and its ligand are highly expressed in tissue infiltrating CD8+ T cells in BPH and PCA patients, thus raising the issue of the role of T cells exhaustion in PCA. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4782.

PROSTATIC VOLUME AND RATIO OF FREE-TO-TOTAL PROSTATE SPECIFIC ANTIGEN IN PATIENTS WITH PROSTATIC CANCER OR BENIGN PROSTATIC HYPERPLASIA

Role of Antimuscarinics Combined With Alpha-blockers in the Management of Urinary Storage Symptoms in Patients With Benign Prostatic Hyperplasia: An Updated Systematic Review and Meta-analysis.

Associations Between Improvements in Lower Urinary Tract Symptoms and Sleep Disturbance Over Time in the CAMUS Trial

Background: Lower Urinary Tract Symptoms (LUTS) after Transurethral Resection of the Prostate (TURP) occur in one-third of Benign Prostatic Hyperplasia (BPH) patients, may be caused by persistent prostatic inflammation and fibrosis. Objective: This study aims to evaluate the role of inflammation and fibrosis in pathological mechanism of LUTS among patients with BPH who underwent TURP by assessing their PSA, TNF-α, and TGF-β level. Design, Setting, and Participant: Data in this study were analyzed with the 2-way hypothesis. The study used odds ratio to define the risk factors of LUTS after TURP. The samples of the study are BPH patients after TURP aged 50-80 years old. Interventions: No intervention(s). Outcome Measurements and Statistical Analysis: The data analyzed using SPSS version 21.0 for Windows. Results and Limitations: There were 34 cases of LUTS and 42 controls without LUTS. We found that there were an increased levels of TNF-α (&gt; 46.95 pg/ml) (OR 55.6, 95% Confidence Interval [CI] 11.1-278.4, p=0.00) and TGF-β (&gt; 207.63 pg/ml) (OR 16.7, 95%CI 5.3-52.8, p=0.00). The result of multiple linear logistic regression analysis obtained equation Y= 0.033 x TNF-α + 0.031 x TGF-β. Population Attributable Risk (PAR) % TNF-α is 60%, PAR % TGF-β is 53%. Conclusion: Combination of elevated levels of TNF-α (&gt;46.95 pg/ml) and TGF-β (&gt;207.63) in prostate tissue is the risk factors for the occurrence of LUTS after TURP. Patient Summary: In this study, we enrolled 76 patients who were diagnosed with BPH and urinary retention. After TURP, there were 34 cases of LUTS and 42 controls without LUTS. We found that the levels of TNF-α and TGF-β between cases and controls were significantly different. We conclude that the combination of elevated levels of TNF-α and TGF-β in prostate tissue is the risk factors for the occurrence of LUTS after TURP.

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objectives of the study was to evaluate the demographic profile of benign prostatic hyperplasia (BPH) patients and prevalence of overactive bladder (OAB) among these patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A real-world, retrospective, observational study (DEMO-2) on BPH patients was conducted across India from April-2021 to March-2022. Demographics, BPH characteristics, status of OAB, and their management were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 5881 BPH patients were included with a mean age of 65.3 years and mean BPH duration of 3.2 years. Majority (80.98%) of the patients had associated comorbidity; hypertension (50.2%), diabetes (26.9%) and dyslipidemia (13%) were the most common. Majority (63%) of the patients complained of incomplete bladder emptying. In BPH patients, 29.9% had OAB. These patients had a higher mean prostate volume (44.96 vs. 42.17 cc) and prostate specific antigen (PSA) levels (4.11 vs. 3.79 ng/ml) versus BPH patients without OAB. For BPH, tamsulosin was the most prescribed drug (85.90%) followed by dutasteride (66.90%); tamsulosin + dutasteride was most common combination therapy (32.6%). In BPH patients with OAB, 82% received OAB medications and solifenacin (63.9%) was the most common medication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: Majority of the BPH patients were between the ages of 50-75 years. Tamsulosin was the most commonly prescribed medication in BPH patients. Combination of tamsulosin and dutasteride was the mainstay of treatment. OAB was seen in 29.9% of the BPH patients, and solifenacin was the most commonly utilized (63.1%) medication in BPH patients with OAB. About 18% of these patients did not receive any specific medication for OAB. Adequate treatment strategies need to be adopted for BPH patients with OAB.&lt;/p&gt;