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Purpose: In this review, we will discuss the state of the literature regarding Aquablation, its limitations, and opportunities for its application in the treatment of benign prostatic enlargement (BPE). Methods: A comprehensive review of original research on Aquablation was conducted. Articles related to transurethral resection of the prostate, holmium laser enucleation of the prostate, greenlight photoselective vaporization of the prostate, and simple prostatectomy were reviewed for discussion. Results: For small–medium prostates (30–80 mL), Aquablation's main advantages include better ejaculatory function and similar functional outcomes compared to TURP. For large prostates (80–150 mL), Aquablation demonstrates shorter operative time and superior ejaculatory function when compared to simple prostatectomy, HoLEP, and Greenlight PVP. In addition, Aquablation displays shorter hospital stays than simple prostatectomy. The integration of software programming and semi-automatic technology increases the reproducibility of the procedure and helps standardize overall outcomes, while also accelerating the learning curve. Its ability to preserve antegrade ejaculation makes Aquablation a very compelling option for sexually active patients. However cost and postoperative bleeding risks remain a concern. Conclusion: The current evidence suggests that Aquablation is a safe and effective alternative for BPE for small to large prostates. Further prospective clinical trials, with comparisons to other BPE modalities, and data from longer follow-up periods are still required. [ABSTRACT FROM AUTHOR]

Objectives: Olfactory bulbectomy (OBX) in experimental studies induces neurochemical, neurodegenerative changes in various parts of the body. But no information is available about how OBX affects the spinal cord in rats. Our study aims to investigate this question. Methods: Twenty‐eight male rats were used. The rats were divided into three groups: six as the control, six as the SHAM, and 16 as the study group in which OBX was performed. The animals were followed for 10 weeks. After decapitation of the animals, olfactory bulb (OB) volumes, the olfactory glomerulus (OG), and the neuron density of the ON (Onuf nucleus) per cubic centimeter at the L4‐S4 level were examined histopathologically and analyzed stereologically. Results: The mean OB volume, remaining normal OG density, and degenerated neuron density (DND) of the ON was measured as 4.32 ± 0.21/mm3, 1842 ± 114/mm3, and 4 ± 1 /mm3 in the control (group I); 3.3 ± 0.14/mm3, 1321 ± 114/mm3, and 43 ± 8/mm3 in the SHAM (group II); and 1.672 ± 0.12/mm3, 852 ± 93/mm3, and 154 ± 11/mm3 in the study group (group III). There was a statistically significant difference between the SHAM and the study group (P <.05). Conclusions: In this study, histopathological bridging between ON‐related lower urinary tract symptoms (LUTS) and OBX was shown the first time. According to the findings, LUTS may be reversed by the protection of the affected spinal cord through the correction of olfaction impairment in neurodegenerative disease. [ABSTRACT FROM AUTHOR]

Background: Obesity is a chronic disease with multisystem morbidity. There are multiple studies reporting the effect of bariatric surgery on cardiovascular and metabolic disease, but few examine its impact on lower urinary tract symptoms. This article aims to perform a systematic review with meta-analysis, to determine the effects of bariatric surgery on lower urinary tract symptoms in male patients. Methods: Medline, Embase, conference proceedings, and reference lists were searched for studies reporting the quantitative measurement of lower urinary tract symptoms score pre- and postweight loss surgery. The primary outcome was International Prostate Symptom Score (IPSS) before and after bariatric surgery. Secondary outcomes were changed in body mass index (BMI) and total body weight (TBW). Weighted mean differences (MD) were calculated for continuous outcomes. Results: Seven studies were included in the analysis of 334 patients undergoing bariatric surgery. Mean study follow-up was between 3 and 36 months. IPSS score ranged from 3–12.7 preoperatively and 1.9–6.9 postoperatively. There was a statistically significant improvement in the IPSS score following bariatric surgery (MD 2.82, 95% CI 0.96 to 4.69, p=0.003). Bariatric surgery also resulted in statistically significant reduction of BMI and TBW. Conclusion: Bariatric surgery produces a significant improvement on lower urinary tract symptoms in men with obesity. This may be due to improvement of insulin sensitivity, testosterone levels or lipid profile associated with weight loss. [ABSTRACT FROM AUTHOR]

