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Background: Lower urinary tract symptoms (LUTS) adversely affect the quality of life and are usually under-reported because of a stigma associated with these symptoms. Unless specifically probed for these symptoms, most patients do not report Lower urinary tract symptoms. This study focused on the treatment-seeking behaviour of otherwise healthy individuals who had LUTS. The study aimed to determine the relationship between lower urinary tract symptoms and treatmentrelated behaviours among adults in the Hazara Division. Methods: This was a descriptive crosssectional, questionnaire-based study of healthy attendants of patients admitted at a private medical centre for any reason who were enrolled in this study and were interviewed using a simple questionnaire after obtaining informed consent. The patients were administered validated tools such as OAB-8 and IPSS. Results: Overall, 23.5% of study participants reported LUTS. Among the 968 study participants, 530 reported having LUTS less than half the time and 438 reported LUTS more than half the time during the past 3 months. Over 23.5% of patients sought any type of treatment for their symptoms. the likelihood of seeking medical attention was more in males experiencing issues such as urgency with distress (aOR 2.21 (1.11-4.05) CI 95%), frequency with distress (aOR 1.88 (1.01-4.21) 95%CI), slow urinary stream with distress (aOR 2.33 (1.13-4.49) CI 95%), hesitation (aOR 1.81 (1.02-2.15) CI 95%), and feeling of incomplete bladder emptying (aOR 3.13 (1.38-4.95) CI 95%). Similarly, females with symptoms like urgency with a fear of urine leak (aOR 5.33 (1.67- 10.93) CI 95%), frequency (aOR 4.88 (1.29-9.94) CI 95%), urgency with distress (aOR 6.11 (2.33- 13.20) CI 95%), and intermittency (aOR 2.32 (1.33-3.78) 95% CI), were more prone to seeking medical help. Conclusion: There is marked under-utilization of treatment for LUTS. Physicians need to adopt a proactive approach to identifying these symptoms and offering treatment. [ABSTRACT FROM AUTHOR]

Prostate enlargement, medically termed as benign prostatic hyperplasia (BPH), is a prevalent and frequently troublesome issue affecting older men. Research suggests that over 50% of males in their 60s may encounter symptoms associated with BPH. While BPH doesn't pose an immediate threat to life, its implications on urinary function can substantially diminish a man's quality of life. The aetiology of BPH involves complex hormonal and inflammatory mechanisms, leading to prostatic enlargement and obstructive symptoms. Traditional management strategies such as a-blockers and 5-a reductase inhibitors offer symptomatic relief but may cause adverse effects. In recent years, natural compounds have gained attention for their potential efficacy and safety in the management of prostate enlargement. This article reviews recent advancements in prevention and treatment of BPH, with a particular emphasis on the utilisation of herbal remedies, namely fireweed (Epilobium angustifolium L.) and nettle (Urtica dioica L.). These plants are a rich source of polyphenols, known for their anti-inflammatory properties. Moreover, they seem to positively influence hormonal balance. These two functions appear to be responsible for alleviating LUTS symptoms. The research was conducted using PubMed, Scopus, and Google Scholar databases to gather relevant studies and findings. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the validity and reliability of the Turkish version of the Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-10 (LURN SI-10). Materials and methods: In this, single-centre study, patients between 18 and 65 years old, who were suffering from lower urinary tract symptoms (LUTS) without any known urinary tract disease and on no medication, were enrolled. The control group consisted of participants, who were admitted to our clinic suffering from any complaint except LUTS and met all of the other inclusion and exclusion criteria. Participants’ demographics such as age, sex, and level of education were recorded. The Turkish version of the LURN SI-10, International Prostate Symptom Score (IPSS) and Overactive Bladder Questionnaire (OAB-V8) were administered to all participants. Construct validity was evaluated by confirmatory factor analysis and concurrent validity was evaluated with correlations to similar measures. Internal consistency (Cronbach's alpha) was used to establish the scale's internal consistency reliability. Results: A total of 164 participants were included in the final analysis. Of those, 57% were male. The individuals were identified as being in the “patient group” (n = 86) and a “control group” (n = 78). The mean age was 48.24 ± 14.30 years. The median total LURN SI-10 scores of patient group and control group were 12.0 (9-18.25) and 4.0 (2.75-6), respectively. The LURN SI-10 questionnaire showed a high correlation with the IPSS and the OAB-V8 questionnaires (r: 0.761; p: 0.001; r: 0.737; p: 0.001, respectively) in concurrent validity analysis. Cronbach’s alpha coefficient of the LURN SI-10 was 0.850. Conclusions: This promising measurement tool can be used to evaluate LUTS in Turkish women and men. Further studies should be conducted to assess the clinical usefulness of this questionnaire.

In 2019, there were 94 million cases of benign prostatic hyperplasia globally among men aged 40 years and older. Assessment of prostate volume (PV) is important in evaluating lower urinary tract symptoms and risks in asymptomatic individuals. Serum prostate-specific antigen (PSA) levels have been suggested as a convenient and useful biomarker for benign prostate hyperplasia (BPH). However, studies suggest that using PSA as a biomarker for BPH and prostate cancer can lead to underestimation of disease severity in patients with a high body mass index (BMI). PSA mass has been proposed as a potentially superior predictor compared to total PSA levels. This retrospective study recruited the male patients visiting Kuang Tien General Hospital who had serum PSA level test, underwent transrectal ultrasonography (TRUS) for evaluation of prostate volume between January 2009 and December 2019. PSA mass was obtained by calculating body surface area (BSA) and plasma volume. The data were proved to build a nomogram, to predict the volume of the prostate, and its accuracy was evaluated using internal validation techniques. Statistical analyses were performed using SAS and R. A total of 417 men were included in this study, with a mean age of 67.3 years, mean BMI of 24.9 kg/m2, mean prostate volume of 43.87 mL, mean PSA level of 2.94 ng/mL, and mean PSA mass of 8.68 ng/mL. The results showed that PSA mass had a higher accuracy than PSA in predicting prostate volume, as evidenced by a higher area under curve (AUC) value of 0.8271 for the PSA mass model compared to 0.8218 for the PSA model. Our nomogram showed a satisfying prediction accuracy. PSA mass may be a superior predictor of prostate volume compared to total PSA levels, although only slight improvement was shown.

