BPH-related Lower Urinary Tract Symptoms Research Articles

Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery

ObjectiveTo evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery.MethodsWe retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months.ResultsAll patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100–145). Median estimated blood loss was 224 ml (IQR: 190–255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up.ConclusionsUS-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.

Enhanced prostatic Esr1+ luminal epithelial cells in the absence of SRD5A2.

Steroid 5α reductase 2 (SRD5A2) converts testosterone to dihydrotestosterone and is crucial for prostatic development. 5α reductase inhibitors (5ARI) reduce prostate size in benign prostate hyperplasia (BPH) and ameliorate lower urinary tract symptoms secondary to BPH. However, the mechanisms of 5ARI functioning are still not fully understood. Here, we used a Srd5a2-/- mouse model and employed single-cell RNA sequencing to explore the impact of SRD5A2 absence on prostate cellular heterogeneity. Significant alterations in luminal epithelial cell (LE) populations were observed, alongside an increased proportion and proliferative phenotype of estrogen receptor 1 (ESR1)+ LE2 cells, following an SRD5A2-independent ESR1 differentiation trajectory. LE2 cells exhibited enhanced estrogen response gene signatures, suggesting an alternative pathway for prostate growth when SRD5A2 is absent. Human prostate biopsy analysis revealed an inverse correlation between the expressions of SRD5A2 and LE2 markers (ESR1/PKCα), and an inverse correlation between SRD5A2 and the clinical efficiency of 5ARI. These findings provide insights into 5ARI resistance mechanisms and potential alternative therapies for BPH-related lower urinary tract symptoms. © 2024 The Pathological Society of Great Britain and Ireland.

Psychological Impact of Sexual Disorders Related to Benign Prostatic Hypertrophy

Objectives: Lower urinary tract disorders related to BPH are today among the most frequent symptoms in urology. The aim of our study is to determine the prevalence of erectile dysfunction in patients with BPH-related lower urinary tract symptoms and the related psychological impact. Methods: We conducted a study to assess the psychological impact of BPH-related sexual dysfunction. We used two scores to assess anxiety-depressive symptoms. The Patient Health Questionnaire-9 (PHQ-9), which gives an indication of the severity of depression, and the Generalized Anxiety Disorder - 7 (GAD-7) 1 for screening patients for generalized anxiety disorder. The severity of erectile dysfunction was specified using the SHIM score (Sexual Health Inventory for Men). Results: A total of 290 participants. The mean age was 58 years, 175 (60%) patients had erectile dysfunction, 120 (60%) of these patients with ED were treated with alpha blockers (OR=2.38, RR = 1.43, p = 0.04). The most represented age group was 60-69 years, 50 (28%) patients were treated with alpha blockers (OR=1.67, RR = 1.15, p = 0.01) while only 10 (5.7%) patients were treated with herbal extracts (phytotherapy). 65% of participants with erectile dysfunction showed varying degrees of depression and 53% of participants with erectile dysfunction showed varying degrees of anxiety. Conclusion: Micturition disorders caused by benign prostatic hyperplasia (BPH) and erectile dysfunction are frequent and often coexist. BPH-related erectile dysfunction has a significant psychological impact.

Transperineal microwave thermoablation for benign prostatic hyperplasia-related lower urinary tract symptoms in an elderly patient.

Transperineal prostate microwave thermoablation (TPMT) has been established as a safe means of treating benign prostatic hyperplasia (BPH); however, its effectiveness in addressing BPH-related lower urinary tract symptoms (LUTS) remains unexplored. This case study aims to evaluate the efficacy of TPMT in LUTS attributed to BPH. An 84-year-old man with LUTS due to BPH-induced bladder outlet obstruction, unresponsive to previous medical treatments, and failed prostate artery embolization, underwent TPMT. Three coaxial needles were positioned at the midline, right, and left sides of the hypertrophic transitional zone of the prostate. Microwave energy, with parameters determined using liver data and targeted ablation area, was applied at 2,450 MHz in continuous mode. The tissue temperature was monitored using bilateral thermocouple sensors. The patient exhibited no changes in defecation rhythm, abdominal discomfort, or anorectal pain. Temporary postoperative hematuria was promptly resolved through saline irrigation within 6 hours, and hematological evaluations showed normal results. Significant clinical improvements were observed (e.g., prostate volume, prostate-specific antigen levels) accompanied by an increase in peak flow rate. Thus, TPMT appears to be a promising intervention for bladder outlet stenosis and LUTS induced by BPH.

