Search Results (99)

Background and Objectives: While transurethral resection of the prostate remains the gold standard for surgical treatment of benign prostatic hyperplasia, anatomical endoscopic enucleation of the prostate provides a safe, durable, and size-independent alternative. Our study introduces a specific technical innovation, i.e., en bloc bipolar prostate enucleation performed exclusively via sheath-tip mechanical dissection without the use of a dedicated enucleation loop, combined with the mushroom technique and early apical release. Materials and Methods: Between January 2018 and May 2023, 252 patients with prostate volumes > 30 mL and significant lower urinary tract symptoms underwent en bloc bipolar prostate enucleation via the mushroom technique with early apical release. Data were retrospectively evaluated to assess perioperative results, postoperative outcomes, and complications. Results: The median age of the cohort was 70 (65–76) years, with a median prostate volume of 60 (40–88.5) mL. The median operative time was 40 (30–70) min, and the median weight of enucleated tissue was 34 (16.5–60) g. Significant improvements were observed in the International Prostate Symptom score, Quality of Life score, maximum flow rate, average flow rate, and postvoid residual urine at 12 months (p < 0.001). The rate of transient stress urinary incontinence decreased from 19.44% at 1 month to 2.38% at 12 months. Conclusions: En bloc bipolar prostate enucleation using the mushroom technique is a safe and effective treatment for benign prostatic hyperplasia, yielding significant improvements in urinary symptoms and flow rates, with a manageable complication profile. Further multicenter studies are needed to confirm these findings. Full article

Background: Benign Prostatic Hyperplasia (BPH) causes Lower Urinary Tract Symptoms (LUTS), impairing quality of life (QoL). Transurethral Resection of the Prostate (TURP) is the gold-standard surgical treatment for Bladder Outlet Obstruction (BOO), but its effects on Autonomic Nervous System (ANS) function—assessed via Heart Rate Variability (HRV)—remains underexplored. To our knowledge, this is the first study to correlate HRV with specific LUTS domains pre- and post-TURP, establishing HRV as a potential biomarker for BPH management. Methods: In a prospective study, 242 men with BPH underwent TURP (2018–2024). Inclusion required age ≥ 50 years, International Prostate Symptom Score (IPSS) ≥ 8, and BOO evidence. HRV (Standard Deviation of Normal-to-Normal Intervals [SDNN], Low-Frequency/High-Frequency [LF/HF] ratio), IPSS, and QoL were assessed preoperatively and 3 months postoperatively. Paired t-tests, Pearson correlations, and multivariate regression (adjusted for age, Body Mass Index [BMI], prostate volume) were used (p < 0.05). Results: HRV (SDNN) increased from 36.97 ± 22.80 ms to 51.67 ± 27.59 ms (p = 0.032), and LF/HF ratio decreased from 1.63 ± 1.60 to 0.73 ± 0.52 (p = 0.028). IPSS fell from 18.5 ± 6.2 to 8.3 ± 4.1 (p < 0.001), with improved voiding (p = 0.004) and storage (p = 0.002) subscores. QoL improved from 3.5 ± 1.2 to 1.8 ± 0.9 (p = 0.003). HRV correlated inversely with IPSS voiding (r = −0.42, p = 0.012; r = −0.38, p = 0.019 post-TURP) and storage subscores (r = −0.29, p = 0.045). Older patients (≥65 years) and those with larger prostates (≥50 mL) showed greater improvements. Conclusions: TURP enhances LUTS, QoL, and ANS function. HRV’s correlation with LUTS suggests its biomarker potential, with possible cardiovascular benefits. Longitudinal studies are needed. Full article

