Lower Urinary Tract Symptoms Research Articles (Page 1)

Radiotherapy plus Long-term Adjuvant Androgen Deprivation with a Luteinizing Hormone-releasing Hormone Antagonist Versus Agonist in Patients with Very High-risk Localized or Locally Advanced Prostate Cancer: The EORTC GUCG-1414 Phase 3 Randomized Trial.

To discuss the benefits and considerations of anticholinergic therapy as first-line treatment for bladder storage symptoms in patients with neurogenic lower urinary tract dysfunction (NLUTD), integrating evidence-based data and clinical experience. A narrative review of international guideline recommendations, available clinical evidence, and professional experience was undertaken to evaluate the role of anticholinergics in managing disorders of bladder storage, such as neurogenic detrusor overactivity (NDO) and intrinsic sphincter dyssynergia (NISD), in patients with NLUTD. Evidence from published studies and guideline statements supports anticholinergics as effective agents for improving lower urinary tract symptoms (LUTS), detrusor overactivity (DO), and overall bladder function in patients with NLUTD. Their use has also been associated with prevention of secondary urinary complications. Anticholinergics remain recommended first-line therapy for bladder storage dysfunction in NLUTD. Clinical use should be guided by individual patient characteristics, balancing efficacy in symptom control with potential side effects and long-term safety considerations.

Background: Lower urinary tract symptoms (LUTS) are major causes of morbidity in men aged 50 years and above. The LUTS causes reduced quality of life with attendant loss of economic activities. Bladder outlet obstruction is an important cause of LUTS. Urodynamic studies is the gold standard for the investigation of men with LUTS, but this is invasive, costly, time consuming and needs expertise to carry out. One of the remodelling that the bladder undergoes in LUTS is change in detrusor muscle / wall thickness (DWT), which can be investigated by ultrasound. LUTS are assessed using International Prostate System Score (IPSS), and the value obtained can be correlated with DWT. This is a sensitive tool in the assessment of men with LUTS. Studies involving correlation of DWT with IPSS are few in the literature and rare in our environment. The aim of this study is to measure DWT among men with LUTS and correlate the results with their IPSS. Subjects and Methods: This study was carried out in Radiology Department of our hospital from December, 2023 to June 2024. Data obtained from the study was entered and analysed using the Statistical Package for Social Sciences (SPSS), Version 20.0. Sociodemographic characteristics, measures of central tendencies and dispersion for continuous numerical variables, paired sample t-test, as well as Pearson correlation tests were used in the analysis. P-value < 0.05 was considered to be statistically significant. Results: The large numbers of participants in the study were between 56 - 65 years (38.1%) with a mean age of 67.2 years. Most of the subject’s have moderate LUTS. There is a positive linear correlation between the Pre-void DWT and IPSS (p-value = 0.035), but not with post-void DWT (p-value = 0.619). Conclusion: There is an increase in pre-void DWT with increase in severity of LUTS.This is a key indicator of severity in patients with LUTS.

Background SARS-CoV-2 exploits TMPRSS2, an androgen-regulated protease highly expressed in prostate tissue, to enter host cells. While inflammation is a recognized promoter of oncogenesis, the possibility that viral prostatitis could precede prostate cancer has not been previously reported. Case presentation We describe the case of a 55-year-old male with no family history of prostate or breast cancer and no germline pathogenic variants on next-generation sequencing (NGS), who developed lower urinary tract symptoms (LUTS) and PSA elevation shortly after a second COVID-19 infection. Multiparametric MRI initially demonstrated diffuse PI-RADS 4 changes compatible with prostatitis. Although symptoms improved with antibiotics, LUTS persisted and were managed with finasteride and doxazosin. Over the following two years, serial imaging revealed progression to a long, poorly demarcated PI-RADS 5 lesion extending from apex to base in the right posterior peripheral zone, and a smaller PI-RADS 4 lesion on the left. Targeted biopsy confirmed acinar adenocarcinoma (Gleason 7 and 6 in 16 of 26 cores). PET-PSMA showed disease confined to the prostate. The patient underwent neoadjuvant therapy with androgen deprivation therapy (ADT) plus a novel hormonal agent (NHA) from April 14 to October 15, 2024, resulting in significant tumor reduction. Radical prostatectomy on November 1, 2024 revealed a small residual acinar adenocarcinoma focus with perineural invasion, negative surgical margins, and molecular evidence of TMPRSS2::ERG gene fusion and PTEN loss. Conclusion This is the first documented case suggesting a potential link between COVID-19-related prostatitis and subsequent prostate cancer in a TMPRSS2::ERG-altered patient without hereditary predisposition. Although causality cannot be established, the findings highlight a hypothesis-generating interface between viral infection, inflammation, and oncogenesis that warrants further study.