OBJECTIVE: The objective of this study is to determine if Aquablation therapy can maintain its effectiveness in treating men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with large-volume (80-150 cc) prostates at 3 years. SUBJECTS AND METHODS: One hundred one men with moderate-to-severe BPH symptoms and prostate volumes between 80 and 150 cc were enrolled in a prospective, nonrandomized, multicenter, international clinical trial in late 2017. Baseline, procedural, and follow-up parameters were recorded at baseline and scheduled postoperative visits. IPSS, Qmax, and treatment failure are reported at 3 years. RESULTS: The mean prostate volume was 107 cc (range 80-150). Mean IPSS improved from 23.2 at baseline to 6.5 at 3 years (16.3-point improvement, p

Introduction: The EPIC study has highlighted the prominence of nocturia as a crucial symptom of overactive bladder (OAB), intertwining OAB and nocturia with bladder, kidney, and brain functions. Methods: Expert opinion, review. Results: To truly comprehend lower urinary tract symptoms (LUTS), we must delve into the interactions among these three systems, alongside their circadian rhythms. Conclusion: The perception of LUTS is a result of the intricate interplay between bladder, brain, and kidney function, which may evolve across a lifetime due to the (dys)functionality of these organs. [ABSTRACT FROM AUTHOR]

Mingshuang Wu,* Chenxi Pan,* Yi He, Bo Yang Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yi He; Bo Yang, The Second Affiliated Hospital of Dalian Medical University, 467, Zhongshan Road, Shahekou District, Dalian, 116044, People’s Republic of China, Tel/Fax +86 411 84671291, Email heyi_gzr@163.com; yangbo20160101@163.comPurpose: The goal of this study was to assess the prognostic impact of the lower urinary tract symptoms (LUTS) in advanced prostate cancer (PCa) patients before progression to castration-resistant prostate cancer (CRPC).Methods: A retrospective analysis of the follow-up data for 152 CRPC patients was performed. Severe LUTS symptom was defined as an International Prostate Symptoms Score (IPSS) ≥ 20 at baseline. Cox regression analysis was conducted to assess CRPC prognostic factors. Nomogram model was created and assessed using the concordance index (C-index), calibration curves, receiver operating characteristic (ROC) curves, and decision curve analyses (DCA).Results: The median CRPC free survival of patients with severe LUTS was 20.5 months, significantly longer than that (7.5 months) of less symptomatic patients. Furthermore, severe LUTS, the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, and Gleason sum were determined to be independent prognostic markers and combined to establish a nomogram, which performed well in the customized prediction of CRPC progression at 6th, 12th, 18th and 24th month. The C-index (0.794 and 0.816 for the training and validation cohorts, respectively), calibration curve, and ROC curve all validated the prediction accuracy. DCA curve showed that it could be effective in helping doctors make judgments. The Nomogram-related risk score separated the patients into two groups with notable progression differences.Conclusion: Severe LUTS was significantly associated with decreased risk for rapid progression to CRPC. The developed nomogram could help identify patients who are at a high risk of rapid CRPC progression and provide tailored follow-up and therapeutic advice.Keywords: LUTS, HALP, castration-resistant prostate cancer, nomogram

Abstract Aims Refractory ketamine‐induced uropathy (KU) (RKU) has devastating effects on the lower urinary tract leading to ureteral obstruction and even renal failure. The only effective treatment for RKU is major surgical reconstruction or urinary diversion. Nevertheless, there is a paucity of awareness about this destructive condition; the aim of this study is to conduct a narrative systemic review of all surgical outcomes of RKU. Methods This is an English language literature review of surgical outcomes in KU patients who underwent reconstructive lower urinary tract surgery or urinary diversion through 5 August 2022. Two independent researchers assessed the relevance of each paper and disputes were settled by a third party. In‐vitro, animal studies, letters to the editor and papers that did not evaluate surgical outcomes were excluded. Results Of the 50 763 identified articles, 622 were relevant based on title, 150 based on abstract, but only 23 papers were relevant by content. In all, 875 patients were documented as having KU, of whom 193 (22%) underwent reconstructive surgery. The data were disconcerting, as the apparent rapid progression from the beginning of KU to end‐stage bladder was only a 1‐year difference of ketamine abuse between those patients who required surgery (4.4 years) and those that did not (3.4 years). Conclusions The data suggest that the time interval from the beginning of ketamine‐induced uropathy to the end‐stage bladder may be measured in months, confounding decision making. There is a dearth of literature about KU, and more research is needed to better understand this pathology.

Non-muscle invasive bladder cancer (NMIBC) accounts for ~70–75% of total bladder cancer tumors and requires effective early intervention to avert progression. The cornerstone of high-risk NMIBC treatment involves trans-urethral resection of the tumor followed by intravesical Bacillus Calmette-Guerin (BCG) immunotherapy. However, BCG therapy is commonly accompanied by significant lower urinary tract symptoms (LUTS) including urinary urgency, urinary frequency, dysuria, and pelvic pain which can undermine treatment adherence and clinical outcomes. Despite this burden, the mechanisms underlying the development of BCG-induced LUTS have yet to be characterized. This review provides a unique perspective on the mechanisms thought to be responsible for the development of BCG-induced LUTS by focussing on the sensory nerves responsible for bladder sensory transduction. This review focuses on how the physiological response to BCG, including inflammation, urothelial permeability, and direct interactions between BCG and sensory nerves could drive bladder afferent sensitization leading to the development of LUTS. Additionally, this review provides an up-to-date summary of the latest clinical data exploring interventions to relieve BCG-induced LUTS, including therapeutic targeting of bladder contractions, inflammation, increased bladder permeability, and direct inhibition of bladder sensory signaling. Addressing the clinical burden of BCG-induced LUTS holds significant potential to enhance patient quality of life, treatment compliance, and overall outcomes in NMIBC management. However, the lack of knowledge on the pathophysiological mechanisms that drive BCG-induced LUTS has limited the development of novel and efficacious therapeutic options. Further research is urgently required to unravel the mechanisms that drive BCG-induced LUTS.

Introduction: Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) affects extra‐respiratory systems, with small‐scale studies showing worsened male lower urinary tract symptoms (LUTS) after coronavirus disease 2019 (COVID‐19). This study explores the correlation between SARS‐CoV‐2 infection and male benign prostatic hyperplasia (BPH) complications using large‐scale real world data. Materials and methods: All male patients attending the public healthcare system in Hong Kong receiving alpha‐blocker monotherapy for LUTS from 2021 to 2022 were included in this study. Patients with and without positive polymerase chain reaction (PCR) test for SARS‐CoV‐2 are selected as the exposure group and control group, respectively. Baseline characteristics are retrieved, with propensity score matching performed to ensure balance of covariates between the two groups. BPH complications were then compared and subgroup analyses were performed. Results: After propensity score matching, 17,986 patients were included for analysis, among which half had PCR‐confirmed SARS‐CoV‐2 infection (n = 8993). When compared to controls, the SARS‐CoV‐2 group demonstrated statistically significant higher incidence of retention of urine (4.55% vs. 0.86%, p < 0.001), haematuria (1.36% vs. 0.41%, p < 0.001), clinical urinary tract infection (UTI) (4.31% vs. 1.49%, p < 0.001), culture‐proven bacteriuria (9.02% vs. 1.97%, p < 0.001) and addition of 5ARI (0.50% vs. 0.02%, p < 0.001). Subgroup analysis demonstrated similar differences across different age groups. There are no statistically significance differences in incidence of retention, haematuria, or addition of 5ARI across different COVID‐19 severities. Conclusions: SARS‐CoV‐2 infection is associated with increased incidence of urinary retention, haematuria, UTI and the addition of combination therapy in the short term, regardless of COVID‐19 severity. This is the largest study demonstrating the detrimental urological effects of SARS‐CoV‐2 infection. [ABSTRACT FROM AUTHOR]

