Prostatic Enlargement Research Articles

Late Arteriovenous Fistula after transurethral resection of the prostate: case report

This study describes a case of symptomatic arteriovenous fistula after Transurethral Resection of the Prostate diagnosed by urethrocystoscopy and confirmed by imaging tests. The patient presented lower urinary tract symptoms associated with hematuria twenty years after being submitted to a TURP. Arterial and venous tomography angiography of the pelvis visualized a hypervascularized lesion involving the membranous urethra and aneurysm of the right external iliac artery. The patient underwent embolization of bilateral prostatic arteries with good post-embolization recovery and complete remission of urinary symptoms. Arteriovenous fistula after transurethral resection of the prostate is a rare pathology that must be considered in the differential diagnosis of persistent hematuria and infravesical obstruction without significant prostatic enlargement. In cases like this, embolization has become a new therapeutic option with excellent obliteration rates and minimal morbidity.

Enhancing date seed phenolic bioaccessibility in soft cheese through a dehydrated liposome delivery system and its effect on testosterone-induced benign prostatic hyperplasia in rats.

The consumption of dairy products, including soft cheese, has been associated with numerous health benefits due to their high nutritional value. However, the phenolic compounds bioaccessibility present in soft cheese is limited due to their poor solubility and stability during digestion. So, this study aimed to develop an innovative soft cheese enriched with date seed phenolic compounds (DSP) extracted ultrasonically and incorporated into homogeneous liposomes and study its attenuation effect on testosterone-induced benign prostatic hyperplasia (BPH) in rats. Date seed phenolic compounds were extracted using 98 and 50% ethanol along with water as solvents, employing ultrasonication at 10, 20, and 30-min intervals. The primary and secondary DSP-liposomes were prepared and dehydrated. The particle size, zeta potential, encapsulation efficiency, and morphology were measured. Incorporating dehydrated liposomes (1-3% w/w) into soft cheese and their impact on BPH using male Sprague-Dawley rats was assessed. After inducing BPH, rats were fed a cheese diet with dehydrated DSP-liposomes. Over 8 weeks, parameters including nutrition parameters, prostate enlargement analysis, biochemical parameters, hormones level, oxidative stress, and cytokines were analyzed. The results showed that ultrasound-assisted extraction effectively reduced the extraction time and 30 min extraction EtOH 50% was enough to extract high yield of phenolic compounds (558 mg GA/g) and flavonoids (55 mg qu/g) with high antioxidant activity (74%). The biological results indicate that prostate weight and prostate index% were diminished in the treatment groups (1 and 2) compared to the BPH control group. The high antioxidant content present in the DSP-liposomes acted as the catalyst for suppressing the responses of the inflammatory cytokines, inhibiting the anti-inflammatory IL-10 production, and suppressing the elevated levels of lipid peroxidation products compared to the BPH group. The treatment group (2) supplemented with dehydrated secondary DSP-liposomes exhibited the most significant variance (p < 0.05) as opposed to the BPH group. Liposomal encapsulation was proved to be a feasible approach for administering DSP in soft cheese, thereby establishing new functional food category possessing prophylactic properties against the advancement of BPH in rats.

Evaluation of intra-operative trans-urethral endoscopic management of possible open transvesical prostatectomy complications

