Purpose: Robotic surgery belongs to the standard therapies for patients with benign prostate hyperplasia (BPH) with large prostates (over 80 g). To evaluate postoperative outcomes and complications of transvesical vs transcapsular multiport robot-assisted simple prostatectomy (RASP) for BPH. Methods: Between September 2019 and November 2024, 100 consecutive patients were included and divided into group 1, n = 40 transvesical, and group 2, n = 60 transcapsular. Outcomes included operative time, catheter duration, hospital stay, and complications (Clavien-Dindo). Results: Patients in the transvesical group had higher baseline symptom bother (International Prostate Symptom Score: 27 vs 18; quality of life: 5.5 vs 3.5). Transcapsular RASP demonstrated shorter console time (71 vs 91 minutes), reduced catheter duration (4.3 vs 6.7 days, p = 0.001), and shorter hospitalization (5 vs 6 days, p = 0.02). Major complications were recorded more frequently in the transvesical group (12.5% vs 3.3%, p = 0.04). Minor complications and readmissions were similar among the study groups (p = 0.3 and 0.8). Conclusion: Transcapsular RASP may lead to quicker recovery, whereas transvesical techniques are more appropriate for complex cases involving bladder issues. The choice of method depends on the surgeon's preference, but further prospective studies are necessary to gather more information.

Lower urinary tract symptoms (LUTS), associated with benign prostatic hyperplasia (BPH), are an aging-related disease, with more than 210 million cases worldwide. Estrogen exposure and estrogen regulation have been implicated in a variety of disease processes, with estrogen receptor (ER)-α pathways associated with disease progression and ERβ pathways considered to be disease-protective through enhanced apoptosis and reduced cellular proliferation. Preclinical models of LUTS/BPH have shown that ERα activation contributes to disease initiation and progression. Self-identified African American (AA) men have a high incidence of LUTS/BPH, with increased incidence of non-surgical treatment failure, larger prostates at time of surgery, and surgery occurring at a younger age compared with self-identified European American (EA) men. While circulating estrogen levels are higher in AA individuals, regulation of ERs, particularly ERβ, in normal and LUTS/BPH human prostate has not been well characterized. In this study, we examined differences in ER expression between peripheral zone (PZ) and transition zone (TZ) prostate tissues using multiplex, multispectral imaging. Additionally, we assessed changes in ERs and steroid metabolism genes involved in ERβ signaling between normal and LUTS/BPH prostate samples. Our study revealed underlying differences in steroid metabolism gene expression between normal AA and EA prostates, which were further altered with LUTS/BPH. Importantly, the contribution of ERα to LUTS/BPH was more pronounced in EA prostate samples, whereas AA prostate samples exhibited an overall increase in the expression of both ER and estrogen metabolism-related genes. Although estrogens have also been implicated in collagen deposition in the prostate of LUTS/BPH patients, we did not observe significant differences in collagen deposition between AA and EA samples. These results suggest that racial differences in steroid hormone signaling pathways within the benign prostate represent a promising area for the development of precision-based therapies to reduce LUTS in aging men. © 2025 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Background and Objective: Benign prostatic hyperplasia (BPH) represents a common condition in aging males. For prostates exceeding 80 g, robotic-assisted simple prostatectomy (RASP) and transurethral prostate enucleation have emerged as leading treatments. This study aimed to comprehensively compare outcomes between these approaches. Methods: We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials and cohort studies. Outcomes included changes in urinary flow rate, International Prostate Symptom Score (IPSS), complication rates, operative bleeding, operative time, hospitalization duration, and catheterization period. Robotic interventions were classified as single-port (SP) or multiport with transvesical (TV), transperitoneal, or transcapsular techniques. Enucleation methods included holmium laser (HoLEP), thulium laser, bipolar, and GreenLight laser vapo-enucleation. Key Findings and Limitations: We included data from 25 studies with 3924 patients. Network meta-analysis showed no significant difference in overall complication rates between RASP and enucleation techniques, though RASP had the highest surface under the cumulative ranking curve scores in the SP approaches, particularly the SPTV approach. Both RASP and enucleation approaches showed similar improvements in urinary flow rates. RASP approaches, particularly SPTV, had the highest decrease in IPSS, but the changes were not statistically significant. Despite longer operative times and Foley catheterization durations for RASP, blood loss was comparable to enucleation techniques. Conclusion and Clinical Implications: Our results suggest that robotic approaches have similar performance to HoLEP when managing large prostates. However, robotic approaches may have slight differences including improved symptom scores, lower incontinence rates, longer operative times, and longer hospital stays. Patient Summary: In this study, we compared two modern surgical approaches for treating enlarged prostates over 80 g-robotic surgery and laser/electrical techniques that remove prostate tissue through the urethra. We found both approaches work equally well for improving urinary flow, with similar bleeding risks, though the robotic approach may better reduce urinary symptoms but requires longer surgery and hospital stays. This information helps doctors and patients choose the most suitable treatment option for large prostate enlargement.