Prostate artery embolization using n-butyl cyanoacrylate glue for symptomatic benign prostatic hyperplasia: A six-month outcome analysis in 103 patients

PurposeThe purpose of this study was to assess the feasibility, safety, and 6-month outcomes of prostate artery embolization (PAE) using N-butyl-cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms. Materials and methodsPatients with BPH-related lower urinary tract symptoms who were treated by PAE using methacryloxysulfolane-NBCA mixed with ethiodized oil (1:8 ratio) between September 2018 and January 2023 were retrospectively included. Vascular mapping was made using cone-beam computed tomography angiography. PAEs were performed as an outpatient procedure, under local anaesthesia. Outcomes were assessed at six months using the International Prostate Symptoms Score (IPSS) and associated quality-of-life score (IPSS-QoL), prostate-specific antigen (PSA) level, prostate volume, and International Index of Erectile Function form 5 (IIEF5). ResultsA total of 103 men with a mean age of 68.4 ± 6 (standard deviation [SD]) years were included. Technical success rate was 100%. The mean fluoroscopy time was 26.4 ± 12.5 (SD) min and the median radiation dose was 23 980 mGy·cm (Q1, Q3: 16 770, 38 450). Compared to baseline, statistically significant improvements were observed at six months for the IPSS (8.9 ± 6.2 [SD] vs. 20.2 ± 6.5 [SD]; P = 0.01), IPSS-QoL (2.1 ± 1.4 [SD] vs. 5.1 ± 0.9 [SD]; P = 0.01), PSA level (3.6 ± 3.2 [SD] ng/mL vs. 4.8 ± 4.2 [SD] ng/mL; P = 0.0001), and prostate volume (78.6 ± 43.5 [SD] mL vs. 119.1 ± 65.7 [SD] mL; P = 0.01). Minor adverse events developed in 19/103 (18.4%) patients. No major complications occurred. Compared to baseline, the IIEF5 did not change significantly at six months (15.3 ± 6.8 [SD] vs. 15.8 ± 6.8 [SD]; P = 0.078). ConclusionPAE with NBCA is a feasible and safe method that provides good outcomes at six months in patients with BPH-related lower urinary tract symptoms. This method deserves further evaluation in randomized trials with longer follow-up.

ITIND for BPH: Technique and procedural outcomes: A narrative review of current literature

In the last few years, new technologies have been developed to treat benign prostatic hyperplasia (BPH) in order to offer valid surgical alternatives to transurethral resection of the prostate with lower complications and hospitalization while maintaining satisfactory functional results. Among these new approaches, transurethral implantation of first- and second-generation temporary implantable nitinol device (TIND and iTIND, respectively) (Medi-TateVR ; Medi-Tate Ltd., Or Akiva, Israel) has been proposed. The aim of this work is to describe the surgical technique and to perform a systematic review of the available literature on follow-up of functional outcomes. A systematic research of the available literature on this topic was performed via Medline, Embase, and Cochrane databases in April 2021. Current evidence regarding the implantation of iTIND to treat BPH-related lower urinary tract symptoms (LUTSs) is still limited. Seven studies have been found. Only one randomized controlled trial has been published reporting short-term follow-up of implantation of iTIND versus sham procedure. All the studies reported that both procedures are safe, effective, and well-tolerated. Moreover, such treatment seems to not affect patient's sexual and ejaculatory functions. In conclusions, current clinical evidence suggests that temporary implantation of iTIND is a valid option for the minimally invasive surgical treatment of BPH-related LUTS. Further studies are required in order to confirm the functional results, especially over a long-term follow-up.

Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?

