Transurethral Resection Research Articles

Male Patient having a Spigelian Hernia, Prince Osman Digna Referral Hospital, Port Sudan City, Red Sea State, Sudan; 2024: A Case Report

Background: Spigelian hernia is a rare type of abdominal hernias; it occurs through a defect in Spigelian aponeurosis of transverse abdominis (Spiegel's fascia). Methods: A 65 years old male, presented to our refer clinic at Prince Osman Digna Referral Hospital; Port Sudan City; Red Sea State; Sudan, on July 2024, complaining of lower abdominal swelling for 2 months without features of obstruction or strangulation; following heavy lifting, obvious during standing and walking, disappear when lying down; and was not associated with gastrointestinal track disturbances. Patient had history of recurrent repaired right inguinal hernia, para-umbilical hernia, and transurethral resection prostatectomy for Benign Prostatic Hyperplasia. No family history of similar conditions. Result: Abdominal examination showed: positive visible cough impulse revealed reducible mass at the left lower abdomen, oval in shape about 15*15cm, without features of peritonism. CT abdomen showed: left lower lateral abdominal wall hernia defect lateral to the rectus abdominis muscle measuring (3*3.7 cm) with hernia sac lie between the external and internal oblique muscles containing bowel loops. Patient diagnosed as Spigelian hernia and planned for mesh hernioplasty. Intra-operative findings revealed: the hernia sac passed through the internal oblique and transverse abdominis muscles, it contained sigmoid colon which released smoothly, sac excised, external oblique aponeurosis sutured by nylon 2, prolene mesh fix onlay, no intraoperative complications. Post-operative course was smooth. Conclusion and recommendations: Spigelian hernia has to be suspected among patients having repeated abdominal hernias. Early diagnosis using CT Abdomen and urgent surgical intervention for such cases were highly recommended.

Preoperative neutrophil-to-lymphocyte ratio (NLR) value as a predictor of recurrence of non-muscle-invasive bladder cancer.

To predict oncological outcomes and select appropriate treatments for non-muscle-invasive bladder cancer (NMIBC), pre-treatment predictors such as neutrophil-to-lymphocyte ratio (NLR) are being used. This study aims to evaluate whether NLR is an independent predictor of disease and disease recurrence in NMIBC patients. In this prospective clinical study, from March 2018 to March 2023, preoperative NLR values were monitored in 99 patients newly diagnosed with NMIBC, who were initially treated with trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical therapy. To evaluate the best NLR cutoff points to predict recurrence, the ROC (receiver operating characteristic) curve and the Youden index were used. The monitoring period was 24 months. With the cutoff value of NLR = 1.73, there is a statistically significant correlation (p = 0.008) between the NLR value and the increased risk of recurrence. Univariate and multivariate Cox regression analyses show the significant prognostic impact of NLR on the recurrence of the disease. The value of NLR > 1.73 is a significant preoperative predictor in risk assessment and will help with proper selection of treatment in the high- and intermediate-risk groups of patients.

Effect of low-dose dexmedetomidine to prolong spinal anesthesia in elderly patients: a prospective randomized controlled study.

Spinal anesthesia for transurethral resection of the prostate (TURP) has a short duration, which poses challenges for postoperative pain management. The present study aimed to investigate the effects of intravenous (IV) dexmedetomidine at a dosage of 0.4µg/kg in prolonging the duration of spinal anesthesia and minimizing postoperative pain in elderly patients undergoing TURP. This prospective randomized controlled trial enrolled 38 patients aged 60-80 years who underwent elective TURP with spinal anesthesia. The patients were randomly assigned to two treatment groups: Group D received IV 0.4µg/kg dexmedetomidine, whereas Group C received IV normal saline after spinal anesthesia administration. The primary outcome was the time to 2-dermatome regression. The 2-dermatome regression time was longer in Group D than in Group C (104.44 ± 16.97min vs. 80.63 ± 15.59min, p < 0.05). The peak sensory block levels were significantly higher in Group D [T7 (T6-T8)] than in Group C [T10 (T7-T10)] (p = 0.017). The incidence of hypotension and bradycardia and postoperative pain at 0, 6, 12, and 24h were not different between two groups. Intravenous dexmedetomidine at a dosage of 0.4µg/kg significantly prolongs the duration of spinal sensory blockade. Although postoperative analgesia was not different, it provided hemodynamic stability without increasing the side effects.

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.

