Benign Prostatic Hyperplasia Research Articles

Prevalence and Risk Factors Associated with Benign Prostate Hyperplasia among Elderly Patients in Baidoa Hospitals in Somalia Cross Sectional Study

Background The disorder known as benign prostatic hyperplasia (BPH) is closely linked to ageing. Its clinical presentation as lower urinary tract symptoms (LUTS) lowers the patient's quality of life, despite the fact that it is not life- threatening. Among males over 65, up to 30% may experience problematic LUTS.  Objectives of the Study The aim of this study is to determine the prevalence and risk factors contributing benign prostate hyperplasia among elder patients in Baidoa hospitals in Somalia.  Materials and Methods The study design was a hospital based cross sectional study.  Results The prevalence of BPH shows that 19.01 % of the participants were becomes BPH while the remaining majority 80.99 was not. The age, the largest group is those aged 70-79 years, with 157 participants, representing 40.9%. In terms of family history of (BPH), 310 participants (80.7%) reported no family history, while 74 individuals (19.3%) indicated that they do have a family history of BPH. Examining systemic diseases, 51 participants (13.2%) have diabetes mellitus, and 67 individuals (17.3%) have hypertension. A smaller subset, 26 participants (6.7%), reported having both diabetes and hypertension. Regarding physical exercise, 310 individuals (80.7%), reported not engaging in regular physical activity, while only 74 participants (19.3%) they do exercise.  Conclusion In summary, the data and reports from this study point to a 19.01% prevalence of benign prostatic hyperplasia (BPH). The development of BPH is significantly predicted by age. Bivariate chi-square analysis revealed a significant link between BPH and erectile dysfunction, kidney illnesses, diabetes mellitus, and urine retention (p-value <0.05). On the other hand, bivariate chi-square analysis revealed a significant relationship between BPH and being overweight and frequently consuming caffeine (p-value <0.05). Diet and lifestyle could be factors in this.  Recommendations Lifestyle and behavioral interventions are reasonable first-line treatments for all patients. Straightforward interventions include limiting intake of the following: fluids prior to bedtime or travel; mild diuretics, such as caffeine and alcohol; and bladder irritants, such as highly seasoned or irritative foods. Older be aware that blocking of the urethra (the urine tube): As the prostate grows larger, it may block the bladder outlet and stop the bladder from emptying. In some cases, urine may get stored up until it starts to leak out. If this happens, see a doctor straight away, so the patients should urinate quickly before experiencing any problem.

Extracellular Vesicles Contribute to Oxidized LDL-Induced Stromal Cell Proliferation in Benign Prostatic Hyperplasia.

Clinical and experimental evidence has linked Benign Prostatic Hyperplasia (BPH) with dyslipidemic and hypercholesterolemic conditions, though the underlying cellular mechanisms remain unclear. This study investigates the impact of dyslipidemia, specifically oxidized LDL (OxLDL), on prostatic stromal cell proliferation and the release of extracellular vesicles (EVs). Mice were fed a high-fat diet, and human prostatic stromal cells (HPSCs) were treated with OxLDL. Proliferation assays and EV characterization were performed to assess the role of EVs in BPH progression. Pro-atherogenic conditions significantly increased cell proliferation in both murine prostatic cells and HPSCs. Treatment with metformin effectively inhibited OxLDL-induced proliferation. Additionally, OxLDL stimulated the production and release of pro-proliferative EVs by HPSCs, which further promoted cellular proliferation. The findings suggest that dyslipidemia drives prostatic stromal cell proliferation and EV secretion, contributing to BPH progression. Metformin demonstrates potential as a therapeutic agent to mitigate these effects, offering insight into novel strategies for BPH management. This study highlights the complex interaction between dyslipidemia, cell proliferation, and extracellular communication in the context of BPH pathogenesis.