Functional hypogonadism is a condition characterized by low testosterone concentrations, occurring more commonly in men as they age. The International Prostate Symptom Score (IPSS) is used to categorize the severity of lower urinary tract symptoms (LUTS) and related symptoms in hypogonadal men. Testosterone therapy (TTh) has previously shown potential in improving total IPSS in men with hypogonadism. However, concerns regarding the effects of urinary function following TTh often prevent treatment in hypogonadal men. To explore this further, two population-based single-center, prospective, cumulative registry studies were combined to contribute to a total population of 1176 men with symptoms of hypogonadism. The total population was separated into a TTh group receiving testosterone undecanoate (TU) for up to 12years and a control group that did not receive treatment. IPSS was recorded at both baseline and at final recorded visit for each patient. Long-term TTh with TU in hypogonadal men resulted in significant improvements in IPSS categories, even in patients with severe symptoms at baseline. In the control group, untreated hypogonadal men experienced a worsening of IPSS categories. These data indicate that TTh improves LUTS in men with hypogonadism and suggest that previous concerns regarding urinary function may have been overstated. [ABSTRACT FROM AUTHOR]

Introduction: Urolift is an established intervention for symptoms of bladder outflow obstruction caused by benign prostate enlargement. Reported advantages include its minimally invasive profile, short learning curve and feasibility as a day case procedure. Our aim was to use a national registry as a means to evaluate the nature of complications and device failures that have been documented to occur. Methods: Retrospective review was performed of the US Manufacturer and User Facility Device Experience (MAUDE) database, a prospective register, which contains voluntarily submitted adverse events associated with surgical devices. Information collected include event timing, underlying cause, procedural completion, complications and mortality status. Results: Between 2016 and 2023, 103 device failures, 5 intra-operative complications and 165 post-operative complications (early: 151, late: 14) were registered. The commonest device problem (56%, n = 58) was failure of the implant to deploy with subsequent requirement for complete replacement. There were 50 cases of documented urosepsis. 62 patients with post operative haematuria were registered including 12 that underwent emergency embolisation. Other complications included stroke (n = 5), pulmonary embolism (n = 3) and necrotising fasciitis (n = 1). Twelve ITU admissions were registered. In the reports, 22 cases were filed that recorded a hospital stay of 7 days or more. Eleven deaths were captured in the database over the study period. Conclusion: While urolift is recognised as less invasive intervention compared to alternatives such as transurethral resection of the prostate, serious adverse events have been reported to occur including death. Our findings can provide learning points for surgeons and allow for improved patient counselling and treatment planning accordingly. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a scoping review of the existing literature and recent developments on prostatic stents for the treatment of benign prostatic hyperplasia (BPH). Methods: A comprehensive search was performed on Embase, MEDLINE, and Web of Science to identify English literature on prostatic stents for the treatment of BPH. Additional studies and upcoming devices were identified through grey literature search and expert consultation. Study characteristics and stent information were extracted and tabulated narratively. Results: Of the 1171 search results, 64 studies were included in this review. iTiND was the prostatic stent with the most long-term evidence. iTiND is a safe and effective minimally invasive treatment for BPH that preserves sexual function. Adverse events are mild and transitory. Emerging stents (e.g. Zenflow, Butterfly, Urocross, and Exime) had 7/64 eligible studies, where no studies had long-term follow-up. These newer stents show promising results for quality of life and BPH symptom management; however, long-term monitoring and head-to-head comparisons are needed. Conclusion: Over the last 50 years, prostatic stents have evolved and demonstrated improved clinical efficacy. iTiND provides a safe and effective outpatient treatment of LUTS secondary to BPH preserving erectile and ejaculatory function. Emerging prostatic stents are a promising, effective, and safe intervention in well-selected patients interested in its benefits. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is an age-related enlargement of the prostate with urethral obstruction that predominantly affects the middle-aged and older male population, resulting in disruptive lower urinary tract symptoms (LUTS), thus creating a profound impact on an individual's quality of life. The development of LUTS may be linked to overexpression of oxytocin receptors (OXTR), resulting in increased baseline myogenic tone within the prostate. Thus, it is hypothesised that targeting OXTR using oxytocin receptor antagonists (atosiban, cligosiban, and β-Mercapto-β,β-cyclopentamethylenepropionyl1, O-Me-Tyr2, Orn8]-Oxytocin (ßMßßC)), may attenuate myogenic tone within the prostate. Organ bath and immunohistochemistry techniques were conducted on prostate tissue from young and older rats. Our contractility studies demonstrated that atosiban significantly decreased the frequency of spontaneous contractions within the prostate of young rats (**** p < 0.0001), and cligosiban (* p < 0.05), and ßMßßC (**** p < 0.0001) in older rats. Additionally, immunohistochemistry findings revealed that nuclear-specific OXTR was predominantly expressed within the epithelium of the prostate of both young (*** p < 0.001) and older rats (**** p < 0.0001). In conclusion, our findings indicate that oxytocin is a key modulator of prostate contractility, and targeting OXTR is a promising avenue in the development of novel BPH drugs. [ABSTRACT FROM AUTHOR]

Uroflowmetry is a non-invasive study used in the diagnosis and monitoring of treatment response for lower urinary tract disorders. For optimal clinical utility, uroflow studies rely on careful clinical interpretation by a trained provider, but currently there is a lack of accepted standardized normal values for the measured uroflow parameters in children. The International Children's Continence Society proposed standardizing the terminology for uroflow curve shapes. However, the patterning of curves is largely at the physician's subjective discretion. The aims of this study were to understand inter-rater reliability in interpreting uroflow curves and to define characteristics of uroflow curves that could be used to provide definitive criteria for uroflowmetry parameters. All members of the SPU Voiding dysfunction Task Force were invited to contribute deidentified uroflows to a centralized HIPAA complaint receiving database. All studies were then distributed to all raters for review. Each observer's findings were recorded according to ICCS criteria (ICCS), additional readings were done using a previously reported system which defined curves as smooth or fractionated (SF) and whether the shape resembled a bell, tower, or plateau (BTP). Flow indexes (Qact/Qest) (FI) for Qmax and Qavg were generated using formulas previously reported for children 4–12 and for patients≥12 years. A total of 119 uroflow studies were read by 7 raters and curves were contributed from 5 sites. Kappa scores for the 5 readers from different institutions were 0.34 and 0.28 for the ICCS and BTP methods, respectively (both considered fair agreement). Kappa for smooth and fractionated curves was 0.70 (for each; considered substantial agreement), which were the two highest agreement scores obtained throughout the study. Discriminant analysis (DA) revealed that the FI Qmax was the dominant vector, and that the ICCS uroflow parameters have a total of 42.8% prediction rate in the training sample. Using DA of a smooth/fractionated system, the total prediction rates were 72% and 65.5% for smooth and fractionated, respectively. Given the poor inter-rater agreement for analyzing uroflow curve pattern based on ICCS criteria in this study and others, one may find it reasonable to consider alternative approaches to describing and characterizing uroflow curves. Our study is limited by lack of EMG and post-void residual data. For a more objective uroflow interpretation and comparison of studies among different centers, we recommend using our proposed system (based on FI, and smooth vs. fractionated curve pattern), which is more reliable. [Display omitted] [ABSTRACT FROM AUTHOR]

