Prostate Size Research Articles

Transurethral microwave thermotherapy with the CoreTherm®Concept in men with prostates larger than 100 grams - a consecutive case series.

Transurethral microwave thermotherapy (TUMT) is well described for lower urinary tract symptoms in men with prostates between 30 and 100 grams. We aimed to describe the results in men with prostates larger than 100 grams. We retrospectively recorded age, prostate size, occurrence of urinary retention, and Danish Prostate Symptom Score (DAN-PSS) prior to treatment in men with prostates exceeding 100 grams. Following treatment, we assessed satisfaction, DAN-PSS, and the results of uroflowmetry and postvoid residual urine. We included 50 consecutive patients with prostates over 100 g. The median age was 78 years, and the median prostate size was 126 g (range 101-230). Forty-four men were treated due to urinary retention and 6 due to lower urinary tract symptoms. Treatments were performed under local anesthesia. The median duration was 15 minutes (range 8-32 minutes) and the median destruction was 25% of the prostatic volume (range 11-26%). Eight patients had destruction of <20%. No side effects were noted. Forty-nine patients completed 6-month follow-up. The 41/49 (84%) men who had tissue destruction of ≥20% reported to be satisfied. The median DAN-PSS score was 3 (range 0-18), the median Qmax was 12 mL/s (range 5.1-23.1 mL/s) and the median postvoid residual volume was 89 mL (range 0-331 mL). Symptoms were unchanged in the 8/49 (16%) men who had <20% tissue destruction. TUMT represents a useful alternative to surgery in men with infravesical obstruction and a prostate of more than 100 grams.

Emerging Role of Laser Lithotripsy for Bladder Stones: Real-World Outcomes from Two European Endourology Centers with a Systematic Review of Literature.

Introduction and Objective: We aimed to look at the evidence for laser lithotripsy for bladder stones (BSs) to provide results from two centers on bladder calculi treatment. In addition, the outcomes of prostatic and other surgical interventions performed in nearly half of all patients. Methods: A retrospective analysis of two large European endourology tertiary centers for patients who underwent laser lithotripsy for BS between 2016 and 2024 (7 years). All patients provided consent and were counseled for the study accordingly, and the studies were registered as an audit in the individual centers. Results: A total of 122 patients were analyzed (mean age of 68.17 ±16.38 years; male:female ratio of 97:25). Thirteen (10.7%) patients had a preoperative long-term catheter. Overall, 42 (34.43%) patients had multiple stones (n = 2.19, ±2.08), with a median stone burden of 32.36 ± 24.13 mm. The mean operative time was 61.6 ± 37.25 minutes, with an overall stone-free rate (SFR) of 95.1% (n = 116). Postoperative complications were noted in nine (7.38%) patients, which included urinary tract infection or sepsis (n = 4, 3%), pain (n = 2, 1.6%), and bleeding/acute urinary retention/urethral stone (n = 1 each, 0.82%). All the complications were Clavien-Dindo I/II and treated conservatively. Six patients (4.9%) with planned concomitant surgical intervention needed a completion (second) intervention at a later date. Sixty patients (49.2%) had concomitant procedure along with their BS treatment. Twenty-two patients (18%) with a mean prostate size of 60.71 cc (±30.50 cc) underwent a transurethral resection of prostate (n = 16, 13.1%) or bladder neck incision (n = 6, 4.9%). Others underwent ureteroscopy (n = 13, 10.7%), transurethral resection of bladder tumor (n = 5, 4.1%), suprapubic catheter repositioning (n = 10, 8.2%), or urethral dilation (n = 10, 8.2%). The mean hospital stay was 1.4 ± 1.33 days. Conclusion: Laser fragmentation of BSs stands out as a safe and efficient choice with a good SFR and low risk of major complications, and perhaps should be considered the new gold standard for BS management. It also allows for concomitant treatment of enlarged prostate and other endourologic procedures with good outcomes.

Retzius-sparing radical prosatectomy: First 200 Australian cases.