ObjectiveTo evaluate the benefits of using transurethral cystoscope and resectoscope for managing possible complications that may occur during open transvesical prostatectomy operation.BackgroundOpen transvesical or retropubic prostatectomy remains, in less technologically developed countries, the standard option for treatment of complicated large benign prostatic hyperplasia. Complications rate with open prostatectomy procedures, especially post-operative bleeding and urinary incontinence, represent a real challenge facing urologists. Hopefully, recent advances in endourology section helped greatly in management of complicated benign prostatic hyperplasia and also offered a tool to deal with possible open prostatectomy complications.Patients and methodsIn a prospective study, fifty (50) male patients with complicated large benign prostatic enlargement associated with large single or multiple bladder stones with stone burden ≥ 3cm3 planned to undergo transvesical prostatectomy divided randomly into two groups. Group (A) included 25 patients who underwent standard T.V.P. and group (B) included 25 patients in whom diagnostic urethro-cystoscopy and a mono-polar resectoscope were used pre- and post-prostatic adenoma enucleation. Patients had follow-up evaluation visits at 1, 3 and 6 months postoperatively to evaluate IPSS, post-void urine estimation, Qmax., and quality of life.ResultsA total of 50 patients were divided equally into two groups. Group (A) included 25 patients who underwent standard transvesical prostatectomy, while group (B) included 25 patients who underwent initial diagnostic urethro-cystoscopy, then bilateral ureteric catheter insertion, followed by prostatic apical demarcation using a monopolar resectoscope. Finally, transurethral hemostasis of the prostatic bed is done after standard transvesical adenoma enucleation. Mean operative time in group (A): 48.3 ± 12.4 min. while in group (B): 68.9 ± 14.1 min (p < 0.001), Hemoglobin deficit in group (A): 2.8 ± 1.1 g/dl. while in group (B): 1.1 ± 0.39 g/dl. (p < 0.001). Enucleated prostate volume in group (A): 89.2 ± 16.1g, while in group (B): 91.2 ± 17.2g (p = 0.673). Post-operative IPSS, Post-void residual urine and Qmax showed insignificant differences between the two groups.ConclusionTrans-urethral endoscopically assisted transvesical prostatectomy provides more safety and fewer morbidities and complications rate compared to standard T.V.P.

Correlation Of Age Factors With Incidence Rates Of Benign Enlarged Prostate Disease At Royal Prima Rsu In 2022

Benign prostatic hyperplasia is a condition where stromal and epithelial contributions are proliferative. The clinical features of benign prostatic hyperplasia are prostate enlargement, lower urinary tract complaints, and bladder obstruction. Several factors are thought to increase the risk of benign prostate hyperplasia, including age, family history, obesity, physical activity, diabetes, diet, smoking and alcohol consumption. This study aims to determine the relationship between age factors and the incidence of benign prostatic hyperplasia disease at RSU Royal Prima Medan. This study used quantitative research with a cross-sectional approach. The sampling technique in this study used a total sampling technique. This study analyzed a sample of 32 data using univariate and bivariate tests using Chi-Square. Based on the univariate test, it is known that the incidence of benign prostatic hyperplasia mostly occurs at the age of 61-70 years, as many as 15 people (46.9%). Based on the results of ultrasound, the size of the prostate volume is mostly 61 - 80 ml, as many as 15 people (46.9%). Based on the bivariate test using Chi-Square, the p-value is 0.023 (p&lt;0.05), so it can be concluded that there is a significant relationship between age and benign prostatic hyperplasia.

Статистический анализ медико-социальных причин формирования доброкачественной гиперплазии предстательной железы у мужчин.

With the world’s population growing and aging, one of the challenges facing physicians and primary care professionals as the population ages is the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). It is known from the literature that 18% of men at the age of 40 report anxiety due to an enlarged prostate, but this figure rises sharply at the age of 50, when already 50% of men complain of unpleasant symptoms associated with an enlarged prostate, and at the age of 90 years of such men becomes 90%. In our study, we analyzed numerous works (articles) that studied the prevalence of benign prostatic hyperplasia in different population groups and at different times. In addition to analyzing the prevalence of benign prostatic hyperplasia, the article presents statistical data on the main causes of the formation of benign prostatic hyperplasia in men.

Prostate volume variation during 1.5T MR-guided adaptive stereotactic body radiotherapy (SBRT) and correlation with treatment toxicity

IntroductionTo evaluate prostate volume change during daily-adaptive prostate SBRT on 1.5 T MR-linac and to correlate it with treatment toxicity. Methodsa series of patients affected by low-to-intermediate risk prostate cancer was treated by 5-fraction SBRT within a prospective study (Prot. n° 23748). Total dose was 35 Gy and 36.25 Gy delivered every day or on alternate days. Treatment toxicity was recorded with the following patient reported outcomes (PROMs): IPSS, ICIQ-SF, and EPIC-26. Results254 patients were included in the analysis. Baseline median CTV volume was 55 cc (range 15.3–163.3). Mean prostate volume were 58.9 cc, and 62.7 cc at first and last fraction respectively (mean volume increase 6.4 %; p = <0.0001). We observed prostate swelling (mean 15.4 % increase) in 50 % of cases, stable volume (≤5% volume change) in 39 % of patients, and prostate shrinkage in 11 % of cases (mean 12.2 % reduction). Baseline CTV > 55 cc showed a trend towards higher CTV shrinkage (-10.5 % versus −14.5 %; p = 0.052). We found no correlation between CTV change and PROMs. Prostate swelling was generally compensated by the planned PTV expansion, even though the mean setup volume dropped from 47.4 cc to 38.9 cc at last fraction, with few cases not covered by initial setup margins. ConclusionThe present study reported a significant prostate volume change during prostate SBRT on 1.5T MR-linac. We observed both prostate swelling in half of cases and few cases of prostate shrinkage. No correlations were found with PROMs in this population treatment with daily-adaptive strategy.

