Diagnosis Of Benign Prostatic Hyperplasia Research Articles

The Impact of Testosterone Therapy on Benign Prostatic Hyperplasia in Hypogonadal Men

ObjectivesTo determine the impact of testosterone therapy on the incidence of benign prostatic hyperplasia in a large cohort of hypogonadal men, and to evaluate the relationship between testosterone therapy in hypogonadal men and prostatic interventions. MethodsWe used the 2011-2020 IBM MarketScan database to identify hypogonadal males above 18 years old and determine if they received testosterone therapy. ICD-9, -10, CPT, HCPCS, and NDC codes were used for diagnoses, interventions, and medications. We ran Cox proportional hazard models to determine the effect of testosterone therapy on receiving a diagnosis of benign prostatic hyperplasia and interventions. Models were adjusted for age, region, population density, and comorbidities, with testosterone therapy within the last 6 months considered a time-varying covariate. ResultsIn our total cohort of 882,570 hypogonadal men, 157,185 (17.8%) were diagnosed with benign prostatic hyperplasia. For the first 2.5 years after hypogonadism diagnosis, there was no significant difference in the diagnosis of prostatic hyperplasia between patients on testosterone therapy and those who were not (HR:1, 95%CI:0.98-1.01, p=0.66). However, from 2.5 years onward, men who were on testosterone therapy had a 32% higher risk of receiving a diagnosis of benign prostatic hyperplasia (HR:1.32, 95%CI:1.28-1.36, p<0.001). Hypogonadal men with benign prostatic hyperplasia who received testosterone therapy showed no significant difference in interventions compared to those who did not receive testosterone (HR:0.95, 95%CI:0.89-1, p=0.08). ConclusionsIn the long term, testosterone therapy increased the risk of receiving a diagnosis of benign prostatic hyperplasia in hypogonadal men. Testosterone therapy in hypogonadal men with benign prostatic hyperplasia did not change the need for interventions.

Public Views on Managing Benign Prostatic Hyperplasia-Related Voiding Dysfunction: Potential Applications of Digital Therapeutic.

This study aims to explore the potential of digital therapeutics in managing voiding dysfunction associated with benign prostatic hyperplasia (BPH). To achieve this, we collected and analyzed news and community data from major Korean platforms to assess the trends in media and community discussions and examine how digital therapeutics can contribute to personalized care and support self-management for patients with BPH-related voiding dysfunction. Data was collected over a 3-year period from October 2021 to September 2024 using the keywords 'prostate,' 'urinary,' and 'treatment.' Key terms and patterns were then identified through word frequency analysis, TF-IDF (term frequency-inverse document frequency) analysis, and N-gram analysis to examine the potential applicability of digital therapeutics in this area. The news data primarily focused on expert-oriented medical information related to the treatment, surgical options, and diagnosis of BPH. In contrast, community data centered on discussions about everyday symptoms and solutions, such as urinary issues and self-care tips. This suggests that patients are particularly interested in practical problem-solving and selfmanagement strategies. This study suggests that digital therapeutics can empower patients with BPH to self-manage their urinary disorders through personalized management tools. Future research can be done to focus on empirically examining the clinical validity and practical applicability of digital therapeutics for BPH through clinical trials.

5α-reductase inhibitors with or without alpha-blockers and risk of incident upper tract urothelial carcinoma in men with benign prostatic hyperplasia: Analysis of US insurance claims data

BackgroundIncreasing data suggests that androgen receptor signaling may play an important role in the carcinogenesis of urothelial cancers. While the chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results, the evidence regarding 5-ARi treatment, and the risk of incident Upper Tract Urothelial Carcinoma (UTUC) development is lacking. Therefore, our objective was to investigate the impact of the 5-ARi administration on the incidence of new UTUC cases using a large US database. MethodsThe MerativeTM Marketscan® database was used to identify men ≥ 50 years old with a diagnosis of BPH and an active 5-ARi prescription between 2007 and 2021 and were subsequently matched with paired controls. A multivariable Cox regression model was implemented to ascertain the association of 5-ARi and/or alpha-blocker (α-B) medications on the incidence of UTUC. Additional subgroup analyses were conducted based on exposure risk (with a 2-year threshold) to investigate the relationship between 5-ARi and UTUC over time. ResultsOverall, n=1,103,743 men BPH without prescriptions for BPH, n=31,142 men on 5-ARi, and n=160,049 using 5-ARi + α-B were identified. Over the follow-up period, a total of n=4,761 patients were diagnosed with UTUC. After matching, UTUC incidence ranged from 0.36% to 0.41% in men without active BPH therapy vs. 0.30% and 0.52% for the 5-ARi and 5-ARi + α-B groups, respectively. In multivariable analysis, the chemoprotective effect on UTUC risk was not observed for either 5-ARi monotherapy (adjusted hazard ratio [aHR]: 0.91, 95% CI: 0.58–1.44) or 5-ARi + α-B combination (aHR: 1.02, 95% CI: 0.87–1.19). This remained true for both short-term (≤ 2 years) and long-term (> 2 years) follow-up periods. ConclusionsThe use of 5-ARi for BPH, whether used alone or in combination with α-B, is not associated with incident UTUC.