Investigating the impact of circadian syndrome (CircS) on the prognosis of NMIBC, identifying potential indicators affecting prognosis, and explaining NMIBC prognosis from the perspective of circadian rhythm disruption to provide a preventable risk factor. A total of 438 patients with non-muscle-invasive bladder cancer (NMIBC) who received intravesical Bacillus Calmette-Guérin (BCG) immunotherapy after transurethral resection of bladder tumor (TURBT) were selected for retrospective analysis by retrieving medical records. The primary outcomes were recurrence-free survival (RFS) and progression-free survival (PFS). The secondary endpoints were safety parameters. Least absolute shrinkage and selection operator (LASSO) regression was used to screen variables for COX regression. Subgroup analysis and sensitivity analyses were used to validate the robustness of the results. Bootstrap and K-fold cross-validations were used to validate the robustness of the models. All adverse events (AEs) were further quantified for association strength using a logistic regression analysis. This retrospective study screened 406 patients who met the inclusion criteria for further analysis. Survival analysis demonstrated significantly lower RFS in patients with CircS compared to the non-CircS cohort (Log-rank P=0.018; HR=1.58, 95% CI: 1.08-2.31). Multivariable analysis of LASSO-selected variables identified CircS (HR=1.72, 95% CI: 1.09-2.73, P=0.021), male gender (HR=2.04, 95% CI: 1.12-3.72, P=0.02), recurrence history (HR=1.79, 95% CI: 1.17-2.73, P=0.007), and tumor diameter >3cm (HR=1.88, 95% CI: 1.24-2.87, P=0.003) as independent predictors of inferior RFS in NMIBC. Notably, elevated serum albumin levels exhibited protective effects (HR=0.91, 95% CI: 0.85-0.98, P=0.008). The prognostic significance of CircS remained robust across multiple RFS validation models, though no significant association was observed with PFS. In the analysis of AEs, patients with CircS showed significantly higher odds, such as lower urinary tract symptoms (LUTS) (OR=1.64, 95% CI: 1.02-2.63, P=0.041), hematuria (OR=2.94, 95% CI: 1.55-5.50, P<0.001), dysuria (OR=4.26, 95% CI: 1.67-11.08, P=0.002), lower abdominal pain (OR=4.28, 95% CI: 1.59-11.73, P=0.004), fatigue (OR=3.86, 95% CI: 1.60-9.34, P=0.002) and arthralgia or flu-like symptoms (OR=7.30, 95% CI: 1.40-53.31, P=0.023). CircS may serve as a potential risk factor affecting the prognosis of NMIBC, manifesting as worse RFS and AEs. Along with gender, tumor size, and recurrence history, it constitutes a high-risk factor for RFS. This finding provides clues for exploring potential causal relationships between clinical syndromes caused by circadian rhythm disruption and bladder tumor prognosis, while also reshaping the understanding of connections between chronic non-neoplastic diseases and neoplastic diseases.

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.

