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Purpose: Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) affects quality of life. Convective water vapor thermal therapy (CWVTT - Rezum) is a minimally invasive surgical treatment for LUTS/BPH which produces significant improvement of LUTS in men with prostates between 30cc-80 cc with minimal de-novo sexual dysfunction. However, outcomes across the prostate volume (PV) spectrum are incompletely described. We aim to elucidate the relationship between PV and outcomes post-CWVTT in men with LUTS/BPH., Materials and Methods: Patients undergoing CWVTT at a tertiary care center were included. The primary outcome was change in IPSS pre-CWVTT compared post-CWVTT between PV tertiles - small (≤38.5 cc), medium (38.5 - ≤55.6cc), and large (>55.6cc). Secondary outcome was time to a minimally clinically important difference (MCID) of 25% decrease in IPSS., Results: 171 patients were divided into small (n=56), medium (n=54), and large (n=61) PV tertiles. The change in IPSS pre-operatively to 3-months was significant for all tertiles with mean difference of [-7.51 (-10.14, -4.83)], [-10.12 (-12.71, -7.53)], and [-11.72 (-14.14, -9.29)] for small, medium, and large PV, respectively (p=<0.001). In multivariable analysis, having diabetes was associated with increased IPSS after 3mo with average increase (95% CI) of [3.67 (0.23,7.11), p=0.037] compared to not having diabetes The median time (Q1, Q3) to -25% in IPSS for small, medium, and large PV were 16.1 (12.1, 17.5), 12.3 (7.1, 15.7), and 13.8 (10.8, 16.3) months, respectively. In multivariable analysis, medium PV had significantly increased incidence of 25% decrease compared to small PV [HR (95%CI): 2.10 (1.19, 3.72), p=0.011]., Conclusions: CWVTT results in significant and durable LUTS improvement across the prostate volume spectrum. All prostate volumes experience the same improvement in LUTS post-CWVTT. However, medium and large glands may improve more quickly than small glands.