The association of 5-alpha reductase inhibitors treatment with prostate cancer in benign prostate hyperplasia patients: A population-based case-control study

Purpose: Benign prostatic hyperplasia (BPH) is the most common cause of difficult voiding in elderly men. Alpha-blockers and 5-alpha reductase inhibitors (5ARIs) are evidence-based standards of care in treating BPH according to current guidelines. We have conducted a nationwide population-based study to evaluate the association of 5ARIs treatment with prostate cancer in patients with benign prostate hyperplasia. Materials and methods: Between 2005 and 2010, patient data from the National Health Insurance Research Database were obtained. Newly diagnosed patients with BPH were divided into 2 groups: prostate cancer group and BPH group. We conducted a retrospective study on their history of medication usage with 5ARIs. Results were compared with a matched noncancerous control group. The outcome measurements were the incidence and the prostate cancer diagnosis-free survival rate after the BPH index date. Statistical analyses included t test, chi-square test, multivariable logistic regression analysis, and Kaplan-Meier curves with log-rank tests. Results: A total of 18,620 newly diagnosed patients with BPH were selected. After eliminating patients according to the exclusion criteria, a total of 17,716 patients were enrolled as the study subjects. Among them, 530 patients (2.99%) developed prostate cancer and 17,186 (97.01%) did not. The mean age of the total case-control study was 69.1 years. The odds ratio of prostate cancer in patients with BPH with 5ARIs usage was 1.14 with a P value of 0.539, indicating that the use of 5ARIs was not associated with a higher risk of developing prostate cancer. Multivariate analysis showed no significant intergroup difference in the risk of developing prostate cancer (odds ratio = 1.14, 95% CI: 0.75–1.74, P = 0.539). A subgroup survival analysis, observing the time interval from BPH diagnosis to the development of prostate cancer based on 5ARIs usage, revealed a nonsignificant difference in the prostate cancer diagnosis-free survival rate, with a P value of 0.3592. Conclusion: The 5ARI usage in patients with BPH was not associated with increased risk of developing prostate cancer. Furthermore, the prostate cancer diagnosis-free survival rate, when stratified based on 5ARIs usage, showed no statistically significant difference. Under our health insurance regulation and clinical practice, 5ARIs are consider safe in treating BPH.

Algorithmic Approach to Benign Prostatic Hyperplasia: An Indian Perspective.

Benign prostatic hyperplasia (BPH) is a prevalent condition affecting aging men, necessitating a comprehensive and evidence-based approach to diagnosis and management. This manuscript, through the summarization of the latest evidence, aims to establish a consensus among clinicians regarding optimal strategies for diagnosing and managing BPH, to improve patient care and outcomes in clinical practice. A panel of urologists conducted a comprehensive review of the literature by searching various databases and search engines (PubMed, Google Scholar, and Cochrane databases). They identified relevant studies on the diagnosis and management of BPH. The literature was summarized and analyzed to develop 14 statements. The panel utilized a Delphi methodology over two rounds (R1 and R2) to reach a consensus on the statements, considering both the literature evidence and expert opinions. The expert panel reached a consensus on 14 statements addressing diverse aspects of BPH, including tailored therapies for different patient profiles and the necessity for a unified diagnosis and management algorithm to enhance patient outcomes. In conclusion, a unified approach to diagnosing and managing BPH promotes consistent and effective patient care. Proper drug selection, considering factors like efficacy and patient-specific characteristics, is crucial for managing BPH. This approach optimizes treatment outcomes and improves the quality of life for BPH patients.