Stress urinary incontinence (SUI) annoyed women worldwide and surgery remain importance for those who failed to observative managements. We retrospectively reviewed medical records of 533 female patients with mixed urinary incontinence and predominant SUI in a medical center. Some patients may have had stage 3 or higher cystocele and underwent concomitant anterior colporrhaphy. Patients were divided into four groups: pubovaginal sling (PVS) alone, PVS with colporrhaphy, transobturator suburethral sling (TOT) alone and TOT with colporrhaphy. The primary outcome was the long-term cumulative success rate in different groups and a successful outcome defined as dry or less than one pad usage per day. The secondary outcomes were subjective postoperative lower urinary tract symptoms and various perioperative complications. The long-term cumulative success rate of PVS group with or without colporrhaphy are significantly higher than those in TOT group with or without colporrhaphy (p< 0.001). The group of PVS with concurrent colporrhaphy obtained highest success rate, followed by the PVS alone, TOT with colporrhaphy and TOT alone (p=0.003). Furthermore, the highest rate of persistent overactive bladder was noted in TOT alone group (p< 0.001). This study suggests PVS is superior to TOT in terms of incontinent symptom control and long-term success rate. Concurrent colporrhaphy may be also helpful for anti-incontinent effect.

Prostate deobstruction surgery effectively relieves lower urinary tract symptoms in men with benign prostatic obstruction, but some patients fail the initial trial without catheter (TWOC) postoperatively, requiring recatheterization. This study aimed to identify clinical and urodynamic predictors of initial TWOC failure following prostate deobstruction surgery. A retrospective single-center study was conducted on 327 men who underwent prostate deobstruction surgery, including transurethral resection of the prostate, GreenLight laser photoselective vaporization, and holmium laser enucleation, at our institution from 2018 to 2024. Clinical characteristics, prostate volume, preoperative and postoperative uroflowmetry, and multichannel urodynamic parameters were evaluated. Initial TWOC failure was defined as recatheterization within one week of catheter removal. Logistic regression was performed to identify predictive factors. Among 327 patients, 41 (12.5%) experienced initial TWOC failure. Uroflowmetry parameters significantly improved postoperatively. Multivariate analysis identified detrusor underactivity (DU) (OR: 2.773, P = 0.012) and low bladder outlet obstruction (BOO) (OR: 2.881, P = 0.041) as independent predictors. Patients with both risk factors had a higher likelihood of initial TWOC failure (OR: 4.560; P = 0.003), while those with high BOO and no DU had lower risk (OR: 0.321, P = 0.003). Notably, even in the presence of high preoperative post-void residual volume (PVR ≥ 300 mL), those with high BOO and no DU still had lower risk of TWOC failure (OR 0.154, P = 0.018). Preoperative multichannel urodynamics improve initial TWOC risk stratification and tailor postoperative catheter management. Patients with DU and low BOO may require prolonged catheterization. In contrast, early catheter removal is feasible in patients with high BOO but preserved detrusor function, even with high preoperative PVR.

Gender-affirming surgery (GAS) has witnessed a worldwide surge in demand due to societal and medical advances. Despite improved access, postoperative urogynecologic complications remain underrecognized and poorly documented. This review aims to classify complication patterns by surgical type, discuss their management, and highlight critical knowledge gaps to improve care for transgender and non-binary (TGNB) individuals. A literature review was conducted using PubMed, Embase, Cochrane, and Web of Science. After screening the articles for relevance, data were synthesized to present a narrative review to evaluate the patterns, management, and knowledge gaps surrounding urogynecologic complications following GAS, with a focus on TGNB populations. Transfeminine vaginoplasty frequently leads to urethral stricture (10-18%), meatal stenosis (5-10%), neovaginal stenosis (up to 30%), and dyspareunia (20-40%). Transmasculine procedures such as phalloplasty and metoidioplasty are associated with urethral fistulas (15-60% and 10-25%, respectively), strictures (25-58% and ~ 20%), and urinary retention (25-58% and 15-25%). Lower urinary tract symptoms are also common. Pelvic floor dysfunction (PFD) affects up to 94.1% of transgender men, impacting urinary and sexual function. Pelvic floor physical therapy (PFPT) before and after surgery can significantly reduce dysfunction rates. Urogynecology complications after GAS are prevalent and significantly impact quality of life, contributing to dysphoria and distress. Major evidence gaps remain, including inconsistent complication definitions, a lack of TGNB-specific patient-reported outcome measures (PROMs), and limited longitudinal data. Addressing these gaps and expanding access to trauma-informed, specialized rehabilitation are essential to improving long-term outcomes for TGNB individuals.