Background: Incidence of symptomatic prostatic diseases increases with age. Nocturia disturbs sleep. We set out to determine the quality of sleep and severity of lower urinary tract symptoms (LUTS) and bother score in patients with benign prostatic hyperplasia (BPH) and carcinoma of the prostate (CAP). Methods: A cross-sectional study of new patients seen in the urology outpatient clinic with bladder outlet obstruction (BOO) from either BPH or CAP over a period of 18 months. Patients were interviewed using Pittsburgh Sleep Quality Index (PSQI) and International prostate symptoms score (IPSS) questionnaires. Data obtained were analyzed using SPSS version 23. Results: 168 patients were interviewed. CAP patients were older than their BPH counterparts. About 45% of the patients had poor sleep quality. CAP patients (52.9%) were more of poor sleepers compared with BPH patients (40.0%). CAP patients (46.3%) had more severe IPSS than BPH patients (33.3%). Both CAP (70.6%) and BPH (76.0%) patients reported high bother score. Conclusion: CAP and BPH patients have high bother score, affirming need for early treatment. CAP patients had more severe lower urinary tract symptoms and poorer sleep quality than BPH patients.

Background: Double J (DJ) stents are basic and commonly used tools in urology. They are self-retaining at both renal pelvis and bladder used in upper urinary tract obstruction, infection caused by hydronephrosis, safety concerns (post endourological procedures) and renal failure secondary to ureteral obstruction. Despite advances in technology, ideal stent has not been invented yet leading to LUTS lower urinary tract infections after stent placement with incidence of 50%-70% postoperatively. Our study was undertaken to analyse early complications of DJ stenting postoperatively at our centre. Methods: Prospective study on postoperative patients with DJ stent in situ for various indications. Follow up of patients attending surgery department was taken. Detailed history and clinical examination with symptoms of complications were recorded at 2nd and 4th postoperative week from time of placement of double-J ureteral stent till its removal. Results: Total 87 patients, with mean age 42.89 ± 14.69 years and M:F 2.49:1 underwent DJ stenting for various indications. Majority of patients had complications like flank/suprapubic pain (47.12%) followed by urgency (42.52%) and haematuria (37.93%) in 2nd postoperative week which were managed conservatively, which reduced to significant rate till 4th post-op week. Major complications like stent migration/encrustations were not seen in any patient. Conclusion: DJ stents have become routine and essential part of urological procedures. Patients must be well informed and counselled about the potential early complications such as frequency, urgency, incontinence and pain along with late complications post stenting. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) are highly prevalent in older men and represent a substantial challenge to public health. Increasing epidemiologic evidence suggests that diabetes and associated hyperglycemia and insulin resistance significantly increase the risks of BPH and LUTS. Plausible pathophysiologic mechanisms to explain these associations include increased sympathetic tone, stimulation of prostate growth by insulin and related trophic factors, alterations in sex steroid hormone expression, and induction of systemic inflammation and oxidative stress. This article presents a comprehensive update of the current understanding of clinical and epidemiologic research on diabetes and BPH/LUTS, describes hypothesized pathophysiologic mechanisms linking these conditions, and recommends future directions for research.

Objective:To evaluate the benefits of functional constipation (FC) management in male patients with male lower urinary tract symptoms (LUTS) coexisting with FC.Materials and Methods:We conducted a prospective study including 1748 men over the age of 40 who were admitted to our clinic with newly diagnosed male LUTS. The patients were evaluated by history, International Prostate Symptom Score (IPSS), uroflowmetry, urinalysis, serum prostate-specific antigen testing, measurement of prostate volume by ultrasonography and post-void residual urine volume. Rectal fleet enema was administered in patients with FC diagnosed according to the Rome III criteria. Uroflowmetry tests were repeated 12 hours after enema. The patients were re-evaluated after treatment with oral sennoside once a day for a month.Results:At the end of the 1st month, 62 patients with male LUTS and FC were re-evaluated. The difference between maximum flow rate Qmax values before the treatment of constipation and in the 1st month after the treatment was statistically significant (p