The new checklist to evaluate educational value of YouTube surgical videos of transurethral resection of the prostate.

Transurethral resection of the prostate (TURP) is a widespread, effective way to treat benign prostatic hyperplasia (BPH). Many medical students and junior clinicians increasingly turn to easily accessible online resources to learn this technique, such as videos on YouTube. This study assessed the educational value of YouTube videos about TURP, which are popular among many young surgeons. We searched YouTube as of August 2, 2022 for videos fulfilling the search terms "transurethral resection of the prostate", "benign prostatic hyperplasia", "BPH", "TURP", "benign prostatic enlargement", "bladder outlet obstruction" and "lower urinary tract symptom". We assessed the educational value of the identified videos using a custom-designed checklist. We identified 47 relevant videos, 20 of which were posted after July 1, 2020. The average number of views was 576,379±208,535 (range, 54-1,385,713). The average quality score of the videos was 7.38±2.53 (range, 4-12) on a 15-point scale, and 20 were judged to be of low educational quality. Quality scores correlated positively with the number of likes (R=0.596, P<0.01). The educational value of most TURP videos on YouTube appears to be low, with most lacking detailed explanations of preoperative preparations and the surgical procedure. High-quality video resources about TURP need to be developed for medical students and junior surgeons. Standard quality criteria should also be developed and disseminated to ensure the production of accurate learning resources for junior clinicians.

Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta-analysis.

Men with detrusor underactivity (DUA)and concomitant bladder outlet obstruction (BOO)due to benign prostatic enlargement (BPE)may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC). This review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short- and long-term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta-analysis was performed using Review Manager (RevMan) software. There were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eightTURP (transurethral resection of the prostate) studies, fourGreenLight PVP (photoselective vaporization of the prostate) studies, twoHoLEP (Holmium laser enucleation of the prostate) studies, oneGreenLight PVP/HoLEPstudy, oneHolmium laser incision of the prostate study, and onestudy did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long-term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS),lower quality-of-life (QoL) score, better maximum flow rate (Qmax), and lower post-voiding residual (PVR)of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow-up. In this meta-analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow-up period after surgery.

The role of irrigation fluid in transurethral resection of the prostate outcomes and surgeon performance.

Transurethral resection of the prostate (TURP) is the gold-standard for the treatment of benign prostate enlargement (BPE) associated with lower urinary tract symptoms (LUTS), after failure of conservative therapy. At present, only resection-rate (grams of prostate resected over time) is regarded as an efficiency parameter to evaluate the skill of the operator and to assess the outcome of the procedure. Five surgeons performed TURP using a Gyrus-type bipolar system in 123 patients with BPE/LUTS who came to our observation from June 2016 to December 2019. The amount of irrigation fluid used during the procedure was registered and correlated to the operating time, resection-rate, prostate adenoma weight, post-operative bladder irrigation time, intraoperative bleeding and days of catheterization. We found an inverse correlation between the amount of irrigation fluid used during TURP and the resection-rate recorded for all operators, according to Spearman's Correlation (r = -0.78, p = 0.002); a direct correlation was also found between the amount of irrigation fluid and the adenoma weight. Finally, we also found a direct correlation with intraoperative bleeding and the duration and amount of bladder irrigation during and after TURP. The amount of irrigation fluid used is proposed as a reliable parameter to estimate the efficiency of the endoscopic procedure as well to assess the skill of the operator and shortterm results. The observed data encourage the possibility of applying this new efficiency indicator to all endoscopic maneuvers.