Introduction: Benign prostatic hyperplasia is a leading cause of lower urinary tract symptoms in aging men. When medical therapy fails, surgery is indicated. This study evaluates the safety and efficacy of Aquablation compared with transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP) in patients with bladder outlet obstruction. Methods and Materials: A prospective analysis of 318 Aquablation patients (2023-2025) was conducted and compared with 83 TURP and 83 HoLEP patients from a retrospective database. Functional outcomes were assessed using International Prostate Symptom Score (IPSS), ICIQ-UI, EF-IIEF, and MSHQ-EJD SF. Complications were graded using the Clavien-Dindo classification. Follow-ups were performed at 3, 6, and 12 months. Results: Aquablation patients had larger prostates than TURP (94 versus 54.7 cc; P < .0001) but smaller than HoLEP (105 cc; P = .002) patients. More Aquablation patients had indwelling catheters and were on anticoagulants (P < .0001). IPSS improvement was the greatest in Aquablation (18.9 points) versus TURP (13.8) and HoLEP (14.7; P = .000). Erectile function was preserved in Aquablation (P = .859), with significantly better ejaculatory function (82.8% preserved) than TURP (36%) and HoLEP (18%). Furthermore, Clavien-Dindo grade 1-2 complications were higher in Aquablation, but serious events (CD 3-4) were comparable. Complication rates declined significantly after the first 30 Aquablation cases. Conclusion: Aquablation is an effective surgical option for medium to large prostates, offering superior symptom relief and preservation of sexual function. Although its learning curve is shorter than HoLEP's, proper training is essential to minimize early complications.

PurposeWe conducted an assessment to investigate the impact of prostate volume on the recurrence of patients with non-muscle invasive bladder cancer (NMIBC). Subsequently, we developed and validated nomograms to accurately evaluate recurrence in NMIBC patients. Additionally, we examined the potential improvement in predictive capability achieved by introducing prostate volume as a variable in the model.MethodsWe conducted a retrospective analysis, enrolling 555 eligible patients from seven independent medical institutions across China. We first evaluate recurrence-free survival outcomes in patients with varying prostate volumes. Subsequently, we divided patients into a training cohort and an external validation cohort. Univariate and multivariate Cox regression analyses were conducted within the training cohort. Accordingly, two nomogram models with and without prostate volumes were developed. Their performance was compared by concordance index, calibration curves, receiver operating characteristics curves, and decision curve analysis. Furthermore, a risk classification model utilizing the nomogram incorporating prostate volume was developed.ResultsThe 3-year recurrence-free survival was markedly lower in patients with large prostate volumes (> 30 ml) compared to those with relatively small prostate volumes (< 30 ml) (p < 0.001). The AUC for the model incorporating prostate volume at 3 years in the training cohort and external validation cohort was 0.828 and 0.811, surpassing the AUC for the model excluding prostate volume at the corresponding intervals, which was 0.796 and 0.778. The 1- and 2-year AUC for the two models also exhibited similar differences. The decision curve analysis results demonstrated the significant superiority of the nomogram incorporating prostate volume over the one without it.ConclusionOur investigation revealed that prostate volume significantly influences recurrence in patients with NMIBC. We successfully developed a more accurate nomogram by introducing prostate volume as a variable and provided new insights to further guide clinical management and individualized treatment of NMIBC patients.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-15028-5.