Association of CYP3A4*1B, CYP3A4*22 and CYP3A5*3 polymorphisms carriage with efficacy and safety of tamsulosin in patients with benign prostatic hyperplasia

Tamsulosin is a first-line drug in the treatment of lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH). Despite high estimates of its efficacy and safety, it rates may vary due to genetic polymorphisms of genes for the enzymes involved in the drugs metabolism.The aim of the work was to evaluate the carriage influence of genes polymorphisms of the CYP3A enzymes group of tamsulosin metabolizers on the efficacy and safety of therapy in patients with LUTS in BPH.Materials and methods. A total of 142 patients with LUTS, with an established BPH diagnosis (N40 according to ICD-10) were included in the study and underwent all stages. All patients received monotherapy with tamsulosin 0.4 mg/day for at least 8 weeks. An IPSS questionnaire with the definition of quality of life, a prostate ultrasound with the determination of the prostate volume and residual urine, as well as uroflowmetry, were used to evaluate the results of the treatment. Controls were performed at 2, 4 and 8 weeks from the start of the therapy. The carriage of polymorphic markers CYP3A4 (*1B, *22) and CYP3A5*3 was determined in patients; HPLC was used to determine drug concentrations in blood plasma and levels of cortisol and its metabolite 6-beta-hydroxycortisol in urine to assess the phenotypic activity of CYP3A.Results. No statistically significant associations between CYP3A phenotype (defined by CYP3A4 and CYP3A5 genotypes) and clinical parameters of the tamsulosin therapy efficacy and the safety assessment in the studied sample of patients were found (p &gt;0.05). Similar data were obtained for individual variants of CYP3A4*1B, CYP3A4*22, CYP3A5*3 (p &gt;0.05). The comparison of the tamsulosin residual equilibrium concentration values in patients in the study sample with respect to the carriers of CYP3A4 and CYP3A5 gene variants did not reveal the presence of significant differences in either CYP3A phenotypes and carriers and non-carriers of individual CYP3A4*1B (p=0.57), CYP3A4*22 (p=0.37) and CYP3A5*3 (p=0.76) variants. No association was found between the metabolic ratio of 6-beta-hydroxycortisol / cortisol in urine and the CYP3A phenotype encoded by a combination of genotypes of CYP3A4 and CYP3A5 gene variants (p &gt;0.05).Conclusion. A possible association between the carriage of CYP3A4*1B, CYP3A4*22, CYP3A5*3 variants, a CYP3A activity assessed by the content of an endogenous substrate of this isoenzyme and its metabolite in urine, the level of plasma concentration of the drug, and the efficacy and safety of tamsulosin, has not been confirmed. The contribution of CYP3A4 and CYP3A5 genetic polymorphisms to clinical parameters of the tamsulosin therapy requires a further study.

Correction of nocturia in patients with benign prostatic hyperplasia. Mini-review and analysis of clinical observations

Aim. To outline the importance of nocturia in benign prostatic hyperplasia (BPH) and justify the feasibility and clinical need for antidiuretic therapy in these patients. Materials and methods. This article is a literature review. PubMed, Embase, and eLibrary databases were used for the search. Relevant publications were included in the literature review. The pilot study included 20 male patients aged 58–75 years with a confirmed diagnosis of BPH. Patients were divided into two groups: standard therapy (Tamsulosin Canon) and combined therapy (Tamsulosin Canon + Nourem). Diurnal diuresis was assessed based on the results of the Zimnitsky test and the nocturnal bladder volume index before and after treatment. Results. During standard therapy, patients had a decrease in the severity of obstructive and irritative symptoms and an improvement in the QoL index (p0.05). However, there was no significant improvement in nocturia. In the combined therapy group, the severity of symptoms significantly decreased by 53.3%, and the QoL index improved by 62.5%. On average, the sleep duration increased by 1.5 hours with almost unchanged rates of daily diuresis. Conclusion. The study showed that in 65% of patients, nocturia was caused not by anatomical and functional changes in the prostate and lower urinary tract but by nocturnal polyuria. Its management has a major role in nocturia treatment. The only pathogenesis-based treatment is the antidiuretic therapy (desmopressin) added to the α1-blocker.

The Impact of SARS-CoV-2 on Patients With Lower Urinary Tract Symptoms (LUTS).