Background: The Optilume benign prostatic hyperplasia (BPH) catheter system is a novel minimally invasive paclitaxel-coated dilation system that has demonstrated substantial and durable results in urinary flow and symptoms., Aim: We now assess the impact of Optilume BPH procedure on sexual function., Methods: Prior published results have described the methods of data collection during the PINNACLE study, which demonstrated durable improvement in urinary symptoms. Follow-up assessments for the current study included IIEF-EF and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD). Semen quality was also examined., Outcomes: IIEF-EF and MSHQ-EjD scores in the Optilume BPH group were not different from the sham group at 3 months, 6 months, or 12 months., Results: A total of 148 men were randomized to receive the procedure (100) or a sham surgical procedure (48). Subjects in both groups had similar rates of erectile dysfunction (ED) previously diagnosed at baseline (56% vs 54.2%, P = .83) and those men who were sexually active. IIEF-EF and MSHQ-EjD scores in the Optilume BPH group were not different from the sham group at 3, 6, or 12 months. Change in IIEF-EF scores remained consistent across all levels of baseline ED severity after Optilume BPH procedure. No clear trend was seen after treatment with Optilume BPH for semen volume, sperm motility, progressive motility, or sperm morphology., Clinical Implications: The Optilume BPH catheter system provides patients with a durable improvement in lower urinary tract symptoms while preserving sexual function., Strengths and Limitations: This study uses validated questionnaires to assess patients' sexual function at baseline and regularly for 1 year after the procedure. Given exclusion criteria regarding patient age and prostate size, the results may not be applicable to all BPH phenotypes., Conclusion: Optilume appears to provide clinical benefit with a high degree of patient satisfaction and minimal impact on sexual function., (© The Author(s) 2025. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The surgical landscape for Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) has evolved with the introduction of Minimally Invasive Surgical Therapies (MISTs), recognizing the impact of sexual function on patients' well-being, and prioritizing ejaculation-sparing approaches., Methods: This systematic review explored ejaculation sparing after classic endoscopic procedures and MISTs (iTind, Rezūm, Urolift, Aquablation, and TPLA) and a literature search yielded 41 studies., Results: While all procedures demonstrated efficacy in improving LUTS/BPH symptoms (IPSS, QoL, Qmax), a subset of studies evaluated ejaculatory function. Positive outcomes were noted, challenging the historical association of BPH surgeries with ejaculatory dysfunction. Variations in study design, patient cohorts, and limited long-term data present challenges. Notably, the lack of baseline specificity, use of alpha-blockers, and non-specific sexual function assessments underscore potential biases., Conclusions: Despite limitations, the review tentatively concluded that MISTs, including iTind, Rezūm, Urolift, Aquablation, and TPLA, appear comparable in sparing ejaculation. Long-term studies are essential to validate sustainability, and comparative research should assess trade-offs between MISTs and traditional surgeries. Incorporating patient-reported outcomes and quality of life assessments will enhance future investigations, refining MISTs as standard therapeutic options for LUTS/BPH., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Introduction: Water vapor thermal therapy (WVTT; REZUM™; Boston, USA) offers symptom relief with reduced risks of complications in patients with lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). WVTT therapy has been validated in the pivotal study in men with smaller prostates (< 80 cc). Yet, its feasibility for larger prostates (≥ 80 cc) remains underexplored., Methods: This retrospective study assessed WVTT efficacy and safety in 131 patients with symptomatic BPH treated between January 2022 and March 2024. Patients were categorized based on prostate size: smaller prostates (SP) (< 80 cc) and larger prostates (LP) (≥ 80 cc). Baseline characteristics, treatment specifics, and post-procedure outcomes-including retreatment rates, symptom scores, and adverse events (AEs)-were recorded. All patients who required surgical retreatment underwent Holmium laser enucleation of the prostate (HoLEP). Statistical analyses compared results between groups over 6- and 12-month follow-up periods., Results: Among the 131 patients, 48 (37%) had LP, with a median volume of 93 cc (Interquartile range (IQR) 88-110). Patients with LP experienced more non-serious AEs, primarily hematuria (p = 0.001), although serious AEs were similar across groups and limited to urinary retention (p = 0.35). At 6 months postoperatively, LP patients had a higher PVR (42 mL(IQR 21-75) vs. 21 mL (IQR2-40); p = 0.032), though this resolved by 12 months. No significant differences were observed between the groups in IPSS, maximum flow rate (Qmax), or erectile function (IIEF-5) scores at either follow-up point. Medical retreatment rates at 12 months were similar (LP: 4% vs. SP: 7%; p = 0.39), as were surgical retreatment rates (LP: 2% vs. SP: 2%; p = 0.51). Ejaculatory function was largely preserved in both groups (LP: 96%, SP: 95%)., Conclusion: WVTT therapy in LP is associated with a higher risk of minor post-operative AEs, with similar functional outcomes at one year compared to SP. Longer follow-up studies are needed to compare the durability of treatment in LP., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The purpose of this study was to investigate the efficacy of Transurethral Holmium Laser of the Prostate (HoLEP) with Double-n Technology in the treatment of benign prostatic hyperplasia (BPH), with a focus on preserving sexual function postoperatively., Methods: Conducted as a multicenter, prospective, single-blind randomized controlled trial, this study enrolled sexually active male patients with BPH. Participants were randomized into three groups: standard HoLEP (Group A), single-n technology (Group B), and innovative double-n technology (Group C), which emphasizes the preservation of the urethral mucosa and nearby structures. The primary endpoints included maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF)., Results: Of the 180 initial participants, 139 completed the study. All groups showed significant improvements in Qmax and IPSS. Initial declines in IIEF scores were noted across all groups, stabilizing to baseline by 3 months without further improvement. Group A had modest antegrade ejaculation rates, starting at 15.4% at 3 months and reaching 23.1% at 12 months. Group B showed a significant improvement, with AE rates rising from 31.8% at 3 months to 45.5% at 12 months, significantly higher than Group A (p < 0.05). Group C had the highest AE rates, starting at 57.8% at 3 months and reaching 77.8% at 12 months, significantly surpassing both Group A and B (p < 0.05). Regarding semen reduction, Group A had 100% reduction at 3 months, which decreased to 77.8% at 12 months. Group B followed a similar trend, from 100% at 3 months to 68.2% at 12 months. Group C showed a more pronounced decline, starting at 84.6% at 3 months and dropping to 37.1% at 12 months, with values significantly lower than both Groups A and B (p < 0.05)., Conclusions: The double-n HoLEP technique shows promising results in improving urinary symptoms while better preserving ejaculatory function and sexual quality of life in BPH patients. This technique could offer a significant advancement in the surgical management of BPH, particularly for sexually active patients., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The popularity of natural products for the treatment of lower urinary tract symptoms (LUTS) differs considerably between countries. Here we discuss the clinical evidence for efficacy in two indications, male LUTS suggestive of benign prostatic hyperplasia and urinary tract infections, and the mechanistic evidence from experimental studies. Most evidence for male LUTS is based on extracts from saw palmetto berries, stinging nettle roots, and pumpkin seeds, whereas most evidence for urinary tract infection is available for European golden rod and combined preparations although this field appears more fragmented with regard to extract sources. Based on differences in sample collection and extraction, extracts from the same plants are likely to exhibit at least quantitative differences in potential active ingredients, which makes extrapolation of findings with one extract to those of others potentially difficult. While only limited information is available for most individual extracts, some extracts have been compared to placebo and/or active controls in adequately powered trials., Competing Interests: Acknowledgments. Research related to lower urinary tract in the lab of MCM is funded in part by Deutsche Forschungsgemeinschaft (Mi 294/10-1), Apogepha Arzneimittel GmbH (Dresden, Germany), and Stiftung Männergesundheit (Berlin, Germany). The medical departments of Apogepha, Bionorica, Dr. Willmar Schwabe, and Pierre Fabre have assisted in the literature search for this manuscript; they were not involved in the writing of this manuscript. Conflict of Interest: AKL declares no conflict of interest. MCM has received research funding, consultancy, and/or lecturer honoraria from Apogepha, Astellas, Dr. Willmar Schwabe, GSK, Sanofi-Aventis, and Stiftung Männergesundheit., (© 2025. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Transperineal prostate microwave thermoablation (TPMT) has been established as a safe means of treating benign prostatic hyperplasia (BPH); however, its effectiveness in addressing BPH-related lower urinary tract symptoms (LUTS) remains unexplored. This case study aims to evaluate the efficacy of TPMT in LUTS attributed to BPH. An 84-year-old man with LUTS due to BPH-induced bladder outlet obstruction, unresponsive to previous medical treatments, and failed prostate artery embolization, underwent TPMT. Three coaxial needles were positioned at the midline, right, and left sides of the hypertrophic transitional zone of the prostate. Microwave energy, with parameters determined using liver data and targeted ablation area, was applied at 2,450 MHz in continuous mode. The tissue temperature was monitored using bilateral thermocouple sensors. The patient exhibited no changes in defecation rhythm, abdominal discomfort, or anorectal pain. Temporary postoperative hematuria was promptly resolved through saline irrigation within 6 hours, and hematological evaluations showed normal results. Significant clinical improvements were observed (e.g. prostate volume, prostate-specific antigen levels) accompanied by an increase in peak flow rate. Thus, TPMT appears to be a promising intervention for bladder outlet stenosis and LUTS induced by BPH. Keywords:Benign prostatic hyperplasia, microwave ablation, prostate, thermoablation, urinary tract symptoms: [ABSTRACT FROM AUTHOR]

In most types of erectile dysfunction, particularly in advanced stages, typical pathological features observed are reduced parenchymal cells coupled with increased tissue fibrosis. However, the current treatment methods have shown limited success in reversing these pathologic changes. Recent research has revealed that changes in autophagy levels, along with alterations in apoptosis and fibrosis-related proteins, are linked to the progression of erectile dysfunction, suggesting a significant association. Autophagy, known to significantly affect cell fate and tissue fibrosis, is currently being explored as a potential treatment modality for erectile dysfunction. However, these present studies are still in their nascent stage, and there are limited experimental data available. This review analyzes erectile dysfunction from a pathological perspective. It provides an in-depth overview of how autophagy is involved in the apoptotic processes of smooth muscle and endothelial cells and its role in the fibrotic processes occurring in the cavernosum. This study aimed to develop a theoretical framework for the potential effectiveness of autophagy in preventing and treating erectile dysfunction, thus encouraging further investigation among researchers in this area. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the trends in research keywords and topics in the field of urology based on text mining over the recent decades. The investigation looked into changes in frequent subject keywords and the trends in prevailing research topics, as reflected in representative urology journals over recent decades. Materials and Methods: A total of 27,129 bibliographic documents were collected from four urology journals, including European Urology, Journal of Urology, BJU International, and World Journal of Urology. The study then examined the changes in the most frequent author keywords over the decades. Moreover, structured topic modeling was employed to identify twenty prevailing research topics in urology and to examine their trends across different periods. Results: The study observed consistently increasing patterns in author keywords and topics related to the prostate and oncology. Conversely, research fields such as pediatrics, male infertility, voiding dysfunction, and cancer biology exhibited a downward trend in urology. Potential factors or reasons underlying these trends were further discussed in this study. Conclusions: This exploratory study uncovered major research topics in the discipline of urology. The findings of this study depict the domain of urology research in recent decades, providing insights for both researchers and clinicians seeking to better understand the research trends in the discipline. [ABSTRACT FROM AUTHOR]