Prevalence of bacteriuria and treatment outcomes in patients with symptomatic Benign prostatic hyperplasia: a prospective observational study

Introduction: The global incidence of Benign Prostatic Hyperplasia (BPH) is rising, with bacterial causes of lower urinary tract symptoms (LUTS) being a common factor contributing to complications in these patients. Aim: To identify the prevalence of bacteriuria and treatment response in patients with symptomatic BPH. Materials and methods: This one-year prospective study included all patients presenting with LUTS due to BPH who met the inclusion criteria. Urine samples were collected and analyzed for microscopy, culture, and sensitivity following standard protocols. Bacterial growth in urine specimens and IPSS of LUTS were recorded before and after antibiotic therapy. Results: A total of 131 patients with symptomatic BPH were studied. Escherichia coli (47.6%) was the most commonly isolated bacteria, followed by Klebsiella pneumoniae and Pseudomonas species. E. coli and Klebsiella showed the highest sensitivity to nitrofurantoin. After one week of antibiotic therapy, 69% of patients had sterile urine cultures, while 31% remained E. coli positive. Significant improvement in IPSS scores was observed after one week of therapy (P<0.05) and there wasno significant change in urine culture (P=0.854). Conclusion: Bacteriuria is a common finding in patients with symptomatic BPH in our setting. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated organisms, with sensitivity to nitrofurantoin and cefixime. A week of antibiotic therapy significantly reduced IPSS scores but did not reduce bacteriuria.

Investigation on clinical risk factors of bladder lesion by machine learning based interpretable model

Bladder lesion commonly occurs in patients with benign prostatic hyperplasia (BPH), and the routine screening of bladder lesion is vital for its timely detection and treatment, in which the risk of bladder lesion progression can be effectively alleviated. However, current clinical methods are inconvenient for routine screening. In this study, we proposed a convenient routine screening method to diagnose bladder lesions based on several clinical risk factors, which can be obtained through non-invasive, easy-to-operate, and low-cost examinations. The contribution of each clinical risk factor was further quantitatively analyzed to understand their impact on diagnostic decision-making. Based on a cohort study of 253 BPH patients with or without bladder lesions, the proposed diagnostic model achieved high accuracy using these clinical risk factors. Bladder compliance, maximum flow rate (Qmax), prostate specific antigen (PSA), and postvoid residual (PVR) were identified as the four most important clinical risk factors. To the best of our knowledge, this is the innovative research to predict bladder lesions based on the risk factors and quantitatively reveal their contributions to diagnostic decision-making. The proposed model has the potential to serve as an effective routine screening tool for bladder lesions in BPH patients, enabling early intervention to prevent lesion progression and improve the quality of life.

Burden of Benign Prostatic Hyperplasia (BPH) in Low- and Middle-Income Countries in Sub-Saharan Africa (SSA)

Burden of Benign Prostatic Hyperplasia (BPH) in Low- and Middle-Income Countries in Sub-Saharan Africa (SSA)

Second-generation MOSES 2.0 versus MOSES 1.0 pulse-modulation technologies for holmium laser enucleation of the prostate (HoLEP).

To report our initial experience with enhanced MOSES 2.0 technology in patients who underwent holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH), in comparison to those who underwent HoLEP with MOSES 1.0 technology at our institution. We retrospectively reviewed data of patients who underwent HoLEP using MOSES 1.0 or MOSES 2.0 pulse-modulation technology from December 2020 to September 2023. Preoperative and intraoperative parameters, postoperative outcomes, as well as perioperative complications were collected and analyzed. A total of 196 patients were included in the study. Among them, 146 patients underwent MOSES 1.0 HoLEP, while 50 had MOSES 2.0 HoLEP. No statistically significant differences in preoperative characteristics were observed between the two groups. The median prostate volume for the MOSES 1.0 and MOSES 2.0 HoLEP groups was 109cc and 117.5cc, respectively. Patients in the MOSES 2.0 group had a shorter median enucleation time (52.5 vs. 42.5min, p < 0.001) and hemostasis time (8 vs. 6min, p = 0.002), along with lower laser energy usage (101 vs. 86.4kJ, p = 0.012), when compared to those in the MOSES 1.0 cohort. Postoperative outcomes, including IPSS, QoL, Qmax, and PVR, were comparable between the two groups at 1, 3, and 6 months postoperative. The incidence of hospital readmission (p = 0.42), as well as one-month postoperative urge urinary incontinence (p = 0.2) and stress urinary incontinence (p = 0.13) were also comparable between the cohorts. HoLEP with second-generation MOSES 2.0 technology is a safe and effective treatment option for BPH. It offers notable improvements, including reduced enucleation and hemostasis times, while using less energy when compared to MOSES 1.0.

