Therapy For Benign Prostatic Hyperplasia Research Articles

Exploring the potential mechanism of Xiaojin Pill therapy for benign prostatic hyperplasia through metabolomics and gut microbiota analysis.

Xiaojin Pill (XJP) is a traditional Chinese medicine prescribed for treating benign prostatic hyperplasia (BPH). It has been proven to have multiple effects, such as regulating sex hormone levels, exhibiting anti-tumor, anti-inflammatory, analgesic, and anti-platelet aggregation properties, and improving immunity. However, the material basis of XJP's therapeutic effect on BPH and its metabolic process in vivo remains to be clarified. At the same time, many microorganisms that exist in the urogenital tract, including those related to BPH, can also affect the health of the host. Using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), the chemical components of XJP were identified. A BPH model was created through bilateral testicular ablation and injections of testosterone propionate. A comprehensive evaluation of XJP efficacy was conducted using pathological ELISA, TUNEL, and immunohistochemical techniques. In addition, UPLC-MS metabolomics and 16S rRNA sequencing revealed the serum metabolic profile and intestinal microbiota composition. We performed a Spearman correlation coefficient analysis to highlight the interactions between "intestinal microbiota-serum factors" and "intestinal microbiota-metabolites." XJP contains 91 compounds that alleviate pathologies of BPH in rats, decreasing prostate weight, index, and serum levels of Dihydrotestosterone (DHT), Prostate-Specific Antigen (PSA), epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) levels. It inhibits prostatic epithelial cell apoptosis and downregulates Bax, TGF-β1, and IGF-1 proteins in the caspase-3 pathway. Metabolomics studies have revealed 10 upregulated and 10 downregulated metabolites in treated rats, with 5-methylcytosine, uracil, and cytosine enriched in pyrimidine metabolism. L-arginine plays a pivotal role in metabolic pathways encompassing pyrimidine metabolism, arginine biosynthesis, and the mammalian target of rapamycin (mTOR) signaling pathway. 16S rRNA sequencing revealed that XJP optimized the diversity and balance of intestinal flora in BPH rats by decreasing the Bacteroidetes/Firmicutes (B/F) ratio, enhancing the beneficial bacteria, such as Eggerthellaceae, Anaerovoracaceae, and Romboutsia, and suppressing the dysfunctional bacteria, such as Atopobiaceae, Prevotellaceae_NK3B31_group, Dorea, and Frisingicoccus. According to the Spearman correlation coefficient analysis, Lactobacillus was found to be most associated with serum factors, whereas Romboutsia showed the highest correlation with metabolites. This finding suggests that XJP modulates pyrimidine metabolism disorders in BPH rats, a regulation that aligns closely with Romboutsia, Prevotellaceae_NK3B31_group, Lactobacillus, Chujaibacter, and Enterorhabdus, thereby providing valuable biological insights. In summary, these findings indicate that XJP possesses a synergistic anti-BHP effect through its multi-component, multi-target, multi-gut microbiota, and multi-metabolic pathway properties. The effect involves the regulation of sex hormone levels, growth factors, and the anti-epithelial cell apoptosis process. The modulation of specific gut microbiota by the host and the involvement of multiple metabolic pathways are likely one of the significant mechanisms of XJP in treating BPH. Notably, pyrimidine metabolism and the intestinal microbial ecosystem are closely intertwined in this process.

Comparison of Clinical Therapeutic Efficacy between TUPKP and HoLEP for Patients Aged 70 Years and Older with Benign Prostatic Hyperplasia: Retrospective Study.

The occurrence of prostate hyperplasia has increased remarkedly, especially in elderly patients; However, research on which surgical treatment is effective and safe for benign prostatic hyperplasia (BPH) in elderly people over 70 years old is limited. This study aimed to investigate the clinical efficacy and safety of transurethral plasma kinetic prostatectomy (TUPKP) and holmium laser enucleation of prostate (HoLEP) as a therapy for benign prostatic hyperplasia (BPH) in the elderly. A total of 148 patients with BPH admitted from December 2022 to December 2023 were chosen and divided into HoLEP (n = 74) and TUPKP (n = 74) groups according to the surgical operation. Perioperative related indexes, preoperative and postoperative international prostate symptom scores and life quality scores were compared between the two groups. The postoperative complications were also counted for the two groups. The HoLEP group had lower intraoperative bleeding, mean operative time, catheter indwelling time and hospital stays than the TUPKP group (p < 0.001). Before treatment, no significant difference in prostate symptom scores was found between the two groups (p > 0.05). After treatment, the prostate symptom scores in the HoLEP group were significantly lower than those in the TUPKP group (p < 0.001). However, the maximum urinary flow rate was significantly higher (p < 0.001) and the residual urine volume was significantly lower (p < 0.001) in the HoLEP group than in the TUPKP group after operation. The complication rate in the TUPKP group was 25.66%, which was significantly higher than the 9.46% in the HoLEP group (p < 0.05). The life quality scores of the HoLEP group were higher than those of the TUPKP group (p < 0.001). HoLEP for BPH therapy is effective and safe with low incidence of postoperative complications.