Background: The connection between sleep patterns (sleep duration, trouble sleeping and sleep disorders) and benign prostatic hyperplasia, commonly referred to as BPH, is not yet clear. Our aim is to investigate the impact of sleep patterns on BPH risk in US men aged 40 and older. Methods: We performed an observational analysis using data from NHANES 2005–2008 on males aged 40 and up, including a total of 2,555 participants. After accounting for confounding variables, we applied weighted multivariable logistic regression to assess the relationship between sleep patterns and BPH risk according to the complex multi-stage sampling design of NHANES. Results: In this study, 11.79% of the 2,555 American participants aged over 40 reported to have BPH. after adjusting for confounding variables, multivariable logistic regression analysis showed that short sleep duration, compared to healthy sleep duration (7–9 hours), was linked to a significantly higher risk of BPH (OR: 1.92, 95% CI: 1.42–2.41). Trouble sleeping and sleep disorder were also strongly associated with BPH. Moreover, there appears to be a stronger association among those with poor sleep patterns (OR: 2.07, 95% CI: 1.46–2.91). Conclusion: Poor sleep patterns in men over 40 in the U.S. is significantly linked to a higher incidence of benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

Background: Benign prostatic hyperplasia (BPH) is a common male urological disease around the world. This study aimed to evaluate global, regional, and national burden of BPH from 1990 to 2021, and to forecast the incidence and prevalence of BPH to 2035. Methods: Using the data and methods of the Global Burden of Disease 2021, we presented the incidence, prevalence, and disability-adjusted life-years (DALYs) of BPH from 1990 to 2021. The trends of burden over time were assessed using estimated annual percentage changes. We applied Bayesian age-period-cohort model to forecast the incidence and prevalence of BPH to 2035. Results: In 2021, the global number of incident cases, prevalent cases, and DALYs of BPH were 137.88, 1125.02, and 22.36 per 100,000 populations, respectively. From 1990 to 2021, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (ASDR) of BPH remained stable. The highest ASIR, ASPR, and ASDR were recorded in Eastern Europe in 2021. Nationally, China had the highest number of incident cases, prevalent cases, and DALYs of BPH. With the increase of socio-demographic index, the trends of ASIR, ASPR, and ASDR all exhibit an initial rise followed by a gradual decline. The global incidence and prevalence are expected to increase from 962.42 to 7878.68 per 100,000 populations in 2022 to 998.55 and 8620.60 per 100,000 populations in 2035, respectively. Conclusions: The persistent burden of BPH continues to pose a critical public health challenge. The escalating prevalence among middle-aged and elderly populations underscores the imperative to tackle this widespread condition. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is a common urological condition affecting elderly men worldwide. In 2021, there were 112,502 (95% UI: 88,131.8–142,634.2) thousand prevalent cases globally, compared to 50,705.8 (95% UI: 38,735.5–65,693.4) thousand cases in 1990, representing a 122% increase. Over the past 30 years, the burden of BPH in low and low-middle socio-demographic index (SDI) regions have shown an upward trend and is projected to continue increasing over the next 15 years. Middle-SDI regions are facing the heaviest absolute burden of BPH. Despite declining prevalence, incidence, and disability-adjusted life years rates in high-middle SDI regions, the absolute BPH burden remains high, ranking second among the five SDI regions. In contrast, high-SDI regions exhibit a relatively low and stable BPH burden, though significant variations exist even among countries within the high-SDI category. Additionally, the global 65–69 age group bears the highest burden, with the 40–44 and 80+ age groups showing increasing trends. The burden of BPH varies significantly across regions, socioeconomic statuses, and countries, yet the absolute burden is generally increasing. The substantial regional differences in BPH burden underscore its widespread impact and potential controllability, indicating the need for more targeted healthcare efforts to address the growing BPH burden. [ABSTRACT FROM AUTHOR]

Introduction: BPH/male LUTS is a prevalent condition in the aging male population with multifactorial pathophysiology. Pharmacotherapy remains the cornerstone of treatment in patients who fail conservative treatment. 5-α-Reductase inhibitors (5-ARIs) are the only class of medication shown to reduce the risk of acute retention and BPH-related surgery and, thus, are commonly used along with other "short acting" medications in combination treatments. Areas covered: Combination treatments with α-blockers and 5-ARIs have been investigated extensively in high quality trials that prove the long-term efficacy of such treatments with acceptable rates of side effects. Combination treatments involving 5-ARIs and other classes of medications (anticholinergics, b3 agonists, PDEI) have been shown to be beneficial in the short term and but studies with longer follow-up periods are required to fully establish their role. Expert opinion: A-blocker/5-ARI combination treatment is a reasonable approach for patients with male LUTS/BPH who are at increased risk of disease progression or have incomplete response to monotherapies. Other combination treatments with 5-ARIs and PDEI or anticholinergics/β-3 agonists can be tried based on predominant symptoms or side effect profile, but patients should be informed about the lack of long-term data. [ABSTRACT FROM AUTHOR]