Hydrolysates of Pomacea canaliculata alleviate testosterone-induced benign prostatic hyperplasia in in vitro and in vivo models

Hydrolysates of Pomacea canaliculata alleviate testosterone-induced benign prostatic hyperplasia in in vitro and in vivo models

Changes in TP53 Gene, Telomere Length, and Mitochondrial DNA in Benign Prostatic Hyperplasia Patients.

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. 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. 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. 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.

Magnetic Resonance Elastography for the Detection and Classification of Prostate Cancer.

We investigated the feasibility of magnetic resonance elastography (MRE) using a pelvic acoustic driver for the detection and classification of prostate cancer (PCa). A total of 75 consecutive patients (mean age, 70; range, 56-86) suspected of having PCa and who underwent multi-parametric MRI including MRE and subsequent surgical resection were included. The analyzed regions consisted of cancer (n = 69), benign prostatic hyperplasia (BPH) (n = 70), and normal parenchyma (n = 70). A histopathologic topographic map served as the reference standard for each region. One radiologist and one pathologist performed radiologic-pathologic correlation, and the radiologist measured stiffness values in each region of interest on elastograms automatically generated by dedicated software. Paired t-tests were used to compare stiffness values between two regions. ROC curve analysis was also used to extract a cutoff value between two regions. The stiffness value of PCa (unit, kilopascal (kPa); 4.9 ± 1.1) was significantly different to that of normal parenchyma (3.6 ± 0.3, p < 0.0001) and BPH (4.5 ± 1.4, p = 0.0454). Under a cutoff value of 4.2 kPa, a maximum accuracy of 87% was estimated, with a sensitivity of 73%, a specificity of 99%, and an AUC of 0.839 for discriminating PCa from normal parenchyma. Between PCa and BPH, a maximum accuracy of 62%, a sensitivity of 70%, a specificity of 56%, and an AUC of 0.598 were estimated at a 4.5 kPa cutoff. The stiffness values tended to increase as the ISUP grade increased. In conclusion, it is feasible to detect and classify PCa using pelvic MRE. Our observations suggest that MRE could be a supplement to multi-parametric MRI for PCa detection.

Efficacy and safety of bioregulatory peptides in the treatment of prostate diseases: a review

The article describes the risk factors, pathogenetic mechanisms of development of various prostate diseases and highlights the problems in their treatment. Information on regulatory peptides and their mechanism of action is presented. Clinical studies proving the high effectiveness of bioregulatory peptides in the treatment of chronic prostatitis, chronic pelvic pain syndrome and benign prostatic hyperplasia are presented. The analysis was carried out and evidence of the effectiveness of domestic drugs Prostatex and Prostateks Plus in the treatment of prostate diseases was presented.

Does size matter? A single institution's comparison of Aquablation in prostates greater than or less than 150 mL.

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

Predictive diagnostic value of mean platelet volume to platelet count and neutrophil to lymphocyte ratios in the gray zone of prostate cancer with tPSA between 4 to 10 ng/mL.