Bilateral urothelial carcinoma of the renal pelvis

Urothelial carcinoma is the 4th most prevalent malignant tumor after prostate (or breast), lung and colorectal cancers. Urothelial carcinoma of the upper urinary tract is quite rare and accounts for 5–10 % of all cases of this type of cancer. Tumors of the renal pelvis are 2 times more common than tumors of the ureter. A clinical case of a 69-year-old patient diagnosed with urothelial carcinoma of the left renal pelvis T2N0M1, stage IV and metastases into the bladder, right renal pelvis is presented. On 08.06.2023, the patient underwent transurethral resection of the bladder tumor, ureteric orifice, nephroureterectomy on the left, retroperitoneal lymphadenectomy. Between 07.2023 and 10.2023, the patient received 6 cycles of chemotherapy according to the following scheme: gemcitabine 1000 mg/m2 intravenously on the 1st and 8th days ++ carboplatin AUC 5 intravenously on the 1st day. Since 11.2023, the patient in receiving maintenance therapy with avelumab.

Metastasis development in non-muscle-invasive bladder cancer.

Non-muscle-invasive bladder cancer (NMIBC) is the most common type of bladder cancer presentation and is characterized by a varying probability of recurrence and progression. Sporadically, patients with NMIBC might also develop tumour metastases without any pathological evidence of muscle-invasive disease within the bladder, a condition known as metastatic NMIBC. In the published literature, this phenomenon is limited to several case reports and small reviews, with few data regarding the possible aetiologies. Several possible factors can be potentially associated with metastatic NMIBC, including tumour understaging, the number of transurethral resection procedures received by the patient, the presence of circulating tumour cells, the modality used for diagnostic cystoscopy and possible gender-associated differences. In this Perspective, our aim was to integrate and report currently available data on this relatively rare entity and provide some potential aetiological explanations.

An Audit on the Safety and Efficiency of Irrigation Fluid Disposal in Urology: Time to Implement Closed Waste Management Systems?

Efficient and safe disposal of irrigation fluid is critical in urological procedures due to high fluid volumes and exposure risks. This audit examines disposal practices using bucket and suction canister systems in a high-volume urology department in the UK and compares the findings with the potential implementation of an automated irrigation waste management system such as the Neptune® 3 (Stryker Corporation,Kalamazoo, Michigan). A retrospective audit of 224 procedures at Cheltenham General Hospital evaluated fluid disposal impacts on staff safety, operating room efficiency, and cost-effectiveness. We found that procedures using high volumes of irrigants, such as transurethral resection of the prostate (TURP) and percutaneous nephrolithotomy (PCNL), are associated with increased risks, including fluid spills, staff exposure to biohazards, and significant use of single-use plastics, resulting in elevated operational costs and frequent procedural interruptions. The Neptune® system proposes significant advantages, such as reducing fluid handling time, staff exposure, and plastic waste. Cost analysis suggests that initial investments in Neptune® would be offset by reduced consumable usage and increased efficiency. These findings support the implementation of closed fluid management systems to improve safety, efficiency, and environmental sustainability in endoscopic urology.

Combined laparoscopic nephroureterectomy with transurethral approach to the ureter in renal tuberculosis treatment

BACKGROUND: Tuberculosis of the genitourinary system is a common cause of organ removal surgeries. Despite the improvement of medical technologies, kidney and urinary tract surgeries for urogenital tuberculosis are traditionally performed using the open method. AIM: To assess the findings of laparoscopic and open combined nephroureterectomy with transurethral resection of the distal ureter in patients with renal tuberculosis. MATERIALS AND METHODS: The findings of 61 nephroureterectomies with transurethral resection of the distal ureter performed for destructive renal tuberculosis were analyzed. Open nephroureterectomy was performed in 31 patients, and laparoscopic approach was used in 30 patients. Patients in both groups were comparable by gender and age. RESULTS: The surgery duration, volume of intraoperative blood loss, rate and severity of postoperative complications were lower in patients who had laparoscopic interventions. When examined 1 month after surgery, patients in both groups showed the improvement of clinical parameters. The following changes were reported: a significant decrease in the nighttime urination rate, a decrease in IPSS scores, and an increase in the functional bladder capacity without significant differences depending on the surgical approach. After the surgery, a significant improvement in the quality of patients’ life was observed. In patients who had laparoscopic surgery, improvements were detected in all the SF-36 questionnaire domains. However, in patients after open surgery with a positive effect on most of assessed parameters no significant improvement of parameters in section “General Physical Health” was found. CONCLUSIONS: Irrespective of the selected approach, combined nephroureterectomy with transurethral resection of the distal ureter is an effective method of surgical treatment of patients with destructive renal tuberculosis. Moreover, the laparoscopic technique has shown a number of significant advantages over open surgery.