Although female sexual dysfunctions are common among women with urogynecological conditions, they have not been thoroughly studied and there are still many questions without an answer. The recent evidence on sexual disorders in women with urogynecological diseases shows a quite wide spectrum of therapeutic approaches, which require the physicians to take into account not only the primary symptoms, but also all the associated factors negatively affected. It has been widely underlined that gynecological diseases are often associated with high stress and have a negative impact on quality of life and psychological well-being of women affected. For this reason, a multidisciplinary approach for the management of these diseases is highly recommended. Also in the case of urogynecological disorders, it is important to take into account psychological outcomes throughout the diagnostic and therapeutic process. In the light of these considerations, the aim of this short review is to evaluate the impact of the main urogynecological diseases and the currently available therapeutic options in order to improve quality of life and sexuality of these patients and to stress the need for a multidisciplinary approach in order to minimize the negative consequences of these diseases for the sexual well-being of women and their partners.

Introduction. CThe basic symptoms in the non-inflammatory form of chronic prostatitis / chronic pelvic pain syndrome (CP / CPTB III B) are Pain, Symptoms of the Lower Urinary Tract (LUTS) and Erectile Dysfunction (ED). Pain is the main and leading symptom. Treatment of patients with this condition is extremely difficult and often ineffective. For the correction of present symptoms, it is considered reasonable to use alphai-Adrenergic Blockers (α1-AB), Antibacterial Drugs, Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and Phytotherapy, since these drugs are approved and have a high level of evidence. However, their use in most cases does not allow to achieve the proper clinical effect.Objectives. Comparative analysis of the effectiveness of combination therapy of the «first-line» (α1-AB + NSAIDs) and combination therapy of the «first-line» (α1-AB + NSAIDs), supplemented by local physical effects on the prostate.Materials and methods. 73 patients with a previously confirmed diagnosis of CP / CPPS III B were included in the study. Study Design: A prospective randomized simple comparative study. The key evaluation criterion is the arterial intraprostatic blood flow rate. Clinical evaluation of patients was carried out by questioning (I-PSS, NIH-CPPS and ICEF-5 questionnaires) before and after taking medications. Drug therapy was performed for 30 days. Randomization: Group 1- first line therapy (α1-AB + NSAIDs). Group 2 - a massage of the prostate was added to the «first-line» therapy (α1-AB + NSAIDs). Statistical analysis was performed using non-parametric statistics.Results. Pain: decrease in pain intensity - by 7.7 and 26.9% for the Group 1 and 2, respectively. LUTS: decrease in severity / reduction - by 18.2 / 0% and 50 / 15.4% of cases for the Group i and 2, accordingly. Treatment satisfaction -3.8 and 26.9% of patients for the Group 1 and 2, respectively. A statistically significant improvement in erectile function was not observed in patients of both groups.Conclusions. In the case when CP / CPPS III B is accompanied by moderate arterial hemodynamic disorders of the prostate, it is possible to achieve an improvement in the results of standard «first-line» therapy recommended by the European Association of Urology. At the same time, it is possible to reduce the intensity of pain and the severity of LUTS. However, there is no improvement in erectile function in these patients.

Abstract Background There is paucity of information on the community-based prevalence and severity of lower urinary tract symptoms (LUTS) in men who are 40 years and older in the southeast region of Nigeria. This study seeks to determine the community-based prevalence of LUTS and the relationship between LUTS, and body mass index (BMI) and mid-abdominal circumference (MAC) in men. Methods An interviewer-administered, questionnaire-based survey. Three of nine settlement clusters were randomly selected while systematic random sampling of 1 in 3 eligible subjects was used to select participants. Analysis was done using SPSS® version 20. Results One thousand three hundred and nineteen duly completed questionnaires were analyzed. The respondents are within ages 40-92 years with mean age 54.2 ± 10.2 years, mean BMI 25.97 ± 4.18Kg/m2 and mean MAC 89.80 ± 12.43 cm. Overall prevalence of LUTS is 20.2%. Nocturia at a prevalence of 19.2% is the most prevalent lower urinary tract symptom and also the earliest to manifest. LUTS prevalence and severity increases with increasing age. About 9.6% report moderate LUTS while 2.3% report severe LUTS. Storage LUTS are reported more frequently than voiding LUTS. LUTS did not vary significantly with BMI, MAC or Wealth-Index. Conclusion LUTS prevalence and severity vary with age, but not with BMI, MAC or Wealth-Index.