Exploration of the Predictive Diagnostic Value of Mean Platelet Volume to Platelet Count Ratio (MPV/PLT,PVI) and Neutrophil-to-Lymphocyte Ratio (NLR) in the tPSA Gray Zone of Prostate Cancer. A retrospective study was conducted on 65 prostate cancer (Pca) patients and 52 benign prostatic hyperplasia (BPH) patients who underwent transperineal prostate biopsy at Xiangtan Central Hospital from December 2021 to December 2023. Descriptive statistics and logistic regression models were used to investigate the predictive diagnostic value of PVI and NLR in the tPSA gray zone of prostate cancer. Receiver operating characteristic (ROC) curves were constructed based on PVI and NLR values to determine the classification thresholds. A total of 117 patients were enrolled, including 65 cases of prostate cancer (PCa) and 52 cases of benign prostatic hyperplasia (BPH). There were no statistically significant differences in age, BMI, history of hypertension, history of diabetes, history of coronary heart disease, pre-biopsy white blood cell count, history of drinking, history of smoking, and tPSA between the PCa and BPH patients. The results of logistic regression analysis showed that PVI (OR=2.03, 95%CI: 1.34~3.07, P<0.00) and NLR (OR=0.32, 95%CI: 0.18~0.58, P<0.00) were independent predictors for diagnosing prostate cancer in the tPSA gray zone (VIF=1.04).The maximum area under the curve (AUC) for PVI was 0.70, with an optimal cut-off value of 0.05 (P ≤ 0.01). The maximum AUC for NLR was 0.76, with an optimal cut-off value of 2.86 (P ≤ 0.01).The calibration curve showed good consistency between the predicted and actual outcomes in both the PCa and BPH groups, indicating that the nomogram model had good predictive performance.When using PVI and NLR to plot the receiver operating characteristic (ROC) curves to predict the assessment of PCa in the tpsa gray zone, the area under the curve (AUC) for PVI was the largest at 0.70, with an optimal cutoff value of 0.05 (P ≤ 0.01). The AUC for NLR was the largest at 0.76, with an optimal cutoff value of 2.86 (P ≤ 0.01). PVI and NLR have certain predictive diagnostic value for Pca in the tPSA gray zone, and appropriate use of PVI and NLR can improve the positive rate of early screening for Pca in the gray zone.

Can We Differentiate Between Organic and Functional Bladder Outlet Obstruction in Males With Parkinson's Disease?

To determine the type of bladder outlet obstruction (BOO) in patients with Parkinson's disease (PD). A case-control study was carried out in 46 patients divided into two groups. Group 1 formed by 23 PD patients with BOO (a URA parameter ≥ 29 cm H2O). Group 2 formed by 23 patients with benign prostatic hyperplasia (BPH) and compressive obstruction (an opening pressure > 35 cm H2O) and URA parameter ≥ 29 cm H2O). Both groups underwent a pressure-flow study to calculate Dynamic Urethral Resistance Relationship (DURR) patterns. Based on previous research, we describe two types of DURR pattern. Pattern A typical of dynamic or functional obstruction and pattern B typical of static or organic obstruction. We found that PD patients had a significantly higher frequency of pattern A (70%) than BPH patients (4%). Other significant differences between groups were age (greater in PD group), bladder compliance (greater in PD group), maximum flow rate [Qmax (greater in BPH group)], maximum detrusor pressure [Pmax (greater in BPH group)], detrusor pressure at maximum flow rate [PQmax (greater in BPH group)], opening detrusor pressure (greater in BPH group), and the bladder contractility parameters BCI and Wmax (greater in BPH group). There were no significant differences in perineal voiding electromyography (EMG) activity between groups nor relationship between voiding EMG activity and the type of DURR pattern. Our results are consistent with the usefulness of the DURR pattern to differentiate between functional and organic BOO in PD patients. Most PD patients have functional obstruction although a minority has organic obstruction consistent with BPH.

Artificial Urinary Sphincter Implants in Men: A National Health Care Data System-Based Study to Assess Reinterventions in France.