Predicting the need for additional intervention in prostate abscess treatment: Insights from a multicenter study and proposal of a Prostate Abscess Complexity Score

Purpose: To evaluate prostate abscess outcomes and identify predictors for additional intervention. Additionally, assess a complexity score for clinical decision-making. Materials and methods: This is a retrospective, multicenter study including 62 consecutively admitted prostate abscess patients. Primary treatment involved antibiotics or a combination with transrectal ultrasound-guided aspiration (TRUS-GA) or transurethral resection of the prostate with abscess deroofing. Outcomes were assessed by comparing resolution with primary treatment to additional intervention. Additional intervention involved escalation to TRUS-GA, repeat TRUS-GA, or transurethral resection of the prostate with abscess deroofing. The sample was further categorized by Prostate Abscess Complexity Score (PACS) into complex and noncomplex. Risk factors, clinical features, abscess characteristics, and reintervention predictors were analyzed using logistic regression and receiver operating characteristic analysis. Results: Sixty-two patients were included, 47 (75.8%) responded well to primary treatment, while 15 (24.2%) needed additional intervention. Risk factors for additional intervention included multifocal abscess (P = 0.005), septa (P = 0.023), bilateral involvement (P = 0.008), abscess diameter ≥3 cm (P = 0.040), and volume ≥20 cc (P ≤ 0.001). The PACS, considering abscess focality, septa, laterality, polarity, abscess diameter, and volume, showed 73% sensitivity and 74% specificity in predicting additional intervention (P = 0.001) with a threshold of ≥6 points to classify as complex. Among complex cases, 80% required additional intervention, compared to 34% in noncomplex cases (P = 0.002). Conclusion: This study highlights personalized treatment for prostate abscess. Identified risk factors (multifocal abscess, septa, bilateral involvement, large abscess diameter, and increased volume) provide insights into predicting the need for additional interventions. The proposed PACS offers a valuable tool for clinical decision-making when ≥6 points are encountered.

Urease-powered nanomotor containing STING agonist for bladder cancer immunotherapy

Most non-muscle invasive bladder cancers have been treated by transurethral resection and following intravesical injection of immunotherapeutic agents. However, the delivery efficiency of therapeutic agents into bladder wall is low due to frequent urination, which leads to the failure of treatment with side effects. Here, we report a urease-powered nanomotor containing the agonist of stimulator of interferon genes (STING) for the efficient activation of immune cells in the bladder wall. After characterization, we perform in vitro motion analysis and assess in vivo swarming behaviors of nanomotors. The intravesical instillation results in the effective penetration and retention of nanomotors in the bladder. In addition, we confirm the anti-tumor effect of nanomotor containing the STING agonist (94.2% of inhibition), with recruitment of CD8+ T cells (11.2-fold compared with PBS) and enhanced anti-tumor immune responses in bladder cancer model in female mice. Furthermore, we demonstrate the better anti-tumor effect of nanomotor containing the STING agonist than those of the gold standard Bacille Calmette-Guerin therapy and the anti-PD-1 inhibitor pembrolizumab in bladder cancer model. Taken together, the urease-powered nanomotor would provide a paradigm as a next-generation platform for bladder cancer immunotherapy.

Observation on the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP) with preservation of the urethral mucosa from the bladder neck to the tip of the prostate for the treatment of benign prostatic hyperplasia.