Prospective Trial of Water Vapor Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia in Subjects with a Large Prostate: 6- and 12-month Outcomes

BackgroundCurrent guidelines recommend Rezūm water vapor thermal therapy for the treatment of benign prostatic hyperplasia (BPH) for prostate glands ranging in volume from 30 to 80 cm3. Few prospective studies have specifically evaluated the use of Rezūm for larger prostates. ObjectiveTo evaluate the safety and efficacy of water vapor thermal therapy in patients with a prostate gland >80 cm3 and ≤150 cm3. Design, setting, and participantsIn this prospective, single-arm study at seven centers in the USA, subjects were males aged >50 yr with symptomatic BPH and prostate volume of >80 cm3 and ≤150 cm3. InterventionRezūm was used to deliver sterile water vapor via a transurethral approach to ablate targeted areas of prostate tissue. Outcome measurements and statistical analysisThe primary efficacy outcome was response to therapy, defined on a per-patient basis as a ≥30% improvement in International Prostate Symptom Score (IPSS) from baseline to 6 mo. The primary safety outcome was a composite of serious device-related safety events. Secondary outcomes included catheterization for device-related retention. IPSS outcomes over time were analyzed via generalized estimating equations. Results and limitationsAmong 47 eligible patients, prostate volume ranged from 80.8 to 148.1 cm3. All patients completed 6-mo follow-up, and 40/47completed 12-mo follow-up. At 6 mo, 83% were treatment responders according to the primary efficacy endpoint. The mean IPSS improvement at 6 mo was 11.9 ± 7.5 points, reflecting significant improvement. The primary safety outcome was met, with no occurrence of device-related composite safety events. The study is limited by the nonrandomized design and early termination, unrelated to safety or effectiveness. ConclusionsOur results are consistent with previous findings for prostate glands of up to 80 cm3, and indicate the safety and efficacy of Rezūm for BPH in patients with a larger prostate. Patient summaryRezūm therapy, in which water vapor is used to treat targeted areas of the prostate, is currently recommended for patients with benign enlargement of the prostate and a prostate size of up to 80 cm3. We found that this treatment was also effective and safe in patients with a larger prostate of 80–150 cm3.

Challenging the Safety Profile of Bipolar TURP Regarding Dilutional Hyponatremia

Objective: To measure the extent of Dilutional Hyponatremia after Transurethral resection of prostate using Bipolar Resection Technique. Material and Methods: The study was conducted at Social Security Teaching Hospital Lahore. The study was carried out between 1st June 2022 to 30th November 2022. All patients who were candidates of surgical option and were planned TURP were included. They had pre-operative sodium levels done and this was compared to post operative levels on first post operative day. All patients included in the study had moderate prostate size and had resection time less than one hour. Results: Total 45 patients having undergone bipolar TURP were included in the study. Among these 45 patients, 19 patients had a decrease in sodium levels postoperatively ,further in these 19 patients, 14 patients had a decrease of less than 5 mEq/L .In 2 out of total 45 patients the sodium levels remained same post operatively. In 24 patients out of total 45 there was an increase in sodium levels, further in these 24 patients ,19 patients had an increase of less than 5mEq/L . In all 45 patients no clinical symptoms of dilutional hyponatremia were observed. Conclusion: There was no significant dilutional hyponatremia seen after bipolar TURP and wherever observed did not caused any clinical impact , proclaiming Bipolar TURP as a safe option for prevention of dilutional Hyponatremia during surgery for Benign prostate enlargement (BPE).

New therapeutic targets to prevent benign prostatic enlargement and symptomatic progression to benign prostatic obstruction-ICI-RS 2023.

Benign prostatic enlargement (BPE) can impact lower urinary tract function due to its potential progression to benign prostatic obstruction (BPO). Treatment options include removal of the obstruction by surgery or through use of therapeutics designed to slow growth or reduce tissue stress imposed by muscular stromal components. Inflammation and development of fibrosis can also raise intrinsic tissue stress within the gland, further impacting obstruction. Outflow tract obstruction can also impact emission and ejaculation if the obstruction persists. This review summarizes an ICI-RS think tank considering novel drug treatments that might address BPO caused by progressive development of BPE, as well as manage decompensation changes to bladder function. Topics included recent advances in our understanding of pathological changes occurring to the prostate and other lower urinary tract tissues during progressive development of BPE, and how prevention or reversal might benefit from the identification of novel drug targets. These included contractile properties of prostatic tissues, the impact of BPE and its effects on bladder function, the deposition of intramural fibrotic tissue with protracted BPO, the role of inflammation in the development of BPE and its progression to BPO. In particular, we discussed current therapeutic options for treating BPE/BPO, and new therapeutic targets, what they treat and their advantage over current medications. Several new drug targets were identified, including soluble guanylate cyclase (sGC), the receptor for nitric oxide (NO•), and sGC activators that promotes sGC-mediated cGMP production when sGC is inactivated and unresponsive to NO•.