The objective of this study is to report the first multi-centred Australian series of 200 cases of Retzius-sparing radical prostatectomy (RSRP). Between April 2017 and June 2024, 200 RSRP procedures (197 robotic, three laparoscopic) were performed separately by the authors in five centres across two Australian cities (Melbourne, Victoria and Brisbane, Queensland). Data were collected prospectively with ethics committee approval (UCH-HREC 2019.01.279) at weeks 1, 4-6, and three-monthly. Exclusion criteria included prostate size >80 cc, significant middle lobe, large anterior tumour, previous TURP or any clinical factor deemed to make RSRP unsuitable. These criteria were relaxed as experience was gained. Median (interquartile range) age, body mass index and PSA were 65 (60-70)years, 26 (25-29)kg/m2 and 5.2 (4.0-7.0)ng/mL. Low, intermediate and high D'Amico risk groups were 3.5%, 75.0% and 21.5%, respectively. Median (interquartile range) skin-to-skin operative time was 163 (125-210)min and blood loss 200 (100-350)mL. There were 17 (8.5%) Clavien-Dindo grade 1-2 complications and 8 (4%) grade 3 complications. Final pT stage was 60.5% pT2 and 39.5% pT3. The overall positive surgical margins (PSM) rate was 14.5% including 3.3% pT2 and 29.1% pT3. At 1week post catheter removal 53.5% were pad-free, increasing to 58.5% and 65.0% at 4 and 6weeks, then 79.5%, 84.6%, 88.2% and 91.3% at 3, 6, 9 and 12 months, respectively. When a security pad is included, 71.5% and 85.5% of men were continent at 4 and 6weeks, then 94%, 96%, 96% and 97% at 3, 6, 9 and 12 months, respectively. Three men required a suburethral sling and one an artificial urinary sphincter. Ninety of 140 (60.4%) preoperatively potent men were potent at 12 months with or without phosphodiesterase-5 inhibitors. RSRP provides excellent early continence and can be introduced safely with good oncological results by experienced minimally- invasive surgeons.

Outcomes and efficacy of robotic-assisted radical prostatectomy using the CMR Versius platform: a prospective study on 118 patients with 1-year follow-up.

To evaluate the outcomes and efficacy of robot-assisted radical prostatectomy (RARP) using the Versius robotic surgical system, aiming to provide comprehensive data on perioperative outcomes, postoperative recovery, and complications. All cases of RARP using the CMR Versius platform performed at Cairo University Hospitalover a two-year period were enrolled in this study. All patients had pathologically confirmed prostate cancer in both localized and locally advanced stages. Data were prospectively collected including preoperative parameters as patients' demographics, serum PSA, and Gleason score after trans-rectal ultrasound guided biopsy. Intraoperative parameters and complications were assessed. Postoperatively, we monitored the oncological and functional outcomes such as continence and sexual functions for at least 12months. Follow up of PSA was done at 6weeks, 3 and 6months, postoperatively. One-hundred-and-eighteen patients continued the follow-up till 12months. The median patient age was 64.26 ± 7.13years. The median PSA value at diagnosis was 9(4.16-64) ng/ml and the median prostate size was 50 (20-167) grams. The mean docking time, console time, and the total operative time were 13.17 ± 1.157, 194.75 ± 24.3 and 225.76 ± 25min, respectively and the median blood loss was 307.46 ± 61.44ml. The mean hospital stay and the mean catheter time were 2.16 ± 0.867 and 7.26 ± 1.441days, respectively. Forty-nine patients underwent nerve-sparing RARP (bilateral in 41 patients and unilateral in 8 patients). Post-operative continence and potency showed progressive improvement over time during follow-up. Twelve months postoperatively, 90.7% of patients were totally continent and 49% of those patients who underwent nerve-sparing RARP (24/49) were potent. With a positive safety profile and a successful oncological outcome, the use of the CMR system for robot-assisted radical prostatectomy presents a safe and promising method in the surgical management of prostate cancer.

Comparative outcomes of thulium laser enucleation by prostate volume: a three-group analysis from a single-center study in Vietnam

sPurposeTo evaluate the impact of prostate volume on the safety and efficacy of Thulium Laser Enucleation of the Prostate (ThuLEP) in treating benign prostatic enlargement (BPE) across different prostate volume groups.Materials and MethodsThis prospective study included 92 BPE patients who underwent ThuLEP, stratified into three groups based on prostate volume: Group A (< 50 ml), Group B (50–80 ml), and Group C ( >80 ml). Preoperative and postoperative functional outcomes, intraoperative parameters, and complications were analyzed and compared among the groups. Statistical analysis was performed using IBM SPSS Statistics 27.ResultsOperative time significantly increased with prostate size (Group C: 105 ± 32.74 min vs. Group A: 71.45 ± 33.87 min, p < 0.001). Enucleation time per ml of prostate tissue was most efficient in Group C (0.98 ± 0.55 min/ml, p < 0.001). Postoperative improvements in IPSS, Qmax, QoL, and PVR were significant across all groups, with no notable differences among the groups at 6 months (p > 0.05). The overall complication rate was low (11.96%), with major complications (Clavien-Dindo grade II or higher) accounting for only 6.52%. No significant differences in complication rates were observed among the groups.ConclusionsThuLEP demonstrated excellent safety and efficacy in treating BPE, regardless of prostate size. Larger prostates required longer operative times but achieved comparable functional outcomes with low complication rates. These findings support ThuLEP as a reliable and versatile surgical option for a wide range of prostate volumes.

Risk factors for rectal wall infiltration in hydrogel spacer placement: Influence of biopsy approach.