During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the management of patients with lower urinary tract symptoms (LUTS) underwent dynamic adjustments in response to an evolving understanding of the virus's impact on different patient populations. Healthcare practitioners reevaluated therapeutic approaches for conditions like benign prostatic hyperplasia (BPH), considering the potential implications of this condition on the severity and progression of coronavirus disease 2019 (COVID-19). This study aims to investigate potential correlations between SARS-CoV-2 infection severity, exacerbation of LUTS, and BPH progression. This retrospective study includes patients hospitalized in our Urology Department between January 2021 and January 2023, presenting with both SARS-CoV-2 and BPH. Their ages ranged from 57 to 88 years, with a mean age of 65.4 years. The diagnosis of BPH relied on a diagnostic triad consisting of digital rectal examination, biological markers (including prostate-specific antigen (PSA) and free PSA, and ultrasound examination, with both conditions confirmed based on test results. Transurethral resection of the prostate (TURP) procedures utilized monopolar Karl Storz resection equipment, using sorbitol and bipolar Olympus devices for transurethral resection of the prostate in saline (TURPis). Haemostasia was performed using roller balls. Anticoagulation followed a prescribed scheme by cardiologists and infectious disease specialists. Statistical analysis was conducted using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Among the 138 hospitalized patients affected by both BPH and COVID-19, 18 required emergency endoscopic procedures (specifically TURP or TURPis) to achieve hemostasis (Figures 1, 2). These individuals presented persistent hematuria despite conservative treatments. The mean duration of surgery was 57.9 minutes. Patients who underwent surgery had a longer average hospital stay compared to those who did not, with durations of 10.5 days versus 7.5 days, respectively. Additionally, urethrovesical catheter insertion was necessary in 29 cases due to acute urinary retention or worsening voiding symptoms during hospitalization. These patients are scheduled for further urological evaluation following the resolution of the COVID-19 episode. In a cohort of 53 patients for whom data were accessible, comparisons were made between the pre-COVID status and the levels of the International Prostate Symptom Score (IPSS), post-voiding residue (PVR), and quality of life (QoL). The findings revealed a mean pre-COVID IPSS value of 11.6 and a COVID-related value of 14.2, with a statistically significant difference noted (p < 0.05). The mean pre-COVID PVR was 42.3 cm2, whereas during the COVID-19 period, it measured 62.5 cm2, also exhibiting a significant difference (p < 0.05). Additionally, the QoL showed a mean pre-COVID-19 score of 2.4 and a COVID-19-associated score of 2.9, again demonstrating statistical significance (p < 0.05). The onset of the SARS-CoV-2 pandemic posed novel challenges in the medical realm, impacting the approach to BPH management. A common practice was delaying treatment for chronic BPH until viral infection remission to reduce associated risks. Additionally, our study revealed a worse evolution in LUTS among individuals with severe COVID-19 symptoms.

Targeting genomic receptors in voided urine for confirmation of benign prostatic hyperplasia.

The objective of this study is to validate a hypothesis that a non-invasive optical imaging assay targeting genomic VPAC receptors on malignant cells shed in voided urine will represent either benign prostatic hyperplasia (BPH) or prostatic cancer (PCa). Risk for BPH in men 50-70 years old is 50-70% and PCa is 17%. BPH and PCa can coexist in 20% of men with BPH. Most commonly practiced methods to diagnose BPH do not distinguish BPH from PCa. Males with BPH (N= 97, 60.8±6.3years, prostate-specific antigen 0.7±0.4ng/mL) and without oncologic disease (N= 35, 63.4±5.8years, prostate-specific antigen <1.5ng/mL) signed informed consent form and provided voided urine. Urine was cytocentrifuged, cells collected on glass slide, fixed, treated with VPAC specific fluorophore TP4303 (Kd 3.1× 10-8M), washed, incubated with DAPI and observed using a fluorescence microscope. Cells with no VPAC did not fluoresce (BPH) and those with VPAC had red-orange fluorescence (PCa). Real-time polymerase chain reaction analyses for VPAC and NKX3.1 assay for cell origin were performed. Eighty-seven subjects were negative for VPAC expression. Positive VPAC expression was noted in 10 subjects. Patient chart review for clinical data on these 10 VPAC positive subjects showed five had nephrolithiasis, three had renal cysts, one had prostatitis and one was being treated with finasteride. Real-time polymerase chain reaction analysis-VPAC expressions for 7 normal and 12 BPH subjects were 1.31 ± 1.26 and 0.94 ± 0.89, respectively (P= 0.46). NKX3.1 showed cells of prostate origin for finasteride-treated patient. Specificity for VPAC urine assay for excluding prostate cancer in this BPH cohort was 88.5%, positive predictive value 0.00% and negative predictive value 100%. VPAC assay may contribute extensively for BPH diagnosis and warrant continued investigation.

