Prostatic Enlargement Research Articles

Leptin Mediates Prostate Stromal Cell Proliferation, Smooth Muscle Contraction, and Mitochondrial Function in Benign Prostate Hyperplasia.

Leptin is a metabolic peptide hormone produced by adipocytes, with proven roles in proliferation of prostate cancer cells and of prostate cells in animal models of benign prostatic hyperplasia (BPH). Thus, the role of leptin as a molecular link connecting BPH and lower urinary tract symptoms (LUTS) suggestive of BPH with metabolic symptoms appears feasible but is still unknown. In fact, a connection between metabolic syndrome and BPH is becoming increasingly evident from epidemiologic studies. Key factors of Lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH/LUTS) are increased prostate smooth muscle tone, and prostate enlargement. Here, we examined the effects of leptin on contraction of human prostate smooth muscle and on growth of stromal cells. We performed microarray analysis to identify genes (fold change ≥ 1.5) associated with BPH/LUTS progression, such as those involved in proliferation, apoptosis, and mitochondrial metabolism, in rat prostate tissue (data from GSE129561). We then used electric field stimulation (EFS) to induce frequency-dependent, neurogenic contractions of human prostate strips, which were enhanced by leptin. We also examined the effect of leptin on human prostate stromal cells (WPMY-1) and found increased cell proliferation and viability upon exposure. To explore the underlying mechanism, we conducted mitochondrial stress assay using near-infrared (NIR) fluorescent dye and flow cytometry (FACS) analysis and observed reduced cellular apoptosis and preserved mitochondrial membrane potential (∆ψM) after leptin treatment. Microarray analysis reveals that leptin regulates prostate smooth muscle contraction and stromal cell proliferation, shedding new light on its involvement in BPH/LUTS pathogenesis and mitochondrial function. We found that leptin enhanced the proliferation rate of prostate stromal cells relative to the control group (0.67 ± 0.05 vs 0.54 ± 0.08, p-value= 0.024). Moreover, leptin (100 ng/mL) potentiated the frequency-dependent, neurogenic contractions of prostate strips elicited by EFS (p= 0.047 between leptin and control group). We also show that leptin treatment increased the mitochondrial membrane potential of prostate stromal cells and inhibited mitochondrial apoptosis. Our results indicate that leptin stimulates the contractility and proliferation of smooth muscle and stromal cells in the human prostate, implying a potential role for leptin in exacerbating BPH/LUTS in obese men. Leptin modulation may be a beneficial therapeutic strategy for patients with metabolic syndrome and BPH/LUTS. Further studies are warranted to elucidate the mechanisms and implications of the leptin system in BPH/LUTS.

Intractable haematuria due to giant prostatic hyperplasia in a resource-challenged centre: between the devil and the deep blue sea

Intractable haematuria due to giant prostatic hyperplasia in a resource-challenged centre: between the devil and the deep blue sea

Sonographic Correlations between Intravesical Prostatic Protrusion and Bladder Outlet Obstruction in Patients with Symptomatic Benign Prostatic Hyperplasia in Ibadan, Nigeria

Background: Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p = 0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP.

Efficacy and safety of transurethral thulium laser enucleation versus robot-assisted prostatectomy for large-volume benign prostatic hyperplasia: a systematic review and meta-analysis.

To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple pasta-ectomy (RASP)for large-volume benign prostatic hyperplasia(> 80ml). In August 2023, we undertook a comprehensive search of major global databases including PubMed, Embase, and Google Scholar, focusing solely on articles written in English. Studies that were merely reviews or protocols without any specific published data were omitted. Furthermore, articles that comprised conference abstracts or content not pertinent to our subject of study were also disregarded. To calculate the inverse variances and 95% confidence intervals (CIs) for categorical variables' mean differences, we employed the Cochran-Mantel-Haenszel approach along with random-effects models. The findings were denoted in the form of odds ratios (ORs) and 95% CIs. A p-value less than 0.05 was deemed to indicate statistical significance. Our finalized meta-analysis incorporated six articles, including one randomized controlled trial (RCT) and five cohort studies. These studies accounted for a total of 1218 patients, 944 of whom underwent Holmium Laser Enucleation of the Prostate (HoLEP) and 274 who underwent Robotic-Assisted Simple Prostatectomy (RASP). The pooled analysis from these six papers demonstrated that compared to RASP, HoLEP had a shorter hospital stay, shorter catheterization duration, and a lower blood transfusion rate. Moreover, HoLEP patients exhibited a smaller reduction in postoperative hemoglobin levels. Statistically, there were no significant differences between the two procedures regarding operative time, postoperative PSA, the weight of prostate specimens, IPSS, Qmax, PVR, QoL, and postoperative complications. (HoLEP) and (RASP) are both effective and safe procedures for treating large-volume benign prostatic hyperplasia. HoLEP, with its benefits of shorter catheterization and hospitalization duration, lesser decline in postoperative hemoglobin, and reduced blood transfusion needs, stands as a preferred choice for treating extensive prostate enlargement. However, further validation through more high-quality clinical randomized trials is required.