This study aimed to investigate the association between the type of prostate biopsy and the occurrence of rectal wall infiltration (RWI) with hydrogel spacer placement in patients undergoing radiotherapy for prostate cancer. A retrospective study was conducted involving 175 patients who received hydrogel spacer placement before radiotherapy at the National Cancer Center East Hospital, between October 2021 and December 2023. The patients were categorized based on the type of prostate biopsy: transperineal and transrectal. Spacer placement was followed by MRI to confirm spacer position. Logistic regression analysis was employed to identify factors associated with significant RWI. Of the 175 patients analyzed, 115 underwent transperineal biopsy (TPB) and 60 underwent transrectal biopsy (TRB). The median age was 74 years, and the median prostate volume was 18.6 mL. RWI occurred in 44 (25.1%) of all cases. TRB was associated with a significantly higher occurrence of RWI grade ≥2 compared to TPB (23.3% vs. 4.3%, p < 0.001). Multivariate analysis identified TRB (OR = 5.81, 95% CI = 1.91-17.60, p = 0.002) and smaller prostate volume (≤18.0 mL) (OR = 4.23, 95% CI = 1.23-13.90, p = 0.018) as significant risk factors for RWI grade ≥2. The study found that TRB significantly associated the risk of RWI following hydrogel spacer placement in prostate cancer radiotherapy. Smaller prostate volumes also heightened this risk. These findings highlight the importance of considering biopsy type and prostate size in planning spacer placement.

Preservation of sexual function with Optilume-a novel treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia.

The Optilume benign prostatic hyperplasia (BPH) catheter system is a novel minimally invasive paclitaxel-coated dilation system that has demonstrated substantial and durable results in urinary flow and symptoms. We now assess the impact of Optilume BPH procedure on sexual function. Prior published results have described the methods of data collection during the PINNACLE study, which demonstrated durable improvement in urinary symptoms. Follow-up assessments for the current study included IIEF-EF and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD). Semen quality was also examined. IIEF-EF and MSHQ-EjD scores in the Optilume BPH group were not different from the sham group at 3months, 6months, or 12months. A total of 148 men were randomized to receive the procedure (100) or a sham surgical procedure (48). Subjects in both groups had similar rates of erectile dysfunction (ED) previously diagnosed at baseline (56% vs 54.2%, P = .83) and those men who were sexually active. IIEF-EF and MSHQ-EjD scores in the Optilume BPH group were not different from the sham group at 3, 6, or 12months. Change in IIEF-EF scores remained consistent across all levels of baseline ED severity after Optilume BPH procedure. No clear trend was seen after treatment with Optilume BPH for semen volume, sperm motility, progressive motility, or sperm morphology. The Optilume BPH catheter system provides patients with a durable improvement in lower urinary tract symptoms while preserving sexual function. This study uses validated questionnaires to assess patients' sexual function at baseline and regularly for 1year after the procedure. Given exclusion criteria regarding patient age and prostate size, the results may not be applicable to all BPH phenotypes. Optilume appears to provide clinical benefit with a high degree of patient satisfaction and minimal impact on sexual function.

A Systematic Review of Medical Treatments for Benign Prostatic Hyperplasia in Dogs: Evaluating Strategies for Reproductive Function Preservation.

Benign prostatic hyperplasia (BPH) is a common condition in intact male dogs and a leading cause of subfertility. While surgical and chemical castration are effective treatments for BPH, managing this condition in breeding dogs is challenging due to the desire to preserve reproductive function. This study systematically reviews medical treatments for BPH that maintain breeding potential. Thus, a comprehensive literature search was conducted across four databases (CAB Direct, Scopus, PubMed, and Web of Science) to identify peer-reviewed studies published between 2000 and 2024, following PRISMA guidelines. Specific inclusion and exclusion criteria were applied, and a risk of bias assessment was performed using a modified Cochrane tool. A total of 35 studies were included, evaluating therapies such as finasteride, osaterone acetate, tamoxifen, and others, with outcomes including prostate size, sperm quality, hormonal levels, and tissue morphology. Evidence suggests that osaterone acetate and finasteride are acceptable treatments for BPH in breeding dogs, in spite of a still debatable effect on some sperm characteristics. Therapies like tamoxifen and acyline should be excluded due to their detrimental effects on reproductive function. Further research is required for apparently promising approaches concerning tadalafil, anastrazole, mepartricin, and U. fissa.

Safety and feasibility of En-bloc holmium laser enucleation for very large prostates (> 200 cc) with trainee involvement.