Objective: To examine the burden of benign prostatic hyperplasia (BPH) in the Middle East and North Africa (MENA) region from 1990 to 2021 by age and sociodemographic index (SDI). Methods: Data were sourced from the Global Burden of Disease (GBD) 2021 database. We analysed the incidence, prevalence, and years lived with disability (YLDs) attributable to BPH across the MENA region and its constituent countries. Results: In 2021, the MENA region had an estimated 4.7 million prevalent cases of BPH, with an age-standardised prevalence rate of 2168.6 per 100,000. BPH contributed to 93.6 thousand YLDs, with an age-standardised YLD rate of 42.8 per 100,000. The highest prevalence and incidence rates were observed in Jordan, Qatar, and Iran, while Egypt and Yemen recorded the lowest rates. The burden of BPH was found to increase with age, peaking in the 65–69 age range. Conclusion: This study reveals an increasing burden of BPH in the MENA region, primarily due to aging populations. These findings underscore the need for tailored public health policies and strategies to enhance early detection, prevention, and management of BPH, thereby reducing its impact on healthcare systems and individuals. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivorship care planning is a recognized yet underutilized aspect of care delivery, and the opportunity for telehealth in cancer survivorship is examined. Methods: We conducted a mixed-methods study in Vermont and New Hampshire to characterize perceptions of rural cancer providers and survivors regarding survivorship transitions in care, consisting of (a) key informant interviews with primary care and oncology clinicians, (b) a broader survey of clinicians, and (c) surveys and focus group discussions with cancer survivors. In these interactions, we also explored the use of a shared telehealth survivorship care planning appointment between oncology clinicians, primary care clinicians, and survivors. Results: Results from surveys and interviews clustered around several themes, namely (1) infrequent care transitioning back to primary care, (2) lack of mental health services, (3) lack of side effect education, (4) low perceived utility of survivorship care plans, (5) clinicians exclusively communicate using the EMR and finding it imperfect, and (6) clinicians and survivors reported conflicting perceptions regarding survivors' access to telehealth options. Conclusions: Our results suggest that telehealth has the potential to augment the delivery of survivorship care planning; however, key technical and logistical concerns need to be addressed, particularly enhanced coordination across clinician scheduling and ensuring payment parity for various telehealth implementation strategies. Implications for Cancer Survivors: Cancer survivorship care planning is a recognized yet underutilized aspect of care delivery. There is an opportunity for the application of telehealth for supportive care in survivorship care planning, which should be a focus of further research. [ABSTRACT FROM AUTHOR]

Introduction: Benign prostatic hyperplasia (BPH) is a prevalent urological condition leading to lower urinary tract symptoms. Minimal invasive surgical treatment (MISTs) such as Rezūm System are emerging aiming to relieve symptoms. We present results from a single centre prospective study. Methods: We prospectively followed patients undergoing Rezūm between 2021 and 2023 from a single centre. International Prostate Symptom Score (IPSS), functional outcomes (maximum urinary flow rate (Qmax) and post-void urinary residual (PVR) and International Index of Erectile Function-5 (IIEF-5) were assessed at 3, 6, 12 and 24 months. Anterograde ejaculation was assessed at 12 months follow up. Linear mixed-effects models (LMMs) for repeated measures were applied to assess differences in the IPSS, maximum flow rate (Qmax), PVR, and International Index of Erectile Function-5 (IIEF-5) from baseline (t0) to 3, 6, 12 and 24 months. Results: After adjusting for prostate volume and symptoms severity, significant differences were observed at 3, 6, 12 and 24 months for IPSS (p < 0.001), Qmax (p < 0.001), PVR (p < 0.001) and IPSS-QoL (p < 0.001) from baseline. No statistically significant changes were found in the IIEF-5 scores at 3, 6, 12 and 24 months from baseline. Anterograde ejaculation remained in 98% of patients after treatment. Conclusions: In conclusion, the study's findings indicate that patients undergoing Rezūm treatment experience sustained improvements in IPSS, Qmax, PVR and IPSS-related quality of life up to 24 months following the intervention. Anterograde ejaculation remained in 98% of patients after treatment. [ABSTRACT FROM AUTHOR]

Background: Inconsistent monitoring of prostate-specific antigen in patients receiving 5-alpha reductase inhibitors for lower urinary tract symptoms/benign prostate enlargement may affect prostate cancer outcomes. This study evaluated real-world practice among urologists treating patients receiving 5-alpha reductase inhibitors. Methods: This non-interventional, cross-sectional study collected data from urologists in Spain (N = 100) and Brazil (N = 100) via a self-reporting questionnaire and patient record forms. Endpoints included: frequency/methodology of prostate-specific antigen monitoring, concerns about the effect of 5-alpha reductase inhibitors on prostate-specific antigen monitoring, triggers of prostate biopsy, and concerns when switching 5-alpha reductase inhibitor formulation. Results: Over half of urologists monitored prostate-specific antigen every 6 months (Spain 59%, Brazil 58%). Preferred methods were the "doubling rule" (Spain 66%, Brazil 41%) and "increase from nadir" (Spain 28%, Brazil 43%). A minority of urologists monitored unadjusted values (Spain 3%, Brazil 11%) or did not monitor prostate-specific antigen (Spain 1%, Brazil 3%). Most urologists ranked the potential for 5-alpha reductase inhibitors to mask prostate cancer as their top concern (Spain 65%, Brazil 56%). The most selected trigger for prostate biopsy was "if doubled (adjusted) prostate-specific antigen level after 6 months of treatment is > 4 ng/mL" (Spain 39%, Brazil 37%). Many urologists were moderately/very concerned about the effect on prostate-specific antigen when switching 5-alpha reductase inhibitor formulation. Conclusions: An unmet need exists for standard guidance and continuous education to support optimal monitoring and interpretation of prostate-specific antigen in patients with lower urinary tract symptoms/benign prostate enlargement treated with 5-alpha reductase inhibitors. [ABSTRACT FROM AUTHOR]