Clinical Effects of Oral Supplementation of Gamma-Cyclodextrin Curcumin Complex in Male Patients with Moderate-To-Severe Benign Prostatic Hyperplasia-Related Lower Urinary Tract Symptoms

Introduction: Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms (LUTSs) in males. Curcumin exhibits anti-inflammatory and anti-tumor properties which may be effective for BPH. This multi-arm observational study evaluated the real-world efficacy of QURMIN^® (Gamma-cyclodextrin-curcumin Complex-CAVACURMIN^®) as single or combination therapy for BPH. Methods: Men with moderate-severe LUTS/BPH, receiving a 6-month supplementation with QURMIN^® alone or in combination with BPH-specific medication were propensity score matched with patients not taking curcumin and then divided into subgroups based on concomitant baseline treatment. Cohorts were compared in the 6-month variation of IPSS, quality of life (IPSS-QoL), Benign Prostatic Hyperplasia Impact Index (BII) and uroflowmetry parameters. Curcumin tolerability was evaluated in terms of discontinuations and adverse effects. Results: The 1:1 propensity score matching resulted in a treatment-naïve (n = 152), an alpha-blocker only (AB) (n = 138) and AB + 5-alpha reductase inhibitors (5-ARIs) (n = 78) subgroup. After 6 months, drug-naïve patients taking curcumin reported significant improvement in IPSS-storage (−3.9, p < 0.001), IPSS-voiding (−2.0, p = 0.011), IPSS-total (−5.9, p < 0.001), IPSS-QoL (−3.9, p < 0.001), BII (−2.0, p < 0.001), Q_max (+3.1 mL/s, p < 0.001), Q_mean (+1.9 mL/s, p = 0.005), post-void residual volume (−7.7 mL, p < 0.001), and PSA (−0.3 ng/mL, p = 0.003), compared to controls. Patients taking ABs and curcumin showed improvement in IPSS-storage (−2.7, p < 0.001), IPSS-voiding (−1.3, p = 0.033), IPSS-total (−3.5, p < 0.001), IPSS-QoL (−1.1, p = 0.004), BII (−1.7, p = 0.006), Q_max (+1.0 mL/s, p = 0.006), and PSA (−0.2 ng/mL, p = 0.01). Patients taking curcumin and AB + 5-ARI showed improvement in IPSS-storage (−1.3, p = 0.007), IPSS-total (−1.6, p = 0.034), IPSS-QoL (−1.1, p < 0.001), and BII (−2.0, p < 0.001). No adverse reactions were reported for curcumin supplementation. Conclusion: QURMIN^® (CAVACURMIN^®) led to significant improvements in symptom burden, uroflow parameters, and QoL, without significant additional side effects, thus proving to be a potential new treatment for BPH, either as a single therapy or in addition to standard treatment.

Exploring the effects and mechanism of peony pollen in treating benign prostatic hyperplasia

Paeonia suffruticosa is widely cultivated globally due to its medicinal and ornamental value. Peony pollen (PP) is commonly used in Chinese folk medicine to make tea to treat benign prostatic hyperplasia (BPH), but its molecular mechanism against BPH is yet to be comprehended. The objective of this research was to experimentally verify the effect of PP in the treatment of BPH and to preliminarily reveal its mechanism of action on BPH using network pharmacology methods. The results revealed that PP could decrease prostate volume and prostate index, serum testosterone (T), dihydrotestosterone (DHT), and estradiol (E2) levels. Moreover, it could improve prostate tissue structure in BPH model animals as well. Additionally, database searches and disease target matching revealed 81 compounds in PP. Of these, 3, 7, 8, 2′-tetrahydroxyflavone, Chrysin, Wogonin, Limocitrin, and Sexangularetin were the top five compounds associated with the therapeutic effects of BPH. Furthermore, 177 therapeutic targets for BPH were retrieved from databases of Swiss Target, DisGeNET, Drugbank, Genecards, OMIM, TTD, and Uniprot. In contrast, core targets AKT1, EGFR, IL6, TNF, and VEGFA were obtained by PPI network diagram. Molecular docking also showed that the main efficacy components and potential core targets in PP had good binding capacity. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomics (KEGG) analysis established that the effect of PP in BPH therapy was mainly through regulating the expression levels of protein kinase B on phosphatidylinositol 3-kinase and phosphatidylinositol 3-kinase-protein kinase B pathways. Additionally, Western blot experiments also exhibited a significant elevation in the activated PI3K and AKT proteins in the model (Mod) group relative to the control (Con) group, and the expression of these activated proteins was significantly reduced after PP administration. In summary, this research provides a scientific basis for employing PP to treat BPH, preliminarily reveals its mechanism of action and potential targets, and lays the foundation for further research and development.