To evaluate the safety and feasibility of "en-bloc" Holmium Laser Enucleation of the Prostate (HoLEP) with trainee involvement in patients with prostates larger than 200 cc. A retrospective analysis was conducted on patients undergoing HoLEP using the "en-bloc" technique for prostate sizes > 200 cc between July-2017 and December-2023 at an academic teaching hospital. Perioperative data was collected, including patient demographics, clinical parameters, operative details and functional outcomes. Patients who continued to experience incontinence at 1 year were further followed up at 2 years to update their continence status. Sub-group analysis was performed to compare outcomes between patients with preoperative prostate size of 200-300 cc and > 300 cc. The analysis included 89 patients with a mean age of 73.12 ± 8.10years. Preoperative prostate weight ranged from 200 to 401 cc with a median of 245 cc, and median PSA was 7.71 ng/ml. Median operative time was 218.5minutes, and median enucleated prostate volume was 164.2cc. Median postoperative PSA was 0.4 [0.21-0.78] ng/ml. At 1-year follow-up, mean IPSS was 1 ± 2.4, Qmax was 27.03 ± 11.57 ml/s and PVR was 21.6 ± 28.6ml. Postoperative complications included blood transfusion (5.6%), acute renal injury (4.5%), urinary tract infection (2.2%), postoperative urinary retention (2.2%) and urethral stricture (5%). Although transient urinary incontinence was noted in 41.6% at 1-3-months, complete continence was achieved in 83.3% and 96.3% at 1 and 2years postoperatively, respectively. Subgroup analysis showed significant differences in operative time and enucleated weight between prostates 200-300 cc and > 300 cc, but no significant differences in postoperative IPSS, PVR or Qmax at 3-months. "En-bloc" HoLEP is a feasible and safe procedure for prostates larger than 200 cc, demonstrating favourable perioperative and functional outcomes despite the extended operative times and involvement of trainees.

Functional and Oncological Outcomes of Very Large Prostate Sizes Post Robotic Radical Prostatectomy: A Propensity Score-Matched Analysis.

Robotic-assisted radical prostatectomy (RARP) is widely used as the main surgical approach to treat prostate cancer in the United States. Prostate size is often described as a factor affecting the outcomes of RARP as shown by many studies. However, these studies are limited to a small number of patients. To evaluate the functional and oncologic outcomes of RARP in very large prostate sizes. Three hundred and seventy-five RARP patients were divided into two groups according to prostate size: Group 1 had prostates larger than 150 g and Group 2 smaller than 50 g. Perioperative variables were matched with propensity score matching 1:3 and postoperative variables were analyzed for significant differences in outcomes between groups. Variables analyzed included estimated blood loss (EBL), operative time, catheter time, hospitalization time, postoperative complications, pathological staging, positive surgical margins (PSM) rates, biochemical recurrence (BCR), potency, and continence rates. The two groups exhibited similar preoperative characteristics. Patients with larger prostates (Group 1) were more likely to have higher blood loss (EBL), longer console time, and more days with catheter. However, we could not find significant difference in the overall postoperative complications (Clavien-Dindo). Pathological outcomes were also statistically different as patients with larger prostates had (69.7%) more pT2 disease and (12.1%) lower rates of PSM. Finally, we could not find significant difference in the functional outcomes between the groups. The results demonstrate that prostate size impacts multiple outcomes. Larger prostates had lower-grade disease, reduced EPE and PSM rates, with no significant differences in BCR or functional outcomes. Perioperative differences, such as increased blood loss and console time, were also observed.

Holmium Laser Enucleation of the Prostate (HoLEP) Versus Transurethral Resection of the Prostate (TURP) in Elderly Patients: Insights Into Recovery, Complications, and Risk Factors.

We compared the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) in elderly men (aged ≥75 years) with benign prostatic hyperplasia (BPH). A retrospective analysis of 151 patients (HoLEP: 72; TURP: 79) was conducted. Preoperative and postoperative parameters, including prostate size, International Prostate Symptom Score (IPSS), catheterization duration, hospital stay, and perioperative complications (incontinence and dysuria), were analyzed. HoLEP significantly reduced catheterization (22 hours vs. 50 hours) and hospitalization times (one day vs. three days) compared to TURP (p < 0.01). However, HoLEP was associated with longer operation times (81.89 min vs. 67.95 min; p < 0.01) and higher rates of dysuria (65.3% vs. 27.8%) and transient incontinence (27.8% vs. 8.9%; p < 0.001). HoLEP offers significant perioperative benefits over TURP, particularly in shortening recovery times; however, further investigation is required to address the higher rates of dysuria and incontinence. Although the retrospective design and surgeon experience constitute limitations, these findings underscore the need for prospective studies. The results support personalized surgical decision-making, emphasizing patient-specific factors such as body mass index (BMI). These insights may help refine perioperative management and improve collaborative decision-making to enhance outcomes in elderly patients with BPH.