Background/Objectives: Carbon-ion radiotherapy (CIRT) offers precise dose distribution and enhanced biological effectiveness in localized prostate cancer. However, the safety of CIRT in patients with a history of surgery for benign prostatic hyperplasia (BPH), such as transurethral resection of the prostate (TURP), remains unclear. This study aimed to evaluate the long-term safety and oncological outcomes of CIRT in this population. Methods: A retrospective analysis was conducted in 74 of 3848 patients with prostate cancer and a history of surgery for BPH who underwent CIRT combined with risk-adapted androgen deprivation therapy between 2007 and 2023. Adverse events were assessed using CTCAE v5.0. Biochemical recurrence-free survival was estimated using the Kaplan–Meier method and risk factors for hematuria with multivariate logistic regression and receiver operation characteristic (ROC) analysis. Results: CIRT was generally well-tolerated. Early Grade 2 genitourinary (GU) adverse events occurred in 5.4% of patients, and late-Grade 2 or higher GU events occurred in 8.1%. The cumulative incidence of Grade 2 ≥ GU events remained 10% at 36 months. Compared to holmium laser enucleation of the prostate, a shorter interval between BPH surgery and CIRT initiation and a history of TURP were independently associated with an increased risk of hematuria. Notably, 5-year bRFS was 100% in low- and intermediate-risk groups and 88.6% in the high-risk group. Conclusions: CIRT demonstrates acceptable oncological outcomes and urinary complication rates in patients with prostate cancer and a history of BPH surgery. These findings suggest that CIRT can be a feasible treatment option in this surgically altered population, but careful patient selection, individualized treatment planning, and long-term follow-up are essential. Given the absence of a non-BPH control group, oncological efficacy should be interpreted with caution. Full article

Background: We investigated the predictive role of prostatic morphology on preoperative multiparametric magnetic resonance imaging for post-prostatectomy urinary incontinence. Methods: Patients who underwent robot-assisted radical prostatectomy between February 2018 and October 2021 and who were not previously incontinent, did not undergo radiotherapy, hormone therapy, or transurethral resection of the prostate, and who had a follow-up longer than 12 months were selected. For each patient, a radiology physician evaluated the preoperative magnetic resonance imaging, measuring prostatic and membranous urethral length, classifying prostatic apex according to the Lee Type, and estimating the presence of the median lobe and its intravesical protrusion. Multivariate logistic regression models evaluated the influence of anatomic features measured in magnetic resonance imaging on urinary continence recovery, defined as daily pad usage less than or equal to one, considering age, body mass index, prostate volume, International Prostatic Symptoms Score, the usage of a nerve sparing technique, and the International Society of Urological Pathology classification. Results: A total of 95 patients who underwent robot-assisted radical prostatectomy were enrolled. Median age, median body mass index, and median PSA density were respectively 66 years (62, 70), 26.12 kg/m² (23.88, 28.09), and 0.16 ng/mL/cc (0.10, 0.26). Patients with urinary continence ranged from 32 (33.7%) at baseline to 93 (97.8%) after one year from surgery. At preoperative magnetic resonance, Lee Type was almost equally distributed, but Type C was less represented (18 patients, 18.9%) and Type D was more frequent (31 patients, 32.2%). Median prostatic urethral length, median membranous urethral length, and median intravesical prostatic protrusion were respectively 36 mm (31, 42), 15 mm (13, 16), and 0 mm (0, 0). Multivariate logistic regression models showed no statistical significance, except for Lee Type C and A comparison at vesical catheter removal after surgery (OR 0.17; 95% CI 0.04–0.71; p-value 0.01). Conclusions: The results of this study showed that patients who had Lee Type C might have higher probability of early urinary continence recovery, but no further statistically significant correlations were found. Full article

Background/Objectives: Prostate artery embolization (PAE) has emerged as a relatively new, minimally invasive alternative for the treatment of benign prostatic hyperplasia. We aimed to compare the perioperative outcomes and trends of PAE versus transurethral resection of the prostate (TURP) and laser enucleation. Materials and Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics, and performed multiple patient-level analyses. Patients with prostate cancer, acute hematuria, and emergent referral to the hospital were excluded. Results: Between 2017 and 2022, a total of 3665 PAEs were performed in Germany compared to 218,388 TURPs and 50,863 laser enucleations. Patients selected for PAE were slightly younger and presented with fewer comorbidities at baseline. The number of laser enucleations increased exponentially in these years, PAEs remained stable, whereas TURPs slightly decreased. Compared to PAE, laser enucleation was associated with higher odds of in-hospital incontinence (4.2% versus 2.7%, OR: 1.6, 95%CI: 1.3–1.9, p < 0.001). On the contrary, PAE was associated with lower odds of in-hospital urinary retention and shorter length of hospital stay compared to TURP (3.2% versus 7.1%, OR: 2.2, 95%CI: 1.8–2.6, p < 0.001, and a 2.6-day difference, 95%CI: 2.5–2.7, p < 0.001, respectively) and laser enucleation (3.2% versus 5%, OR: 1.5, 95%CI: 1.3–1.8, p < 0.001, and a 1.5-day difference, 95%CI: 1.4–1.6, p < 0.001, respectively). Conclusions: PAE offers more favorable perioperative outcomes compared to TURP and laser enucleation, but the use of this relatively new procedure has remained nearly stable in recent years. Full article