Our goal was to evaluate the feasibility, safety, and short-term outcomes of prostate artery embolization (PAE) with N-butyl cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTSs). A two-center retrospective study of 50 patients (mean age, 67.6 ± 7.4 years; range, 54–85 years) treated with NBCA between 2017 and 2020 was conducted. PAE was performed using a mixture of Glubran 2 glue and Lipiodol in a 1:8 ratio, under local anesthesia, on an outpatient basis, after cone-beam computed tomography vascular mapping. Mean total injected NBCA/Lipiodol volume was 0.9 ± 0.3 mL, total injection time was 21.9 ± 7.8 s, and total radiation dose was 18,458 ± 16,397 mGy·cm. Statistically significant improvements over time occurred for the International Prostate Symptoms Score (9.9 ± 6.8 versus 20.5 ± 6.7, p = 0.0001), quality-of-life score (2.2 ± 1.5 versus 4.9 ± 1.0, p = 0.0001), prostate-specific antigen level (4.6 ± 3.0 versus 6.4 ± 3.7, p = 0.0001), and prostate volume (77.3 ± 30.5 versus 98.3 ± 40.2, p = 0.0001) at a median of 3 months versus baseline. Minor adverse events developed in 11/50 (22%) patients, but no major complications occurred. The International Index of Erectile Function did not change significantly. PAE with NBCA is feasible, safe, fast, and effective for patients with BPH-related LUTSs. Prospective comparative studies with longer follow-ups are warranted.

Comparison of bipolar plasmakinetic resection of prostate versus photoselective vaporization of prostate by a three year retrospective observational study

Comprehensive evaluation of photoselective vaporization of the prostate (PVP) versus plasmakinetic resection of the prostate (PKRP) in treating benign prostatic hyperplasia (BPH) is inadequate. This single-centre, retrospective observational study was designed to compare their efficacy, complications and sexual function. A total of 215 patients under PVP or PKRP were included in the study, propensity score matching (PSM) was performed to match the baseline characteristics of the two groups, and perioperative and three-year follow-up data were compared between them. Finally, 120 patients (60 for PVP and 60 for PKRP) were matched after PSM. Compared with the PKRP group, the intraoperative haemoglobin loss was lower (9.08 vs 13.75 g/L, P < 0.001) and the duration of catheterization and postoperative hospital stay were shorter (2.97 vs 4.10 day, P < 0.001; 3.95 vs 5.13 day, P < 0.001, respectively), but the operation time was longer (56.72 vs 49, 90 min, P < 0.001) in the PVP group. Urination measurements were improved for both groups after surgery, although no significant differences were found between them during follow-up. Sexual function after surgery was partly increased; however, frequent retrograde and discomfortable ejaculation occurred in both groups. In addition, dysuria incidence and retreatment were higher in the PVP group at 12 months. In conclusion, PVP is safe and effective in relieving BPH-related lower urinary tract symptoms with less perioperative blood loss and earlier recovery without inferior sexual function effects. However, the study is potentially affected by residual unmeasured confounding.

Predisposing factors of persistent storage symptoms after holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia and their correlations to the symptom recovery period

Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms (LUTS) in older men. Although medical treatments can reduce BPH-related LUTS and even prevent invasive treatments, at least one in five men who complain of LUTS due to BPH will eventually need surgery. Of LUTS, storage symptoms persist in 20 to 40% of patients even after the obstruction is resolved. The present study aims to investigate the predisposing factors of the persistent storage symptoms after HoLEP in patients with BPH and their correlations to the recovery time of the symptoms. A total of 127 patients with complaints of storage symptoms and who underwent transurethral HoLEP surgery at Pusan National University Hospital from May 2014 to June 2017 were included in this study. Urodynamic studies were performed in all patients, and BOO was confirmed by urodynamic studies before HoLEP. All patients were asked to complete the IPSS (also known as the American Urological Association score) and the Overactive Bladder Symptom Score (OABSS) questionnaire to evaluate LUTS on the day before HoLEP and 3 months after HoLEP. Patients were divided into group I, which included patients with persistent storage symptoms after HoLEP, and group II, which included patients without storage symptoms after HoLEP. Of a total of 127 patients, 68 were included in group I, and the remaining 59 were included in group II. In the univariable analysis, group I showed statistically significantly older mean age, higher mean peak detrusor pressure during filling cystometry, and lower mean MCC than group II. Multivariate analysis of these three variables showed that only mean age and mean peak detrusor pressure during filling cystometry had statistically significant differences. In group I, 12 patients had storage symptoms until 12 months after surgery. When comparing these patients with the remaining 56 patients, only mean age showed statistically significant differences. Old age and high peak detrusor pressure during filling cystometry were the predictors of persistent storage symptoms after HoLEP. Furthermore, older patients were unlikely to recover storage symptoms until 12 months after operation.