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In late 2019, an outbreak of pneumonia of unknown etiology was reported in Wuhan (China). The causative agent was quickly identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the impact of COVID-19 (coronavirus disease 2019) on various organs and symptoms has been studied, there is still a dearth of data regarding its effect on the genitourinary system. In this study, we investigated the impact of different COVID-19 strains on lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). A total of 69 patients who had previously been infected with COVID-19 from August 2021 to October 2021 and January 2022 to May 2022 were assessed. The two periods were purposively selected based on the dominant COVID-19 variant: the Delta strain for the first period and Omicron for the second, respectively. All patients had BPH and were followed up in two outpatient practices. Demographic information was collected, and LUTS were assessed using the international prostate symptom score (IPSS) questionnaires before and after COVID-19. Ultrasound examinations were performed to determine the prostate gland volume and the post-voided residual (PVR) in each patient. All patients affected by COVID-19 exhibited a worsening of LUTS. The degree of deterioration differed between those infected with different COVID-19 strains. Patients infected with the Delta strain had more severe LUTS than those with the Omicron strain. There is currently limited information available regarding the emerging pathophysiological processes in the urogenital system related to COVID-19. This present study serves as a preliminary investigation into the impact of COVID-19 on LUTS in BPH patients and could serve as a basis for more extensive multicenter studies leading to fundamental discoveries.

Aim: Lower Urinary Tract Symptoms (LUTS) are common conditions seen in women of all ages and by clinicians of nearly all specialties. The prevalence of LUTS has been measured by numerous epidemiological studies around the globe. However, there are insufficient data from India, particularly among women consulting gynecology clinics. This observational study was conducted to determine the proportion of LUTS among women attending the Gynecology OPD. Material and methods: For the evaluation, a standardized, pretested, structured, and scored Bristol LUTS questionnaire containing sociodemographic information and a clinical history of LUTS symptoms has been utilized. The symptoms of LUTS were classified as storage, voiding, and stress symptoms. Each response received a score between 0 and 4. Patients were categorized into no/minimal LUTS (score1–7), moderate LUTS (score8–19), and severe LUTS (score>20). In our study, 48% of women attending the Gynecological OPD had LUTS. Age and vaginal delivery had a significant influence on the incidence of LUTS. Results: Despite the high prevalence of LUTS, few patients in our study spontaneously reported symptoms of LUTS. This underreporting may be due to a lack of awareness as well as social stigma. Many consider these symptoms to be a normal part of the ageing process, especially in postmenopausal women. Conclusion: Although all of the patients we have identified are based on the evaluation of a symptomatic questionnaire, a urodynamic study should be conducted to determine whether or not these women have different types of LUTS.

Introduction. Benign prostatic hyperplasia (BPH) is a common condition in aging men that is often associated with lower urinary tract symptoms (LUTS).Objective. To determine the clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and develop an algorithm for improving the efficacy of treating lower urinary tract symptoms in benign prostatic hyperplasia.Materials & methods. The study included 112 BPH-patients who received tamsulosin therapy or a combination of tamsulosin + solifenacin for three months. After three months of therapy, the patients were divided into two groups depending on the effectiveness of therapy: group 1 — a positive result (n = 77); group 2 — no positive effect (n = 35). Due to the lack of efficacy in patients of group 2, a multichannel urodynamics was performed, according to the results of which the patients were prescribed treatment with a subsequent assessment of the result after 3 months.Results. After 3 months of therapy in patients of group 1, a decrease in pollakiuria was noted. Regression of obstructive and irritative symptoms was also observed, and the urination-associated quality of life (QoL) improved. The maximum urine flow rate (Q max) remained unchanged mainly. By the sixth month, the frequency of urination continued to decrease (11.05 vs 9.32 episodes; p = 0.022), as well as the improvement of other parameters (IPSS, QoL, Q max and post-void residual urine volume (PVR) (80.87 vs 56.17 ml; p = 0.012). The indicators of patients of group 2 following three months of therapy remained without significant changes. Sixteen patients underwent transurethral prostate resection, 19 patients underwent therapy correction, which allowed reducing the number of episodes of daily pollakiuria. The total IPSS score decreased by 4.37 compared to baseline (IPSS (obstructive) — 13.79 vs 7.26 pts; p = 0.032). The QoL value was 2.84 pts, Q max — 14.90 mL/s, PVR — 10.58 mL.Conclusion. 19.8% of BPH-patients are resistant to drug therapy. The ineffectiveness of therapy may be due to the severe BOO. In the absence of the effect of the therapy within 3 months, it is recommended to perform multichannel urodynamics. Correction of therapy according to the multichannel urodynamics data improves its effectiveness by the sixth month of treatment. Indicators of IPSS, Q max and PVR after 3 months of therapy allow predicting the effectiveness of therapy, or suspect the need for surgical treatment.

BackgroundContinuous α1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men.ObjectiveWe aim to evaluate the feasibility and usability of the PERSONAL (Placebo-Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy.MethodsWe recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility.ResultsWe enrolled 19 men within 23 days, and 100% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74% vs 17/19, 89% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95% at baseline and at follow-up). In total, 58% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms.ConclusionsThis pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men.

Background: Multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. In children the first manifestations can sometimes overlap with acute neurological symptoms. Urological symptoms have not been much studied in childhood. We shared our experience with MS urological manifestation in children. Methods: This article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. We collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams. Results: We report on six MS pediatric cases with urological manifestation. Urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. Urodynamic exams showed both overactive and underactive bladder patterns. Treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor Onabotulinum Toxin-A injection. A low acceptance rate of invasive evaluation and urological management was observed. Conclusions: The MS diagnosis was traumatic for all our patients. We believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams.

Benign prostatic hyperplasia and its associated lower urinary tract symptoms seriously affect both the physical and mental health of older men. In order to determine the efficiency of Chinese Qigong Yi Jin Jing on prostate health in older individuals, thirty participants were randomized into either an Yi Jin Jing group (n = 15) or a control group (n = 15). After the 6-month intervention, the Yi Jin Jing group showed a significant decrease in international prostate symptom score and a significant increase in maximal urinary flow rate (compared with the control group p =.005, p =.001, respectively). Also, testosterone level increased and estrogen/testosterone ratio decreased in the Yi Jin Jing group (compared with the baseline p =.004, p =.002, respectively); estrogen level and estrogen/testosterone ratio were lower in the Yi Jin Jing group (compared with the control group p =.029, p =.012, respectively). The results showed that Yi Jin Jing is a promising way to reduce the risk of benign prostatic hyperplasia-lower urinary tract symptoms in older men. [ABSTRACT FROM AUTHOR]

Leiomyosarcoma of the prostate is a rare and aggressive tumor, with a quarter of the patients harboring metastatic disease, commonly in the lung. It usually presents with urinary obstruction in a relatively younger patient group. A 29-year-old male presented with lower urinary tract symptoms to the urologist. Computed tomography scan revealed a large pelvic mass involving the prostate. Biopsy on two occasions yielded leiomyoma. Instead of conventional radical surgery, en-bloc resection of the mass was done while preserving the remaining portion of the prostate, seminal vesicles, and ejaculatory duct. Histopathology revealed a high-grade leiomyosarcoma with negative margins. The patient had excellent recovery of defecation, erectile, and ejaculatory functions within 2 months after adjuvant radiotherapy. At the 24-month follow-up there was no evidence of disease. En-bloc resection of the tumor can be considered in select cases to improve functional outcomes and sustain a higher quality of life in patients. [ABSTRACT FROM AUTHOR]