Background/Objectives: Benign prostatic hyperplasia (BPH) is a prevalent condition in aging men and a major cause of lower urinary tract symptoms (LUTSs). While traditional treatments such as transurethral resection of the prostate (TURP) are effective, they are associated with notable morbidity. Ultrasound-guided transperineal laser ablation (TPLA) has emerged as a minimally invasive alternative. This study aimed to assess the 12-month efficacy, safety, and functional outcomes of TPLA in patients with LUTS secondary to BPH. Methods: This was a single-center, retrospective observational cohort study including 53 patients with moderate-to-severe LUTS due to BPH who underwent TPLA between November 2021 and May 2024. Baseline and follow-up assessments were conducted at 1, 3, 6, and 12 months, including IPSS, Qmax, PVR, prostate volume (MRI), QoL, IIEF-5, and MSHQ-ED/Bother scores. The procedure was performed under local anesthesia using the EchoLaser™ system, and ablation was guided via real-time transrectal ultrasonography. Results: Statistically significant improvements were observed in IPSS (median decrease from 30 to 13), Qmax (5.5 to 13.0 mL/s), and PVR (200 to 85 mL). Prostate and adenoma volumes decreased by 41.2% and 58.3%, respectively. Quality of life scores improved, and erectile function remained stable. Ejaculatory function improved significantly based on MSHQ-ED and MSHQ-Bother scores. No major complications or conversions to surgery occurred. Conclusions: TPLA appears to be a safe, effective, and minimally invasive treatment modality for LUTS caused by BPH. It offers sustained symptomatic relief, prostate volume reduction, and preservation of sexual function, making it a promising alternative for patients unfit or unwilling to undergo invasive surgery. Full article

Background/Objectives: Lower urinary tract symptoms (LUTSs) due to benign prostatic obstruction (BPO) represent a common condition affecting aging men. Transurethral resection of the prostate represents the gold standard surgical treatment but is not without complications such as retrograde ejaculation, bleeding and urinary retention. The temporary implantable nitinol device (iTIND) is considered a minimally invasive surgical technique, designed to treat LUTS while preserving erectile and ejaculatory function. Herein we report the results of a multi-center, real-world assessment of the iTIND procedure. Methods: Data from five international centers treating LUTS with the iTIND device were collected. We recorded changes through an International Prostatic Symptom Score (IPSS) questionnaire with Quality of Life (QoL), International Index of Erectile Function (IIEF5) questionnaire, antegrade ejaculatory function, maximum flow (QMax), post voiding residual volume (PVR) and freedom from repeat intervention. Results: A total of 74 subjects were enrolled; median follow-up was 12 months. IPSS and QoL changed from a median of 23 and 4 points at baseline to 11 and 2 points, respectively, at the last follow-up. A mean improvement in Qmax and PVR from 9 mL/s and 56 mL at baseline to 13 mL/s and 40 mL was noticed at the last follow-up. Total median operative time was 10 min, and the median time of iTIND indwell time was 7 days. The median device removal time was 5 min. There were no changes in IIEF5 scores and antegrade ejaculation rate. No intraoperative complications were reported, and non-serious postoperative complications occurred in six patients (two urinary retention, two mild haematuria, two urinary tract infection). Finally, four patients underwent reoperation during the follow-up period. All procedures were performed as outpatient day cases. Conclusions: Our results confirms that treatment with the iTIND is effective and safe in terms of improving urinary symptoms and quality of life without impacting sexual function. Longer follow-up is required to better define the durability of this minimally invasive procedure. Full article