Diagnosing urinary tract infections (UTIs) in older women is challenging due to the high prevalence of asymptomatic bacteriuria (ASB). This study aimed to investigate whether pathogen-related factors differ between older women with UTI and those with ASB, and to gain further insight into the persistence of Escherichia coli in ASB. In this exploratory study, E. coli isolates from 46 participants were analysed. The study included community-dwelling and long-term care facility women aged ≥ 65years diagnosed with either UTI (defined as ≥ 2 new-onset lower urinary tract symptoms, pyuria, and bacteriuria) or ASB (E. coli ≥ 104CFU/mL in two consecutive urine samples). Whole-genome sequencing (WGS) was performed to identify previously described putative uropathogenicity factors (PUFs), antimicrobial resistance genes, multilocus sequence typing (MLST) sequence types (STs), and Clermont phylogroups. We analysed 31 isolates from UTI patients and 32 sequential isolates from 15 ASB patients. All ASB patients carried genetically similar E. coli strains in two consecutive samples taken 2-4weeks apart. The isolates represented a diverse range of STs, with ST69, ST73, and ST141 being the most prevalent. Although no significant difference in the overall number of PUFs between UTI and ASB groups was observed, distinct patterns emerged. UTI-associated isolates more frequently harbored cnf1 and sfaH, whereas iha, iucC and sat were more common in ASB isolates. Our findings suggest potential individual differences in the presence of PUFs between UTI and ASB isolates. Further functional studies are warranted to explore the role of these factors in bladder colonization and UTI pathogenesis. Additionally, their interactions with host-specific factors should be examined to better understand bacterial persistence and disease development in older women.

The prevalence of liver dysfunction among men has been steadily increasing in recent decades. Among the various non-invasive assessment tools available, the Fibrosis-4 (FIB-4) Index has emerged as a particularly valuable and widely adopted scoring system for evaluating liver fibrosis. This study investigated the relationship between liver fibrosis evaluated by the FIB-4 Index and male health care parameters. Participants were assessed using standardized questionnaires, including the International Prostate Symptom Score (IPSS) for lower urinary tract symptoms (LUTS), the Sexual Health Inventory for Men (SHIM) and EHS (Erection Hardness Score) for erectile function, and the AMS (Aging Males Symptoms rating scale) for late onset hypogonadism. Endocrinological parameters, including dehydroepiandrosterone sulfate (DHEA-S), insulin-like growth factor 1 (IGF-1), total testosterone and cortisol levels, as well as metabolic factors, including hemoglobin A1c (HbA1c) and triglyceride level, were evaluated as potential confounders. The patient age was 50.62±0.24 years. The analysis revealed significant associations between higher FIB-4 Index quintiles and worsening sexual function and LUTS. Among endocrine factors, DHEA-S and IGF-1 exhibited decreasing trends with higher FIB-4 Index values, whereas cortisol showed an increasing trend. Surprisingly, no significant association was observed between FIB-4 Index and testosterone levels. HbA1c increased, but triglycerides did not correlate with FIB-4. Multiple regression confirmed IPSS and SHIM scores were independently linked to the FIB-4 Index (p<0.05). These findings highlight the importance of hepatic assessment in men with erectile dysfunction and LUTS, supporting a multidisciplinary approach to care.