The Effect of Pre-Biopsy Prostate MRI on the Congruency and Upgrading of Gleason Grade Groups Between Prostate Biopsy and Radical Prostatectomy

Introduction: Prostate biopsy results form the mainstay of patient care. However, there is often significant discordance between the biopsied histology and the ‘true’ histology shown on a radical prostatectomy (RP). Discordance in pathology can lead to the mismanagement of patients, potentially missing clinically significant cancer and delaying treatment. There have been many advancements to improve the concordance of pathology and more accurately counsel patients; most notably, the induction of pre-biopsy mpMRIs has become a gold standard to aid in triaging and identifying clinically significant cancers, and also to facilitate ‘targeted’ biopsies. Although there have been multiple reviews on MRI-targeted biopsies, upgrading remains an ongoing phenomenon. Aim: To assess the rates of prostate cancer upgrading and the clinical implication of upgrading on NCCN stratification. Methods: We conducted a retrospective audit of 2994 men with non-metastatic prostate cancer diagnosed between 2010 and 2019 who progressed to a radical prostatectomy within 1 year of diagnosis without alternative cancer treatment from the multi-institutional South Australia Prostate Cancer Clinical Outcomes Collaborative registry. The study compared the histological grading between the biopsies and radical prostatectomies of men with prostate cancer and the varying rates of upgrading and downgrading for patients with and without a pre-biopsy MRI. Data were also obtain on suspected confounding variables; age, PSA, time to RP, T-stage at diagnosis and RP, number of cores, number of positive cores, prostate size, tumour volume and procedure type. The results were assessed through cross tabulation and uni- and multi-variate logistic regression while adjusting for confounders. Results: Upgrading occurred in (926) 30.9% of patients and downgrading in (458) 15.3% of patients. In total, 71% (410/579) of grade group 1 and 24.9% (289/1159) of grade group 2 were upgraded following a radical prostatectomy. By contrast, 33.4% (373/1118) of patients without prebiopsy MRI were upgraded at RP compared to 29.5% (553/1876) of the patients who received a pre-biopsy MRI. When analysed on a uni-variate level, the inclusion of a pre-biopsy MRI demonstrated a statically significant decrease in upgrading of the patient’s pathology and NCCN risk stratification (p = 0.026, OR 0.83, CI 0.71–0.98) (p = 0.049, OR 0.82, CI 0.64–1.01). However, when adjusted for confounders, the use of an MRI did not maintain a statistically significance. Conclusions: When considering the multiple variables associated with tumour upgrading, a pre-biopsy MRI did not show a statistically significant impact. However, upgrading of Gleason Grade Group following a prostatectomy is an ongoing phenomenon which can carry significant treatment implications and should remain a consideration with patients and clinicians when making decisions around treatment pathways. More research is still required to understand and improve biopsy grading to prevent further upgrading from affecting treatment choices.

AQUABEAM robotic system use-results survey: Aquablation for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia in the Japanese Population.

To evaluate the safety, efficacy, and patient-reported outcomes of Aquablation therapy using the AQUABEAM Robotic System for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in a Japanese population. This post-market use-results survey included 103 Japanese men with BPH who underwent Aquablation across five centers with previously Aquablation naïve physicians. Data were collected at baseline, during the procedure, at discharge, and at 3 and 6 months post-procedure. Key outcomes included International Prostate Symptom Score (IPSS), quality of life (QoL), uroflowmetry parameters, and adverse events. The mean age of patients was 71.1 years, and the average prostate size was 82.3 mL. At 6 months, the mean IPSS significantly improved from 18.1 ± 9.0 to 6.1 ± 5.0 (p < 0.0001), and QoL scores improved from 4.9 ± 1.3 to 1.8 ± 1.3 (p < 0.0001). Uroflowmetry showed a significant increase in Qmax from 8.3 ± 4.4 to 15.5 ± 7.8 mL/s (p < 0.0001) and a decrease in post-void residual volume (PVR) from 85.6 ± 107.2 to 43.3 ± 60.0 mL (p = 0.0006). At the 30-day primary safety endpoint, there were no reported adverse events of pad-use incontinence, erectile dysfunction, or ejaculatory dysfunction reported, and no device-related serious adverse events were reported. One subject (0.97%) experienced a Clavien-Dindo grade 3 adverse event. Aquablation therapy using the AQUABEAM Robotic System is a reproducible, safe, and effective treatment for Japanese men with BPH, providing significant improvements in LUTS and QoL with a favorable safety profile.

Musculoskeletal and body composition response to high-dose testosterone with finasteride after chronic incomplete spinal cord injury-a randomized, double-blind, and placebo-controlled pilot study.