The mediating role of phthalate metabolites on dietary inflammatory index and prostatic enlargement in Taiwanese adults

The mediating role of phthalate metabolites on dietary inflammatory index and prostatic enlargement in Taiwanese adults

Diagnostic efficacy of systemic immune-inflammation biomarkers in benign prostatic hyperplasia using receiver operating characteristic and artificial neural network

Benign prostatic hyperplasia (BPH) is a chronic, progressive disease characterized by mesenchymal cell-predominance and stromal and glandular cell-hyperproliferation. Although, the precise cause of BPH is unknown, it is believed to be associated with hormonal changes in aging men. Despite androgens and ageing are likely to play a role in the development of BPH, the pathophysiology of BPH remains uncertain. This paper aims to evaluate the diagnostic efficacy of platelet-to-lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR) and systemic immune-inflammation index in in diagnosing BPH. A single-center-randomized-retrospective study was carried out at Alzahraa university hospital between January 2022 and November 2022 on 80 participants (40 non-BPH subjects and 40 patients with symptomatic enlarged prostate) who visited the outpatient clinic or admitted to the urology department. The BPH cases were evaluated by digital rectal examination (DRE), International Prostate Symptom Score (IPSS), prostate size, prostate specific antigen (PSA), TRUS biopsy in elevated PSA > 4 ng/ml, PLR, NLR and systemic immune inflammatory (SII). The diagnosing efficiency of the selected parameters was evaluated using Receiver Operating Characteristic (ROC) and Artificial Neural Network (ANN) showing excellent discrimination with 100% accuracy and AUC = 1 in the ROC curves. Moreover, the accuracy rate of the ANN exceeds 99%. Conclusion: PLR, NLR and SII can be significantly employed for diagnosing BPH.

Acute Myocarditis as a Complication of Acute Prostatitis: Case Report

Introduction: Myocarditis is an inflammation of cardiac muscle. Several pathogens proved to cause acute myocarditis. E. coli pathogen as a cause of myocarditis is rare. Case Presentation: We had a 28 years old male who had fever, lower urinary tract symptoms, and lower back pain three days ago. Digital rectal examination revealed enlarged prostate. The diagnosis was acute prostatitis. We started with the right antibiotics. Later, he developed acute chest pain with normal laboratory findings and imaging studies. As a result, we made the diagnosis of acute myocarditis as a complication of acute prostatitis. Discussion: Several pathogens proved to cause myocarditis. E.coli as a cause of myocarditis is rare and a few reports published. Usually, serum laboratory, ECG, and imaging studies of the heart are negative. Treating the cause of acute prostatitis will lead to recovery from myocarditis. Conclusion: In normal full cardiac investigations in a patient with chest pain and acute prostatitis, physicians should suspect E.coli sepsis as a cause of myocarditis.

The role of inflammatory processes and zinc levels in prostatic enlargement among Iraqi samples.

This study aimed to investigate the role of inflammatory processes in benign prostatic enlargement among men with elevated prostate-specific antigen (PSA) levels without a history of prostatic disease. Additionally, we aimed to examine the influence of serum zinc levels on prostate volume. We investigated the associations between systemic inflammatory markers, serum PSA, and serum zinc levels in 48 men without a history of prostatic disease, aged between 60-72 years, and 30 healthy men in the same age range. Data collection occurred between 1/2/2022 to 1/10/2022. The results are presented as mean values ± standard error (SE), and statistical significance was determined at p≤0.05. The levels of sIL-8 (P: 44.295±1.002, C: 1.404±0.2562), IL-6 (P: 7.406±0.5632, C: 4.468±0.830), CRP (P: 14.765±0.565, C: 6.267±0.538), increased significantly in patients with high PSA, while zinc levels (P: 92.305±2.8235, C: 114.565±8.861) decreased in the patient group. Regarding white blood cell (WBC) parameters, patients exhibited a significant increase in WBC total count (P: 12995.00±488.47, C: 7713.333±777.778), neutrophil % (P: 69.450±1.619, C: 51.200±1.826), lymphocyte % (P: 39.50±2.024, C: 30.867±1.268), and NLR (2.013±0.105). Conversely, there were no significant differences in eosinophil % (P: 3.450±0.4558, C: 3.267±0.5297), basophil % (P: 0.300±0.105, C: 0.267±1182), or monocyte % (P: 3.450±0.4558, C: 3.267±0.5297) between the two groups. In men without known prostatic illness, increased PSA was linked to markers of systemic inflammation. The results indicate the role of inflammatory processes in increasing the size of the prostate gland, as evidenced by the increased levels of immune markers like white blood cells and interleukins, along with the influence of zinc. Future research is required to determine how these markers relate to the development and incidence of prostate cancer.