Opportunistic prostate-specific antigen testing in Norwegian men: a public health challenge.

To describe age-specific prostate-specific antigen (PSA) distributions and resulting prostate cancer diagnoses that arise from population-wide opportunistic PSA testing. Over 8 million PSA tests were performed on >1.4 million Norwegian men from 2000 to 2020. During this period 43 486 men were diagnosed with localised prostate cancer. Most of the PSA testing reflected opportunistic testing. Age-specific PSA value distributions were constructed for men aged 45-75 years with and without prostate cancer. The distributions of PSA values in men with and without prostate cancer widened with age and overlapped extensively from 3 to 7 ng/mL. Localised prostate cancer diagnoses increased 10-fold from the age of 45 to 75 years. PSA testing identified intermediate- or high-grade cancers in 21% (95% confidence interval [CI] 19-23%) of men aged 50-54 years and 42% (95% CI 41-43%) of men aged 70-74 years. Grade group (GG)1, GG2, GG3 and ≥GG4 constituted 49%, 31%, 10% and 10% of cancers identified at age 50-54 years and 26%, 26%, 18%, and 30% of cancers identified at age 70-74 years. Opportunistic PSA testing increases with ageing and often generates values that cannot discriminate benign prostate enlargement from prostate cancer. A clinical cascade using additional imaging or serum tests is necessary to avoid negative biopsies and the overdiagnosis of indolent disease. The declining specificity of PSA testing with ageing poses a significant public health challenge especially among older men aged ≥70 years.

Correlation between Physician-Administered International Prostate Symptoms Score and Peak Urine Flow Rate in Assessment of Benign Prostatic Enlargement Patients.

To determine the correlation between international prostate symptom score (IPSS) questionnaire, completed by benign prostatic enlargement patients with the aid of their physicians and the peak urine flow rate from uroflowmetry. This was a prospective study carried out over a period of one year (which year and which period). IPSS questionnaire was administered, and uroflowmetry done for 76 consecutive patients from urology clinic of University of Nigeria Teaching Hospital (UNTH) who consented to the study. Seventy-six patients were recruited for the study. The mean age of the patients was 63.53 ± 9.84. Using the international prostate symptom score to assess symptoms severity, 16 patients had mild symptoms, 36 patients had moderate symptoms, while 24 patients had severe symptoms. The means quality-of-life score was 4.42 ± 1.83. Fifty-eight patients had obstructed peak flow rate (Qmax) on uroflowmetry, 14 patients had equivocal Qmax, while 4 patients had normal Qmax. Statistically significant, negative medium correlations were observed between Qmax and total IPSS, Qmax and the IPSS voiding and storage subscores, as well as Qmax and disease specific quality-of-life score (QoL). There is a statistically significant medium negative correlation between total IPSS and Qmax. This negative medium correlation was also observed between Qmax and IPSS subscores and between Qmax and QoL.

One-year outcomes after prostate artery embolization versus laser enucleation: A network meta-analysis.

Although holmium laser enucleation (HoLEP) is considered a size-independent procedure for treatment of an enlarged prostate, prostate artery embolization (PAE) is emerging as an alternative modality to treat moderate and large benign prostatic hyperplasia. This study aims to compare the early post-operative and short-term efficacy of PAE and HoLEP. PubMed, Cochrane Library and EMBASE databases were searched. Network meta-analysis was performed following PRISMA-N-guidelines. Post-operative parameters analysed include international prostate symptom score (IPSS), quality of life (QOL), post-void residual urine (PVR), maximal uroflow rate (Qmax) and serious adverse events (SAE). Random effects model calculated weighted mean differences (WMD). If 95%CI crossed the line of no effect (WMD =0), evidence indicated no statistically significant difference between treatments compared. Qualitative and quantitative syntheses included 20 and 18 studies with 1991 and 1606 patients, respectively. At 3months, there was no statistically significant difference between PAE and HoLEP in IPSS score improvement [WMD: -2.21: 95%CI: (-10.20, 5.78), favouring PAE], QoL score improvement [WMD: -0.22:95%CI: (-1.75, 1.32), favouring PAE] and PVR improvement [WMD: 26.97: 95%CI: (-59.53, 113.48), favouring HoLEP]. However, PAE was found inferior to HoLEP for Qmax improvement [WMD: 8.47, 95%CI: (2.89, 14.05), favouring HoLEP]. At 1-year follow-up, there was no statistically significant was found between PAE and HoLEP for IPSS score improvement [WMD:6.03, 95%CI: (-1.30, 13.35)], QoL score improvement [WMD: 0.03, 95%CI: (-1.19, 1.25)], PVR improvement [WMD:4.11, 95%CI: (-32.31, 40.53)] and Qmax improvement [WMD:2.60, 95%CI: (-2.20, 7.41)] with all differences favouring HoLEP. PAE was superior to HoLEP for SAE [PAE vs. HoLEP-OR: 0.68, 95%CI: (0.25, 1.37)]. HoLEP was superior to PAE at 3months for Qmax improvement. There was no significant difference in IPSS, QoL, PVR and Qmax improvement at 1year between PAE and HoLEP. PAE was also associated with lesser SAE compared to HoLEP. Studies on the long-term outcome of PAE are needed to establish the durability of early outcomes after PAE.