Effect of TNF-α Inhibitor Therapy on Growth of the Prostate Gland

BackgroundInflammation has been linked to the development of benign prostatic hyperplasia (BPH). SRD5A2 is a pivotal enzyme in the development and growth of the prostate gland and a critical target for BPH therapy. TNF-α regulates epigenetic changes in SRD5A2, leading to suppression of SRD5A2 gene and protein expression. It is unknown whether TNF-α inhibitor therapy affects prostate growth. ObjectiveTo evaluate the effect of TNF-α inhibitor therapy on prostate growth via analysis of measurements on serial pelvic imaging scans. Design, setting, and participantsIn this retrospective cohort study, we analyzed serial pelvic cross-sectional imaging (magnetic resonance imaging or computed tomography scans) for men aged ≥18 yr receiving TNF-α inhibitors. Our inclusion/exclusion criteria yielded a treatment cohort of 99 men. An age-matched cohort was constructed with the same inclusion/exclusion criteria but without TNF-α therapy (n = 99). Outcome measurements and statistical analysisProstate growth on serial pelvic cross-sectional imaging was the primary outcome measure. Results and limitationsThere was no significant difference in total prostate volume (TPV) at baseline between the two groups. The TNF-α treatment group had a lower mean TPV on follow-up (26.21 ± 9.43 vs 32.71 ± 18.89 cm3; p = 0.002) and a lower median prostate growth rate (−0.01 vs 0.68 cm3/yr; p = 0.001). A multivariable linear regression model adjusted for age, race, initial TPV, and body mass index also revealed a significantly lower growth rate for men in the treatment group. ConclusionTNF-α inhibitor use was negatively correlated with the prostate growth rate, suggesting that inflammatory mediators regulate prostate growth. Patient summaryWe examined prostate growth rates in men taking TNF-α inhibitors and found that these drugs have a shrinking effect on the prostate. We conclude that TNF-α inhibitors may impede prostate growth.

Selenium in combination with a tomato lipid extract as a therapy for benign prostatic hyperplasia and its alterations in rats with induced BPH.

Benign prostatic hyperplasia (BPH) is the most common adenoma in old men. Tomatoes are a rich source of bioactive compounds that, as well as selenium (Se), possess antioxidant and antiproliferative activity. The aim was to evaluate the therapeutic effect of Se in combination with a tomato extract in aged rats with BPH. Aged male Wistar rats were divided in the following groups (n = 10 rats/group): Control (C), BPH, BPH + Finasteride (BPH + F), BPH + Tomato Lipidic Extract (BPH + E), BPH + Selenium (BPH + S) and BPH plus E plus S (BPH + E + S). After 4 weeks of treatment, prostate weight, diuresis, antioxidants enzymes, prooxidants and inflammatory markers, growth factors and androgens were determined. BPH + E + S reduced prostate weight by 59.29% and inhibited growth by 99.35% compared to BPH + F which only decreased weight and inhibited growth by 15.31% and 57.54%, respectively. Prooxidant markers were higher with BPH + F (49.4% higher vs. BPH), but BPH + E + S decreased these markers (94.27% vs. BPH) and increased antioxidant activity. Finally, diuresis was higher with the BPH + E + S combination and markers of inflammation and growth factors were significantly lower with respect to BPH + F. Our findings provide a beneficial and protective therapeutic option of E + S directed against androgens, oxidative stress and inflammation that regulates cell proliferation in the prostate gland.

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

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

Ethnobotanical Study of Plants Used in the Management of Benign Prostate Hyperplasia in Ilorin, Nigeria