Significant concerns remain regarding the long-term outcomes of AMS 800 artificial urinary sphincter (AUS) implants in men. The objective was to assess the long-term AUS reintervention (replacement or removal) rates after a first-ever AUS implantation. This population-based retrospective cohort study included all men age ≥ 18 years in France who underwent a first-ever AUS implantation (identified using a unique device identifier) for male stress urinary incontinence (SUI) after prostate cancer (PCa) or benign prostatic hyperplasia (BPH) treatment, between January 1, 2006, and December 31, 2018. The primary outcome was reintervention-free survival rates (replacements and removals), estimated using the Kaplan-Meier method. Secondary outcomes were replacement and removal. A multivariable Cox proportional hazards model was used to assess associations between patient and hospital factors and the hazard of reintervention. The study included 8475 men with a median age of 69 years (IQR, 65-74) and a median follow-up time of 6 years (IQR, 3-9). Reintervention-free survival was 71% (95% CI, 70-72) at 2 years, 57% (95% CI, 55-58) at 5 years, and 40% (95% CI, 38-41) at 10 years. Reintervention-free survival was lower after BPH surgery, after radiotherapy combined with RP, and in centers performing fewer implantations. Removal-free survival was 83% (95% CI, 83%-84%) at 2 years, 75% (95% CI, 74%-76%) at 5 years, and 66% (95% CI, 65%-68%) at 10 years. Among men undergoing AUS implantation for SUI because of PCa or BPH treatment, the probability of reintervention was 29% within 2 years after implantation. The median time to reintervention was 6.6 years (IQR, 6.4-7.1), and the reintervention-free survival rate at 10 years was 40%. These insights can inform therapeutic decision making for patients and surgeons during the management of male SUI.

Efficacy and Safety of a Self-Improved Continuous Bladder Irrigation Sensor Device in Patients after Transurethral Resection of the Prostate: A Prospective Study.

To explore the efficacy and safety of a self-improved continuous bladder irrigation (CBI) sensor device after transurethral resection of the prostate (TURP). A total of 160 patients with benign prostatic hyperplasia who received TURP from June 2021 to May 2022 were selected. According to the envelope randomization method, patients were divided into a control group (80 cases) and study group (80 cases). In the control group, the speed of bladder flushing fluid was adjusted according to the clinical experience of nurses. On the basis of the control group, the self-improved CBI sensor device was used in the study group to observe the postoperative comfort and complication rate in the two groups. The comfort of patients in the study group was significantly higher than that of patients in the control group (97.50% vs. 88.75%, P = .023), and the number of postoperative complications in the control group was significantly higher than that in the study group (8.75% vs. 1.25%, P = .021). Meanwhile, the average amount of irrigation fluid in the study group was obviously lower than that in the control group (26.4 L vs. 27.8 L, P = .011). In addition, patients in the study group had a significantly shorter hospital stay than the controls (3.3 days vs. 3.6 days, P = .005). Implementation of the new self-improved CBI sensor device for patients after TURP can improve their awareness regarding disease-related knowledge, alleviate their fear and anxiety, improve their compliance and comfort with treatment and nursing, and reduce the incidence of complications.

Is detrusor underactivity the urodynamic characteristic of long-COVID in patients with benign prostate hyperplasia?

Although coronavirus disease 19 (COVID-19) was reported to involve with multiple organs, COVID-19 reports focusing on urinary system mostly evaluated the association between lower urinary tract symptoms and COVID-19 using questionnaire score. In this study, sonography video urodynamic studies was first conducted to explore the effects of COVID-19 on contractility of bladder detrusor of patients with benign prostate hyperplasia (BPH). Clinical data was respectively reviewed and compared between BPH patients with previous COVID-19 infection (COVID-19 group) and without previous COVID-19 (non-COVID-19 group). The incidence of detrusor underactivity (DU) was compared between 2 groups. Comparison of age and noninvasive parameters was conducted between BPH patients with DU and without DU in COVID-19 group. Correlation coefficient between noninvasive parameters and detrusor contractility was determined and receiver operating characteristic curve of noninvasive parameters was used to choose the most appropriate cutoff for detection of DU in COVID-19 group. Beside a significant increase in the incidence of DU in BPH patients of COVID-19 group, a lower detrusor contractility and a greater bladder wall thick was detected compared to that of patients in non-COVID-19 group. Post-voiding residual urine was found to have a linear correlation with detrusor contractility in COVID-19 group. It was suggested that COVID-19 infection would further exacerbate impairment of detrusor previously resulted from bladder outlet obstruction in BPH patients. DU may be a urodynamic characteristic of long-COVID.