Lower urinary tract symptoms (LUTS) significantly affect patient quality of life. Treatment options for bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) (a common cause of LUTS) are insufficient to relieve discomfort. As the incidence of BPH is increasing, new pharmacological targets for LUTS treatment are required. Corticotropin-releasing hormone (CRH) is a neuropeptide that controls normal micturition in rodents. Herein, we investigated the role of spinal CRH in regulating micturition in sham and BOO rats, and evaluated CRH as a therapeutic target for bladder dysfunction in BOO model Sprague–Dawley rats. Histological analysis, cystometry with intrathecal administration of CRH agonists/antagonists, western blotting, and real-time PCR assessed the role of CRH and its receptors (CRHR1 and CRHR2) in micturition in sham and BOO rats. CRH administration shortened the voiding interval, while pretreatment with antagonists against CRHR2 (but not CRHR1) suppressed CRH-induced frequent voiding. Western blotting confirmed CRHR1 expression in the dorsal root ganglia (DRG) and bladder, but not the spinal cord, of rats. Real-time PCR showed higher CRHR2 mRNA expression in the spinal cord and DRG than in the bladder in both groups. Overall, spinal CRH facilitates the micturition reflex via CRHR2, and is a promising therapeutic target for LUTS. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is a prevalent urinary system disorder. Despite evidence of a significant genetic component from previous studies, the specific pathogenic genes and biological mechanisms are still largely unknown. The study utilized the FinnGen R10 dataset, encompassing 177,901 individuals (36,601 cases and 141,300 controls), and the GTEx v8 EQTLs files to conduct single-tissue and cross-tissue transcriptome-wide association studies (TWAS). FUSION method was utilized to validate the findings in specific tissues. Gene Analysis and Multi-marker Analysis of Genomic Annotation (MAGMA) were used to identify potential susceptibility genes. The intersection genes of the above results were analyzed by Mendelian randomization (MR), summary data-based MR (SMR) and colocalization studies. Fine-mapping of causal gene sets (FOCUS) software was employed to accurately locate risk genes. Gene Expression Omnibus (GEO) analysis explores the differential expression of genes. Finally, The GeneMANIA tool was utilized to further understand the functional roles of these susceptibility genes. The cross-tissue TWAS analysis revealed 28 genes associated with BPH susceptibility. Single-tissue TWAS and MAGMA further refined eight genes, and subsequent MR, SMR, FOCUS and colocalization analysis pinpointed INO80B as the key gene. The differential expression of this result was verified by GEO. INO80B may help prevent excessive prostatic cell proliferation by regulating cell cycle-related gene expression. Our research identified the INO80B gene, whose predicted expression is associated with BPH risk and hence provided a new insight into the genetic basis of this disease. However, further functional studies are necessary to elucidate the potential biological activity of these significant signals. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is critically important to cancer rehabilitation. However, PA levels are generally lower in colorectal cancer (CRC) survivors compared to other cancer survivors. The purpose of this study was to examine the effectiveness of PA interventions in increasing PA levels and to provide recommendations for developing PA interventions in CRC survivors. Methods: A systematic literature search was conducted in Cochrane Library, Embase, PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, and Wan Fang Data from January 2010 to March 1, 2024. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of eligible studies, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method was used to evaluate the certainty of evidence. The random-effects model was used in meta-analysis, and data were analyzed using standardized mean differences and 95% confidence intervals. Results: A total of 22 studies were included in this review, all of which were rated as having good methodological quality based on the PEDro scale. In the meta-analysis, nine of these studies involving 684 participants were included, and results showed that PA interventions have a positive effect on increasing total PA levels in CRC survivors (Z = 2.79, p = 0.005). Results of subgroup analysis revealed that supervised PA interventions (Z = 2.82, p = 0.005) and PA interventions with multiple intervention components (Z = 3.06, p = 0.002) effectively increased total PA levels for CRC survivors. In addition, research evidence suggests that daily as the frequency (Z = 4.28, p < 0.001), Moderate-to-vigorous physical activity (MVPA) as the intensity (Z = 2.29, p = 0.022), aerobic combined with resistance exercise as the type of PA (Z = 4.19, p < 0.001) is appropriate for increasing total PA levels in CRC survivors. Conclusions: The findings of this review provide strong evidence supporting the positive role of PA interventions in improving total PA levels among CRC survivors. This study offers preliminary insights into the appropriate patterns of PA interventions (e.g., frequency, intensity, type) for enhancing total PA levels in CRC survivors. However, further high-quality clinical trials are needed to determine the optimal timing, duration, and delivery methods of PA interventions to maximize their effectiveness in this population. [ABSTRACT FROM AUTHOR]

Purpose: Identifying and managing risk factors for lower urinary tract symptoms (LUTS) is crucial because it impacts the quality of life of elderly individuals. Lifestyle factors, including physical activity (PA), and their relationship with LUTS have not been well studied. This objective of this study was to investigate the association between PA and LUTS. Materials and Methods: A total of 7,296 men were included in this cross-sectional study. PA was quantified in metabolic equivalent (MET)-hours per week, and LUTS severity was assessed using the international prostate symptom score. Logistic regression was used to analyze the association between PA and LUTS, including voiding and storage symptoms. Results: The average age of the participants was 57.8 years, and the prevalence of LUTS was 41.3%. After adjusting for potential confounders, PA was inversely associated with the prevalence and severity of moderate-to-severe LUTS, showing a doseresponse pattern (all p for trend <0.01). Compared to the minimal activity group, which engaged in <5 MET-hours per week of PA, the odds ratios for moderate to severe LUTS were 0.83 (95% confidence interval [CI]: 0.72–0.97) for men engaging in 15–30 MET-hours per week, 0.82 (95% CI: 0.71–0.95) for 30–60 MET-hours per week, and 0.72 (95% CI: 0.62–0.84) for ≥60 MET-hours per week. The possible protective effect of PA was still observed in the additional analysis for voiding and storage symptoms showing the same dose-response pattern (all p for trend <0.01). Conclusions: A higher PA level was associated with a lower prevalence and severity of total, voiding, and storage LUTS in a dose-dependent manner in Korean men. [ABSTRACT FROM AUTHOR]

To investigate the relationship between the Chinese Visceral Adiposity Index (CVAI) and the risk of developing Benign Prostatic Hyperplasia (BPH). Using data from the China Health and Retirement Longitudinal Study (CHARLS), we included 3,295 men aged 45 years and older. Multivariate logistic regression and restricted cubic spline models were employed to analyze the association between CVAI and the risk of BPH. During the 4-year follow-up period, 267 cases of BPH were identified. CVAI was positively associated with the risk of developing BPH (OR = 1.23, 95% CI: 1.07–1.42), with a significant dose-response relationship (P < 0.001). Stratified analysis showed that the effect of CVAI on BPH risk was consistent across various subgroups. There is a positive correlation between CVAI and the risk of developing BPH. Managing visceral fat content and maintaining a healthy fat distribution pattern may help reduce the risk of BPH. [ABSTRACT FROM AUTHOR]