PE003 - Retzius-sparing Robot-Assisted Simple Prostatectomy (RASP) in the treatment of male patients with lower urinary tract symptoms due to large benign prostatic enlargement.

PE003 - Retzius-sparing Robot-Assisted Simple Prostatectomy (RASP) in the treatment of male patients with lower urinary tract symptoms due to large benign prostatic enlargement.

Optimal interval for delayed retrieval surgery with reciprocating morcellators after enucleation of giant prostatic hyperplasia in holmium laser enucleation of the prostate

ObjectiveThe aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate, investigate whether performing morcellation as a two-stage procedure improves tissue retrieval efficiency, and seek to determine the optimal interval between the two surgeries. MethodsThis study included nine cases of holmium laser enucleation of the prostate with an enucleated prostate weight exceeding 200 g, indicative of substantial prostate enlargement. Morcellation was performed on Day 0 (n=4), Day 4 (n=1), Day 6 (n=1), and Day 7 (n=3). The intervals were compared regarding the morcellation efficiency, beach ball presence, and pathology. ResultsThe mean estimated prostate volume was 383 (range 330–528) mL; the median enucleation weight was 252 (interquartile range [IQR] 222, 342) g; and the median enucleation time was 83 (IQR 62, 100) min. The mean morcellation efficiency was 1.44 (SD 0.55) g/min on Day 0 and 13.69 (SD 2.46) g/min on day 7. The morcellation efficiency was 4.15 g/min and 10.50 g/min on Day 4 and Day 6, respectively, with significantly higher in the two-stage group compared to one-stage group (11.0 g/min vs. 1.5 g/min; p=0.014). Efficiency was strongly correlated with intervals (p<0.001); the incidences of beach balls were 100% (4/4) and 60% (3/5) in the immediate and two-stage surgery groups, respectively. ConclusionThe efficiency of two-stage morcellation with reciprocating morcellators was highly related to the postoperative interval, with the maximum efficiency reached on Day 7.

154 A Scoping Review of the Management of Benign Prostate Hyperplasia in Africa

Abstract Aim Benign prostatic hyperplasia (BPH) is a non-malignant prostate gland enlargement of unknown cause that affects more than 50% of men over 60 and is the most common cause of bladder outlet obstruction and voiding symptoms. BPH is treated primarily with watchful waiting, phytotherapy, and medical or surgical options. In this study, we sought to examine the different management practices in African urological centres, outcomes of management, and complications. Method A literature search was conducted using PubMed, African Journal Online, and Google Scholar regarding the management of BPH from inception till date. Articles were selected based on their relevance to the management of benign prostatic enlargement in Africa. Results are reported according to the PRISMA extension for scoping reviews. Results Exactly 2999 patients were included in the study. Seventy-three (73.49%) percent of these patients totalling 2204, underwent surgical management of BPH, 124 (4.13%) patients were treated with phytomedicines, and 684 (22.80%) patients were treated with medical therapy. A total of 808 patients opted for non-surgical treatment for BPH in the included studies. In this group, 124 were treated using phytochemicals or natural herbs, and 648 were treated with standard prescription medications. Conclusions While surgical treatment for benign prostatic enlargement is shifting towards minimally invasive procedures in the developed world, open prostatectomy is still quite popular in Africa. Further research should focus not only on the reason for these disparities in management but also on the rationale for the selection of medical, surgical, or phytotherapy in African urological centres.