The association between anogenital distance and benign prostatic hyperplasia related lower urinary tract symptoms in Chinese aging men.

We conducted the study to investigate the relationship between anogenital distance (AGD) and benign prostatic hyperplasia (BPH) related lower urinary tract symptoms (LUTS). From May 2018 to January 2020, 220 subjects: 110 men with BPH-related LUTS (BPH-LUTS group) and 110 men without any urination complaints (control group) were selected. Clinical questionnaires, detailed physical examinations, including AGDas (distance between the anus and posterior base of the scrotum) and AGDap (distance between the anus and upper penis) measurements, and blood tests were all assessed. The two groups were similar in terms of basic features (P > 0.05). The AGDap and AGDas in the control group were significantly shorter than the BPH-LUTS group (P < 0.001). Adjusted multivariate analyses showed that AGDas was significantly related to International Prostate Symptom Score (IPSS), post-voiding residual volume (PVR), total prostate volume (TPV) and maximum urine flow rate (Qmax) (P = 0.002, P = 0.009, P = 0.001, P = 0.028, respectively). However, the associations between AGDap and IPSS score, PVR, TPV, Qmax and total testosterone (TT) were all negligible (P > 0.05 for all). The associations between TT and BPH-LUTS related evaluations were also negligible (P > 0.05 for all). Furthermore, the study revealed that the AGDas cut-off values for mild, moderate, and severe symptom (based on IPSS score) in BPH-LUTS cases were 27.4mm and 46.8mm [area under curve (AUC): 0.802 and AUC: 0.779, respectively], respectively. Longer AGDas was related to more severe BPH related symptoms. It may be useful to consider AGD as a marker for BPH-LUTS. Further well-designed studies are remained to be done to explore the intriguing problem.

Urethral-sparing Robot-assisted Simple Prostatectomy: An Innovative Technique to Preserve Ejaculatory Function Overcoming the Limitation of the Standard Millin Approach

BackgroundDespite recent technical innovations in the treatment of benign prostatic hyperplasia (BPH), retrograde ejaculation is still one of the most frequent adverse effects, with a major impact on patients’ quality of life. ObjectiveTo evaluate the efficacy of our technique of urethral-sparing robotic-assisted simple prostatectomy (usRASP) in obtaining effective deobstruction and maintaining anterograde ejaculation, and secondarily, to compare these outcomes with those of a control group of patients who underwent standard robotic adenomectomy according to the Millin technique. Design, setting, and participantsWe prospectively enrolled patients between August 2017 and July 2019 with large BPH (prostate volume >80 ml) affected by significant BPH-related lower urinary tract symptoms (LUTS) who underwent usRASP. Then, a retrospective control group treated with standard Millin robotic-assisted simple prostatectomy (RASP) was selected. Surgical procedureThe innovative aspect of our technique is the pivotal role of enucleation of the adenoma from all the anatomical structures, especially from the urethra. On the basis of the final results, the patients were divided into three groups (full, partial, or failed urethral sparing). Control group patients underwent standard Millin. MeasurementsAll perioperative and follow-up data were collected, and descriptive, univariate, and multivariate analyses were performed. Results and limitationsNinety-two patients were enrolled. Full urethral-sparing adenomectomy was performed in 56 cases (60.86%). Urethral-sparing adenomectomy with minimal urethral infraction occurred in 21 cases (22.82%). In 15 patients (16.48%), the procedure was converted to standard RASP. Clavien grade ≥3 complications occurred in two patients (2%). Among the 70 patients with preoperative ejaculation, 57 (81%) maintained anterograde ejaculation at the 12th postoperative month. The maximum flow rate increased (17 m/s from baseline, p = 0.034), and International Prostate Symptom Score decreased rapidly (from 20 to 5 points; p < 0.001). With respect to the technique of the control group patients, usRASP allows the same perioperative and urinary functional outcomes, but with an improvement in terms of sexual function, especially for the ejaculation (p < 0.001 at every time point). A small sample size and short follow-up time are the major limitations of this study. ConclusionsUrethral-sparing RASP has been found to be a safe and effective procedure that allows resolution of LUTS in large BPH and maintaining of ejaculatory function in a high percentage of patients. Patient summaryBased on our findings, this technique should be considered as an option when counseling patients with large benign prostatic hyperplasia who are motivated to preserve antegrade ejaculation.