Background: Benign Prostate Hyperplasia (BPH) is a prevalent illness in older men. It is a condition where the prostate becomes enlarged and blocks the ease of urine passage out of the bladder. Around 50% of the male population develops symptoms of BPH around 51- 60 years of age. Current therapeutic management options come with undesirable side effects like weight gain, dizziness, and impotence, hence, the need to source for safer alternatives initiated by the acquisition, recording, and preservation of traditional knowledge of medicinal plants.&#x0D; Objective: This study aims to preserve indigenous knowledge by documenting medicinal herbs in use as therapy for BPH.&#x0D; Materials &amp; method: Ethnobotanical survey was carried out in the study areas through interviews using a semistructured questionnaire. Respondents included elderly members of the communities, herbalists, and practitioners of traditional medicine. Quantitative ethnobotany index (Use value index) and descriptive statistics were used to analyse data.&#x0D; Results: 50 respondents were interviewed, 64% were Herb sellers, 22% TMPs, Others 14%. 37 plants belonging to 24 plant families were mentioned in the survey. Methods of preparation of recipes mentioned includes: maceration (37%), decoctions (52%), juice (7%), infusions and paste/powder (4%). Method of administration were majorly oral route. The plant family Fabaceae (19%) had the highest representation. This was followed by the families Annonaceae (8%), Euphorbiaceae (6%), Curcubitaceae, Menispermaceae, Combretaceae, Apocynaceae and Rutaceae with 5% each. Other plant families represented 42% of the total number of plants mentioned.&#x0D; Conclusion: The study areas are endowed with abundant flora which serves as a repository for researchers in the quest to develop less toxic drugs with little or no side-effect for the management of BPH

Risk Factors for Persistent Lower Urinary Tract Symptoms 1 Month Following Convective Water Vapor Thermal Therapy (CWVTT-Rezum)

To investigate the incidence and risk factors of persistent lower urinary tract symptoms (LUTS) 1 month and later following convective water vapor thermal therapy (CWVTT) in men with LUTS secondary to benign prostatic hyperplasia (BPH). Patients who underwent CWVTT from 11/2018-5/2021 at a single institution were eligible for inclusion and retrospectively identified. Pertinent patient, operative, and outcomes data were extracted. The primary outcome was clinically significant LUTS improvement at 4 weeks following CWVTT. Persistent LUTS was defined as failure to reach a minimally clinical important difference of 25% reduction on International Prostate Symptom Score at 4 weeks. One hundred nine patients qualified. Fifty percent of patients experienced persistent LUTS at 1 month. Eighty-two percent of men ultimately reached the minimally clinical important difference. For each additional month following CWVTT, the odds of achieving clinically significant LUTS improved by 9% (Odds ratio (OR)=0.91, P=.0033). Bladder outlet obstruction index and prior surgical BPH therapy were associated with persistent LUTS on multivariate logistic regression. Every 10-unit increase in Bladder outlet obstruction index noted at baseline was associated with a 15% increased likelihood of achieving minimally clinical important difference in LUTS at 4 weeks following CWVTT (OR=0.85, P=.01). Patients receiving prior surgical BPH therapy were 3.5 times more likely to experience persistent LUTS at 1 month (OR=3.47, P=.01). Fifty percent of men experienced persistent LUTS 1 month following CWVTT. However, LUTS improved with time and the majority of men ultimately achieved clinically significant LUTS improvement. A lower baseline Bladder outlet obstruction index and prior BPH procedures are risk factors for persistent LUTS following CWVTT.

Adoption and Outcomes of Holmium Laser Enucleation of the Prostate in the United States

To investigate the utilization of holmium laser enucleation of the prostate (HoLEP) using a large real-world cohort. We compare the safety, readmission, and retreatment rates of HoLEP to other widely used endoscopic surgical interventions for benign prostatic hyperplasia (BPH) including transurethral resection of the prostate (TURP), photoselective vaporization of the prostate, and prostatic urethral lift. Men who underwent endoscopic treatments for BPH from 2000 to 2019 were identified in the Premier Healthcare Database (n=218,793). We compared the relative proportion of each procedure performed and annual physician volume data to identify trends in adoption and utilization. Readmission and retreatment rates were determined at both 30- and 90-dayspostoperation. Multivariable logistic regression was used to assess the association between procedure type and outcomes. HoLEP accounted for 3.2% (n=6967) of all the BPH procedures performed between 2000 and 2019 and increased from 1.1% of the procedures in 2008 to 4% in 2019. Patients undergoing HoLEP had lower odds of 90-days readmission compared to TURP (Odds ratio (OR) 0.87, p=0.025). HoLEP had similar odds of retreatment compared to TURP at both 1-year (OR 0.96, p=0.7) and 2-years (OR 0.98, p=0.9), while patients undergoing photoselective vaporization of the prostate and prostatic urethral lift were more likely to retreat within 2-years (OR 1.20, P<0.001; OR 1.87, P<0.001). HoLEP is a safe therapy for BPH with lower readmission and comparable retreatment rates to the gold standard TURP. Despite this, the utilization of HoLEP has lagged behind other endoscopic procedures and remains low.