Association between circulating inflammatory proteins and benign prostatic disease: a Mendelian randomization study

Previous research has suggested that circulating inflammatory proteins are associated with benign prostatic disease (BPD). This Mendelian randomization (MR) study was conducted to further investigate the causal relationship between 91 inflammatory proteins and BPD. Genome-wide association study (GWAS) summarized data of benign prostatic hyperplasia (BPH) and prostatitis were obtained from the FinnGen Biobank. The latest study offered the GWAS data on 91 proteins related to inflammation. We performed a bidirectional MR to investigate the causal association between inflammatory proteins and BPD. The outcomes of the IVW method indicated that decreased levels of circulating interleukin-17 C (IL-17 C) (OR = 0.92, 95%CI = 0.85–0.99, p-value = 0.0344) were suggestively associated with a higher risk of BPH and elevated levels of interleukin-10 receptor subunit alpha (IL-10RA) (OR = 1.24, 95%CI = 1.05–1.47, p-value = 0.0132) and urokinase-type plasminogen activator (uPA) (OR = 1.13, 95%CI = 1.00–1.28, p-value = 0.0421) were suggestively related to a higher risk of prostatitis. Furthermore, reverse MR revealed that BPH may promote the expression of circulating factors, including natural killer cell receptor 2B4 (CD244) (OR = 1.07, 95%CI = 1.01–1.13, p-value = 0.0192), T-cell surface glycoprotein CD6 isoform (CD6) (OR = 1.07, 95%CI = 1.01–1.13, p-value = 0.0192), and leukemia inhibitory factor receptor (LIF-R) (OR = 1.07, 95%CI = 1.01–1.15, p-value = 0.0163). Moreover, the results of sensitivity analyses indicate that heterogeneity and horizontal pleiotropy are unlikely to distort the findings. The results of this study indicate a potential association between circulating inflammatory proteins and BPD, which may become new diagnostic indicators or drug targets for clinical application in the prevention and treatment of BPD. However, further investigation is required.

General anesthesia is associated with lower perioperative bleeding and better functional outcomes than spinal anesthesia for endoscopic enucleation of the prostate: a single-center experience.

Holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) are safe and effective treatment options for benign prostatic hyperplasia (BPH). Spinal anesthesia (SA) is widely used for endoscopic enucleation of the prostate (EEP) in place of general anesthesia (GA). We aimed to assess the impact of GA vs. SA on blood loss, postoperative course and functional outcomes after HoLEP and B-TUEP. After propensity score matching, we analyzed data from 148 patients treated with EEP in our centre for symptomatic BPH. We recorded patient's characteristics, procedural data, type of anesthesia (SA vs. GA). Postoperatively we evaluated hemoglobin drop, catheterization time (CT), and length of hospital stay (LOS). Functional outcomes were evaluated with the International Prostate Symptoms Score (IPSS) at baseline and 3 months after surgery. Descriptive statistics and linear regression models tested the association between anesthesia type and EEP outcomes. After matching groups were comparable in terms of pre- and intra-operative variables. Of all, 111 (75%) patients were treated under SA. Haemoglobin drop was lower in GA compared to SA group (1 vs. 1.4g/dL, p < 0.01). CT was shorter in the GA group (1 vs. 2 days, p = 0.01). Postoperative IPSS score was lower in GA group (4 vs. 8, p = 0.04). Multivariable linear regression models revealed that prostate volume (p = 0.01) and SA vs. GA (p = 0.01) were associated with higher haemoglobin drop, after accounting for age and use of anticoagulants/antiplatelets. Similarly, SA vs. GA (p = 0.02) and postoperative complications occurrence (p < 0.001) were associated with a longer LOS, after accounting for age, prostate volume and use of anticoagulants/antiplatelets. EEP can be safely performed under both GA and SA. GA offers better outcomes in terms of perioperative bleeding and 3-month functional outcomes.