Context: Data supporting successful and satisfactory penile prosthesis (PP) implantation outcomes are mainly based on subjective, rather than objective, analysis., Objective: To systematically review and objectively analyze, all available data related to patient and partner PP satisfaction., Evidence Acquisition: An extensive search was performed, including the following key-words: ("penile prosthesis" and "satisfaction"). The search, which accrued data from January 1, 1969, up to July 31, 2023, was restricted to English-language articles including human participants., Evidence Synthesis: Out of 663 retrieved articles, 83 were considered including, 12,132 subjects with a mean age and mean follow-up of 58.6 [range 20; 77.1] years and 47.6 [range 6; 374] months, respectively. Overall, a high patient satisfaction rate was observed 83[80; 86]%. The satisfaction rate increased in subjects with three-piece PP and in those with a higher rate of cardiovascular or neurological diseases and was independent of the patient's age. Partner's satisfaction rate was lower when compared to that observed in men and it increased according to the use of inflatable devices and the presence of patient Peyronie's disease. The long-term complication rate was limited ranging from 3% for erosion to 4.6% when mechanical failure was considered., Conclusions: Patient and partner satisfaction is excellent and increases with time. The number of complications is limited and is strongly associated with the presence of diabetes mellitus., Patient Summary: We found a high couple satisfaction score that was higher when reported by males compared to females. Patient satisfaction increased with time, and it was independent of age., (© 2024 American Society of Andrology and European Academy of Andrology.)

Background: Postoperative medication use is an important yet relatively unexplored element of the benign prostatic hyperplasia patient journey. We assessed and compared the percentage of patients who required medication postoperatively after the three most common BPH surgeries in the real world: transurethral resection of the prostate (TURP), photovaporization procedure with GreenLight Laser (PVP), and prostatic urethral lift (PUL) with the UroLift system., Methods: Within a random representative sample of US Medicare and commercial insurance claims, patients with at least one year of follow-up data available after an outpatient TURP, PVP, or PUL procedure were linked to pharmaceutical claims to elucidate rates of continuous and de novo use of alpha-blockers, 5-alpha reductase inhibitors, or combination medical therapy. Periods of interest were perioperative (use within three months postoperatively and not beyond) and one and five years postoperatively., Results: 36 629 men diagnosed with BPH underwent outpatient TURP (n = 20 319), GreenLight PVP (n = 10 517) and PUL (n = 5 793) procedures within the claims dataset. The rate of medical therapy use through one year was lowest for PUL (4.1%) compared to TURP (6.2%) and PVP (6.6%), and was equivalent between procedures through five years (10.6% TURP, 10.4% PVP, and 10.3% PUL)., Conclusions: Patients who undergo surgery to treat BPH may desire to discontinue or bypass BPH medications. However, these data demonstrated that approximately 10% of BPH patients used medication through five years postoperatively, regardless of which procedure they underwent., Competing Interests: Competing interests: Drs. Kaufman, Elterman, Chughtai, and Roehrborn are paid consultants for NeoTract/Teleflex, Inc. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards., (© 2025. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: Endoscopic enucleation of the prostate (EEP) is a preferred treatment for benign prostatic hyperplasia (BPH). This bibliometric analysis aims to analyze the application trends and research hotspots of EEP., Methods: We conducted a bibliometric analysis of publications indexed in the Web of Science Core Collection from 1989 to 2023. The techniques examined include holmium laser enucleation (HoLEP), thulium laser enucleation (ThuLEP/ThuFLEP), bipolar/monopolar transurethral enucleation (b-TUEP/m-TUEP), GreenLight laser enucleation (GreenLEP), and diode laser enucleation (DiLEP). We utilized VOSviewer, CiteSpace, and the R package 'bibliometrix' for the analysis., Results: A total of 739 English-language studies were analyzed, revealing a steady increase in EEP-related publications. HoLEP was the most extensively studied technique, followed by ThuLEP and b-TUEP, while ThuFLEP gaining emerging interest. There has been a notable lack of high-quality randomized controlled trials (RCTs) for GreenLEP, DiLEP and m-TUEP. China, the United States, and Germany led in publication volume and collaboration networks. Key contributors in the field were identified, with recent research focusing on topics like postoperative transient urinary incontinence (TUI) and the role of robot-assisted simple prostatectomy (RASP) in comparison to EEP., Conclusions: EEP is gaining widespread clinical acceptance for BPH treatment. Future research should focus on addressing the gap in high-quality RCTs, especially for underexplored techniques like GreenLEP, DiLEP and m-TUEP, and explore strategies to reduce postoperative TUI. Prospective comparisons between RASP and EEP will be crucial for optimizing surgical approaches in BPH management., Competing Interests: Declarations. Ethics approval: As this study utilized data from Web of Science and did not involve direct interaction with human participants or the use of personal identifiers, ethical approval was not required. The research was conducted in compliance with the ethical standards set forth in the Declaration of Helsinki. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To contextualise the national population-based temporal surgical trends in the management of benign prostatic hyperplasia (BPH) in Australia., Methods: Google Trends (GT) was used to analyse the level of patients' online interest in various surgical options for the treatment of BPH. Analysis of variance was performed and the average rates of change in GT popularity score was calculated for the period from 1 January 2010 to 31 October 2022. Data regarding surgical volume were extracted from the Medicare Benefits Schedule and the Australian Institute of Health and Welfare databases, and population-adjusted rates of BPH procedures performed were calculated accordingly., Results: The level of online interest in Australia was highest for transurethral resection of the prostate (TURP) and population data also showed that TURP remained the most utilised procedure across the study period. Nationwide, there was an increased uptake of photovaporisation of the prostate, accounting for 7.6% of BPH procedures in 2020-2021, with correspondingly lower rates of TURP and simple prostatectomies performed. Holmium laser enucleation of the prostate (HoLEP) appeared to be underutilised and had the lowest mean popularity score, while prostatic urethral lift (PUL) and transurethral water vapour ablation (TUWA) showed strong uptake in the more recent years. The average rates of change were highest for TURP at +1.59/year (P < 0.001), followed by PUL at +0.56/year (P < 0.001) and TUWA at +0.50/year (P = 0.004), while the lowest was for HoLEP at +0.09/year (P = 0.116)., Conclusion: Differences were found between GT analysis and actual BPH procedures performed at a population level. This study highlights that clinicians need to adapt and provide better patient counselling to ensure a shared decision-making process when choosing the treatment procedure for BPH/male LUTS., (© 2025 BJU International.)