Giant prostatic enlargement: A presentation of a rare asymptomatic case

Benign prostatic hyperplasia is a histological diagnosis and the most frequent benign tumor in older men, and its incidence strongly correlates with advanced age. Giant prostate enlargement (GPE), also known as giant prostatic hyperplasia, is a term given for severely enlarged prostates that weigh more than 500g. GPE cases reported in literature is less than 30. We describe our experience of removing previously asymptomatic 528g prostate by open transvesical prostatectomy. According to transrectal ultrasound (TRUS) the prostate size is 482 ml and prostate‑specific antigen level of 5.1 ng/ml. Histological examination showed nodular prostatic hyperplasia, an adenomatous variant with foci of cystic atrophy, chronic prostatitis. The patient's post-operative recovery went without any relapses and complications.

Biocompatibility and efficacy of prostatic urethral lift in benign prostate hyperplasia: an in vivo and in vitro study

The study aimed to assess the biocompatibility and efficacy of a prostatic urethral lift (PUL) for benign prostatic hyperplasia (BPH). Human BPH-1 cells were co-cultured with implant anchors and sutures, and cytotoxicity was measured. Scanning electron microscopy (SEM) was used to observe adhesion and growth of cells and to evaluate implant biocompatibility. Fifteen male beagle dogs were randomly assigned to the surgical (n = 9) or sham-operated (n = 6) groups. The surgical group underwent cystotomy, and PUL was used to insert two implants in each lobe of the prostate to compress the enlarged prostate and dilate the urethra; the sham group underwent cystotomy without implant insertion. Compared with the control group, no significant difference in cell viability among the groups with different co-culture times of implant anchors and sutures (P > 0.05) was observed. SEM revealed good adhesion and growth of prostate cells on the implants. Improvements in urine flow rates remained stable at 7, 28, and 180 days after surgery, and the urethral diameter in the prostate region was significantly increased compared with that before surgery. PUL is a biocompatible and effective treatment for BPH, improving the urine flow rate without causing inflammation, tissue damage, or cytotoxic effects. Here, the basis for further PUL application was provided.

Audit of Urological Procedures in a Tertiary Health Center

Background: Urology is a branch of medicine that focuses on the surgical and medical diseases of the geni-tourinary system. This area of specialty can be broken down into several subspecialties. The information on the spectrum of urological procedures is sparse in our environment. This study aimed todeterminethe spec-trum of urological procedures at Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, Oyo State Nigeria.. The study’s objective was to determine the age and gender distribution, the type and in-dication of the procedures, and the common subspecialty categorization. This may serve as a policy frame-work for healthcare development in the field of urology, including sub-specialization. Methods: The records of patients with urological procedures between July 2013 and June 2022 were re-trieved from the hospital’s Medical Records Department. The information retrieved from case files was ana-lyzed using SPSS version 23. Results: A total of 1,069 urological procedures were done between the years under review. This comprises 998males (93.31%) and 71 females (6.64). The most common in-patient urological procedure was open sim-ple prostatectomy (14.1%, 151 patients), while the most common outpatient urological procedure was pros-tatic needle biopsy (32.74%; 350). Urethrocystocopy accounted for 7.48% (80). Suspected prostate cancer was the most common indication for these procedures (32.74%; 350), while benign prostate enlargement was the most common indication for in-patient procedures. Conclusion: The most common outpatient procedure was prostate biopsy, while the most common in-patient procedure was open simple prostatectomy..

The Impact of Prostate Volume on the Prostate Imaging and Reporting Data System (PI-RADS) in a Real-World Setting.

Multiparametric magnetic resonance imaging (mpMRI) has emerged as a new cornerstone in the diagnostic pathway of prostate cancer. However, mpMRI is not devoid of factors influencing its detection rate of clinically significant prostate cancer (csPCa). Amongst others, prostate volume has been demonstrated to influence the detection rates of csPCa. Particularly, increasing volume has been linked to a reduced cancer detection rate. However, information about the linkage between PI-RADS, prostate volume and detection rate is relatively sparse. Therefore, the current study aims to assess the association between prostate volume, PI-RADS score and detection rate of csP-Ca, representing daily practice and contemporary mpMRI expertise. Thus, 1039 consecutive patients with 1151 PI-RADS targets, who underwent mpMRI-guided prostate biopsy at our tertiary referral center, were included. Prior mpMRI had been assessed by a plethora of 111 radiology offices, including academic centers and private practices. mpMRI was not secondarily reviewed in house before biopsy. mpMRI-targeted biopsy was performed by a small group of a total of ten urologists, who had performed at least 100 previous biopsies. Using ROC analysis, we defined cut-off values of prostate volume for each PI-RADS score, where the detection rate drops significantly. For PI-RADS 4 lesions, we found a volume > 61.5 ccm significantly reduced the cancer detection rate (OR 0.24; 95% CI 0.16-0.38; p < 0.001). For PI-RADS 5 lesions, we found a volume > 51.5 ccm to significantly reduce the cancer detection rate (OR 0.39; 95% CI 0.25-0.62; p < 0.001). For PI-RADS 3 lesions, none of the evaluated clinical parameters had a significant impact on the detection rate of csPCa. In conclusion, we show that enlarged prostate volume represents a major limitation in the daily practice of mpMRI-targeted biopsy. This study is the first to define exact cut-off values of prostate volume to significantly impair the validity of PI-RADS assessed in a real-world setting. Therefore, the results of mpMRI-targeted biopsy should be interpreted carefully, especially in patients with prostate volumes above our defined thresholds.