Case-based presentation of the S2e guideline on the diagnosis and treatment of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is the most common disease of the lower urinary tract in men. The prevalence increases continuously with increasing age and achronic progressive course is to be expected. In order to reduce the morbidity of affected patients and to improve their quality of life, the expert panel Benign Prostatic Hyperplasia (BPH) of the German Society of Urology (DGU) has written anew version of the evidence-based "S2e guideline on the diagnosis and treatment of BPH". Using acurrent patient case, the contents of the new S2e guideline are illustrated, from diagnosis to the decision-making process for asuitable treatment choice. The case presented here shows the possible complexity and difficulty that can arise in the diagnosis of BPH, the need for further diagnostic steps and the finding of asuitable therapy in order to fulfill the patient's wishes, if possible.

Nursing diagnoses in patients undergoing prostatectomy at the central hospital of Nampula, 1st semester of 2019

Introduction: The nursing diagnosis is a clinical assessment of a human response to health conditions/life processes, or a vulnerability to that response, by an individual, family, group or community. The research aims to describe the main nursing diagnoses in patients undergoing prostatectomy admitted to Surgery II at the Hospital Central de Nampula. Objectives: This is a descriptive study with a quantitative approach, involving patients admitted to surgery II undergoing prostatectomy. All patients with the medical diagnosis of benign prostatic hyperplasia or prostate cancer who underwent prostate surgery were included, thus all patients who underwent prostate surgery but who had other chronic diseases were excluded. Data were analyzed with SPSS statistical package to obtain descriptive analysis, percentage and use of the following Q-square statistical test of independence. Results: the study involved 33 patients undergoing prostatectomy, 54.5% of these patients had primary schooling and the most predominant age group was 66-75 years old (39.4%). A total of 461 nursing diagnoses were found, and the most frequent were: Impaired walking 5.4%, Constipation 4.8, Risk of infection 6.9, Risk of vascular trauma 7.4%, Acute pain 5.4% and Deficit in self-care for bathing 6.7%. The following diagnoses were associated with the nursing diagnosis: impaired walking p value 0.000, dentition p value 0.006, constipation (p value 0.001), risk of electrolyte imbalance p value 0.000) and risk of falls (p value 0.000). Conclusion: the use of the nursing process by nurses facilitates the survey of health problems in sick patients in order to intervene in care using real nursing diagnoses, risk and health promotion.

Association between chronic prostatitis and the subsequent benign prostatic hyperplasia: a population-based national cohort study.

To explore the association between chronic prostatitis (CP) and the subsequent development of benign prostatic hyperplasia (BPH). Data analyzed were medical claims of Taiwan's National Health Insurance program. From 2010 to 2017, 3571 patients ≧20years with CP diagnosed by certified urologists were enrolled. Patients with past BPH diagnosis and diagnosis of prostate cancer, inguinal hernia, interstitial cystitis, and urethritis in the past and within one year after the first CP diagnosis were excluded. Age-matched controls were randomly selected from all non-CP individuals of the same exclusion criteria in the study period with a CP/non-CP ratio of 1:4. The follow-up was made from the first CPdiagnosis to death or the end of 2018. The endpoint was the newly diagnosed BPH. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of BPH in association with CP. Over a maximum of 8years of follow-up, 287 (8.03%) and 258 (0.43%) BPH events were noted for the CP and non-CP group, respectively, representing a covariate adjusted HR (aHR) of 4.30 (95% CI, 3.61-5.13). Younger patients tended to suffer from higher aHRs, especially those aged 20-39years (aHR: 11.45, 95% CI, 5.12-25.64). The Taiwan national health database indicated that CP patients had a significantly higher risk of developing BPH later than non-CP patients. Interestingly, the younger the CP is diagnosed (under 40), the greater the risk.

Primary diffuse large B-cell lymphoma of the prostate: Histopathological diagnosis of a rare entity in the prostate.