AbstractFunctional hypogonadism is a condition characterized by low testosterone concentrations, occurring more commonly in men as they age. The International Prostate Symptom Score (IPSS) is used to categorize the severity of lower urinary tract symptoms (LUTS) and related symptoms in hypogonadal men. Testosterone therapy (TTh) has previously shown potential in improving total IPSS in men with hypogonadism. However, concerns regarding the effects of urinary function following TTh often prevent treatment in hypogonadal men. To explore this further, two population-based single-center, prospective, cumulative registry studies were combined to contribute to a total population of 1176 men with symptoms of hypogonadism. The total population was separated into a TTh group receiving testosterone undecanoate (TU) for up to 12 years and a control group that did not receive treatment. IPSS was recorded at both baseline and at final recorded visit for each patient. Long-term TTh with TU in hypogonadal men resulted in significant improvements in IPSS categories, even in patients with severe symptoms at baseline. In the control group, untreated hypogonadal men experienced a worsening of IPSS categories. These data indicate that TTh improves LUTS in men with hypogonadism and suggest that previous concerns regarding urinary function may have been overstated.

Introduction: The objective of this study was to explore potential novel biomarkers for moderate to severe lower urinary tract symptoms (LUTS) using a metabolomics-based approach, and statistical methods with significant different features than previous reported. Materials and Methods: The patients and the controls were selected to participate in the study according to inclusion/exclusion criteria (n = 82). We recorded the following variables: International prostatic symptom score (IPSS), prostate volume, comorbidities, PSA, height, weight, triglycerides, glycemia, HDL cholesterol, and blood pressure. The study of 41 plasma metabolites was done using the nuclear magnetic resonance spectroscopy technique. First, the correlations between the metabolites and the IPSS were done using Pearson. Second, significant biomarkers of LUTS from metabolites were further analysed using a multiple linear regression model. Finally, we validated the findings using partial least square regression (PLS). Results: Small to moderate correlations were found between IPSS and methionine (-0.301), threonine (-0.320), lactic acid (0.294), pyruvic acid (0.207) and 2-aminobutyric-acid (0.229). The multiple linear regression model revealed that only threonine (p = 0.022) was significantly associated with IPSS, whereas methionine (p = 0.103), lactic acid (p = 0.093), pyruvic acid (p = 0.847) and 2-aminobutyric-acid (p = 0.244) lost their significance. However, all metabolites lost their significance in the PLS model. Conclusion: When using the robust PLS-regression method, none of the metabolites in our analysis had a significant association with lower urinary tract symptoms. This highlights the importance of using appropriate statistical methods when exploring new biomarkers in urology. [ABSTRACT FROM AUTHOR]

Introduction: Practice patterns around the use of urodynamic evaluation (UDS) for benign prostatic hyperplasia (BPH) surgery are largely undefined. As such, we investigated factors associated with the use of UDS for BPH. Methods: We used American Board of Urology case log data from 2008 to 2020, to compare patient‐ and surgeon‐sided factors associated with UDS utilization and BPH surgeries. We performed logistic regression models to identify factors independently associated with UDS usage for BPH. Results: Among urologists performing UDS, the majority (80%) self‐identified as general urologists and practiced in a private practice group (69%). Compared with urologists who performed no UDS, urologists who performed any UDS for BPH were more likely to be from the Mid‐Atlantic (20.3% vs. 10.6%, p < 0.01) and practice in regions with populations of >1 000 000 (34.7% vs. 28.5%, p < 0.01). Overall, UDS utilization declined over time (odds ratio [OR]: 0.95 year‐to‐year, 95% confidence interval [CI]: 0.91–0.99). In adjusted analyses, the odds of performing UDS was higher among male (OR: 2.19, 95% CI: 1.17–4.09), older (OR: 1.05, 95% CI: 1.03–1.06), and female pelvic medicine and reconstructive surgery subspecialty (OR: 3.23, 95% CI: 2.01–5.2) urologists. Additionally, performing UDS for BPH was associated with higher BPH surgical case volume (OR: 1.004, 95% CI: 1.001–1.008). Conclusion: There is a significant practice variation in use of UDS for BPH. Although overall BPH surgeries are increasing, urologists are increasingly less likely to perform UDS for BPH. Specifically, urologists who perform UDS have significantly higher BPH case volume than those who do not perform UDS, suggesting that UDS usage may not factor into BPH surgery decision‐making. [ABSTRACT FROM AUTHOR]

Introduction: Intravesical botulinum toxin A (BTX‐A) has been long established as treatment for overactive bladder and neurogenic bladder dysfunction. However, most published data are reported among a female cohort. Adverse events such as intermittent self‐catheterization (ISC) and urinary tract infections (UTIs) play a large role in discontinuation of therapy. There is currently limited information regarding predictive factors to appropriately counsel male patients. Materials and Methods: We retrospectively collected data on male patients undergoing their first intravesical BTX‐A therapy from January 2016 to July 2021 in two high‐volume centers. Data included demographics, past medical and surgical history, and urodynamic parameters. Patients were excluded if they had a long‐term catheter or ISC before initiation of therapy. Results: A total of 69 men were included in the study with a median age of 66 years. There were 18 patients with neurogenic bladder dysfunction. Thirty men had urge incontinence secondary to radical prostatectomy or bladder outflow surgery. Overall rates of ISC were 43.5%. Predictors for ISC included a baseline postvoid residual (PVR) ≥ 50 mL (odds ratio [OR]: 4.2, 95% confidence interval [CI]: 1.36–13.03, p = 0.01), BTX‐A dose >100 units (OR: 4.2, 95% CI: 1.36–13.0, p = 0.01). Stress urinary incontinence was protective against ISC (OR: 0.20, 95% CI: 0.04–1.00, p = 0.049) as well as history of prostatectomy/bladder outflow obstruction (BOO) surgery (OR: 0.16, 95% CI: 0.05–0.47, p < 0.001). A multivariable logistic regression model with these factors yielded a c‐statistic of 0.80 (optimism‐adjusted = 0.75). An enlarged prostate was the only predictor for UTI among our male cohort (OR: 8.0, 95% CI: 2.03–31.5, p = 0.003). Conclusions: This is the first study assessing risk factors of adverse events among men following BTX‐A injection. High PVR and BTX‐A dose of >100U were predictors of requiring ISC after BTX‐A. Stress incontinence, previous radical prostatectomy, and BOO surgery were all protective against needing ISC post‐BTX‐A. An enlarged prostate was associated with development of UTI. These factors can be used to assist in counseling male patients regarding their risk of ISC and UTI. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effects of sex hormone imbalance on rat prostatic inflammation and fibrosis and identify the key molecules involved. Methods: Castrated Sprague–Dawley (SD) rats were treated with a constant dose of oestradiol (E2) and different doses of dihydrotestosterone (DHT) to achieve different oestrogen/androgen ratios. After 8 weeks, serum E2 and DHT concentrations, relative seminal vesicle weights, histopathological changes and inflammation were measured, collagen fiber content and oestrogen receptor (ER) and androgen receptor (AR) expression were detected, mRNA sequencing and bioinformatics analysis were performed to identify differentially expressed genes (DEGs). Results: The severity of inflammation in the rat dorsolateral prostate (DLP) was higher, collagen fibre content and ER expression in the rat DLP and prostatic urethra were increased and AR expression in the rat DLP was decreased in the 1:1 E2/DHT-treated group than that in the 1:10 E2/DHT-treated group. RNA-seq analysis identified 487 DEGs, and striking increases in the expression of mRNAs encoding collagen, collagen synthesis and degradation enzymes, growth factors and binding proteins, cytokines and chemokines, and cell-surface molecules were confirmed in the 1:1 E2/DHT-treated group compared to the 1:10 E2/DHT-treated group. mRNA expression of secreted phosphoprotein 1 (Spp1) and protein expression of osteopontin (OPN, encoded by Spp1) were increased in the 1:1 E2/DHT-treated group compared to the 1:10 E2/DHT-treated group, and Spp1 expression correlated positively with Mmp7, Cxcl6 and Igfn1 expression. Conclusions: The imbalance in the oestrogen/androgen ratio may affect rat prostatic inflammation and fibrosis, and OPN might be involved in this process. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) are both well-established, minimally invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of ≥200 cc. Materials and Methods: Between 2009 and 2020 a total of 53 patients with a prostate volume of ≥200 cc were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and postvoid residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien–Dindo Classification. Results: Patients treated with RASP had significantly larger prostate volumes compared with HoLEP (median 226 cc vs 204.5 cc, p = 0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 mL/s vs +10.70 mL/s, p = 0.724) and a reduction of the IPSS score (−12.50 vs −9, p = 0.246) as well as improvement of the QoL (−3 vs −3, p = 0.880). Median operative time was similar in both groups (150 minutes vs 132.5 minutes, p = 0.665). The amount of resected tissue was lower in the RASP group (134.5 g vs 180 g, p = 0.029) and there was no significant difference in postoperative prostate-specific antigen (1.2 ng/mL vs 0.8 ng/mL, p = 0.112). Despite a similar median catheterization time (3 days vs 2 days, p = 0.748), the median hospitalization time was shorter in the HoLEP group (4 days vs 3 days, p = 0.052). Complication rates were similar in both groups (32% vs 36%, p = 0.987). Conclusion: Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates ≥200 cc. These findings will require external validation at other high-volume centers. [ABSTRACT FROM AUTHOR]