High-dose testosterone replacement therapy (TRT), paired with finasteride (type II 5α-reductase inhibitor), improves body composition, muscle strength, and bone mineral density (BMD) in older men, without inducing prostate enlargement-a side effect associated with TRT. Men with spinal cord injury (SCI) exhibit neuromuscular impairment, muscle atrophy, bone loss, and increased central adiposity, along with low testosterone. However, sparse evidence supports TRT efficacy after SCI. This parallel-group, double-blind, placebo-controlled, and randomized clinical trial (RCT) is a pilot study that enrolled men (N = 12) with low to low-normal testosterone and gait impairments after chronic motor-incomplete SCI. Participants received high-dose intramuscular TRT (testosterone-enanthate, 125 mg/week) with finasteride (5 mg/day) vs. vehicle+placebo for 12 months. Change relative to baseline was determined for body composition, musculoskeletal outcomes, and prostate size, with effect sizes calculated between groups using Hedges' g. Adverse events and feasibility were assessed. TRT + finasteride consistently increased testosterone (g = 1.16-3.08) and estradiol (g = 0.43-3.48), while concomitantly reducing dihydrotestosterone (g = 0.31-2.27). Very large effect sizes at both 6 and 12 months suggest TRT + finasteride increased whole-body fat-free (lean) mass (+3-4% vs. baseline, g = 2.12-2.14) and knee extensor (KE) whole-muscle cross-sectional area (+8-11% vs. baseline, g = 2.06-2.53) more than vehicle+placebo. Moderate-to-large effect sizes suggest TRT + finasteride increased KE maximal voluntary isometric torque (+15-40% vs. baseline, g = 0.47-1.01) and femoral neck and distal femur BMD from 6 months onward (g = 0.51-1.13), compared with vehicle+placebo, and reduced fat mass 9-14% within the whole-body, trunk, and android (visceral) regions at 12 months (g = 0.77-1.27). TRT + finasteride also produced small effect sizes favoring lesser prostate growth than vehicle+placebo (g = 0.31-0.43). The participant retention, drug compliance, and incidence and severity of adverse events were similar among the groups. These data provide proof-of-concept and rationale for larger RCTs aimed at discerning the impact of TRT + finasteride on body composition, musculoskeletal health, and physical function in men with SCI, along with effect sizes and variance of responses to assist in planning subsequent trials. ClinicalTrials.gov, identifier NCT02248701.

Tolerability of Transperineal Prostate Biopsy Under Local Anaesthetic Using Pre-Emptive Over-the-Counter Analgesia: An Interventional Study in Patients with Abnormal Clinical Prostate Findings

Objective: Transperineal prostate (TP) biopsy is the key diagnostic tool for evaluating prostate cancer and is feasible under local anaesthetic (LA) alone. However, concerns about its tolerability encourage use of a multimodal analgesia approach. Pre-emptive over-the-counter analgesia with LA may provide a simple and low-risk option. The objective of this study was to investigate the effects of over-the-counter analgesia on TP biopsies conducted under LA. Methods: This interventional single-centre study investigated 160 participants who undertook a TP biopsy under LA, with and without pre-emptive analgesia (1 g of paracetamol and 400 mg of ibuprofen). Pain tolerability was measured using a visual analogue scale (VAS) at three procedural points (probe insertion, LA infiltration, and biopsy); an overall average VAS score was subsequently calculated. The abstracted secondary variables include patient details (age, prostate size, and PSA level), biopsy details (number of cores and volume of LA used), and preferability for LA use in future TP biopsies. An inferential statistical analysis was performed using Wilcoxon’s Rank Sum non-parametric test, Pearson’s test of correlation, and Pearson’s Chi-squared test. Results: The groups were comparable in age, prostate size, and PSA level. Median VAS scores were consistently lower in the intervention cohort, but without statistical significance. A higher volume of LA was associated with lower overall VAS (p = 0.03). LA was strongly preferred over GA for hypothetical future TP biopsies in both cohorts. Conclusions: Pre-emptive analgesia does not significantly improve tolerability of TP biopsy under LA. Our study substantiates evidence that TP biopsy is generally well tolerated under LA and preferred over GA.

Comparison of frequency of postoperative requirement of additional analgesia and mean length of hospital stay in patients undergoing transurethral resection of prostate with and without postoperative catheter traction.