The Effect of the Presence of Lower Urinary System Symptoms on the Prognosis of COVID-19: Preliminary Results of a Prospective Study

Purpose: To investigate the effectiveness of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS), which occur as a natural result of aging and androgen exposure, in predicting disease prognosis in male patients diagnosed with COVID-19. Methods: The study was planned prospectively. The study included 63 male patients over 40 years of age diagnosed with COVID-19. The patients were diagnosed with COVID-19 based on the results of reverse transcription polymerase chain reaction tests of oropharyngeal and nasopharyngeal swabs obtained as per the World Health Organization guidelines. The presence of LUTS was assessed by the International Prostate Symptom Score (I-PSS), a subjective assessment, and the I-PSS was filled for the patients included in the study. The patients were divided into three groups based on their scores in the I-PSS survey: group 1: mild (0–7), group 2: moderate (8–19), and group 3: severe (20–35). The data of all three groups were statistically analyzed. Results: In the assessment performed between the groups, it was identified that for patients in group 3, the length of hospital stay was longer, intensive care requirement was more frequent, and their mortality rates were numerically higher. In the evaluation made regarding the time to intensive care admittance, this was identified to be the shortest in group 3. Conclusion: As a result of our study, we think that in patients with COVID-19, BPH-related LUTS can guide clinicians in predicting prognosis.

The relationship between anogenital distance and benign prostate hyperplasia-related lower urinary tract symptoms.

Anogenital distance (AGD) is the length between the genitals and anus which shows an androgenic activity in the evolution of the reproductive system in the uterine life. For prostatic evolution and development during the embryological stage, androgen exposure is required. In this study, we aimed to investigate the relationship between AGD and benign prostate hyperplasia (BPH)-related lower urinary tract symptoms (LUTS). A total of 70 patients who were admitted to our urology clinics with LUTS due to BPH (LUTS group) and 70 patients without LUTS (control group) were included. All patients were administered an International Prostate Symptom Score form. Data including height, weight, body mass index, total prostate-specific antigen, prostate volume and uroflowmetry Qmax values of all patients were evaluated. The AGD of the LUTS and control groups was measured. The mean AGDAS values of the LUTS group were significantly lower than the control group (p=.013). There was no statistically significant difference between the two groups in terms of the mean adjusted AGDAP values (p=.241). However, the mean adjusted AGDAS values were significantly lower in the LUTS group than the control group (p=.002). Our study results suggest that AGD may be a useful marker in BPH-related LUTS.

The role of prostatic inflammation in the development and progression of benign and malignant diseases.