In Vivo and in Silico Assessment of Ameliorative Effects of Xylopia aethiopica on Testosterone Propionate-Induced Benign Prostatic Hyperplasia

Abstract Xylopia aethiopica (XAE) is a commonly used herbal medicine and contains rich active ingredients for a variety of biological activities. The study aimed to explore the role of XAE in the management of benign prostatic hyperplasia (BPH). In the study, testosterone propionate-induced BPH in albino rats was established and treated with different concentrations of ethanol extract of XAE leaf. After treatment, the rats were sacrificed, and the body and prostate weights were recorded. The prostate-specific antigen (PSA) and acid phosphatase (ACP) levels in the blood samples were also determined. Gas chromatography-mass spectrometry was conducted to assess the active chemical compounds. Docking analysis was performed to screen chemical compounds by evaluating their binding affinity with two pro-BPH protein targets (cellular prostatic ACP and PSA). Our data showed the presence of 44 chemical compounds in XAE leaf extract. The body and prostate weights, as well as the levels of PSA and ACP, were significantly increased in BPH induction, and the changing trend was significantly reversed by additional XAE treatment. Interestingly, PSA and ACP levels in XAE-treated groups were reduced to almost the same levels as those in the healthy control. Docking analysis identified four top-posed compounds: β-amyrin, α-amyrin, α-amyrenone, and lupenone with stronger binding energies to prostatic ACP being −9.8, −8.3, −8.4, and −8.6, respectively, compared with the standard drug finasteride (−8.3). Furthermore, the two-dimensional analysis revealed strong interactions through hydrogen bonding, covalent interactions, and several van der Waal forces between the lead compounds and the target proteins. Notably, there was a recurrence interaction between similar residues Asn-1062, Lys-1250, Lys-1059, and Phe-1060 on the protein targets and the lead compounds. The study first revealed the role of XAE in BPH therapy and will help in drug design based on the lead compounds discovered in this work.

Rezum: a novel transurethral water vapor therapy for benign prostatic hyperplasia

Rezum: a novel transurethral water vapor therapy for benign prostatic hyperplasia

Comparative effects of finasteride and laser-irradiated silver nanoparticles on testicular function and histology in testosterone induced benign prostatic hyperplasia in rats

AimsThe objective of this study was to compare the effects of finasteride, a medication used to treat benign prostatic hyperplasia (BPH), and laser irradiated silver nanoparticles (AgNPs), a potential candidate for BPH therapy (Sanchez-Salas, 2017; Marghani et al., 2022) [1,2], on the sex hormone profiles, sperm quality, steroidogenesis, testicular oxidative stress, and histomorphology changes in BPH rats. Materials and methodsBPH was induced in male Sprague-Dawley (SD) rats via intramuscular (i.m.) injection of 5 mg/kg BW testosterone propionate (TP) for 14 days. Once the BPH model was induced, rats were divided into four groups (n = 6) as follows: the control group; the BPH group; the BPH/Fina group, which received 5 mg/kg BW finasteride by oral gavage daily for 14 days; and the BPH/AgNPs group, which received a daily intraperitoneal (i.p.) injection of 50 mg/kg BW AgNPs, followed by 5min of exposure to a 532 nm NIR laser in the prostatic area for the constitutive 14 days. Key findingsOn day 14, the BPH rats had a significant increase in prostate specific antigen (PSA), dihydrotestosterone, and prostate weights, while testicular weights and sperm quality were significantly lower than in the control rats. On day 28, laser irradiated AgNps treated BPH rats showed improved sex hormone balance, testicular weights, sperm quality, steroidogenesis, and an ameliorative effect on testicular histopathology compared to finasteride. SignificanceSurprisingly, these findings suggest that laser irradiated AgNPs can be used as an alternative therapy to finasteride for the treatment of BPH without causing negative effects on the testes.

Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation.

Benign prostatic hyperplasia (BPH) is one of the most common diseases affecting men and can present with bothersome lower urinary tract symptoms (LUTS). Historically, transurethral resection of the prostate (TURP) has been considered the gold standard in the treatment of LUTS due to BPH. However, TURP and other traditional options for the surgical management of LUTS secondary to BPH are associated with high rates of sexual dysfunction. In the past decade, several novel technologies, including Aquablation therapy, convective water vapor therapy (Rezum), and transperineal prostate laser ablation (TPLA), have demonstrated promising evidence to be safe and effective while preserving sexual function. In this review, we discuss three ablative minimally invasive surgeries: Aquablation, Rezum, and TPLA. We review their techniques, safety, as well as perioperative and functional outcomes. We go into further detail regarding sexual function after these ablative minimally invasive surgical therapies. Aquablation is a surgeon-guided, robot-executed, heat-free ablative waterjet procedure with sustained functional outcomes at 5 years while having no effect on sexual activity. Rezum is an innovative office-based, minimally invasive surgical option for BPH that delivers convective water vapor energy into prostate adenoma to ablate obstructing tissue. Rezum leads to significant improvements in Qmax, IPSS while preserving sexual function. TPLA is another office-based technology which uses a diode laser source to produce thermoablation. It leads to improvement in Qmax, IPSS, and QoL while preserving ejaculatory function. Overall, ablative minimally invasive surgical therapies have demonstrated excellent safety and efficacy profiles while preserving sexual function. These modalities should be discussed with patients to ensure informed and shared decision-making. Ablative minimally invasive surgical therapies may be particularly interesting to patients who value the preservation of their sexual function.