Rezūm therapy is a minimally invasive treatment for male lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO), validated in selected patients through randomized trials. However, its effectiveness in broader real-world populations remains underreported. This single-center retrospective study included 110 patients treated with Rezūm between 2020 and 2022. Patients were stratified according to their conformity to the original trial criteria ("pilot" vs. "nonpilot" groups). Functional outcomes, retreatment rates, sexual function and adverse events were analyzed at 24 months. At 24 months, both groups experienced a significant and sustained reduction in IPSS from baseline, with a median decrease of 18 points (IQR: 15-20) in the pilot group and 19 points (IQR: 16-22) in the non-pilot group (p = 0.2). Improvements in IPSS-QoL, Qmax, and PVR were also significant and comparable between groups. Overall, 23% of patients required retreatment: 24% in the pilot group and 24% in the non-pilot group (p = 0.9), including medical retreatment in 15% and 5%, and surgical retreatment in 8% and 16%, respectively (p = 0.2). No independent predictor of retreatment was identified. Ejaculatory function was preserved in over 90% of patients at 24 months in both groups, and erectile function remained stable throughout follow-up. Rezūm therapy provides effective, durable symptom relief and preserves sexual function at 2 years, even in patients with larger prostates, prior surgery, or indwelling catheters.

The evaluation of high-power holmium laser enucleation in patients with very large prostate (≥200 ml) and preoperative indwelling urinary catheter

Aquablation is a robotic-assisted, water jet-based transurethral therapy for benign prostatic hyperplasia (BPH). Concerns about postoperative hematuria led to the practice of limited transurethral resection (TUR) with cauterization. This study aimed to assess the impact of tranexamic acid (TXA) on hematuria outcomes when combined with limited TUR after Aquablation. We retrospectively analyzed men undergoing Aquablation at our institution (October 2020-July 2024). Demographic, prostate, surgical, and hematuria outcomes were extracted from electronic medical records. Kruskal-Wallis test compared medians. Of 131 patients, 113 (86%) had limited TUR; 31 (27%) received 1 g TXA perioperatively. TXA patients had larger prostates (86 g vs. 70 g, p = 0.003). No TUR patients, with or without TXA, required transfusion. Among TUR patients, TXA did not significantly affect preoperative, postoperative, or postoperative day-one hemoglobin. Patient-initiated communications and emergency visits for hematuria were minimal and similar between groups. Hematuria outcomes were independent of prostate size, TUR volume, or TUR-to-prostate ratio. Subgroup analysis (<80 g vs. ≥80 g) showed no TXA effect. No TXA recipient had a thromboembolic event within 30 days. At one month, median urinary flow increased by 12.8 mL/sec interquartile range [IQR]: 8.7-18.8, and median International Prostate Symptom Score (IPSS) decreased by 7 (IQR: 3-12). Limited TUR during Aquablation provides effective hemostasis. TXA had minimal impact on bleeding and was not associated with thromboembolic events. Routine TXA use should be reconsidered when limited TUR is performed.