Underactive bladder as defined by the International Continence Society in the 2023 Japan Community Health Survey.

To investigate the characteristics of underactive bladder (UAB) in participants of the 2023 Japan Community Health Survey (JaCS 2023). The JaCS 2023 was conducted among individuals aged 20-99 years old who had anonymously registered with a Japanese online research company. We divided the 6210 participants of JACS 2023 into UAB and non-UAB groups as defined by the International Continence Society Working Group (ICS-WG) and evaluated the prevalence of UAB as well as concomitant lower urinary tract symptoms. In addition, an association between UAB and vulnerability-related factors, namely participants' characteristics including frailty and comorbidities, was explored by univariable and multivariable analyses. The prevalence of UAB in Japanese community-dwelling men and women aged 20 years or older was 9.3% and 4.0% overall (p < 0.0001), respectively, and when excluding benign prostatic hyperplasia or pelvic organ prolapse, 7.0% and 3.7%, respectively, (p < 0.0001). A significant increase in the prevalence of UAB with age was observed (p < 0.0001). In addition, storage symptoms including overactive bladder were more frequent in the UAB group than the non-UAB group (p < 0.0001). Frailty and several comorbidities were independently associated with UAB. According to the definition proposed by the ICS-WG, the JaCS 2023 demonstrated that UAB was more prevalent in men than in women and increased in prevalence with age. Storage symptoms including overactive bladder sometimes coexisted with UAB. Vulnerability-related factors were associated with UAB.

Comparative assessment of attitudes and expectations: Iranian patients versus urologists in the management of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is common and presents as lower urinary tract symptoms (LUTS). Understanding patient concerns and treatment preferences is essential for effective management. This study aimed to investigate the attitudes, preferences, and expectations of Iranian patients with BPH, and compare them with those of urologists in addressing this condition. A cohort of patients diagnosed with BPH underwent assessment during their initial visit. Before any counseling, their attitudes, concerns, and expectations regarding benign prostate enlargement were evaluated using semi-structured interviews. Patient responses were analyzed based on educational levels and age. Additionally, correspondence was initiated with thirty urologists who graduated within the past twelve years to assess their attitudes toward BPH, concerns, and treatment approaches. Interview questions were constructed using the Delphi method, and their validity was confirmed. Responses from both groups were analyzed and compared. Descriptive statistics, independent t-test, Chi-squared test, Mann-Whitney U, and principal component analysis (PCA) with varimax rotation were used for statistical analysis. The study comprised 261 patients and 30 urologists. Findings revealed that 86.2% of patients and 86.7% of urologists perceived a lack of sufficient patient knowledge about BPH. Patients across all educational levels and age groups expressed a desire for more information about their condition. Primary concerns among patients included exacerbation of urinary symptoms, potential malignancy, and sexual dysfunction. While patients generally preferred pharmacological treatments, those older than 75 years showed a significantly higher preference for surgical options. Conversely, urologists exhibited greater concern for long-term clinical complications associated with BPH. Results indicated significant parallels between the attitudes of urologists and patients in assessing the multifaceted impact of BPH on patient well-being. This study enhances our understanding of patient attitudes and concerns regarding BPH, thereby facilitating more effective treatment strategies. Our findings encourage urologists to enhance patient perspectives by delivering comprehensive information. Furthermore, the comparison between patient and urologist attitudes towards BPH underscores the importance of tailored care and patient-centered approaches in optimizing outcomes for individuals with BPH.