Secondary lymphoma of the prostate is described as the involvement of the prostate gland by lymphomatous spread from a primary site. This condition is exceedingly rare and often presents diagnostic and therapeutic challenges. The symptoms often mimic those of benign prostatic hyperplasia or prostate cancer, including LUTS (lower urinary tract symptoms) and even complete urinary retention. Here, we present a rare case of a 62-year-old male patient undergoing chemotherapy for stage IV mantle cell stomach lymphoma and subsequently secondary prostatic involvement. The patient presented with complete urinary retention, accompanied by biochemical (PSA = 11.7 ng/mL) and imaging (Magnetic Resonance Imaging-PIRADS V lesion) suspicion for prostate cancer. Histopathologic analysis of the MRI-targeted prostate fusion biopsy revealed secondary prostatic lymphoma. The chosen treatment was transurethral resection of the prostate (TUR-P) for relief of symptoms, which significantly improved urinary function (postoperative IPSS = 5 and Qmax = 17 mL/s). This case underscores the importance of considering prostatic lymphoma in the differential diagnosis of bladder outlet obstruction, especially in patients with a known lymphoma history. This report also provides a focused review of the literature on secondary prostatic lymphoma, highlighting the diagnostic challenges, treatment options, and clinical outcomes. Full article

Background/Objectives: The Pleth Variability Index (PVI) is a non-invasive parameter used to guide fluid management by reflecting respiratory-induced variations in the plethysmographic waveform. While PVI’s reliability in various positions has been studied, data on its behavior in geriatric patients undergoing transurethral resection of the prostate (TUR-P) in the lithotomy position remain limited. This study aimed to evaluate the effect of the lithotomy position on PVI in geriatric versus non-geriatric patients under spinal anesthesia. Methods: This prospective observational study included 90 patients undergoing elective TUR-P in the lithotomy position under spinal anesthesia. Patients were divided into geriatric (≥65 years, n = 48) and non-geriatric (<65 years, n = 42) groups. PVI and Perfusion Index (PI) were recorded at baseline, in the supine position, and in the lithotomy position. Fluid and vasopressor requirements, along with hemodynamic parameters, were also analyzed. Results: PVI values at the 5th minute in the lithotomy position were significantly higher in the geriatric group compared to the non-geriatric group (p = 0.019). No significant differences were observed in PI values or intraoperative hypotension rates between the groups. Neurological comorbidities were more prevalent in the geriatric group (p = 0.025). Conclusions: PVI appears to be a more sensitive indicator of fluid responsiveness in elderly patients under spinal anesthesia in the lithotomy position. Its age-dependent variability suggests clinical utility in guiding fluid management in geriatric populations, while the stable hypotension rates support the effectiveness of PVI-guided goal-directed therapy. Full article

Objectives: This study aimed to evaluate perceptions and practices of urologists in Saudi Arabia regarding discussions of erectile dysfunction (ED) and ejaculatory dysfunction (EjD) with patients before initiating BPH treatments. Methods: A cross-sectional survey was conducted using a structured questionnaire distributed during the 36th Saudi Urological Annual Conference held in Riyadh in February 2025 among urologists in Saudi Arabia. A binary outcome variable, “frequent and open discussion,” was created based on a scoring system using the median score of these responses. Data analysis included descriptive statistics and univariate (p < 0.25) and multivariate (p < 0.05) logistic regression using SPSS version 27. Results: Discussions about ED risks were most frequent before prescribing 5-alpha reductase inhibitors (5-ARIs) (51.3%) and combined alpha-blockers and 5-ARIs therapy (50.0%), whereas EjD risks were more frequently addressed before alpha-blocker monotherapy (59.2%) and transurethral resection of the prostate (TURP) (56.6%). A substantial proportion of urologists discussed alternative treatments based on sexual dysfunction risks, particularly before TURP (53.9%), alpha-blockers (47.4%), and 5-ARIs (43.4%). Univariate analysis revealed a trend towards more open discussions among non-Saudi urologists (OR 4.58, 95% CI 0.88–23.74, p = 0.06) and a significant association with working in private hospitals (OR 3.68, 95% CI 0.39–35.14, p = 0.03). However, these associations did not hold in multivariate analysis. Conclusions: Urologists in Saudi Arabia demonstrate variability in discussing sexual complications with patients before BPH treatments. Consistent and comprehensive discussions about ED and EjD risks are crucial for informed patient decision-making. Standardized guidelines and educational programs are needed to enhance urologists’ communication skills and ensure consistent patient counseling. Full article