BackgroundOpen transvesical prostatectomy (OTP) is still used for the treatment of benign prostatic obstruction (BPO) in patients with large prostate volumes, particularly where endoscopic techniques are not available. Intraoperative bleeding remains an important concern, but reliable preoperative predictors have not been established. This study aimed to investigate whether preoperative pelvic imaging features are associated with intraoperative blood loss in OTP.MethodsWe retrospectively analyzed 60 patients who underwent OTP between 2018 and 2025. Preoperative magnetic resonance imaging or computed tomography was reviewed to obtain pelvic and prostatic measurements. Estimated intraoperative blood loss was extracted from operative notes. Correlation and multivariate regression analyses were performed to explore potential predictors.ResultsThe mean estimated blood loss was 183.3 ± 111.7 ml, with a median of 160 ml (IQR: 100–220). Significant correlations were observed with prostate volume (r = 0.44, p < 0.001), apical depth (r = 0.38, p = 0.003), and operative duration (r = 0.36, p = 0.005). In multivariate regression, prostate volume (β = 0.88, p < 0.001) and apical depth (β = 0.54, p = 0.020) remained significant independent predictors, whereas other pelvic measurements showed weaker or non-significant associations. The final model explained 32% of the variance in estimated blood loss (R² = 0.32).ConclusionsProstate volume and apical depth may provide preliminary indicators of bleeding risk in OTP, while the role of other pelvic dimensions appears limited. These findings should be interpreted with caution due to the retrospective design, modest sample size, and reliance on estimated blood loss. Prospective studies with standardized measurement methods are warranted.

Prostate size has traditionally been considered a determinant of surgical difficulty and postoperative outcomes in radical prostatectomy. Larger glands often present challenges in bladder neck dissection, with potential implications for continence and oncological safety. We describe the maximal anatomic bladder neck preservation at the prostatic origin (MANO) technique, designed to enable safe circumferential dissection at the true bladder neck origin irrespective of gland size. This retrospective study analyzed 341 patients undergoing nerve-sparing robotic-assisted radical prostatectomy (RALP) with the MANO technique between 2017 and 2023. Patients were stratified into three groups by MRI-estimated prostate volume: < 30cc (n = 83), 30-50cc (n = 147), and > 50cc (n = 111). Perioperative, pathological, functional, and oncological outcomes were compared. Continence was defined as 0-1 pad/day, assessed at 3, 12, and 24 months. Larger prostates were associated with older age and higher preoperative PSA (p < 0.05). Mean operative time increased with gland size (165.2 vs. 191.5min, p < 0.001), and hospital stay was longer for > 50cc prostates (p = 0.003). Blood loss showed a non-significant increase with prostate size. Pathological stage, Gleason grade, and margin status were comparable across groups. Early continence at 3 months was similar (≈71% across cohorts, p = 0.607), with > 85% continent at 12months in all groups. Biochemical recurrence rates did not differ significantly (p = 0.630). Complications were infrequent, with no ureteric injuries reported. The MANO technique enables safe bladder neck preservation across all prostate sizes. Despite increased operative complexity in larger glands, functional and oncological outcomes remain equivalent. This approach may standardize bladder neck management in RALP and support improved continence recovery irrespective of prostate volume.

The 4K Score is a blood-based test that estimates the risk of clinically significant prostate cancer (Grade Group ≥2, GG2 + ) by combining four kallikrein markers with clinical variables. However, benign prostatic hyperplasia (BPH) can elevate PSA levels, potentially leading to risk overestimation in men with large prostates. We developed a novel metric, 4K Density (4K Score divided by prostate volume), to adjust for prostate size and improve risk stratification. We retrospectively reviewed 3150 men who underwent 4K Score testing at the University of Miami Desai Sethi Urology Institute from 2014 to 2024. After excluding those without a prostate biopsy or MRI within six months of the 4K Score, 1983 men remained. Statistical analysis using SAS v9.4 included logistic regression, receiver operating characteristic (ROC) analysis, and Youden's Index to determine optimal cutoffs for GG2+ detection. The performance of 4K Density was compared to the 4Kscore and PSA Density in predicting GG2+ cancer. Among the 1983 men, 661 (33%) had GG2+ cancer. 4K Density was significantly higher in men with GG2+ cancer compared to those without (median 0.93 vs. 0.25, p < .0001). In multivariable analysis, 4K Density was the strongest independent predictor (OR 3.51, 95% CI 3.64-4.66), outperforming 4Kscore and PSA density. 4K Density also had the highest AUC (0.81, (95%CI)), compared to 4Kscore (0.76, 95 %CI, <0.0001) and PSA density (0.76, 95% CI, <0.0001). At an optimized cutoff of 0.56, 4K Density achieved 89.9% NPV and 48.5% PPV for detecting GG2+ cancer. 4K Density is a novel, volume-adjusted biomarker that improves detection of clinically significant prostate cancer and outperforms PSA density and the 4Kscore test. It may be helpful in larger prostates, where confounding from BPH is present. Prospective validation is warranted to confirm its clinical utility.