To evaluate the role of prostatic inflammation in the development and progression of benign and malignant prostatic diseases. Preclinical studies demonstrate that the activation of a chronic inflammatory prostatic response plays an important role in the pathogenesis and progression of benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Approximately 40-70% of patients with BPH-related lower urinary tract symptoms harbour chronic inflammation at pathologic evaluation. These individuals should be considered at increased risk of symptom progression and acute urinary retention. Although currently available drugs approved for the treatment of BPH do not have an anti-inflammatory activity, the development of novel molecules that target the inflammatory pathway represents a promising area in the pharmacological treatment of BPH. Preclinical evidences support a potential role of chronic prostatic inflammation in the malignant transformation of prostatic cells. However, clinical investigations on the association between prostatic inflammation and the risk of PCa report conflicting results. Men with BPH-related lower urinary tract symptoms and chronic prostatic inflammation should be considered at increased risk of symptom progression and acute urinary retention during follow-up. Although preclinical studies provide a biological rationale for the relationship between inflammation and the risk of PCa, clinical investigations report conflicting results and the direct relationship between inflammation and malignant transformation in the human prostate is still debated.

Correlation between Fasting Glucose, Erectile Dysfunction, and Lower Urinary Tract Symptoms in Benign Prostate Hyperplasia Patients

This study is aimed to determine the correlation between fasting glucose level, erectile dysfunction,and lower urinary tract symptoms (LUTS) in patients diagnosed with benign prostatic hyperplasia (BPH). Weenrolled patients with BPH-related LUTS aged over 50 years old. LUTS and erectile dysfunction (ED) wereevaluated using International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5(IIEF-5). Diabetes mellitus was established if fasting glucose level was above 126mg/dL. Forty-two patientswere enrolled in this study from outpatient clinic in Kardinah Hospital, Tegal during January–March 2015.Patients’ mean age was 68.8±8.6 years old with most of them suffered from ED (83.3%) and also suffered fromsevere LUTS (80.96%). Mean fasting glucose level was 108.3 + 21.1 mg/dl. However, diabetes mellitus wasobserved in 26.2% subjects with mean fasting glucose level was 136.8+7.8mg/dl. IPSS score was correlatedwith fasting glucose level (r=0.879, p<0.001) and IIEF-5 score (r= -0.346, p=0.025). IIEF-5 score showednegative correlation with age (r=-0.31, p=0.046) and fasting glucose level (r=-0.305, p=0.049). Higher fastingglucose level in a man older than 50 years with BPH would increase severity of LUTS and ED. Normal 0 false false false IN X-NONE X-NONE

1079 A randomized clinical trial comparing prostatic injection of botulinum neurotoxin type A (Botox®) to optimized medical therapy in patients with BPH-related LUTS: End-of-study results of the PROTOX trial

1079 A randomized clinical trial comparing prostatic injection of botulinum neurotoxin type A (Botox®) to optimized medical therapy in patients with BPH-related LUTS: End-of-study results of the PROTOX trial

Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome.

Epidemiological studies have shown that age is the principal unmodifiable risk factor of lower urinary tract symptoms (LUTS). Until the past decade, the process of lower urinary tract ageing was, therefore, considered unmodifiable - as ageing per se. However, the traditional dogma that BPH-related LUTS (BPH-LUTS) is an immutable consequence of old age is no longer acceptable. Results from multiple preclinical and clinical studies indicate that several modifiable, age-related metabolic aberrations (metabolic syndrome, obesity, dyslipidaemia, diabetes) are important determinants in both the development and the progression of BPH-LUTS. Metabolic syndrome and its related comorbidities, such as sex steroid alterations and low-grade inflammation, have been related to BPH-LUTS development and progression. With the correct treatment and recommended lifestyle changes, many individuals with metabolic syndrome might be able to prevent or delay the onset of metabolic-syndrome-related complications; however, whether promoting healthier lifestyles can really alter a man's propensity to develop BPH-LUTS remains to be clarified.