Kaempferol Alleviates Mitochondrial Damage by Reducing Mitochondrial Reactive Oxygen Species Production in Lipopolysaccharide-Induced Prostate Organoids.

Common prostate diseases such as prostatitis and benign prostatic hyperplasia (BPH) have a high incidence at any age. Cellular stresses, such as reactive oxygen species (ROS) and chronic inflammation, are implicated in prostate enlargement and cancer progression and development. Kaempferol is a flavonoid found in abundance in various plants, including broccoli and spinach, and has been reported to exhibit positive biological activities, such as antioxidant and anti-inflammatory properties. In the present study, we introduced prostate organoids to investigate the protective effects of kaempferol against various cellular stresses. The levels of COX-2, iNOS, p-IκB, a pro-inflammatory cytokine, and ROS were increased by LPS treatment but reversed by kaempferol treatment. Kaempferol activated the nuclear factor erythroid 2-related factor 2(Nrf2)-related pathway and enhanced the mitochondrial quality control proteins PGC-1α, PINK1, Parkin, and Beclin. The increase in mitochondrial ROS and oxygen consumption induced by LPS was stabilized by kaempferol treatment. First, our study used prostate organoids as a novel evaluation platform. Secondly, it was demonstrated that kaempferol could alleviate the mitochondrial damage in LPS-induced induced prostate organoids by reducing the production of mitochondrial ROS.

Effect of transurethral resection of prostate on Uroflowmetry parameters on patients having benign prostatic hyperplasia

Objective: To determine improvement in uroflowmetry after Transurethral resection ofprostateStudy design: A prospective observational Study Place and Duration of the Study: January 2014 to June 2016 Department at urology POF HospitalWah Cantt, Pakistan INTRODUCTION:Lower urinary tract problems affect 15%–60% of men over 40. Complex symptoms include frequency, urgency, nocturia, problems commencing urination, insufficient bladder emptying, low steam force, and steam stoppage. BPH frequently causes male LUTS. Benign prostatic enlargement Chronic BOO may induce urine retention, renal insufficiency, recurrent UTIs, extensive hematuria, and bladder calculi. It involves prostate histopathological cellular element proliferation. BPH and LUTS rise considerably with age. BPH affects 70% of US men aged 60–69 and 80% over 70. Autopsy examinations indicated 8%, 50%, and 80% histological frequency in the 4". and 9*decades. LUTS risk factors and larger prostates cause benign prostatic enlargement. Formerly, TURP was the best BPH procedure. Higher disease pathophysiology knowledge and digital rectal examination, transabdominal, and transrectal ultrasounds are the second most prevalent interventions in adult male patients worldwide. Urodynamic and serum PSA tests may misdiagnose the condition and require surgery. Uroflowmetry records voiding time from urinal pee. It would assess average flow and obstruction severity. For boys 14–45, the average flow rate is 21 mL/s, 46–65 mL/s, and 66–80 mL/s. Uroflowmetry in post-TURP benign hypertrophic hyperplasia patients will be examined after transurethral prostate removal. keywords: transurethral resection , prostate Uroflowmetry parameters, prostatic hyperplasia

Effects of algerian nettle (Urtica dioica L.) on benign prostatic hyperplasia and their mechanism of action elucidation: in vivo and in silico approaches