Introduction: For sexual dysfunction and lower urinary tract symptoms (LUTS), obesity is identified as an independent risk factor. The current study aimed to evaluate the effect of significant rapid weight loss by bariatric surgery on LUTS and sexual function among men and women with class III obesity. Method: A group of patients who were planned to undergo bariatric surgery was enrolled in the study. Male patients were given the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaires. In the female group, they filled in the female sexual function index (FSFI) and the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) questionnaires. Patients were followed up 1 year after their bariatric surgery. Results: All questionnaires were completed by eighty-one patients. (mean age ± SD: 39.4 ± 9.2 years; mean body mass index (BMI) ± SD: 47.15 ± 5.4 kg/m2). The total score of the IPSS questionnaire decreased from 5.83 ± 3.01 preoperatively to 2.37 ± 1.66 postoperatively. The weight loss caused significant improvement in the storage phase of LUTS domains, but there were no considerable changes in the voiding phase. In the IIEF questionnaire, domains of sexual desire, overall satisfaction, and orgasmic function improved significantly. There was not a significant change in any FSFI domains after bariatric surgery. Mean ICIQ-SF decreased, but it was not substantial. Conclusion: Bariatric surgery can significantly improve the storage phase in men, but not the voiding phase. Sexual desire, orgasmic function, and overall satisfaction were significantly improved in men. No significant improvement in sexual function and UI in women was observed. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the reliability of transperineal interstitial laser ablation of the prostate (TPLA) in preserving antegrade ejaculation compared to transurethral resection of the prostate (TURP). Patients and Methods: In this single‐centre, prospective, randomized, open‐label study, consecutive patients with indication for surgical treatment for benign prostatic obstruction (BPO) were enrolled between January 2020 and September 2021 (NCT04781049). Patients were randomized to one of two treatment arms: Group A: TPLA (experimental group) and Group B: TURP (reference standard group). The primary endpoint was change in ejaculatory function (assessed by the Male Sexual Health Questionnaire – Ejaculatory function domain [EJ‐MSHQ]) at 1 month after surgery. Secondary endpoints included comparison of visual analogue scale (VAS) scores, changes in sexual function (assessed using the five‐item International Index of Erectile Function [IIEF‐5]), change in International Prostate Symptom Score [IPSS], change in quality of life score, and maximum urinary flow rate [Qmax] improvement at 1–6 months, as appropriate. Results: Fifty‐one patients (26 TPLA vs 25 TURP) were analysed. No differences in the perception of pain assessed by VAS and no differences in IIEF‐5 score were found between the groups. The distribution of ejaculatory function assessed by the EJ‐MSHQ remained unmodified after TPLA (P = 0.2), while a median 30% decrease in EJ‐MSHQ score was observed after TURP (P = 0.01). Absence of antegrade ejaculation was reported in one patient in the TPLA group (vs 18 patients in the TURP group). A statistically significant difference between the treatment groups was found in terms of postoperative Qmax (TPLA vs TURP: 15.2 [interquartile range 13.5–18.3] mL/s vs 26.0 [interquartile range 22.0–48.0] mL/s; P < 0.001). Both treatments significantly improved Qmax, with a mean 23.9 mL/s improvement after TURP (95% confidence interval [CI] 17.1–30.7) vs 6.0 mL/s after TPLA (95% CI 5.0–7.0), and IPSS, with a mean decrease of 11.6 (95% CI 9.7–13.5) vs 5.8 after TPLA (95% CI.2–9.6) with respect to baseline. Conclusion: In our study, TPLA preserved ejaculatory function in 96% of cases in addition to providing significant relief from BPO. [ABSTRACT FROM AUTHOR]

Background: Functional hypogonadism is a condition in which some, but not all, older men have low testosterone levels. Rather than chronological age per se, the causality of hypogonadism includes obesity and impaired general health (e.g., metabolic syndrome). An association between testosterone deficiency and lower urinary tract symptoms (LUTS) has been reported, yet due to prostate safety concerns, men with severe LUTS (IPSS score > 19) have invariably been excluded from entering testosterone trials. Irrespective, exogenous testosterone has not been demonstrated to cause de novo or worsen mild to moderate LUTS. Objective: This study investigated whether long-term testosterone therapy (TTh) could have a protective effect on improving the symptoms of LUTS in hypogonadal men. However, the exact mechanism by which testosterone exerts is beneficial effect remains uncertain. Patients and methods: In this study 321 hypogonadal patients with an average age of 58.9 ± 9.52 years received testosterone undecanoate in 12-week intervals for 12 years. One hundred and forty-seven of these males had the testosterone treatment interrupted for a mean of 16.9 months before it was resumed. Total testosterone, International Prostate Symptom Scale (IPSS), post-voiding residual bladder volume and aging male symptoms (AMS) were measured over the study period. Results: Prior to TTh interruption, it was observed that testosterone stimulation improved the men's IPSS, AMS and post-voiding residual bladder volume, while their prostate volume significantly increased. During the TTh interruption, there was a significant worsening in these parameters, although the increase in prostate volume continued. When TTh was resumed, these effects were reversed, implying that hypogonadism may require lifelong treatment. [ABSTRACT FROM AUTHOR]