Lymphoma of the prostate is rare whether it is primary extranodal lymphoma or secondary involvement of the prostate by primary lymphoma elsewhere. Of all the lymphomas of the prostate, primary lymphomas of the prostrate are very rare. Although less frequent, it should be a differential diagnosis when evaluating prostate tumors. Here, we report a case of a 61-year-old man who presented with hematuria with clot retention. A cystoscopy with clot removal and transurethral resection of the prostate (TURP) was performed. This biopsy was sent for histopathological examination at an external center, where a diagnosis of benign prostatic hyperplasia was given. Fifteen days later, the patient presented with hematuria again. On examination, clots were present in the bladder. There was significant prostatomegaly. A re-resection of the prostate was performed and sent for another review to us. The biopsy was reported as high-grade round cell neoplasm, most likely lymphoma. Immunohistochemistry (IHC) was recommended for confirmation. Tumor cells showed immunoreactivity for CD20, B-cell Lymphoma (BCL)-2, BCL-6, Myelocytomatosis (c-Myc), and multiple myeloma 1 (MUM1). Cluster Differentiation (CD)10 was negative. Kiel-67 was high. A final diagnosis of double-expressor diffuse large B-cell lymphoma (DLBCL) of non-germinal center type was made. We share this case to emphasize the fact that primary lymphoma of the prostate is primarily a histopathological diagnosis as the clinical presentation is not unique. Owing to its rarity, the clinical and histopathological suspicion is low. Hence, keeping the differential in mind while evaluating prostate biopsy is beneficial in a timely diagnosis of the entity as the management of prostatic carcinoma and lymphoma is different.

Spinal Anestesi Pada Tindakan Transuretral Resection Of Prostat (TURP)

Spinal anesthesia is the choice for Transurethral Resection of Prostate (TURP) procedures. TURP is a surgical procedure performed for patients with prostatic hyperplasia. When a TURP procedure is performed, excessive fluid absorption will occur because during the procedure the injured area causes the vein to open and irrigation fluid will be absorbed. The position of the surgical procedure in the lithotomy position makes the situation worse. Spinal anesthesia helps peripheral blood collection and reduces circulatory overload, early detection of TURP syndrome and bladder perforation. In this case, the procedure was carried out on a 67 year old man with a diagnosis of benign prostate hyperplasia (BPH) with a TURP surgical procedure. The patient was composmentis, ASA III. The patient underwent spinal anesthesia with a sub arachnoid block using Bupivacaine. During TURP procedures, TURP syndrome can occur which is influenced by the use of fluid as irrigation to widen the operator's field of view. Saline fluid should be used, but because it is expensive, H2O is often used as irrigation fluid. A complication of the TURP procedure is TURP syndrome

Nursing process for a patient post-operative transvesical prostate adenomectomy for benign prostatic hyperplasia. Lima -2020

Introduction: transvesical prostate adenomectomy is the surgical procedure in patients with a very large prostate and with decreased lumen of the bladder neck. It is an open surgery with a suprapubic abdominal incision to remove the prostatic adenoma.Objective: to describe the nursing process to respond to the real and potential needs of a patient post-transvesical prostate adenomectomy with a diagnosis of benign prostatic hyperplasia. Methods: qualitative study, single case, carried out on an 81-year-old male patient, developing the five stages of the nursing process. The assessment was carried out through Marjory Gordon's functional health patterns. To prepare the diagnoses, plan and care interventions, the NANDA, NOC and NIC taxonomy was considered respectively, the evaluation was obtained by applying the difference between the baseline and the final Diana scores. Results: it was proven that postoperative pain is an ailment that requires nursing interventions with updated scientific knowledge to guarantee specialized and quality care. Nursing interventions against the deterioration of gas exchange were aimed at optimizing oxygenation and ventilation. Interventions to reduce infection were aimed at identifying risks and taking actions to reduce exposure to pathogens; like hand washing. Within the five nursing diagnoses found, three were prioritized: impairment of gas exchange, acute pain and risk of infection, based on the SSPFR format (signs and symptoms, problem and related factor, problem at risk and associated condition); The administration of the care plan was applied, achieving the improvement and change score of +1, +1 and +1 successively in each diagnosis. Conclusions: the nursing care process showed results in favor of the patient's evolution, it also shows this process as the scientific and practical tool that allows the nurse to plan and execute individualized and systematic care plans in the face of a specific situation, in order to resolve or prevent the patient's needs