Homoeopathic Approach to Benign Prostate Hypertrophy

Benign prostatic hyperplasia is one of the common medical conditions affecting the geriatric male. This causes dysuria, constant urgency to urinate, frequent urination and retention of urine, which makes it difficult to carry out daily tasks as usual. BPH can develop when the transitional zone of the prostate’s stromal and epithelial cells proliferates due to processes through to be driven by inflammation and sex hormones leading to prostate enlargement for the majority of patient, Treatment options for men with BPH begin with careful wating and continue from medication to surgical intervention. The beginning point on the treatment pathway will be determined by the patient’s symptoms and the severity. With Homeopathy, we can reduce the conversion of testosterone into Dihydrotestosterone and increasing level of estrogen. Keywords: Benign prostate hypertrophy, Homoeopathy, Prostate, Benign prostatic enlargement.

Study on the Synthesis of Pine Sterol Esters in Solvent-free Systems Catalyzed by Candida rugosa Lipase Immobilized on Hydrophobic Macroporous Resin.

Pine sterol ester is a kind of novel food source nutrient with great advantages in lowering blood cholesterol levels, inhibiting tumors, preventing prostate enlargement, and regulating immunity. Macroporous resins with large specific surface area, stable structures, and various functional groups (epoxy, amino, and octadecyl groups) have been selected for immobilization of Candida rugosa lipase (CRL) to improve its stability and efficiency in the synthesis of pine sterol esters. A solvent-free strategy using oleic acid (substrate) as an esterification reaction medium is an important alternative for avoiding the use of organic solvents. The immobilization conditions of CRL immobilized on several kinds of commercial macroporous resins were optimized. Fortunately, by adsorption (hydrophobic interaction), a high immobilization efficiency of CRL was obtained using macroporous resins with hydrophobic octadecyl groups with an immobilization efficiency of 86.5%, enzyme loading of 138.5 mg/g and enzyme activity of 34.7 U/g. The results showed that a 95.1% yield could be obtained with a molar ratio of oleic acid to pine sterol of 5:1, an enzyme amount of 6.0 U/g (relative to pine sterol mass) at 50°C for 48 hours. The hydrophobic macroporous resin (ECR8806M) with a large specific surface area and abundant functional groups was used to achieve efficient immobilization of CRL. CRL@ECR8806M is an efficient catalyst for the synthesis of phytosterol esters and has the potential for further large-scale applications. Therefore, this simple, green, and low-cost strategy for lipase immobilization provides new possibilities for the high-efficiency production of pine sterol esters and other food source nutrients. This article is protected by copyright. All rights reserved.

Impact of Duration of Catheterization on the Success Rate of Trial Without Catheter in Acute Urinary Retention Due to Benign Prostatic Enlargement.

The most common cause of acute urinary retention in men over 50is benign prostate enlargement (BPE). Following the urethral catheterization, a trial without a catheter (TWOC) under the cover of alpha-blockers is given. The timing of TWOC varies from Day 3 to Day 7 of the retention episode. There is a need to study the improvement in the success rate of TWOC with the increasing number of days of catheterization. To measure the success rate of TWOC in acute urinary retention due to benign prostatic enlargement with increasing days of catheterization. The study was conducted in Social Security Teaching Hospital Lahore. Patients who presented with acute urinary retention due to benign prostatic enlargement were catheterized and given alpha-blockers. The patients were divided into two groups, one group having TWOC after three days and the other having TWOC after seven days. The success rate of TWOC was calculated and compared in the two groups. All patients included in the study had the first episode of acute retention with a moderately enlarged prostate and no element of second pathology or neurological deficit. A total of 48 patients were included in the study, divided into two groups of 24 patients each. In the first group who underwent TWOC after seven days of catheterization, 15 out of 24 patients had successful TWOC with a success rate of 62.5%. In the second group of 24 patients, who had TWOC after three days of catheterization, only 11 patients had successful TWOC with a success rate of 45.8%. There was a marked improvement in the success rate of TWOCwith increasing days of catheterization after an acute retention episode, secondary toBPE.