Background/Objectives: Benign prostatic hyperplasia (BPH) is a common urological condition that can significantly impair quality of life in aging men by causing lower urinary tract symptoms (LUTS), including nocturia, weak stream, and incomplete emptying. While pharmacotherapy and surgical approaches such as transurethral resection of the prostate (TURP) remain cornerstone treatments, minimally invasive surgical therapies (MISTs) have emerged to bridge the gap between long-term medication use and invasive surgery. This narrative review assesses Rezūm therapy (water vapor thermal therapy, WVTT) by examining its mechanism of action, clinical efficacy, safety profile, and place in the BPH treatment algorithm. Methods: This narrative review synthesizes evidence from randomized controlled trials (RCTs), prospective studies, real-world cohorts, and published systematic reviews with meta-analyses to provide a comprehensive evaluation of Rezūm therapy for BPH. Key outcomes assessed include changes in International Prostate Symptom Score (IPSS), urinary flow rates, retreatment rates, adverse events, and sexual function preservation. Results: Across multiple studies, Rezūm significantly reduces IPSS (typically by ≥50%) and increases peak urinary flow by 4–5 mL/s. These improvements are durable, with five-year follow-up data showing low retreatment rates of approximately 4–5% and sustained symptom relief. The procedure, performed under local or minimal anesthesia, has a favorable safety profile: most adverse events are mild or transient, and notable complications, such as bleeding requiring transfusion or persistent sexual dysfunction, are rare. Importantly, Rezūm preserves both erectile and ejaculatory function in most patients, setting it apart from many traditional surgical interventions associated with higher sexual side effect rates. Conclusions: Rezūm is an effective and minimally invasive alternative for men with moderate prostatic enlargement who desire durable symptom improvement while avoiding the morbidity and sexual side effects associated with more invasive surgery. Future research should aim to further refine patient selection and assess long-term outcomes in broader populations. Full article

Background/Objectives: To assess the incidence and factors associated with urethral stricture following monopolar transurethral resection of the prostate (mTURP) and open simple prostatectomy (OSP) over a 21-year period. Methods: We conducted a retrospective cohort study of adult male patients insured by Clalit Health Services in Israel, who underwent either mTURP or OSP at multiple centers. Key baseline characteristics, including age, body mass index (BMI), socioeconomic status, Charlson comorbidity index score, and the incidence of urethral stricture, were collected. Postoperative urethral strictures were identified using the ICD-10 code N35.9 (urethral stricture, unspecified). Results: Between January 2000 and December 2021, 54,872 patients underwent simple prostatectomy across 29 hospitals, with 43,525 (79%) undergoing mTURP and 11,347 (21%) undergoing OSP. The median age of patients undergoing mTURP was 73.6 years, while those undergoing OSP had a median age of 72.1 years (p < 0.0001). The incidence of urethral strictures was 1.15% (500) following mTURP and 0.538% (61) following OSP, with an incidence rate ratio (IRR) of 2.139 (p < 0.0001). On multivariable analysis, factors associated with the development of urethral stricture included the type of procedure (HR = 2.349, 95% CI: 2.081–2.653, p < 0.0001), older age at surgery (HR = 1.012, 95% CI: 1.007–1.018, p < 0.0001), higher Charlson Index score (HR = 1.128, 95% CI: 1.109–1.148, p < 0.0001), and lower BMI (HR = 0.990, 95% CI: 0.982–0.999, p = 0.027). Conclusions: Our study highlights a higher incidence of urethral stricture following mTURP compared to OSP. Additionally, older age and a higher Charlson comorbidity index were associated with increased risk of stricture development postsurgery. Full article