BackgroundMale breast cancer (BC) is rare, accounting for only approximately 1% of all cases of BC, and poorly characterized. In contrast, prostate cancer is the most prevalent cancer in men and serves as a model for understanding male-specific tumor biology. The advent of high-throughput technologies has enabled the development of gene expression signatures for both breast and prostate tumors that could inform prognosis and guide treatment. In this respect, the role of the tumor microenvironment, particularly cancer-associated fibroblasts (CAFs), remains largely underexplored. Here, we sought to identify a CAF-related gene signature in male patients with BC and prostate cancer to reveal specific protumorigenic mechanisms and identify novel therapeutic targets for both malignancies.MethodsRNA sequencing was performed to analyze and compare the transcriptomes of CAFs isolated from female and male BC patients. Differentially expressed genes (DEGs) between female and male breast CAFs were identified and subjected to enrichment analyses. Using a set of candidate upregulated genes in male breast CAFs, K-means clustering of prostate cancer patients was performed using multiple datasets to define a prognostic gene signature. Kaplan‒Meier curves and log-rank tests were conducted to assess differences in patient outcomes and other clinical variables between groups of patients with high or low prognostic gene expression. The clustering results were then validated using decision tree analysis, and boosted calculations were employed to increase the classifier performance.ResultsTranscriptomic profiling revealed 775 DEGs between female and male breast CAFs. Owing to the limited transcriptomic data from male BC patients, we leveraged large prostate cancer cohorts to investigate the relevance of the genes expressed by male breast CAFs. A six-gene signature (ASPN, COL4A1, COL4A2, COL5A3, COMP and FN1) that could predict patient outcomes in multiple independent cohorts of prostate cancer patients was identified.ConclusionsWe identified a novel gene signature with strong prognostic value in prostate cancer and potential relevance to male BC. This gene signature represents a complementary tool to standard clinical parameters for improving patient stratification and management.

Background: Benign Prostatic Hyperplasia (BPH), a condition that affects men during their aging process, is associated with symptoms related to the urinary tract. Procedures such as Holmium Laser Nucleation of the Prostate (Hole) and Transurethral Resection of the Prostate (TURP) provide substantial symptom relief through surgical approaches. The safety and efficacy of these treatments continue to play a central role in the choice of management. Objectives: To compare the clinical outcomes, complications and times to recovery after Hole and TURP in management of BPH. Methodology: This study was conducted as a prospective study at Muhammad Teaching Hospital, Peshawar, from January 2023 to January 2024. Patients with benign prostatic hyperplasia (BPH) presented for holmium laser nucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) were included. In this study, we evaluated short-term clinical outcomes, specifically symptom relief after the procedure, complications, and duration recovery periods. In this study, we used the t-test and chi-square test, with significance defined as p &lt; 0.05. Results: One hundred patients have been surveyed (75 per group). Participants were aged 65.2 years (SD = 7.4). HoLEP exhibited less rate of complications (p = 0.01), reduced catheterization duration (p &lt; 0.05) and quicker recovery (p &lt; 0.05) in comparison to TURP. TURP patients had increased bleeding and hospitalization times. Significant improvements were recorded in the urinary flow in both groups. Conclusion: HoLEP has been associated with better safety, faster recovery, and fewer complications than TURP especially on larger prostates with promising alternative in the treatment of BPH.