Some patients report persistent/recurrent lower urinary tract symptoms (LUTS) after benign prostatic enlargement (BPE) surgery. This study aims to systematically assess the incidence of storage symptoms and dysuria after transurethral treatment of BPE in randomized studies comparing transurethral resection of the prostate (TURP) versus Enucleation versus Ablation procedures. This study adhered to the 2020 PRISMA framework. A broad literature search was performed in January 2025, using Embase, PUBMED, and Scopus using a combination of Medical Subject terms and keywords. Only English and randomized studies were accepted. Incidence of postoperative LUTS (storage symptoms and dysuria) was sorted in early (up to 3 months), and persistent (> 3 months) and assessed using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% confidence interval (CI), and p values. OR > 1 indicates that TURP decreases the odds of postoperative LUTS. A total of 35 studies were accepted (546 patients in Enucleation, 1678 in Ablation, and 1702 in TURP). Incidence of early postoperative LUTS favors the TURP group compared with Ablation (OR 1.72). Subanalysis demonstrates no difference between monopolar (M)-TURP and Ablation but LUTS favors bipolar (B)-TURP (OR 10.69). Early postoperative LUTS favors the TURP compared with Enucleation (OR 1.71). Persistent postoperative LUTS favors the TURP group compared with Ablation (OR 2.75). Early postoperative storage symptoms favor B-TURP over Ablation (OR 4.00) and Enucleation (OR 1.71). Late postoperative storage symptoms favor TURP over Ablation (OR 2.13). Early postoperative dysuria was similar between TURP versus Enucleation and versus Ablation. Persistent postoperative dysuria favors M-TURP compared with Ablation (OR 6.92). TURP is associated with a lower odds of early and persistent LUTS compared to Ablation and Enucleation and is a valuable option particularly when minimizing postoperative LUTS is a priority.

Uroflowmetry (UF) is one of the most commonly used noninvasive tests in the evaluation of children with lower urinary tract symptoms (LUTS). However, studies have highlighted a weak agreement among experts interpreting voiding patterns. This study aims to assess the impact of Machine Learning (ML) models, which have become increasingly prevalent in medicine, on the interpretation of voiding patterns. The study included UF tests of children aged 4-17 years who were referred to our clinic with LUTS. Voiding patterns were independently interpreted by three experts in pediatric urology. Discrepancies in interpretations were jointly re-evaluated by these three observers, and a consensus was reached. Voiding volume (VV), voiding duration (VD), and urine flow rates at 0.5-s intervals were converted into numerical data for analysis. Eighty percent of the data set was used as training data for ML, while the remaining 20% was reserved for testing. A total of five different ML models were employed for classification: Decision Tree, Random Forest, CatBoost, XGBoost, and LightGBM. The models that most accurately identified each voiding pattern were determined. We included a total of 500 UF tests in our study, comprising 221 boys (44.2%) and 279 girls (55.8%). The mean age of the children was 9.17 ± 3.41 years. In the initial assessment, 311 tests (62.2%) were interpreted identically by the observers, while 189 tests (37.8%) were interpreted differently by at least one observer (Fleiss' κ = 0.608). Of the samples used for ML training, 253 (50.6%) exhibited a bell-shaped pattern, 52 (10.4%) a tower pattern, 103 (20.6%) a staccato pattern, 40 (8%) an interrupted pattern, and 52 (10.4%) a plateau voiding pattern. Among the models tested, the highest accuracy was achieved with XGBoost (85.00% ± 2.90), while the lowest accuracy was observed with the Decision Tree model (81.80% ± 1.47). When evaluating voiding patterns individually, the interrupted voiding pattern demonstrated the highest accuracy rates (95%-100%), where as the tower (63.46%-73.08%) and plateau (61.54%-71.15%) patterns had the lowest. The current trial demonstrated, for the first time, that ML models achieved an acceptable accuracy rate in interpreting UF patterns in children. Consequently, artificial intelligence (AI) models have the potential to help standardize the analysis of UF voiding patterns in the future. ClinicalTrials.gov (Ref: NCT06814847).

UroLift, Rezūm, and iTind for Benign Prostatic Hyperplasia.