Erectile Dysfunction after Transuretheral Resection of the Prostate in Patients with Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) is commonly associated with lower urinary tract symptoms (LUTS) in aging men, which can significantly impact their quality of life. Transurethral resection of the prostate (TURP) is a standard treatment for BPH, yet its effects on erectile function remain controversial. Objective: To assess the impact of TURP on erectile function in patients with BPH and to evaluate the potential relationship between the relief of obstructive urinary symptoms and changes in erectile function postoperatively. Methods: This single-center, non-randomized study enrolled 177 male patients aged 50 to 80 years with a clinical diagnosis of BPH and an International Prostate Symptom Score (IPSS) greater than 8. Participants underwent monopolar TURP and were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire one month post-surgery. Data were analyzed using SPSS version 21 with Chi-square tests applied to examine the influence of age and IPSS scores on erectile function, considering a p-value ≤0.05 as significant. Results: The mean age of participants was 57.53 ± 6.96 years, and the mean resected prostate tissue weight was 122.82 ± 12.05 grams. Post-TURP, 44.6% of patients were found to have some degree of erectile dysfunction. However, no significant changes in erectile function were observed one month following TURP (p=0.602 for age, p=0.878 for IPSS score). Conclusion: TURP did not significantly affect erectile function one month postoperatively in BPH patients with severe urinary symptoms. While some improvement in erectile function was noted, the results suggest that the benefits of TURP on erectile function may not be immediate. Further longitudinal studies with larger sample sizes are required to provide more definitive conclusions.

Evaluation of Private Payer and Patient Out-of-Pocket Costs Associated With the Surgical Management of Benign Prostatic Hyperplasia

ObjectivesTo evaulate and compare the financial burden of various surgical interventions for the management of benign prostatic hyperplasia (BPH). MethodsWe identified commercially insured men with a diagnosis of BPH who underwent a procedure of interest (SP, TURP, HoLEP, PVP, PUL, or WVTT) between 2015-2021 with the OptumLabs Data Warehouse. Primary outcome was total healthcare costs (THC) which included both patient out-of-pocket (OOP) and health plan paid (HPP) costs for the index procedure and combined follow-up years 1-5. A generalized linear model was used to estimate adjusted costs controlling for demographic and clinical characteristics. Patients undergoing WVTT were excluded from extended follow-up analyses due to limited data. ResultsAmong 25,407 patients with BPH, 10,117 (40%) underwent TURP, 6,353 (25%) underwent PUL, 5,411 (21%) underwent PVP, 1,319 (5%) underwent SP, 1,243 (5%) underwent WVTT, and 964 (4%) underwent HoLEP. Index procedure costs varied significantly with WVTT being the least costly [THC: $2,637 (95% CI: $2,513 – $2,761)], and SP being the costliest [THC: $14,423 (95% CI: $12,772 – $16,075)]. For aggregate index and 5-year follow-up costs, HoLEP ($31,926 [95% CI: $29,704–$34,148]) was the least costly and PUL ($36,596 [95% CI: $35,369-37,823]) was the costliest. ConclusionsBPH surgical treatment is associated with significant system-level healthcare costs. The level of impact varies between procedures. Minimally invasive options, such as WVTT, may offer initial cost reductions; however, HoLEP and SP are associated with lower follow-up costs.

Use of phosphodiesterase 5 inhibitors is not associated with ocular adverse events.

Phosphodiesterase 5 inhibitor (PDE5i) use has been linked to a number of ocular side effects, such as serous retinal detachment (SRD), retinal vascular occlusion (RVO), and ischemic optic neuropathy (ION). We investigated the risk for SRD, RVO, and ION in patients using PDE5is. We utilized the IBM MarketScan (2007-2021) Commercial and Medicare Supplemental Databases (version 2.0) for this analysis. To estimate overall events risk, Cox proportional hazard models were applied to calculate the hazard ratios (HRs) for erectile dysfunction (ED) diagnosis and the different treatments, adjusting for region, median age, obesity, diabetes mellitus, hyperlipidemia, smoking, hypertension, coronary artery disease, and sleep apnea. Additionally, the same analyses were performed to calculate the HRs for benign prostatic hyperplasia (BPH) diagnosis and the different treatments. HRs for SRD, RVO, and ION. In total, 1 938 262 men with an ED diagnosis were observed during the study period. Among them, 615 838 (31.8%) were treated with PDE5is. In total, 2 175 439 men with a BPH diagnosis were observed during the study period. Among them, 175 725 (8.1%) were treated with PDE5is. On adjusted Cox regression analysis, PDE5i use was not associated with SRD, RVO, ION, and any ocular event when compared with ED diagnosis and other ED treatments. Importantly, as the intensity of ED treatment increased, so did the risk of ocular events. In addition, PDE5i use was not associated with SRD and ION when compared with BPH diagnosis and other BPH treatments. In contrast, in patients with BPH, PDE5i use was associated with RVO (HR, 1.14; 95% CI, 1.06-1.23). Importantly, patients with BPH receiving other medical treatment (ie, 5a reductase/alpha blocker; HR, 1.11; 95% CI, 1.06-1.16) or surgical treatment (HR, 1.10; 95% CI, 1.02-1.19) had a higher risk of RVO. We did not observe any consistent association between PDE5i use and any ocular adverse events (SRD, RVO, and ION). Because we did not have access to the patients' medical records, we recorded outcome definitions using ICD-9 and ICD-10 coding. Patients using PDE5is for ED or BPH indications did not have an increased risk of ocular events, even when compared with other treatments for ED or BPH.