Case Report: Incidental finding of Zinner syndrome in an asymptomatic 53-year-old Palestinian male

IntroductionZinner syndrome (ZS) is a rare condition characterized by a triad of seminal vesicle cyst (SVC), ipsilateral ejaculatory duct obstruction, and ipsilateral renal agenesis. The diagnosis is often delayed due to non-specific symptoms, such as lower urinary tract symptoms and infertility, typically appearing in the second and third decades of life.Case presentationWe present the first published case of ZS in Palestine, involving a 53-year-old male patient who sought medical attention for right-sided hernia repair. Pre-operative imaging revealed a combination of findings, including a solitary left kidney with cysts, mild hydronephrosis, an enlarged prostate, suspicious soft tissue density, and abnormal lymph nodes. The diagnosis of ZS was confirmed through an abdominal ultrasound, identifying a dilated seminal vesicle and completing the criteria of ZS.DiscussionThe typical for ZS is to present in late second decade of life with nonspecific urogenital symptoms and infertility, However, our patient’s incidental diagnosis during the preoperative evaluation of incisional hernia in a relatively old age with no previous complaints, the identification of a high aortic bifurcation at the level of the left kidney and a double Inferior Vena Cava (IVC) in this case of ZS represents novel and distinctive findings not commonly reported in previous cases.ConclusionOur patient’s presentation and findings expand our understanding of the anatomical variations associated with ZS. This case report contributes to the advancement of knowledge in the field of ZS and provides valuable insights for future clinical management and research investigations.

Relationship between PSA and Serum Zinc in BPH-Afflicted Iraqi Men

Background: Benign prostatic hyperplasia (BPH) is a common benign tumor of the prostate that becomes more common as men age. The enlarged prostate may compress the urinary tube (urethra), which runs through the middle of the prostate, preventing urine from flowing from the bladder to the outside. Complete obstruction can develop if BPH is severe enough. BPH usually appears after the age of 40 and progresses slowly. Aim of the Study: Studying the connections between serum zinc and PSA in Iraqi BPH patients is the aim of this investigation. Patients and Methods: The case-control study lasted three months, from mid-November to the end of February, at Al-Kindi Teaching Hospital and Ghazy Al-Hariri Hospital in Baghdad Governorate, Iraq. It entailed gathering 90 blood samples, which were separated into two groups. The first group (A) consisted of 60 patients with benign prostatic hyperplasia ranging in age from 45 to 80 years, while the second group (B) consisted of 30 apparently be healthy males aged 45 to 80 years. All participants in this study provided diagnose permission. Patients diagnosed with benign prostate hyperplasia had an international prostate symptom score of 18 or higher; the patient's prostate volumes (PV) were equal to or more than 25 milliliters. Radiologists with competence in the department used transabdominal ultrasound equipment manufactured in Germany by Siemens to figure out how big the prostate gland is. Both groups had their serum zinc and PSA levels measured by ELISA (Enzyme-Linked Immunosorbent Assay) assays The calculation of BMI was be calculated with the help of given standard formula. BMI = [(Weight in Kilograms / (Height in Meters x Height in Meters)]. Results: The study that the mean prostate size was elevated significantly in the BPH group (54.0 ± 8.4 cc ) as compared with the control group (19.66 ± 2.88 cc (P:0.01). There is a significant increase in the PSA concentration of benign prostatic hyperplasia patients, (3.14 ± 0.95 ng/ml), as compare with control subjects, (0.84 ± 0.10 ng/ml) (P:0.01). There is significant reduction in the serum zinc concentration of benign prostatic hyperplasia patients, (70.4 ± 9.63 ng/ml), as compare with control subjects, (99.3 ± 10.5; p≤0.01). The higher percentage of benign prostatic hyperplasia in patients above 66 years, and the lowest is in age group 45-55 years. Conclusion: Benign prostatic hyperplasia patients of all ages had considerably higher serum PSA than age-matched healthy controls. Benign prostatic hyperplasia patients of all ages had considerably lower serum zinc than age-matched healthy controls. Prostate size and PSA are greater in benign prostatic hyperplasia patients of all BMIs. Benign prostatic hyperplasia patients had significantly lower serum zinc than healthy controls of the same BMI.