Change in Prostate Volume and Symptom Improvement in Men Treated With Rezūm Water Vapor Therapy

To evaluate the change in prostate volume (PV) and relationship to improvement in urinary symptom scores following Rezūm therapy. Quality of life outcomes and PV were assessed at baseline and 12months postprocedure. Percent change from baseline in outcomes and PV were calculated, as was the number of Rezum injection to baseline PV ratio. Association between total number of injections and changes in outcomes and PV were evaluated using linear regression models. A total of 49 men (mean age=67.8; standard deviation=9.4) underwent the procedure between April 2019 and September 2020, with a median baseline PV of 71.5 cc (range 24-150) and median number of vapor injections of 11.0 (range 4-21). At 12months, the median percent change in PV was -34.0% (interquartile range: -49.2%, -16.7%), with 45/49 (91.8%) patients having reduced volume. Among the 45 patients with reduced volume at 12months, every 10% increase in volume reduction was associated with a 7.5% (95% confidence interval, 1.4%-13.6%; P=.02) improvement in the International Prostate Symptom Score. There was no significant association between total number of injections or injection to baseline volume ratio and change in PV. In this cohort of men treated with Rezūm therapy for benign prostatic hyperplasia, it was demonstrated that there is a correlation between greater PV reduction and greater symptomatic improvement. This study showed no association between more injections or the ratio of injections to PV changes, refuting the claim that more injections are better.

Six novel minimally invasive therapies for benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms in men. When drug treatment is ineffective or conventional surgery is not suitable, novel minimally invasive therapies can be considered. These include prostatic urethral lift, prostatic artery embolisation, water vapor thermal therapy, Aquablation-image guided robotic waterjet ablation, temporary implantable nitinol device and prostatic stents. These novel therapies can be performed in outpatient setting under local anesthesia, with shorter operative and recovery times, and better protection of ejaculatory function and erectile function. General conditions of the patient and advantages and disadvantages of the each of these therapies should be fully considered to make individualized plans.

MP76-12 PROSTATIC URETHRAL LIFT EFFICACY IN PATIENTS WITH PRIOR BENIGN PROSTATE HYPERTROPHY TREATMENT AND PRIOR RADIATION THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP76-12 PROSTATIC URETHRAL LIFT EFFICACY IN PATIENTS WITH PRIOR BENIGN PROSTATE HYPERTROPHY TREATMENT AND PRIOR RADIATION THERAPY Young Son, Emma Troyer, Ryan Moriarty, Sage Grenz, Maya Sengha, Dayna DeVincentz, Benjamin Fink, and Thomas Mueller Young SonYoung Son More articles by this author , Emma TroyerEmma Troyer More articles by this author , Ryan MoriartyRyan Moriarty More articles by this author , Sage GrenzSage Grenz More articles by this author , Maya SenghaMaya Sengha More articles by this author , Dayna DeVincentzDayna DeVincentz More articles by this author , Benjamin FinkBenjamin Fink More articles by this author , and Thomas MuellerThomas Mueller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms (LUTs) caused by benign prostatic hyperplasia (BPH) in men is one of the most frequently encountered complaints in the urologist's office. Prostatic urethral lift (PUL) has been shown to be an efficacious and a minimally invasive treatment for BPH. There is a paucity of data with salvage PUL in BPH. The aim of the study is to determine the effect of PUL in patients with previously treated BPH and radiation therapy. METHODS: A retrospective chart review was performed on 445 patients between 6/2016 to 5/2022 of a single surgeon’s experience with PUL. Patients were subgrouped into those that had previous transurethral resection of prostate (TURP), transurethral needle ablation (TUNA), PUL, or radiation therapy (external beam radiation or brachytherapy). The previously treated groups were then compared to those undergoing primary PUL (no previous treatment for BPH). Patient demographics, international prostate symptom score (IPSS) and quality of life (QOL) were assessed through 24 months. RESULTS: A total of 444 patients were retrospectively reviewed. The previous prostatic urethral lift group consisted of 8 (1.8%) patients, previous TUNA had 12 (2.7%) patients, previous TURP had 15 (3.3%) patients and the previous radiation group had 14 (3.1%) patients of the total cohort. The previous urolift group were older (80.9 years) and had larger prostate volume (69.9 grams). The previous TURP group had the largest post void residual (PVR) at 276.1ml. The decrease in IPSS was seen in all groups that were noninferior to primary PUL (no prior treatment group). There was statistical significance for IPSS for the prior radiation group compared to primary PUL at 18 months (4.97 vs. 3.0). CONCLUSIONS: Efficacy of PUL has not been well studied in patients with previous prostatic treatments. Our study is one of the largest single surgeon’s experiences with patients with PUL. We show that repeated PUL in patients that had previous PUL, TUNA, TURP, or radiation can be effective. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1095 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Young Son More articles by this author Emma Troyer More articles by this author Ryan Moriarty More articles by this author Sage Grenz More articles by this author Maya Sengha More articles by this author Dayna DeVincentz More articles by this author Benjamin Fink More articles by this author Thomas Mueller More articles by this author Expand All Advertisement PDF downloadLoading ...