Photoselective Vaporization of the Prostate vs Plasmakinetic Resection of the Prostate: A Randomized Prospective Trial With 12-Month Follow-up in Mainland China

To compare the short-term efficacy and safety results of photoselective vaporization of the prostate (PVP) and plasmakinetic resection of prostate (PKRP), 2 methods of treating benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) in mainland China. One hundred twenty patients with LUTS secondary to BPH were randomly divided into 2 groups: PVP group (n = 61) and PKRP group (n = 59). Perioperative data and postoperative complications were recorded for both groups. Patients were followed up for 12 months after treatment. Compared with PKRP, PVP required a longer operation time (56 vs 41 minutes; P <.01). PVP also needed shorter catheterization time (2.4 vs 3.5 days; P <.01) and shorter length of hospitalization (3.5 vs 5.1 days; P <.01). International Prostate Symptom Score, Qmax, and quality of life score were significantly improved for both groups after surgery, and no significant differences were apparent between the 2 groups, for up to 12 months. Short-term complications were assessed in regard to necessity of blood transfusion (1 vs 1), clot retention (1 vs 0), reoperation (1 vs 0), incontinence (0 vs 0), urethral stricture (1 vs 0), and retrograde ejaculation (4 vs 6) in the PVP vs PKRP groups, respectively. In patients with BPH-related LUTS, PVP may be a superior treatment to PKRP as it relates to the endpoints of this study, with short-term results after a 12-month follow-up as length of hospital stay and catheterization time needed were both less than what was required for PKRP. Long-term comparative data are required to clearly define the role of PVP and PKRP in patients.

Comparison of the Effects of Hexanic Extract of Serenoa repens (Permixon) and Tamsulosin on Inflammatory Biomarkers in the Treatment of Benign Prostatic Hyperplasia-Related Lower Urinary Tract Symptoms

ContextChronic prostatic inflammation appears to have a key role in the pathogenesis and progression of benign prostatic hyperplasia (BPH). The PERMIN study compared the effects of hexanic extract of Serenoa repens (Permixon; Pierre Fabre, Castres, France) and tamsulosin on inflammation-related biomarkers secreted in urine of patients with BPH-related lower urinary tract symptoms (LUTS). ObjectiveTo review key features of the PERMIN study as they relate to treatment effects on the messenger RNA expression of selected inflammation-related genes and proteins. Evidence acquisitionThis article is based primarily on material presented at a satellite symposium entitled, “Inflammation and Prostatic Diseases: From Bench to Bedside,” held during the 2015 annual meeting of the European Association of Urology in Madrid, Spain. Current data regarding the link between inflammation and BPH were reviewed. Evidence synthesisPermixon showed a more pronounced effect than tamsulosin on selected inflammation-related genes and proteins. Among the 15 most frequently expressed genes in patients at baseline, 73% were favourably affected by Permixon versus 27% with tamsulosin, as indicated by the combination of downregulation and fewer upregulation effects. Expression of inflammatory proteins (CCL2/MCP-1, CXCL10/IP-10, macrophage migration inhibitory factor [MIF]) was downregulated in a higher percentage of patients and upregulated in a lower percentage of patients treated with Permixon compared with tamsulosin. In Permixon-treated patients, greater improvement in the International Prostate Symptom Score was observed at 3 months in those who overexpressed MIF protein at baseline compared with those who did not (−6.4 vs −4.5). ConclusionsDownregulation of inflammation-related genes and proteins by Permixon brought meaningful symptomatic improvement in patients with moderate to severe LUTS. Patients with high chronic prostatic inflammation may benefit from early treatment with Permixon. Patient summaryDownregulation of inflammation-related genes and proteins by Serenoa repens (Permixon) was associated with meaningful symptomatic improvement in patients with moderate to severe lower urinary tract symptoms. Patients with high chronic prostatic inflammation may benefit from early treatment with Permixon.

MP71-12 INCREASE OF FRAMINGHAM RISK IS ASSOCIATED WITH SEVERITY OF LOWER URINARY TRACT SYMPTOMS: CONFIRMING RELATIONSHIP BETWEEN BOTH DISEASES