A male in his 60s presented with a four-month history of dysuria and lower urinary tract symptoms (LUTS). He had a history of elevated PSA and benign prostatic hyperplasia (BPH), previously treated with transurethral resection of the prostate (TURP). Multiparametric MRI (MP-MRI) revealed a PI-RADS 5 lesion, raising suspicion of malignancy. However, histopathological analysis from MRI fusion-targeted biopsies confirmed tuberculous prostatitis. The patient was treated with antituberculosis drugs, resulting in symptomatic improvement and a significant PSA decline. This case highlights the diagnostic challenge of distinguishing tuberculous prostatitis from prostate cancer, particularly in tuberculosis-endemic regions. Our literature review reveals that patients with tuberculous prostatitis undergoing MRI are at least 50 years old, originate from endemic areas, and exhibit PI-RADS scores ranging from 2 to 5, indicating inter-rater variability. Histopathological confirmation remains essential in cases with ambiguous imaging and clinical findings. Full article

Background: This study aimed to investigate the effects of prostate tissue on platelet activation markers, primarily assessed through P-selectin expression, and to assess the formation of platelet–leukocyte aggregations in response to prostate tissue exposure. Furthermore, we compared platelet activation induced by prostate tissue homogenates with that induced by thrombin stimulation. These processes may play a role in the development of disseminated intravascular coagulation (DIC) following transurethral resection of the prostate (TURP). Methods: We collected prostate tissue samples from 12 patients undergoing TURP. The samples were homogenized and used to stimulate platelet-rich plasma in vitro. Flow cytometry was used to measure platelet P-selectin expression and platelet–leukocyte aggregation. Additionally, four experimental groups were established: (A) saline control, (B) thrombin stimulation, (C) phosphate-buffered saline (PBS) control, and (D) prostate tissue homogenate. Data were analyzed to assess the impact of prostate tissue and thrombin on platelet activation and platelet–leukocyte interactions. Results: Prostate tissue homogenates significantly increased platelet P-selectin expression and platelet–neutrophil aggregation compared with the control groups (p < 0.05). Overall, platelet–leukocyte aggregation was not significantly different between the thrombin and prostate tissue groups. However, prostate tissue exposure did not significantly affect platelet–monocyte and platelet–lymphocyte aggregations. Conclusions: Prostate tissue exposure during TURP induces platelet activation, particularly platelet P-selectin expression and platelet–neutrophil aggregation, suggesting a potential mechanism for DIC development. These findings highlight the importance of monitoring platelet activity in patients undergoing TURP and indicate that interventions targeting platelet P-selectin expression and platelet–neutrophil interactions may help mitigate DIC risk. Full article

Background/Objectives: To evaluate the impact of Minimally Invasive Surgical Therapies (MISTs) on Australian trends for surgeries treating lower urinary tract symptoms (LUTSs) caused by benign prostatic obstruction (BPO). The recent adoption of the prostatic urethral lift (PUL) and water vapour thermal therapy (such as Rezum) into the Medicare Benefits Scheme (MBS) item schedule on the 1 March 2024 has likely had an impact on Australian surgical trends and we aim to describe their impact on the use of other commonly offered BPO-related surgeries. Methods: This study analyses population-adjusted rates of BPO-related surgeries in Australia from January 2004 to September 2024 using publicly available online Medicare Statistics and Census Data. Independent t-tests and significance levels were calculated to compare procedure rates before and after the introduction of PUL and Rezum in March 2024. Results: In total, 301,648 BPO surgical procedures were claimed under MBS in Australia from January 2004 to September 2024, with transurethral resection of the prostate (TURP) being the most common (78%). Procedure rates increased overall with significant shifts in treatment preference: TURP rates have steadily declined in Australia after peaking in 2009 (123.4 per 100,000 adult men), whilst photo-selective vaporisation of the prostate (PVP) and enucleation have risen. Following the introduction of PUL and Rezum on 1 March 2024, enucleation and simple prostatectomy rates increased, while Transurethral needle ablation (TUNA) and urethral and prostatic prosthesis (UPP) decreased. TURP rates were unaffected. Conclusions: Throughout the past two decades, BPO surgical trends in Australia have shifted, with TURP declining as PVP and enucleation have risen. The 2024 MBS listing for PUL and Rezum has boosted their uptake whilst reducing both TUNA and UPP claims. Simple prostatectomy rates remained stable. Full article