In our outpatient practice, we are increasingly seeing men aged 35 to 45 years who have permanent low normal testosterone levels. Aim We set out to investigate whether there is an association between permanent low normal testosterone levels and lower urinary tract symptoms in young men. Patients and Methods For the period from January 2013 to December 2015 at the Andrology office at Hospital "St. Sofia", we examined 73 men aged 35 to 45 years with normal or elevated body mass index, permanent low normal testosterone level and micturition disorders. In order to compare the results we obtained, at the very beginning of the study, we selected a control group of 20 healthy men of the same age. Results We obtained, although within reference ranges, significantly lower values for total testosterone in the 73 men with micturition disorders we studied, compared with those in the control group without micturition disorders. Conclusions 1. Our study shows that in some men at a young age, some deviation in normal testosteronе secretion occurs, with a concomitant decrease in maximum urine flow, which is remarkably different from the same indicator in their peers with a high normal testosterone level. 2. We identify permanent low normal testosterone, overweight, and obesity as predictors of initial lower urinary tract symptoms in young men. 3. According to our study, the altered E2/T ratio is also relevant to the initial onset of lower urinary tract symptoms in young men.

Objective:To evaluate pediatric patients with lower urinary tract dysfunction (LUTD) who received bladder or external sphincter botulinum toxin A (BTX) injection in terms of effectiveness and permanence.Materials and Methods:We analyzed 80 patients treated with intradetrusor (n=48) n or intrasphincteric (n=32) BTx injection between May 2007 and December 2019. We divided the patients into 2 groups: Neurogenic bladder (NB) and LUTD. Clinical assessment of results was mainly done with Dysfunctional Voiding and Incontinence Symptoms Score (DVISS) and quality of life questionnaires and dryness status. Uroflowmetry with electromyography and video-urodynamic study was performed postoperatively.Results:Mean age and follow-up time were 123.0±48.3 and 30.1±5.8 months. For bladder BTx (NB: 18 patients; LUTD: 30 patients), the response rate was 79.1% (n=38). NB patients’ response duration was shorter (32 vs 87 weeks) and required subsequent multiple injections more (55% vs 23%) than the LUTD group. For sphincter BTx (NB: 13 patients; LUTD: 19 patients) clinical improvement was found in 75% (n=24) n of the patients. There was no significant difference between the NB and LUTD groups. DVISS and quality of life questionnaires showed substantial decrease in the LUTD groups after bladder (p

Lower urinary tract symptoms (LUTS) are caused by higher tension at the bladder neck level (due to fibrosis or stiffness) or benign prostatic hyperplasia, which causes static obstruction of the bladder outlet. Both forms cause a group of symptoms such as hesitancy, intermittency, weak stream, nocturia, urine frequency, and urgency. Additionally, LUTS (obstructive or irritative symptoms) are common in elderly men with hypogonadism, identified as the reduced testes capability in producing sex steroids and sperm, and are categorized as testosterone deficiency. Even though the mode of action (MoA) of testosterone therapy (TTh) on hypogonadal men needs more researched and understanding, the effectiveness of TTh in the development of male genital organs has been reported in several studies. This review shows the latest updates of TTh in LUTS including potential adverse effects, advantages, and disadvantages.

Abstract Background Lower urinary tract symptoms (LUTS) are common among diabetic patients and represent hidden and mysterious morbidity. The pathophysiology of LUTS among diabetes mellitus (DM) patients is multifactorial. Importantly, LUTS is known to cause physical and psychological distress. Thus, this study describes LUTS among DM patients, investigates factors that may associate with it, and assesses the possible relationship between LUTS and the quality of life of diabetics. Methods Over 6 months, data were collected from 378 diabetic patients in primary health care clinics. Demographic and clinical characteristics, Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7) were used to collect data. Univariate and multivariate analyses were performed. Results Three hundred seventy-eight participants were included in this study. (29.9%) were (58–67) years old. 49% were female. Half of the cohort was overweight, and a third were obese. 81% were Type 2 DM. Almost all of them are on medical treatment. A median score of 5.50 (2.00–8.00) for the UDI-6 scale and a median score of 5 (0.00–10.00) for the IIQ-7 scale were reported. Multiple linear regression models showed that residency (p = 0.038) and regular exercise (p = 0.001) were significantly and negatively correlated with the UDI-6 score, while female gender (p = 0.042), insulin use (p = 0.009) and the presence of comorbidities (p = 0.007) were positively correlated with this score. Furthermore, age (p = 0.040) and body mass index (BMI) (p

Introduction. The aging process in men is accompanied by a progressive decrease in the level of serum testosterone (Tc). In addition to chronological aging, various factors contribute to the decline in testosterone levels. One of such factors contributing to the decrease in endogenous Tc and the development of secondary hypogonadism is the long-term use of testosterone preparations (TPs) used for non-medical purposes.Objective. To assess the nature of lower urinary tract symptoms following discontinuation of long-term non-medical use of testosterone preparations.Materials and methods. A clinical and statistical analysis of examination results in 31 men aged 22 – 46 years who received TPs for non-medical purposes while visiting gyms and subsequently turned to urologist with complaints of lower urinary tract symptoms (LUTS) was carried out. The study used the International Prostatic Symptom Score (IPSS) questionnaire, laboratory and instrumental examinations: general urine examination, general blood examination, prostate secretion microscopy, evaluation of serum total Tc, follicle-stimulating and luteinizing hormones, prolactin, estradiol, prostate ultrasound and bladder ultrasound, uroflowmetryResults. When assessing LUTS, the prevalence of irritative symptoms was noted. The level of serum total Tc in 13 (41.9%) men was in the range of 8 – 11 nmol/l, in 18 (58.1%) men it was below 8 nmol/l. In addition, most patients (77.4%) had areas of reduced blood flow in the prostate, and 67.7% had prostate fibrosis.Conclusion. Discontinuation of the use of long-term non-medical TPs can lead to the development of secondary hypogonadism and LUTS, which in most cases are irritative. In the treatment of these patients, an interdisciplinary rehabilitation program should be developed.