MP76-06 WATER VAPOR THERMAL THERAPY FOR BPH: IS LESS MORE?

You have accessJournal of UrologyCME1 Apr 2023MP76-06 WATER VAPOR THERMAL THERAPY FOR BPH: IS LESS MORE? Michelle C. Leach, Vi Nguyen, Clara Cerrato, Mimi V. Nguyen, and Seth K. Bechis Michelle C. LeachMichelle C. Leach More articles by this author , Vi NguyenVi Nguyen More articles by this author , Clara CerratoClara Cerrato More articles by this author , Mimi V. NguyenMimi V. Nguyen More articles by this author , and Seth K. BechisSeth K. Bechis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Water vapor thermal therapy is an effective treatment for lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) but can be associated with short term post-procedural irritative voiding symptoms. We sought to evaluate the effect of a minimal approach of water vapor thermal therapy (Rezum, Boston Scientific, Marlborough, MA, USA), defined as 1 vapor treatment per prostate lobe, on urinary symptoms and quality of life (QOL) compared to patients who received multiple treatments per lobe. METHODS: We performed a single-institution retrospective review of patients who underwent water vapor therapy for the treatment of symptomatic BPH from February 2017 to September 2022. Propensity score matching was utilized to generate patient cohorts based on the number of treatments per lobe (1 per lobe including median lobe if present vs ≥2 per lobe) matched for age, BMI, and pre-operative prostate volume (cc). Primary outcome of interest was post-operative complications and irritative symptoms. Secondary outcomes included differences in International Prostate Symptom Score (IPSS) and QOL sub score at baseline and at 1, 3, 6, and 12 months after the procedure. RESULTS: 146 patients were included in the PSM with 73 patients who received one vapor treatment per lobe and 73 patients receiving 2 or more treatments per lobe. DEMOGRAPHICS TABLE (Table 1a). On MVA, an increasing number of treatments (HR 1.3, p=0.039) and treatment of the median lobe (HR 4.7, p=0.008) were significant risk factors for adverse events after REZUM. On MVA looking at risk of post-op urinary retention, only increasing number of treatments (HR 1.6, p=0.005) was an independent risk factor while use of BPH medications, prostate volume, and median lobe treatment were not (p=0.3-0.72). Patient’s with minimal treatment had improved IPSS total and voiding sub-score at 1 month and non-inferior IPSS scores at 3-, 6-, and 12- month follow-up. CONCLUSIONS: Minimal Rezum treatment approach with a single water vapor injection per lobe is a safe and effective option for patients undergoing long-term treatment for BPH and is associated with improved postoperative complications and irritative voiding symptoms. Further studies are needed to investigate the effect of this minimal approach on longer-term outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1092 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelle C. Leach More articles by this author Vi Nguyen More articles by this author Clara Cerrato More articles by this author Mimi V. Nguyen More articles by this author Seth K. Bechis More articles by this author Expand All Advertisement PDF downloadLoading ...