This study investigates the efficacy and safety of transurethral prostate laser resection (HoLEP) with preservation of the urethral mucosa from the bladder neck to the tip of the prostate for the treatment of benign prostatic hyperplasia (BPH). A retrospective study was conducted on 208 patients with BPH treated at our hospital. In the control group, the urethral mucosa from the bladder neck to the tip of the prostate was not retained during surgery to ensure maximum removal of possible diseased tissue. The urethral mucosa was preserved in the observation group, which was finely separated to avoid injury, in order to protect urinary control function to the greatest extent and reduce postoperative complications. The surgical-related indicators, urinary function, sexual function, quality of life (QOL), and occurrence of postoperative complications were compared between the 2 groups of patients. After the procedure, both groups of patients experienced an increase in maximum flow rate and a decrease in residual urine volume (P < .05). The observation group showed a higher immediate postoperative urinary continence rate of 98.23% compared to 85.26% in the control group (P < .05). After the procedure, both groups of patients exhibited a significant increase in International index of erectile function-5 scores (P < .05). The retrograde ejaculation rates were compared between the 2 groups of patients before the procedure (P > .05). After the procedure, the occurrence rate of retrograde ejaculation decreased in both groups of patients, with the observation group being lower than the control group (P < .05). The International prostate symptom score (IPSS) scores and QOL scores were compared between the 2 groups of patients before and after the procedure (P > .05). After the procedure, both groups of patients showed a decrease in IPSS scores and QOL scores compared to before the procedure (P < .05). The occurrence of complications such as urethral injury, urinary incontinence, urinary retention, and postoperative bleeding was compared between the 2 groups of patients (P > .05). The efficacy and safety of performing HoLEP treatment for BPH patients with preservation of the urethral mucosa from the bladder neck to the tip of the prostate are comparable to those without preservation. However, it can improve immediate urinary continence rate and reduce retrograde ejaculation rate.

Cystoscopy and Transurethral Resection of Bladder Tumors with Stent and Foley Catheter Placement

Cystoscopy and Transurethral Resection of Bladder Tumors with Stent and Foley Catheter Placement

Characteristics and outcomes in bladder Leiomyoma management: a systematic review of case reports and case series from the past 20 years

IntroductionBladder leiomyomas (LM) are uncommon, non-cancerous growths that originate from the smooth muscle cells of the bladder and constitute 0.5% of bladder tumor cases. This review aims to compile existing data and present a summary of bladder leiomyomas’ characteristics, management, and related outcomes.MethodWe conducted systematic review of studies that investigated bladder leiomyoma. Case studies or series describing individuals with bladder leiomyoma who underwent surgery and the outcomes were included. Four databases were used in our literature search, which was carried out until January 2024: PubMed, Proquest, EBSCOHost, and Google Scholar. We utilized MeSH terms such as “leiomyoma,” “urinary bladder,” and looked for synonyms of “bladder leiomyoma” in free text.ResultsA total of 99 studies with 119 patients were included. Most reported bladder leiomyoma cases were female, accounting for 79.0% of all cases. While symptomatic patients primarily presented with lower urinary tract symptoms (LUTS) (59.7%), hematuria (24.4%), acute urine retention (11.8%), and about 16.8% of cases were incidentally detected. Storage-related symptoms were the most common LUTS (37.0%). Different diagnostic techniques were used, frequently combining CT (Computed Tomography), MRI (Magnetic Resonance Imaging), USG (Ultrasonography), and/or cystoscopy. Bladder leiomyomas were commonly found on the left lateral wall (26.9%) and the bladder neck (17.6%). In more than half of the cases (52.1%) the treatment techniques used were transurethral resection (TURBt/TUR). Fifteen out of 119 cases (12.6%) had recurrence or remain symptomatic. Symptomatic symptoms at first presentation and extended location are frequently found among recurrent or symptomatic cases after first management.ConclusionManagement of bladder leiomyoma should focus on the relief of symptoms and recurrence and be personalized based on the tumor characteristics, patient symptoms, and surgeon’s expertise. Further investigation is necessary to fully understand the best course of treatment and long-term results for bladder leiomyomas. In particular, prospective trials with bigger participant pools and meticulously controlled factors should be the main emphasis of this research.

Comprehensive analysis of single-cell and bulk RNA sequencing reveals postoperative progression markers for non-muscle invasive bladder cancer and predicts responses to immunotherapy