Purpose of Review: The term neurogenic bladder (NGB) generally used for neurogenic lower urinary tract dysfunction (NLUTD) refers to storage and/or voiding dysfunction of the lower urinary tract, in patients after a neurological illness. The aim of management of NGB is to preserve renal function, achieving effective bladder emptying, urinary continence, and improving overall QOL. This is possible with detailed history taking, physical examination, relevant investigations, patient education, and an agreed treatment plan and a regular follow-up. Currently in India, there are no guidelines available for management of NGB. Considering India as a developing country and having a diversified health care system where the private sector in addition to the public health system plays an equally important role in delivering health care across the population, and with population distributed asymmetrically on the socioeconomic ladder, it is difficult to develop a single management protocol for management. This review is a step to understand current practices in India and how it differs in management of NGB, globally. Recent Findings: The European Association of Urology (EAU) and American Urology Association (AUA) guidelines have been recently updated in 2022 and 2021 respectively. Summary: Most clinicians in India follow a set protocol in line with available international guidelines suitable to local available services and expertise keeping in mind the best interest of patients. However, differences in management between concerned clinicians still exist; hence, there is a need for more research and formulating uniform consensus to approach management of neurogenic bladder in India. [ABSTRACT FROM AUTHOR]

Purpose: The Butterfly Prostatic Retraction Device ("Butterfly") is a permanent nitinol implant for benign prostatic hyperplasia. This study examines the chronic response of prostate tissue to the Butterfly in histological specimens from patients in the Butterfly pilot clinical study. Methods: Retrospective qualitative and semi-quantitative review of histological specimens of seven (7) patients who participated in the Butterfly pilot clinical study. Patients had at least 1-month implantation with the Butterfly prior to implant removal and TURP. Tissue samples were graded by two pathologists. Results: Four out of six patients had IPSS decreased from baseline. All seven patients' samples had signs of chronic inflammation; one demonstrated acute inflammation and one demonstrated fibrosis. In three cases, intraglandular calcification was identified. There was no ischemic necrosis induced by the implant, and no encrustation, urethral edema, or cellular atypia was noted. Conclusion: The Butterfly demonstrated an overall favorable safety profile in terms of tissue response. This study demonstrates that there is no significant tissue reaction in the prostatic urethra due to presence of Butterfly device. [ABSTRACT FROM AUTHOR]

Introduction: Ireland's population is living longer, and the prevalence of any LUTS is estimated to be 63–83% in adult men, increasing with age. Ireland has one of the lowest urologists per population ratio in Europe, at approximately 1:127,027. The patients waiting the longest are those with routine benign conditions such as men with LUTS. The impact on quality of life for men experiencing LUTS can be profound. Methods: Sláintecare funded an ANP post in TUH to develop an integrated referral pathway for male LUTS and develop a secondary care nurse-led clinic for LUTS and tackle the ever increasing new and return waiting lists. The initial focus of this role was on reducing pre-existing outpatient (OP) waiting lists. This is a review of the first 12-month outcomes of this ANP post. Results: A total of 410 new patients were assessed over the 12-month period. The mean waiting time from referral to review was 24 months; however, some referrals dated back to 2014. Four hundred forty-two return patients were reviewed in the 12-month period. All these patients were waiting longer than 18 months for a return appointment. In absence of the ANP-led clinic, there was no capacity for any of these patients to be reviewed in the general urology clinics. Overall outcomes were as follows: 38% were given advice and education and discharged. Treatment was initiated in 42% and follow-up arranged. Physical review was deemed necessary for 11% of patients. Only 6% of patients reviewed required referral back to consultants' clinic. Conclusion: This study demonstrates the safety, efficacy and financial advantage of an ANP-led clinic for adult men presenting with lower urinary tract symptoms previously triaged by a consultant urologist. [ABSTRACT FROM AUTHOR]

Purpose:: We present our observations of a urodynamic pressure flow study graph pattern that may be associated with bladder neck hypertrophy or prostate median lobe enlargement. Materials and Methods:: We report 23 male patients with signs and symptoms of lower urinary tract dysfunction who underwent urodynamic testing with pressure flow study analysis. We recognized an unusual pressure flow plot curve and found that these patients had cystoscopic evidence for bladder neck hypertrophy or cystoscopic or ultrasound evidence for prostate median lobe enlargement. Results:: The patients here demonstrated showed a pattern of increasing detrusor pressure on the pressure flow study — graph phase after maximum of flowrate, where a decreasing pressure pattern is expected. We contemplated that his pattern may show how bladder outflow dynamics is affected by the anatomical features of these patients and how patients may have symptoms of LUT dysfunction or significant residual urine despite a relatively good maximum flow rate. Conclusion:: We present a not previously described variation of the pressure flow study graph pattern common in men with prostatic hyperplasia, in a series of patients with median lobe prostatic hyperplasia and or hypertrophy of the bladder neck.

Lower urinary tract symptoms (LUTS) are including an overactive bladder, voiding and storing urine. The causes of LUTS include infectious and inflammatory. In this paper we present a rare case of LUTS caused by scabies mites and could be the third case reported in the medical literature. A 12-year-old child came to hospital complaining of tenesmus, dysuria and hematuria several days ago. A diagnosis of LUTS was established and investigations showed the scabie mite is the possible cause for the disease. Scabies mites have the ability of entering into the urinary tract leading to LUTS in patients affected with scabies.

The purpose of this study was to assess the importance of the post-void residual (PVR) ratio (PVR ratio) in achieving a favorable trifecta outcome for patients suffering from lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) who undergo transurethral resection of the prostate (TURP). Starting from 2015, a series of patients with LUTS-BPE who underwent TURP were included in a forward-looking study. These patients were assessed using the international prostate symptom score (IPSS) screening tool, uroflowmetry, and a transrectal ultrasound to measure prostate volume (TRUS). Both the PVR urine volume and the PVR ratio (PVR-R), which is the PVR as a percentage of total bladder volume (voided volume + PVR), were measured. The assessment of outcomes was based on the trifecta favorable outcome, defined as meeting all of the following criteria: (1) absence of perioperative complications, (2) a postoperative IPSS of less than eight, and (3) a postoperative maximum urinary flow rate (Qmax) greater than 15 mL/s. A total of 143 patients were included, with a median age of 70 years (interquartile range 65–73). Of these, 58% (83/143) achieved a positive trifecta outcome. Upon conducting a multivariate analysis, both IPSS and Qmax were identified as predictors of a positive trifecta outcome, whereas the PVR-R did not prove to be an independent predictor. In summary, it was found that preoperative IPSS and Qmax are indicative of a trifecta outcome following TURP, whereas PVR-R is not.

Methods for reducing power consumption in circuits of finite state machines (FSMs) are discussed in this review. The review outlines the main approaches to solving this problem that have been developed over the last 40 years. The main sources of power dissipation in CMOS circuits are shown; the static and dynamic components of this phenomenon are analyzed. The power consumption saving can be achieved by using coarse-grained methods common to all digital systems. These methods are based on voltage or/and clock frequency scaling. The review shows the main structural diagrams generated by the use of these methods when optimizing the power characteristics of FSM circuits. Also, there are various known fine-grained methods taking into account the specifics of both FSMs and logic elements used. Three groups of the fine-grained methods targeting FPGA-based FSM circuits are analyzed. These groups include clock gating, state assignment, and replacing look-up table (LUT) elements by embedded memory blocks (EMBs). The clock gating involves a separate or joint use of such approaches as the (1) decomposition of FSM inputs and (2) disabling FSM inputs. The aim of the power-saving state assignment is to reduce the switching activity of a resulting FSM circuit. The replacement of LUTs by EMBs allows a reduction in the power consumption due to a decrease in the number of FSM circuit elements and their interconnections. We hope that the review will help experts to use known methods and develop new ones for reducing power consumption. We think that a good knowledge and understanding of existing methods of reducing power consumption is a prerequisite for the development of new, more effective methods to solve this very important problem. Although the methods considered are mainly aimed at FPGA-based FSMs, they can be modified, if necessary, and used for the power consumption optimization of FSM circuits implemented with other logic elements.