Objective: To determine and to compare the frequency of postoperative requirement of additional analgesia and mean length of hospital stay in patients undergoing TURP with and without postoperative catheter traction. Study Design: Analytical Cross Sectional Study. Setting: Department of Urology, Allied Hospital, Faisalabad. Period: Dec 2023 to March 2024. Methods: After ERC approval &amp; informed consent a total of 48 patients with comparable baseline characteristics such as age and preoperative prostate size who underwent TURP and were having significant postoperative hematuria (≥ grade 2 on a standardized hematuria colorimetric card) were enrolled in the study &amp; were divided into two groups i.e. group A and group B, each having 24 patients. Group A patients were subjected to postoperative catheter traction with thigh using an adhesive band that was maintained over the night, while group B patients were not subjected to this postoperative intervention. Patients of both the groups received a single shot of IM diclofenac sodium 75mg in the recovery room and later on oral diclofenac sodium 50mg was given twice a day. All Patients were presented with a visual analogue scale (VAS) every 6 hourly during the first 24 hours postoperatively and were given additional IM diclofenac sodium 75mg if the reported pain was of moderate-severe intensity as indicated by the VAS score and an entry was made on the pro forma. Also, at the time of discharge total days spent in the hospital by patients of both the groups after undergoing TURP and any postoperative complications were noted. Results: 79.16% of group A patients required additional postoperative analgesia as compared to a value of 29.16% of group B patients (p= 0.0001). The mean hospital stay of group A and group B was 4.04 ± 0.65 days and 3.25 ± 0.65 days respectively (p=0.0001).

Short- and Medium-Term Outcomes Assessment of Urethral Prostatic Lift (UroLift) as a Minimally Invasive Treatment for Benign Prostatic Hyperplasia in a Tertiary Care Centre.

Benign prostatic hyperplasia (BPH) is the enlargement and overgrowth of the prostate leading to the compression of the urethra and resulting in obstruction to the outflow of urine. Prostatic urethral lift (UroLift) is a budding minimally invasive technique that utilises mechanical manipulation of the prostate tissue so that the urethra is free from compression, thereby creating a channel for the outflow of urine. The aim of the audit was to assess the short-to medium-term outcomes in our centre in terms of improvement in symptoms, quality of life (QoL) and complication rates. A retrospective observational study was employed. All patients who had UroLift procedure between December 2021 and December 2022 were included. Sixty-four patients were found for the chosen period. Age ranged between 48 and 91 with a mean age of 73. The average prostate size was 48.63 g (31-50 g). Of the patients,64% (n=41) had the procedure performed under general anaesthesia, whilst the rest had either regional or local anaesthesia or entonox. Two to eight clips were used per patient, with four being the median number of clips. Furthermore, 53.13% (n=34) had a catheter post-procedure, with 52.94% (n=18) of these achieving trial without catheter (TWOC) in less than seven days. Of the patients, 67.18% (n=43) had no complications, 7.8% (n=5) went into acute urinary retention requiring short-term catheterisation, 1.56% (n=1) had bleeding requiring blood transfusion and 6.25% (n=4) had infection. Overall, 17.18% (n=11) had failure of procedure requiring other forms of intervention for BPH at two years post-operatively. The median improvement in post-void residual scan and quality of life (QoL) scores were 58 mL and 1.5, respectively. Although transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for BPH, UroLift offers a less minimally invasive approach with better short-term recovery, preservation of sexual function and low complication profile. The failure rate from UroLift from previous studies falls within the range of 7%-22%, and the figures attained in our centre are comparable to these.

Robot-assisted simple prostatectomy for men with benign prostatic hyperplasia and bothersome LUTS-a retrospective cohort study.

BPH is a common urological pathology that affects 2480 per 100,000 men worldwide. With a rising population and increased age expectancy, the prevalence of benign prostatic hyperplasia (BPH) is increasing (Awedew et al. in Lancet Healthy Longev 3(11), 2022). There are many surgical management options for BPH with LUTS, including open simple prostatectomy (OSP), holmium laser enucleation of the prostate (HoLEP), transurethral resection of prostate (TURP), and transurethral electro vaporization of the prostate (TUVP) (Cho et al. in Int Neurourol J 24(1), 2020). However, these options often have a steep learning curve and increasing complexity with larger prostates. Robot-assisted simple prostatectomy (RASP) offers an alternative approach for large and very large glands for those already trained in robotic-assisted radical prostatectomy (RARP), particularly as robotic surgery continues to increase in popularity and is steadily becoming the standard of care in the management of prostate disease (Madersbacher et al. in Gerontology 65(5), 2019). The aim of this study was to demonstrate the surgical outcomes for men undergoing RASP for bothersome LUTs and/or acute urinary retention (AUR) secondary to BPH. A retrospective study was performed which included 105 patients who underwent RASP for the treatment of BPH causing lower urinary tract symptoms or acute urinary retention. This study reviews the pre-operative, (age, PSA, weight, prostate size) operative (duration, histology, estimated blood loss and hospital length of stay) and post-operative (duration of indwelling catheter, trial of void outcome, complications and post-operative PSA) outcomes, to evaluate the effectiveness of RASP for the management of BPH with LUTS. Data were analyzed using standard descriptive measures and multivariate logistic regression for comparison of continuous variables, significance was set to a CI of 95%. The median age of patients was 75years (IQR 70-78) with a median prostate size of 135.5cc (IQR 112.25-162.25). Patient demographic and pre-operative LUTS assessments are summarized in Table1. Median operative time was 60min (IQR 50-80), estimated blood loss was 350ml (IQR 200-563), specimen weight was 98.5g (IQR 69.5-120). Prostate size on imaging directly impacted operative duration (CI 0.07-0.2, p = < 0.001). Eleven (10.5%) of the patients involved in the review had a post-operative complication, two (1.9%) considered major complications Clavien-Dindo grade ≥ 3. There was a statistically increased risk of complications associated with advanced age and prostate size (p = 0.043 and p = 0.001). This study, although limited by its retrospective nature, demonstrates the safety and utility of robotic simple prostatectomy in the context of large and very large prostate volumes. In particular, it offers a safe alternative for men with large prostates who otherwise may not be suitable for endoscopic management. Further prospective and randomized control trials are needed to reinforce the efficacy of RASP to assess its functional and cost effectiveness long term.