Introduction and Hypothesis: This study aims to systematically estimate the global prevalence of overactive bladder (OAB), identify demographic and regional factors contributing to prevalence variations, and assess trends in prevalence over the past two decades., Methods: This cross-sectional study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. From inception to April 2024, computerized searches for OAB prevalence-related literature were conducted on PubMed, Embase, Web of Science, and Cochrane. Studies of OAB prevalence in the general population were included. Two independent researchers conducted the screening, data extraction, and quality assessment of the included studies., Results: A total of 53 studies, encompassing 610,438 participants, were ultimately included in the analysis. The meta-analysis determined the global prevalence of OAB to be 20% (95% CI 0.18-0.21). Over the past 20 years, there has been an increase in OAB prevalence, rising from 18.1% (95% CI 0.13-0.23) to 23.9% (95% CI 0.19-0.29). Among women, the prevalence of OAB was 21.9% (95% CI 0.20-0.24), indicating higher rates compared to men (OR = 16.1, 95% CI 0.15-0.18). The study also found higher prevalence rates among overweight and obese individuals (OR = 18.6, 95% CI 0.13-0.24) and those aged 60 years and above (OR = 28.3, 95% CI 0.24-0.33). Middle-income countries exhibited higher prevalence rates compared to high-income countries., Conclusions: The study highlights higher risks of OAB among obese individuals, women, and the elderly. OAB prevalence has shown an increasing trend over the past 20 years., Competing Interests: Declarations. Ethical Approval: This study is a meta-analysis, it does not involve direct interaction with human participants or the use of personally identifiable data. Therefore, the study does not require Institutional Review Board (IRB) approval. Conflict of Interest: The authors declare that they have no conflict of interest., (© 2025. The Author(s).)

Abstract: The study aimed to assess the long-term device survival of a 3-piece inflatable penile prosthesis (PP) in patients with erectile dysfunction (ED). This retrospective observational longitudinal study involved patients with drug-refractory ED who underwent primary 3-piece inflatable PP implantation at a single center from 1992 to 2019. The outcomes included complications of various inflatable PP models, and Kaplan-Meier analysis was used to estimate the probability of PP survival. Of the total 426 patients, 140 (32.9%) were implanted in the period of 1992-2000, 128 (30.0%) in the period of 2001-2008, and 158 (37.1%) in the period of 2009-2019. The PP used in the study included AMS 700 CX (62.0%, n = 264), AMS 700 CXR (7.7%, n = 33), AMS Ultrex Plus (10.3%, n = 44), and Alpha I (20.0%, n = 85). The overall complication rate was 28.2% (120/426), and the majority happened after 6 months. The causes of device removal included mechanical failure (11.0%, n = 47), infection (3.9%, n = 17), cylinder extrusion (6.3%, n = 27), and unspecified (0.2%, n = 1). Of the total mechanical failures (n = 47), 18 (38.3%) occurred in the cylinders, 10 (21.3%) occurred in the pump, 7 (14.9%) occurred in the reservoir, 6 (12.8%) occurred in the connections, and 6 (12.8%) were nonspecific. Global average survival rates of the PP at 1 year, 5 years, 10 years, and 15 years were 96.2%, 86.7%, 77.5%, and 58.7%, respectively. The 3-piece inflatable PP has an excellent device survival rate at 5 years and 10 years., (Copyright ©The Author(s)(2025).)

Objectives: The clinical outcomes of tamsulosin therapy for LUTS/BPH patients vary, with up to one-third of patients reporting unsatisfactory results. Enhancing the effectiveness and safety of tamsulosin therapy for LUTS/BPH patients remains a significant challenge in current medical practice. Limited data exists regarding the impact of CYP2D6 genetic polymorphisms on the efficacy and safety of tamsulosin therapy. Given that tamsulosin is metabolized by CYP2D6, variations in this enzyme may influence the drug's pharmacodynamic response. The objective of this study was to evaluate the impact of CYP2D6 pharmacogenetic markers on tamsulosin efficacy and safety in patients with LUTS associated with BPH., Methods: The study included 142 male patients with LUTS and a confirmed diagnosis of BPH (N40 ICD-10). Patients were followed for a minimum of 8 weeks and underwent four examinations (at days 0, 14, 28, and 56). Treatment efficacy was assessed using the IPSS with quality of life assessment, transrectal ultrasound of the prostate with estimation of prostate volume and residual urine volume, and maximum urinary flow rate (Qmax). Allelic variants of CYP2D6 ( *2, *3, *4, *6, *9, *10 , and *41 ) were determined by polymerase chain reaction in all patients.., Results: In the subgroup with moderate symptoms, individuals classified as poor and intermediate metabolizers exhibited significantly higher ΔQmax compared to normal metabolizers (4.25 [2.5; 6.1] vs. [0.6; 4.3], p=0.001826). Moreover, carriers of the CYP2D6*10 CT heterozygous genotype demonstrated lower IPSS scores at the last two visits compared to those with the CC genotype (visit 3: -7.45 ± 3.93 vs. -5.25 ± p=0.05; visit 4: -8.91 ± 3.88 vs. -6.31 ± 5.7), as well as reduced IPSS irritative symptoms at visit 2 (-3.87 ± 2.70 vs -2.47 ± 3.1, p=0.05), and a significant increase in ΔQmax ([2.5; 5.9] vs. [0.6; 4.7], p=0.01). In the subgroup with severe symptoms, individuals with CYP2D6*41  GA + AA genotypes exhibited less residual urine volume following therapy compared to those with the GG genotype ([15.0; 32.0] vs. [3.0; 19.0], p=0.007029). The CYP2D6 polymorphic variants did not impact the tamsulosin safety. The study did not reach the estimated power for CYP2D6*3 , CYP2D6*6 , and CYP2D6*9 polymorphisms due to their low frequency of occurrence in the study population. The multivariate logistic regression model indicated that potential predictors of tamsulosin therapy efficacy in LUTS/BPH patients may include BMI (p<0.001), prostate volume (p<0.002), as well as the carriage of CYP2D6*4 (p<0.001) and CYP2D6*10 (p=0.012) markers. The model explained 81.9 % of the variance in the predicted outcome and accurately forecasted tamsulosin therapy efficacy in BPH with a precision of 92.1 %., Conclusions: The present study identified potential markers that could serve as predictors of the effectiveness of tamsulosin. Specifically, genetic markers such as CYP2D6*4 , CYP2D6*10 , CYP2D6*41 , and non-genetic factors like BMI and prostate volume were associated with the clinical efficacy of tamsulosin therapy in LUTS/BPH patients.., (© 2025 Walter de Gruyter GmbH, Berlin/Boston.)