CHRDL1, NEFH, TAGLN and SYNM as novel diagnostic biomarkers of benign prostatic hyperplasia and prostate cancer.

Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) are common male diseases whose incidence rates gradually increase with age. They seriously affect men's physical health and quality of life. This study aimed to identify new biomarkers for the diagnosis of BPH and PCa. Two datasets, GSE28204 and GSE134051 (including human PCa and BPH), were downloaded from the GEO database. The batch effect was removed for merging, and then differential gene expression analysis was conducted to identify BPH and PCa cases. The diagnostic biomarkers of BPH and PCa were further screened using machine learning and bioinformatics. ROC curves were drawn to evaluate the diagnostic accuracy of the selected biomarkers. An online website and qPCR were used to preliminarily explore the expression levels of PCa biomarkers. The correlations between the expression of biomarkers and the tumor microenvironment, tumor mutation load and immunotherapy drugs were evaluated. We identified fifteen genes (CHRDL1, DES, FLNC, GSTP1, MYL9, TGFB3, NEFH, TAGLN, SPARCL1, SYNM, TRPM8, HPN, PLA2G7, ENTPD5 and GPR160) as critical diagnostic biomarkers. After reviewing the literature on all selected biomarkers, we found few studies on the four genes CHRDL1, NEFH, TAGLN and SYNM in BPH or PCa. We defined these four genes as new potential diagnostic biomarkers (NPDBs) of BPH and PCa. All NPDBs were downregulated in PCa patients and PCa cell lines and upregulated in BPH patients and cell lines. When the immune landscape and mutation frequencies were analyzed, the results showed that the tumor microenvironment (TME), immune landscape, tumor mutation burden, and drug response were significantly correlated with NPDB expressions. We found four new diagnostic markers of BPH and PCa, which may facilitate the early diagnosis, treatment, and immunotherapeutic responses assessment and may be of major value in guiding clinical practice.

5-alpha reductase inhibitors (5-ARi) with or without alpha-blockers (α-B) for Benign Prostatic Hyperplasia do NOT lower the risk of incident Bladder Cancer: United States insurance claims data.

Chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer (BCa) risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results. We sought to examine the effect of 5-ARi on new BCa diagnoses in a large US database. Men ≥ 50 y/o with a prescription for 5-ARi after BPH diagnosis were identified in the IBM® Marketscan® Research de-identified Databases between 2007 and 2016 and matched with paired controls. Incident BCa diagnoses were identified after BPH diagnosis and/or pharmacologic treatment. Multivariable regression modeling adjusting for relevant factors was implemented. Sub-group analyses by exposure risk were performed to explore the association between 5-ARi and BCa over time. Administration of alpha-blockers (α-B) w/o 5-ARi was also examined. In total, n = 24,036 men on 5-ARi, n = 107,086 on 5-ARi plus alpha-blockers, and n = 894,275 without medical therapy for BPH were identified. The percentage of men diagnosed with BCa was 0.8% for the 5-ARi, 1.4% for the 5-ARi + α-B, and 0.6% for the untreated BPH group of incident BCa (adjusted hazard ratio [aHR], 0.90, 95% confidence interval [CI] 0.56 - 1.47), and 1.08, 95%CI 0.89 - 1.30, respectively). This was also true at both shorter (≤ 2yr) and longer-term (> 2yr) follow up. In addition, α-B alone had no change in BCa risk (HR 1.06, 0.86-1.30). We did not find any diminished risk of new BCa in men treated with 5-ARi (i.e., chemoprotective effect). The current report suggests that 5-ARi do not change a man's bladder cancer risk.