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Evaluation and Symptoms1 Apr 2015MP71-12 INCREASE OF FRAMINGHAM RISK IS ASSOCIATED WITH SEVERITY OF LOWER URINARY TRACT SYMPTOMS: CONFIRMING RELATIONSHIP BETWEEN BOTH DISEASES Giorgio Ivan Russo, Tommaso Castelli, Salvatore Privitera, Eugenia Fragalà, Vincenzo Favilla, Giulio Reale, Daniele Urzì, Sebastiano Cimino, and Giuseppe Morgia Giorgio Ivan RussoGiorgio Ivan Russo More articles by this author , Tommaso CastelliTommaso Castelli More articles by this author , Salvatore PriviteraSalvatore Privitera More articles by this author , Eugenia FragalàEugenia Fragalà More articles by this author , Vincenzo FavillaVincenzo Favilla More articles by this author , Giulio RealeGiulio Reale More articles by this author , Daniele UrzìDaniele Urzì More articles by this author , Sebastiano CiminoSebastiano Cimino More articles by this author , and Giuseppe MorgiaGiuseppe Morgia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2625AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cardiovascular diseases (CVD) and lower urinary tractsymptoms (LUTS) are health problems that are becomingmore prevalent in the aging population. Both share similar risk factors (e.g., age,diabetes, hypertension, obesity, smoking) but underlying pathophysiology is not well understood. The aim of this cross-sectional study is to evaluate the relationship between LUTS and CVD assessed by the Framingham score risk. METHODS Between September2010 to September 2014, 336 consecutive patients with BPH related LUTS were enrolled in this cross-sectional study. The patients with neurogenic bladder, previous pelvic surgery, urological cancers, hypogonadism were excluded from the study.Patients underwent physical examination and blood samples collection. LUTS of the patients were evaluated by culturally and linguistically validated versions of International Prostate Symptom Score (IPSS). LUTS severities were classified as mild (IPSS 0–7), moderate-severe (IPSS 8–35).The general 10-year cardiovascular disease Framingham risk,expressed as a percent, assesses risk of atheroscleroticCVDevents (i.e., coronary heart disease, cerebrovasculardisease, peripheral vascular disease, and heart failure) was calculated for each patients using age, high-density lipoprotein, total cholesterollevel, systolic blood pressure, antihypertensivemedication use, diabetes, and current smokingstatus. Individuals with low risk had 10% or less CHD risk at 10 years, with intermediate risk 10-20%, and with high risk 20% or more. RESULTS Median age was 67.0yrs (IQR: 61.0-72.0), median IPSS was 18.0 (IQR: 14.0-23.0), median PSA was 3.72ng/ml (IQR: 1.58-6.69), median prostate volume was 50.0 cc (IQR: 35.0-65.0), median Framingham risk was 17.0 (IQR: 12.0-21.0). As category Framingham risk increases, we observed higher IPSS (14.5 vs. 17.0 vs. 19.0; p<0.05), high IPSS-storage (7.5 vs. 8.0 vs. 8.5; p<0.05) and low IIEF-erectile function (23.5 vs. 23.0 vs. 16.0; p<0.05). Prostate volume significantly increase in intermediate Framingham risk vs. low risk (52.5 vs. 39.0; p<0.05). Linear regression analysis showed positive association between Framingham risk and IPSS (β= 0.16; p<0.01), IPSS-storage (β= 0.13; p<0.05) and IPSS-voiding (β= 0.14; p<0.01). Multivariate logistic regression analysis demonstrated that insulinemia (OR: 1.11 [1.04-1.19]; p<0.01) and Framingham score ≥ 10 (OR: 3.07 [0.99-9.47]; p<0.01) were independently associated with moderate-severe LUTS after adjusting with age, PSA and prostate volume. After adjusting for covariates intermediate Framingham risk (OR: 7.89 [1.98-31.51]; p<0.01) and high Framingham risk (OR: 2.59 [1.20-5.5]; p<0.05) were independently associated with moderate-severe LUTS. CONCLUSIONS In this cohort of patients, increase of Framingham risk was significantly associated with severity LUTS. This results strength the relationship between two different aspect of male health that must be investigated in order to reduce CVD risk in patients affected by LUTS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e916 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Ivan Russo More articles by this author Tommaso Castelli More articles by this author Salvatore Privitera More articles by this author Eugenia Fragalà More articles by this author Vincenzo Favilla More articles by this author Giulio Reale More articles by this author Daniele Urzì More articles by this author Sebastiano Cimino More articles by this author Giuseppe Morgia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...