Benign prostatic hyperplasia (BPH) is a common urological disease in middle-aged and elderly men. The main pathological mechanisms of BPH include static factors that increase prostate volume and dynamic factors that increase prostate tension. The RhoA/ROCK signaling pathway is a classical pathway that regulates cell contraction, migration, and growth. In this review, we summarize the potential role of RhoA/ROCK signaling in the development of BPH. The RhoA/ROCK signaling pathway can enhance the contraction of prostate smooth muscle through the Ca 2+ sensitization pathway and increase passive tension in the prostate through tissue fibrosis. Additionally, RhoA/ROCK signaling promotes cell proliferation by regulating cell division and may influence apoptosis by affecting the actin cytoskeleton. Furthermore, risk factors, such as inflammation, metabolic syndrome, and hormonal changes, can upregulate RhoA/ROCK signaling, which in turn promotes these risk factors, eventually leading to the development of BPH. Given the role of RhoA/ROCK signaling in regulating multiple pathogenic factors of BPH, this pathway represents a promising molecular target for BPH treatment and warrants further study., Competing Interests: Declarations. Conflict of interest: The authors declare that there is no conflict of interest. Institutional review board statement: Not applicable. Informed consent statement: Not applicable., (© 2025. The Author(s) under exclusive licence to Japan Human Cell Society.)

Background: Surgical management options for lower urinary tract symptoms due to benign prostatic hypertension have remained limited in prostates of large volume. The advent of the Aquablation has created a potential minimally invasive option for treatment in prostates of all volumes. Thus, this study aims to evaluate outcomes and complications of Aquablation in clinical practice based on prostate volume., Methods: Collected variables included adverse events with Clavien-Dindo classifications, transfusion rates, surgical retreatment rates, continued medication use postoperatively, and International Prostate Symptom Score (IPSS) with Quality-of-Life indicator. Aquablations were stratified by preoperative prostate volume., Results: One hundred seventy-four men were included in the study. The average postop decrease in IPSS was 10.28, with a 2.02 point decrease in Quality-of-Life at 1 year. Postop increase in peak urinary flow rate was 7.65 mL/s for an average of 16.44 mL/s. Hemoglobin drop average was 1.78 g/dL, but only 2.3% of patients required a transfusion. 12.9% of patients required surgical retreatment. Six months after Aquablation, 22.9% and 12.9% of patients continued taking Alpha-blockers and Androgen receptor inhibitors, respectively. Adverse events occurred in 33 patients (19.0%). Eighteen patients were excluded from secondary analysis due to unrecorded prostate volume, leaving 123 with volumes <150 mL and 33 with volumes ≥150 mL. Groups were comparable with respect to length of stay, adverse events, blood transfusion, IPSS with Quality-of-Life indicator preoperative and postoperative, postop peak urinary flow, and postop alpha-blocker use. Larger prostates had a higher rate of adverse events, retreatment, postop hemoglobin drop, and postop use of finasteride., Conclusions: Aquablation is a viable treatment option for benign prostatic hyperplasia. Efficacy, safety, subjective outcomes, and adverse event rates were not impacted by prostate volume. However, size does matter as prostates ≥150 mL had higher surgical retreatment rates and postop finasteride use., (© 2024 Wiley Periodicals LLC.)

Purpose: To analyze the safety and efficacy of additional venous leak embolization after an initial arterial revascularization to treat patients with combined arteriogenic and venogenic erectile dysfunction (ED)., Materials and Methods: Single-center observational study from October 1, 2019, to September 30, 2022, including 26 patients with ED resistant to phosphodiesterase-5-inhibitors (PDE5i) and without significant clinical benefit after arterial revascularization of erection-related arteries. Additional treatment with venous leak embolization was performed 458 ± 424 days after arterial revascularization. Arterial obstruction and venous leak were verified based on color Doppler flow analysis, computed tomography angiography, and computed tomography cavernosography. The primary safety endpoint was any major adverse event 6 weeks after the procedure. The primary feasibility endpoint was defined as an IIEF-6 (International Index of Erectile Function-6) score improvement of ≥ 4 points at 6-week follow-up post intervention., Results: Procedural success was achieved in all patients with no major adverse events on follow-up. The primary feasibility endpoint at 6-week follow-up was reached with 3/26 (11.5%) of patients following arterial revascularization only. Six weeks after additional venous embolization, the primary feasibility endpoint was reached in 17/26 (65.4%) of patients., Conclusion: Venous leak embolization yields additional clinical improvement and treatment potential in patients with vasculogenic ED not responding to PDE5i due to mixed arterio-venous disease and insufficient clinical improvement after arterial revascularization alone., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval and patient consent to participate are available (EKNZ 2018–00408). Informed Consent: Informed consent was obtained from all individual participants included in the study. Consent for Publication: Consent for publication was obtained for every individual person’s data included in the study., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Penile prosthesis implantation (PP surgery) is a well-established solution for severe, medication-refractory erectile dysfunction (ED). Despite its effectiveness, limited data exists on patient characteristics influencing the timing of PP surgery after ED onset. We aimed to investigate predictors for early PP surgery and compare preoperative factors in men who had early (<12 months) vs. late PP surgery (≥12 months). We analyzed data from 210 men undergoing inflatable PP surgery for medication-refractory ED to investigate predictors for early PP surgery. Men with early PP surgery were older (64 vs. 61 years), had more comorbidities, (97.2% vs. 63.3% CCI ≥ 1). Linear regression analysis showed that more comorbidities were associated with an earlier time to PP surgery (Coeff: -1.82, 95% CI: -3.08 to -0.56, p = 0.004). At multivariate Cox regression analysis, CCI ≥ 1 emerged as the sole predictor of early PP surgery (OR: 1.29, 95% CI: 1.07-1.56, p = 0.007) after adjusting for age, ED etiology, and ethnicity. Our study sheds light on factors influencing decisions for early vs. late PP surgery post-medication-refractory ED. Men with more comorbidities were more likely to receive early PP surgery, emphasizing the importance of preoperative counseling and personalized treatment plans., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)