We aimed to evaluate the outcomes of Thulium fiber laser enucleation of the prostate (ThuFLEP) in men with prostate volumes (PV) ≥ 150 mL and to compare them with those with PV < 150 mL. We retrospectively analyzed the patients who underwent ThuFLEP between December 2020 and June 2024 for benign prostatic obstruction (BPO). Patients were categorized into two groups according to prostate volume, with Group 1 including those with PV < 150 mL (n = 355) and Group 2 including those with PV ≥ 150 mL (n = 147). Perioperative and postoperative functional outcomes, as well as complications, were evaluated and compared. Both groups demonstrated significant improvements in functional parameters (International Prostate Symptom Score-IPSS, maximal urinary flow rate-Qmax and postvoid residual urine volume-PVR) compared with baseline values at the 1, 6 and 12 months postoperatively. Postoperative IPSS, QoL scores, Qmax, PVR values, and rates of urge urinary incontinence (UUI) and stress urinary incontinence (SUI) were comparable between groups at all follow-up intervals (p > 0.05). No patient exhibited postoperative SUI or UUI at 6 and 12 months postoperatively. Complication rates were similar between groups, and no Grade ≥ 4 Clavien-Dindo complications occurred. ThuFLEP is a safe and effective LEP technique for very large prostates (≥ 150 mL). It yields significant improvements in postoperative functional outcomes with low perioperative complication rates, supporting its use as a minimally invasive alternative for BPO in routine endourology practice.

IsoPSA density improves risk stratification and biopsy decision-making for clinically significant prostate cancer.

Purpose:To evaluate if prostate-specific antigen density (PSAD) predicts incidental prostate cancer (iPCa) in patients undergoing robot-assisted simple prostatectomy (RASP) for benign prostatic hyperplasia (BPH).Methods:A total of 100 consecutive patients undergoing RASP for BPH were analyzed. Patients were stratified into low-risk and higher-risk groups based on their iPCa risk: 60 patients (PSAD ⩽ 0.1 ng/mL/cc) and 40 patients (PSAD > 0.1 ng/mL/cc), respectively. Outcomes included iPCa detection rates, preoperative imaging/biopsy utilization, and postoperative complications. A multivariable logistic regression and an univariate linear regression analysis were conducted to assess whether PSAD can predict the incidence of PCA.Results:iPCa was detected in 8% of cases. Five patients had <5% tumor material in their final pathology (pT1a), while three had more than 5% (pT1b). iPCa was detected in eight patients, six with International Society of Urological Pathology (ISUP) 1 and 2 with ISUP > 2. Patients with ISUP 1 were managed with active surveillance; only one chose robot-assisted radical prostatectomy, and the two with ISUP 2 and 3 opted for external radiation. Seven iPCa cases occurred in the low-PSAD group (11.7%), and one in the high-PSAD group (2.5%). In multivariate logistic regression, only a prior negative prostate biopsy was the strongest predictor of iPCa (odds ratio = 5.2, p = 0.01). PSAD > 0.1 ng/mL/cc was not associated (p = 0.09). A univariate linear regression using PSAD as a continuous variable showed no significant association (p = 0.27).Conclusion:PSAD, whether dichotomized (threshold of >0.1 ng/mL/cc) or continuous, didn’t predict iPCa in men with large prostates. To optimize cancer detection, patients with large prostates may profit from prostate MRI before bladder outlet surgery, especially those with a history of prior prostate biopsy. Further research, including larger multicenter studies, is needed to validate our results.

Benign prostatic hyperplasia is one of the main causes of urinary symptoms in older men and has a considerable impact on quality of life. Although transurethral resection of the prostate remains the standard treatment, minimally invasive options with lower morbidity and shorter recovery times have emerged in recent years. This article provides an update on emerging therapies such as prostate artery embolization, ClearRing prostate implant, and holmium laser enucleation. The available evidence on their clinical efficacy, safety profile, and applicability in different contexts, including patients withhigh surgical risk or large prostates, is analyzed. These alternatives allow for progress toward more individualized treatment, with a focus on functional preservation and patient well-being.