BackgroundNon-muscle-invasive bladder cancer (NMIBC) is renowned for its high recurrence, invasiveness, and poor prognosis. Consequently, developing new biomarkers for risk assessment and investigating innovative therapeutic targets postoperative in NMIBC patients are crucial to aid in treatment planning.ApproachesDifferential gene expression analysis was performed using multiple Gene Expression Omnibus (GEO) datasets to identify differentially expressed genes (DEGs) between NMIBC and normal tissue, as well as between NMIBC and muscle-invasive bladder cancer (MIBC). Functional enrichment analysis was conducted based on the DEGs identified. Subsequently, prognosis-related genes were selected using Kaplan–Meier (KM) analysis and Cox regression analysis. The Boruta algorithm was utilized to further screen for core DEGs related to postoperative progression in NMIBC based on the aforementioned prognosis-related genes. Single-cell and clinical correlation studies were performed to verify their expression across various stages of bladder cancer. To investigate the link between core genes and the immune microenvironment, single-sample gene set enrichment analysis (ssGSEA) was utilized, and Receiver Operating Characteristic (ROC) and KM analyses were performed to confirm predictive power for immune therapy outcomes. Machine learning (ML) models were constructed using the DepMap dataset to predict the efficacy of core gene inhibitors in treating bladder cancers. The prognostic performance of the core genes was evaluated using ROC curve analysis. An online prediction tool was developed based on the core genes to provide prognostic predictions. Finally, RT-qPCR, CCK-8, and Transwell assays were used to verify the pro-tumor effects of the GINS2 in bladder cancer.ResultsA total of 70 DEGs were identified, among which 11 prognostic genes were obtained through KM analysis, and an additional 8 prognostic genes were obtained through COX analysis. The Boruta algorithm selected AURKB, GINS2, and UHRF1 as the three core DEGs. Single-cell and clinical variable correlation analyses indicated that the core genes promoted the progression of bladder cancer. The analysis of immune infiltration revealed a strong positive association between the core genes and both activated CD4 T cells and Type 2 helper T cells. Two random forest (RF) models were constructed to effectively predict the treatment effect of bladder cancer after targeted inhibition of AURKB and GINS2. In addition, an online nomogram tool was developed to effectively predict the risk of postoperative progression in NMIBC patients undergoing TURBT. Finally, RT-qPCR, CCK8, and Transwell assays showed that GINS2 promoted the growth and progression of bladder cancer.ConclusionAURKB, GINS2, and UHRF1 have the potential to enhance postoperative management of NMIBC patients undergoing transurethral resection of bladder tumor (TURBT) and can predict immunotherapy response, establishing them as promising therapeutic targets.

Comparison of bipolar radiofrequency thermotherapy and transurethral prostate resection in treatment of benign prostate hyperplasia

Comparison of bipolar radiofrequency thermotherapy and transurethral prostate resection in treatment of benign prostate hyperplasia

The role of MRI in muscle-invasive bladder cancer: an update from the last two years.

Muscle invasive bladder cancer (MIBC) is aggressive and requires radical cystectomy and neoadjuvant therapy, yet over 40% of patients face recurrence. The loss of the bladder also significantly reduces quality of life. Accurate staging, crucial for treatment decisions, is typically done through transurethral resection (TURBT), but inconsistencies in pathology affect diagnosis in 25% of cases. MRI is the most precise imaging method for evaluating local tumor invasiveness. This review discusses recent advances in MRI for staging MIBC and predicting responses to neoadjuvant therapy. Vesical imaging - reporting and data system (VI-RADS) accuracy may improve if combined with ADC maps and tumor contact length, while a bi-parametric MRI approach without contrast could reduce side effects without losing diagnostic precision, though evidence is mixed. VI-RADS shows promise in predicting neoadjuvant therapy responses, and the new nacVI-RADS score is in development. Non-Gaussian diffusion-weighted imaging techniques and machine learning could enhance accuracy but need more integration with mpMRI. VI-RADS may assist in evaluating responses in bladder-sparing regimens. Urodrill, an MRI-guided biopsy, aims to replace diagnostic TURBT but needs more accuracy data. MRI in MIBC is evolving, offering potential for accurate local staging and reduced side effects by avoiding TURBT. Predicting neoadjuvant treatment response could guide personalized treatment and bladder preservation. Larger trials are needed to validate these findings.

Comparing Urethral Stricture Rates Following Bipolar and Monopolar Transurethral Resection of the Prostate: A Retrospective Study

Comparing Urethral Stricture Rates Following Bipolar and Monopolar Transurethral Resection of the Prostate: A Retrospective Study

Factors Contributing to Early Recovery of Urinary Continence Following Radical Prostatectomy: A Narrative Review.

Stress urinary incontinence (SUI) is a common condition in patients following radical prostatectomy (RP), which has a significant impact on all aspects of quality of life and is associated with significant social stigma. The factors that improve urinary incontinence in patients following surgery remain controversial. The aim of our narrative review was to identify and synthesise the latest evidence on pre-, intra- and post-operative factors and predictors that contribute to early continence recovery after RP. In this narrative review, primary resources were identified by searching PubMed, EMBASE and Medline, and secondary resources were collected by cross-referencing citations in the relevant articles. We started our review by searching for systematic reviews of factors and predictors that contribute to early recovery of urinary continence after RP. We then reviewed societal guidelines such as the American Urological Association and European Urological Association guidelines on male urinary incontinence. This review focuses on the pre-, intra and postoperative factors that influence postoperative SUI after RP, as well as highlighting modifications in surgical techniques that lead to early continence recovery. Increasing age, higher BMI, shorter membranous urethral length (MUL), and larger PV are independent prognostic factors for SUI within 3 months after RP. Factors such as modified surgical technique preservation of anatomical structure lead to influence postoperative early continence recovery. SUI after RP is influenced by various factors. These factors include not only anatomical landmarks and patient-related factors such as age, BMI, length of MUL and prostate volume, but also prior transurethral resection or laser enucleation of the prostate, the surgeon's expertise, the surgical approach and NS technique.