Single-port transvesical simple prostatectomy for the surgical treatment of benign prostatic hyperplasia: functional and continence outcomes.

Robot-Assisted Simple Prostatectomy (RASP) is recommended for the treatment of large prostate glands. The introduction of the Single-Port (SP) platform in 2018 has enabled transvesical approach to SP-RASP with promising outcomes. Our aim was to describe the functional and urinary continence outcomes of SP-RASP. Clinical and surgical data from all consecutive patients who underwent transvesical SP-RASP between February 2020 and March 2024 were collected in a prospectively maintained institutional dataset and retrospectively analyzed. All procedures were performed using the da Vinci SP platform without any conversions to open surgery. Postoperative outcomes were gathered and analyzed, with a particular focus on the incidence of urinary incontinence (UI) and the time to continence recovery. Overall, 89 patients underwent SP-RASP, with a median prostate size of 110 grams (90-171.5) and a median PSA level of 5.5 mg/dl (2.77-10.93). All patients were on at least one prostate medication prior to surgery. Preoperative evaluations showed a median International Prostate Symptoms Score (IPSS) of 23 (20-27), Quality of Life (QoL) of 4 (3-5), and Post-voiding Residual (PVR) of 153 ml (60-400). The median operative time was 180 min (164-200), with a median estimated blood loss of 100 ml (30-180). Postoperatively, no patients required continuous bladder irrigation. The median postoperative opioid intake was 6.5 morphine equivalents (0-10), with over 78% not requiring narcotics after discharge. Overall, 77.5% were same day discharged. No Clavien-Dindo > 2 complications were recorded. The median follow-up time was 18 (7-35) months. At the last postoperative urological evaluation, the median IPSS was 5 (3-7), QoL was 1 (0-2), and PVR was 10 ml (0-25). Only 4 patients (4.5%) experienced UI postoperatively, and all were continent within 3 months. The UI incidence rate and functional outcomes of SP-RASP are very encouraging, likely due to precise adenoma and urethra dissection and bladder neck reconstruction. This approach also allows for same-day discharge.

Do 5-Alpha Reductase Inhibitors Influence the Features of Suspicious Lesions on Magnetic Resonance Imaging and Targeted Biopsy Results for Prostate Cancer Diagnosis?

5-alpha reductase inhibitors (5-ARIs) change hormonal pathways and reduce prostate size. We evaluated the effects of 5-ARIs on prostatic multiparametric magnetic resonance imaging (mpMRI) suspicious findings and in the identification of prostate cancer using targeted biopsies. We conducted a retrospective study including 600 consecutive patients who, between 2017 and 2021, underwent combined transperineal fusion biopsies. Primary outcomes were Prostate Imaging Reporting and Data System version 2 (PIRADS v2) scores and the identification of clinically significant prostate cancer from suspicious lesions (targeted CSPC). Outcomes were compared between patients treated with 5-ARIs for a minimum of 6 months and the other patients. Patients treated with 5-ARIs were older (p < 0.001) with higher rates of previous prostate biopsies (p = 0.004). PIRADS scores were 3, 4, and 5 in 15 (29%), 28 (54%), and 9 (17%) patients among the 5-ARI group and 130 (24%), 308 (56%), and 110 (20%) patients among the others, and the scores were not different between the groups (p = 0.69). The targeted CSPC identification rate among 5-ARI patients was 31%, not different compared to the non-5-ARI group (p = 1). Rates of targeted CSPC for each PIRADS score were not affected by 5-ARI treatment. The 5-ARI was not associated with neither PIRADS ≥ 4 score nor targeted CSPC on logistic regression analyses (OR = 0.76, 95% CI 0.4-1.4 and OR = 1.02, 95% CI 0.5-1.9, respectively). 5-ARI treatment is not associated with PIRADS score alterations or targeted biopsy results. Patients treated by 5-ARIs with suspicious lesions should not be addressed differently during the mpMRI-related diagnostic process.