MP59-10 ADOPTION, SAFETY, AND EFFICACY OF HoLEP FOR BENIGN PROSTATIC HYPERPLASIA IN THE UNITED STATES

You have accessJournal of UrologyCME1 Apr 2023MP59-10 ADOPTION, SAFETY, AND EFFICACY OF HoLEP FOR BENIGN PROSTATIC HYPERPLASIA IN THE UNITED STATES Ilon Weinstein, Camilo Arenas-Gallo, Xian Wu, Danly Omil-Lima, Aaron Brant, Bashir Al Hussein Al Awamlh, Christopher Gaffney, Irina Jaeger, and Jonathan Shoag Ilon WeinsteinIlon Weinstein More articles by this author , Camilo Arenas-GalloCamilo Arenas-Gallo More articles by this author , Xian WuXian Wu More articles by this author , Danly Omil-LimaDanly Omil-Lima More articles by this author , Aaron BrantAaron Brant More articles by this author , Bashir Al Hussein Al AwamlhBashir Al Hussein Al Awamlh More articles by this author , Christopher GaffneyChristopher Gaffney More articles by this author , Irina JaegerIrina Jaeger More articles by this author , and Jonathan ShoagJonathan Shoag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) was developed as a more efficient method of surgically managing benign prostatic hyperplasia (BPH) than the gold standard transurethral resection of the prostate (TURP). While institutional studies have demonstrated HoLEP to have comparable efficacy and reduced peri-operative morbidity compared to TURP, little is known of its adoption, safety, and efficacy in the community. We compare readmission and retreatment rates of HoLEP to other widely used endoscopic procedures for BPH including TURP, photoreceptive vaporization of the prostate (PVP), and Urolift. METHODS: Men who underwent endoscopic treatments for BPH from 2000-2019 were identified in the service-level, hospital-based, all-payer claims Premier Healthcare Database (n=218,793). We compared the relative proportion of each procedure performed and annual physician volume data to identify trends in adoption and utilization. Readmission and retreatment rates were determined at both 30- and 90- days post-operation. Multivariable logistic regression was used to assess association between procedure type and outcomes. RESULTS: HoLEP accounted for 3.2% (n=6,967) of all BPH procedures performed between 2000 and 2019 and increased from 1.1% of procedures in 2008 to 4% in 2019. From 2008-2019 the mean annual number of HoLEP cases per physician increased from 2.03 to 7.23. Patients receiving HoLEP demonstrated lower odds of 90-day readmission compared to TURP (OR 0.87, p=0.025). HoLEP demonstrated similar odds of retreatment compared to TURP at both 1-year (OR 0.96, p=0.7) and 2-years (OR 0.98, p=0.9), while patients undergoing PVP and Urolift were more likely to be retreated within 2-years (OR 1.20, p<0.001; OR 1.87, p<0.001). CONCLUSIONS: HoLEP remains a safe therapy for BPH with lower readmission and comparable retreatment rates to the gold standard TURP. Despite this, the adoption and utilization of HoLEP has lagged behind other endoscopic procedures like TURP, Urolift, and PVP over the past two decades. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e811 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ilon Weinstein More articles by this author Camilo Arenas-Gallo More articles by this author Xian Wu More articles by this author Danly Omil-Lima More articles by this author Aaron Brant More articles by this author Bashir Al Hussein Al Awamlh More articles by this author Christopher Gaffney More articles by this author Irina Jaeger More articles by this author Jonathan Shoag More articles by this author Expand All Advertisement PDF downloadLoading ...

Targeting benign prostate hyperplasia treatments: AR/TGF-β/NOX4 inhibition by apocynin suppresses inflammation and proliferation

IntroductionApocynin (Apo), an NADPH oxidase (NOX) inhibitor, has been widely used to treat various inflammatory diseases. However, the therapeutic effects of Apo on benign prostatic hyperplasia (BPH), a multifactorial disease associated with chronic inflammation and hormone imbalance, remain unknown. ObjectivesThe link between androgen signaling, reactive oxygen species (ROS), and prostate cell proliferation may contribute to the pathogenesis of BPH; therefore, the aim of this study was to identify the specific signaling pathway involved and to demonstrate whether the anti-oxidant Apo plays a role in the prevention and treatment of BPH. MethodsIngenuity pathway analysis and si-RNA transfection were conducted to demonstrate the androgen receptor (AR) and NOX4 linkage in BPH. Pathological markers of BPH were measured by H&E staining, immunoblotting, ELISA, qRT-PCR, and immunofluorescence to examine the effect of Apo. Rats stimulated with testosterone and BPH-1 cells were used as BPH models. ResultsAR and NOX4 network-mediated oxidative stress was upregulated in the BPH model. Next, we examined the effects of Apo on oxidative stress and chronic prostatic inflammation in BPH mouse models. In a testosterone-induced BPH rat model, Apo alleviated pathological prostate enlargement and suppressed androgen/AR signaling. Apo suppressed the upregulation of proinflammatory markers and promoted the expression of anti-oxidant factors. Furthermore, Apo regulated the TGF-β/Glut9/activin pathway and macrophage programming. In BPH-1 cells, Apo suppressed AR-mediated proliferation and upregulation of TGFB and NOX4 expression by alleviating oxidative stress. Apo activated anti-oxidant and anti-inflammatory systems and regulated macrophage polarization in BPH-1 cells. AR knockdown partially abolished the beneficial effects of Apo in prostate cells, indicating AR-dependent effects of Apo. ConclusionIn contrast with existing BPH therapies, Apo may provide a new application for prostatic disease treatment, especially for BPH, by targeting the AR/TGF-β/NOX4 signaling pathway.