This study investigated the effect of Urtica dioica roots etheric extract (UDEE) on oxidative stress, and urine obstruction with histopathological examinations of prostatic and renal tissues,and suggests computational methods as a complementary method, to make a hypothesis on the overall effect of UDEE in the treatment of benign prostatic hyperplasia (BPH).Gas chromatography/mass spectrometry was utilised to characterise UDEE.BPH was induced in rats through daily subcutaneous injections of testosterone propionate. Rats were also orally administered UDEE or a vehicle. After four weeks, prostate weight, urine output, and biochemical markers were evaluated. UDEE treatment demonstrated significant regression of prostatic enlargement, improved biochemical and histopathological characteristics, and regulation of antioxidant activity levels. Phytosteroids stand out, act by inhibiting 5α-reductase and aromatase. This study provides an insight into treatment of BPH, demonstrating safety of this compound towards the kidney compared to finasteride without severe side effects.

Redefining Clinically Significant Hematuria After Holmium Enucleation of the Prostate.

Introduction and Objective: Holmium laser enucleation of the prostate (HoLEP) is often offered for symptomatic prostatic enlargement at high risk for bleeding. However, prior studies define clinically significant hematuria (CSH) narrowly as the need for blood transfusion or significant decrease in hemoglobin. We sought to evaluate risk factors contributing to a broader definition of CSH, which may contribute to alteration of clinical course. Methods: We analyzed 164 patients in a prospectively maintained database who underwent HoLEP at a single institution across two surgeons from November 2020 to April 2023. HoLEP was performed using Moses 2.0 (Boston Scientific) laser and the Piranha enucleation system (Richard Wolf). We defined CSH broadly as follows: clot retention, return to operating room, perioperative management variation due to hematuria, or continued gross hematuria past 1 month postoperatively. Univariable and multivariable ANOVAs were used. Multivariable analysis of CSH risk based on the use of antiplatelet (AP) agents or anticoagulants included correction for age, enucleation time (surrogate for case difficulty), and prostate volume. Results: 17.7% (29/164) of our patients developed CSH after HoLEP. Longer enucleation time was a mild risk factor for developing CSH (multivariate odds ratio [OR] 1.01, p = 0.02). The strongest predictor of CSH was the use of anticoagulation or AP agents (OR 2.71 p < 0.02 on univariable analysis, OR 2.34 p < 0.02 on multivariable analysis), even when aspirin 81 mg was excluded. Conclusion: With a broadened definition, 18% of patients developed CSH following HoLEP, which impacted the clinical course. Our data suggest that the current definition of significant hematuria is too narrow and does not capture many patients whose clinical course is affected by hematuria. While safe, anticoagulants and APs significantly predicted an increased CSH risk, and patients should be counseled accordingly.

Sustainable UV approaches supported by greenness and whiteness assessments for estimating a recently FDA-approved combination for managing urologic disorders: Tukey's test

Erectile dysfunction caused by a urinary tract infection and an enlarged prostate is a common problem among men nowadays. A brand-new FDA-approved combination of finasteride (FNS) and tadalafil (TDF) is currently recommended, particularly for those with prostatic problems in addition to erectile dysfunction. TDF boosts FNS's short-term efficacy in addition to treating erectile dysfunction, one of the sexual adverse effects typically associated with FNS therapy. Accordingly, this research introduces three straightforward spectrophotometric techniques for determining FNS and TDF in their pure and pharmaceutical forms concurrently, in addition to providing a dissolution study for their formulation as per the FDA’s directions. FNS and TDF have superimposed UV spectra, making direct concurrent analysis of these medications impossible. To resolve this overlap, we utilized the following UV techniques: the dual-wavelength method, the deconvoluted Fourier method, and the ratio difference method, with linear ranges of (0.50–15) µg/mL for TDF and (5–100) µg/mL for FNS. The LODs ranged from (0.12–0.15) µg/mL and (0.88–1.14) µg/mL, while the LOQs ranged from (0.37–0.46) µg/mL and (2.66–3.45) µg/mL for TDF and FNS, respectively. The proposed techniques were verified as per ICH recommendations and compared statistically to the published approach using three statistical tests. A complete green profile was provided to assess the foregoing techniques’ greenness using four metrics, along with the whiteness assessment using the RGB algorithm. The foregoing UV methods have been demonstrated to be sustainable, highly sensitive, specific, and suitable for quality assurance testing.