Small prostate associated with higher incidence of detrusor underactivity and tendency of combination with bladder stone in patients with bladder outlet obstruction.

Benign prostate hyperplasia is the leading cause of lower urinary tract symptoms due to bladder outlet obstruction (BOO) in elderly male patients. The impact of prostate volume (PV) on clinical and urodynamic characteristics was evaluated in those patients with BOO requiring prostate de-obstruction maneuvers in this study. We retrospectively reviewed the clinical data of 301 patients underwent transurethral resection of prostate due to combination with urinary retention (UR) alone and bladder stone (BS) alone. The present study investigated the differences of subjective symptoms, sonographic parameters, and urodynamic characters and assessed the proportion of UR to BS as well as the incidence of detrusor underactivity (DU) in those patients according to PV. There was not a difference of age, international prostate symptoms scores, post-voiding residual, and peak flow rate (Qmax) among 3 groups (all P > .05), whereas increasing of intravesical prostate protrusion (IPP), bladder wall thick (BWT), detrusor pressure at Qmax, bladder contractility index, bladder outlet obstruction index (BOOI), and quality of life scores with enlargement of PV was found (all P < .05). Correlations between PV and IPP (R = 0.251), Qmax (R = -0.188), post-voiding residual (R = 0.215), BWT (R = 0.170), and quality of life scores (R = 0.165) at large prostate and relationships between BWT and BOOI (R = 0.246) and bladder contractility index (R = 0.239) in moderate prostate as well as IPP and BOOI (R = 0.204) in large prostate were significantly found (all P < .05). Significant higher proportion of UR was found in patients with moderate (18%) and large prostate (47.6%) when compared to that of small prostate (3.7%), whereas higher proportion of BS was found in patients with small prostate (96.7%) compared to that of moderate (82%) and large (52.4%) prostate. Lower incidence of DU was discovered in large prostate (31.9%) compared with small (55.6%) and moderate (47.2%) prostate. BOO patients with small prostate were associated with less severity of BOO but higher incidence of DU and had a tendency of occurrence of BS, which gave a support for the theory that multifactor involved in the formation of BS rather than BOO only.

CLINICOPATHOLOGICAL CORRELATION OF P53 EXPRESSION IN BENIGN PROSTATIC HYPERPLASIA AND PROSTATE ADENOCARCINOMA

Objective: To assess clinicopathological parameters in patients with benign prostatic hyperplasia and prostate adenocarcinoma, and evaluate their correlation with p53 overexpression in these prostatic conditions. Methods: The present ambispective study was conducted in the Department of Pathology in a tertiary care hospital of Northern India from 2022 to 2024. This study included prostatic trucut biopsies, transurethral prostatic resection (TURP) chips, and radical prostatectomy specimens from patients with benign prostatic hyperplasia (BPH) or prostatic adenocarcinoma. Tissue samples were processed, embedded in paraffin, sectioned, and stained with hematoxylin and eosin (H&amp;E) for histopathological evaluation. Immunohistochemical (IHC) analysis was performed to assess p53 expression using the GenomeMe antibody. Data on age, histological type and histological grade were collected. Statistical analysis included Chi-square test was conducted to evaluate associations between p53 overexpression and clinicopathological parameters. Results: The study analyzed 50 cases, revealing significantly higher p53 expression in prostatic adenocarcinoma compared to BPH. The majority of participants were aged between 61-70 years (46%). There were 50% patients with adenocarcinoma, 26% with BPH, 20% with BPH and chronic prostatitis, and 4% with BPH with prostatic intraepithelial neoplasia. There were strong associations between p53 overexpression and specific diagnoses, histological type and histological grade (Gleason scores) in prostate cancer. Conclusion: The study findings suggest that p53 overexpression is closely linked to malignant prostate conditions and could potentially serve as a valuable biomarker for distinguishing between benign and malignant prostatic diseases, as well as predicting tumor aggressiveness.