IntroductionWater vapor thermal therapy (WVTT) has emerged as a minimally invasive surgical therapy (MIST) for benign prostatic hyperplasia (BPH) management. While international studies have confirmed its safety and efficacy, real-world data from Japanese outpatient clinics remain scarce. This study aimed to evaluate the one-year clinical outcomes of WVTT performed in a single urology clinic, representing the first Japanese single-center report describing one-year clinical outcomes of outpatient WVTT.MethodsWe conducted a retrospective cohort study at Mizuhodai Urology, including 52 patients who underwent WVTT between March 2023 and September 2024. Baseline and follow-up assessments at one, three, six, and 12 months included quality of life (QOL, International Prostate Symptom Score (IPSS)-QOL), prostate volume (PV), and postvoid residual (PVR) volume. Adverse events (AEs) were classified using the Clavien-Dindo system. Risk factors for the restart of BPH medication and failure of the first trial of void (TOV) were analyzed using multivariate logistic regression.ResultsSignificant improvements in QOL, PV, and PVR were maintained throughout the 12-month follow-up period. All procedures were completed as day-case interventions under spinal anesthesia, with a median operative time of 3 min and a mean hospitalization duration of 259 min. Catheter removal was achieved in all patients, although the first TOV failed in seven cases. Restart of BPH medication was required in seven patients after a median of 339 days. Multivariate analysis identified PV ≥60 mL as a risk factor for medication restart and PV ≥70 mL for first TOV failure. AEs occurred in six patients within 14 days, all grade I-II, with no grade ≥III events.ConclusionClinic-based WVTT was safe and effective for BPH management, with sustained improvement in QOL, PV, and PVR at one year. To the best of our knowledge, this is the first Japanese study reporting one-year outcomes of WVTT. These results support its feasibility as a minimally invasive, office-based therapy while underscoring the importance of patient selection in larger prostates.

Efficacy of Water Vapor Thermal Therapy by Prostate Volume in Large (>80cc) and Average (≤80cc) Cohorts-A Systematic Review and Meta-Analysis.

Background. Benign prostatic hyperplasia (BPH) is one of the most common urological conditions in elderly men. Its prevalence increases with age, reaching over 80% in men over 80. When conservative treatment is ineffective, surgery remains the gold standard, particularly for prostates of large volume. However, the effectiveness and safety of various surgical techniques for large and very large prostates (≥80 ml), especially considering anatomical features of the vesico-urethral segment, remain a subject of ongoing investigation. Aim: to compare the long-term outcomes of different surgical techniques for BPH in patients with large and very large prostate volumes, taking into account the anatomical characteristics of the vesico-urethral segment. Materials and Methods. A retrospective single-center study was conducted including 563 patients with BPH (prostate volume ≥80 ml) who underwent one of the following procedures between 2019 and 2021: mechanical enucleation (n=106), monopolar TURP (n=51), bipolar TURP (n=302), or transurethral enucleoresection of the prostate (TUERP, n=104). Parameters evaluated included operative time, catheterization duration, hospitalization period, and changes in IPSS, QoL, Qmax, voided volume, post-void residual urine, as well as postoperative complications at 12 months. Results. TUERP showed the most favorable outcomes with the lowest IPSS (7 [6;9]) and QoL (1.5 [1;2]) scores at 12 months, highest Qmax (18.7±2.3 ml/s), lowest residual urine volume (32±12.6 ml), and the shortest hospitalization and catheterization durations. Bipolar TURP also demonstrated good efficacy, although slightly inferior to TUERP in some parameters. Mechanical enucleation, despite removing the largest tissue volume, was associated with longer surgery, extended hospitalization, and higher rates of complications. Monopolar TURP had the least favorable outcomes in terms of symptom relief and postoperative safety. Conclusion. TUERP is the most effective and safe surgical approach for BPH in patients with large and very large prostates, providing optimal urinary function recovery and quality of life improvement with a low rate of complications. Bipolar TURP remains a viable alternative for prostates up to 100 ml. The choice of surgical technique should be individualized based on prostate volume, anatomical characteristics, and the surgeon's expertise.