Background: Bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPE) is common in elderly men, with a significant impact on quality of life. Transurethral resection of the prostate (TURP) remains the standard surgical treatment, but its safety in patients over 80 years of age is debated due to comorbidities and higher perioperative risks. Aims and Objective: To evaluate the safety, efficacy, and functional outcomes of monopolar TURP in men aged ≥80 years. Materials and Methods: We retrospectively reviewed records of men aged over 80 years who underwent monopolar TURP at our center between January 2022 and January 2025. Data collected included age, prostate size, presentation, comorbidities, medications, perioperative complications, and catheter-free trial outcomes. Surgical success was defined as a satisfactory patient-reported outcome, successful catheter-free trial, and post-void residual (PVR) &lt;100 mL at 1 month. Results: Twenty-nine patients (mean age 86.8 years) were included. Fourteen (48.3%) presented with lower urinary tract symptoms and 15 (51.7%) with acute urinary retention. The mean prostate size was 70.8 g. All patients achieved catheter-free status post-operatively, with a mean PVR of 41.2 mL. The complication rate was 6.9% (urethral stricture in one patient, meatal stenosis in one patient); all were minor and manageable. No cases of transurethral resection syndrome, blood transfusion, reoperation, or perioperative mortality occurred. One patient was incidentally diagnosed with prostate carcinoma on histopathology. Conclusion: Monopolar TURP in men over 80 years is a safe and effective procedure with excellent functional outcomes, low morbidity, and no perioperative mortality. Careful patient selection, perioperative optimization, and meticulous surgical technique are key to achieving favorable outcomes in this high-risk group.

Medical Therapy for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms.

Pudendal neuropathy is a cause of pelvic pain, specifically pudendal neuralgia. The pudendal nerve is related to sensory, motor, and autonomic functions. We present the case of a 41-year-old man who suffered from chronic pelvic pain. In detail, the patient described stinging burning pain in the glans penis, proctalgia, lower urinary tract symptoms, sensation of "muscle tension" and squeezing pain. He was diagnosed with prostatitis and, following, pudendal neuralgia. Our patient was treated with antibiotics and analgesics, without improvement of symptoms. He was then submitted to decompression surgery of the pudendal nerve, with partial improvement. The patient started a rehabilitation program and was treated with OnabotulinumtoxinA (BoNT-A) injections into the piriformis muscle with benefit. BoNT-A positive effects on pain relief may corroborate piriformis muscle compression of the pudendal nerve. BoNT-A may also reduce the release of neurotransmitters from the pain pathways. Early identification of pudendal neuralgia could have prevented the progression to chronic pain. There is still not an established role for BoNT-A in post-operative pudendal nerve decompression patients. Our case corroborates that more studies should be performed to explore BoNT-A administration in these patients.

Novel Stent-like Devices for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

ObjectivesTo describe a single academic centre experience in the establishment of Multidisciplinary Meetings (MDM) for the management of male non‐neurogenic Lower Urinary Tract Symptoms (LUTS) and Benign Prostate Hyperplasia (BPH).Materials and methodsRetrospective analysis of all the cases discussed in MDM for LUTS/BPH in our academic centre over a year, and analysis of the implementation rates, reasons for failure of implementation and discrepancies between the proposal and the final decision.ResultsOver one year, 108 cases were discussed. The implementation rate of the recommendation was 71% (77/108). The reasons for the failure of implementation of the recommendation were patient preference in 6 (5%), lost to follow‐up in 13 (12%), consultant decision in 4 (4%), patient deterioration or new comorbidities in 2 (2%), improvement of LUTS symptoms in 4 (4%) and the suggested technique was not available for technical reasons in 1 (1%). The consultant's proposal was validated in 98 cases (90.7%) and a different decision was made in 9 cases (8.3%).ConclusionThe establishment of a MDM for male LUTS/BPH is feasible and could contribute to the improvement of the management of patients. Further studies are needed to evaluate all its aspects.

TMEFF2 promotes hyperplastic prostate progression by degrading BAX via TRIM17.