SRAM-based field programmable gate arrays (FPGAs) are widely used in mission-critical applications, such as aerospace and avionics. Due to the increasing working frequency and technology scaling of ultra-nanometer technology, single event transients (SETs) are becoming a major source of errors for these devices. In this paper, we propose a workflow for evaluating the behavior of SETs in SRAM-based FPGAs. The method is able to compute the propagation-induced pulse broadening (PIPB) effect introduced by the logic resources traversed by transient pulses. Besides, we developed an accurate look-up table (LUT) layout model able to effectively predict the kinds of the SETs induced by radiation-particle and to accurately mimic the phenomena of the SET generation and propagation. The proposed methodology is applicable to any recent technology to provide the SET analysis, necessary for an efficient mitigation technology. The experimental results achieved from a set of benchmark circuits mapped on a 28-nm SRAM-based FPGA and compared with the fault injection experiments demonstrate the effectiveness of our technique.

Lower Urinary Tract Symptoms (LUTs) in men are usually associated to benign prostatic hyperplasia (BPH), a non-malignant prostate enlargement. Unfortunately, BPH etiology is still unclear. Recent works highlighted a relevant inflammation role in BPH onset and development. Consequently, to complement the 5-α reductase (and α-adrenergic receptor agonists-based therapy, an anti-inflammatory therapy should be devised. To reduce potential adverse effects of multi-drug treatment, plant extract-based therapies are becoming increasingly common. Serenoa repens, the main phytotherapic treatment for BPH, is not sufficient to front the multi-faceted etiology of BPH. In response to this, a novel, multiple phytotherapic agents-based formulation, LENILUTS®, was developed. In the present work, we compared, using an in vitro approach, the prostatic safety and efficacy of LENILUTS® with a commercial formulation, based only on Serenoa repens, and a 5αR inhibitor, Dutasteride. Furthermore, preliminary in vitro experiments to investigate the active principles, bioaccessibility and bioavailability of LENILUTS® were performed. Our results showed a better prostatic safety and therapeutic efficacy of LENILUTS® compared to the commercial formulation and Dutasteride, with increased anti-inflammatory, and pro-apoptotic activity, and a stronger inhibitory effect on the release of the key enzyme 5αR and Prostatic-Specific Antigen (PSA). The limited bioaccessibility and bioavailability of the active principles of LENILUTS® were highlighted. Considering the results obtained, the LENILUTS® formulation is more promising for BPH and LUTs therapy compared to formulations based on Serenoa repens only, but further efforts should be made to improve the bioaccessibility and bioavailability of the active principles.

Background: How COVID-19 affects lower urinary tract symptoms (LUTS) in men has not been demonstrated by published research. This study examined the de novo development of LUTS and the change in the severity of pre-existing LUTS in men hospitalized with COVID-19. A follow-up period of 12 months after COVID-19 infection provided data on the long-term effect of COVID-19 vs. LUTS. Methods: Data were collected from 70 male patients diagnosed with COVID-19 via nasopharyngeal swab RT-PCR technology between June 2020 and April 2021. The patient’s age, comorbidities, date of COVID-19 diagnosis, date of LUTS, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), creatinine, and D-dimer levels, urinalysis, urine culture and duration of hospital stay were recorded. Statistical analyses were conducted to compare between pre-COVID and post-COVID IPSS and other data. Results: 42 patients were included in this study with a, mean age of patients were 54.76 ± 11.95 years. In 8 patients there was no change in IPSS pre- vs. post-COVID. In the remaining 34 patients (80.9%), the median IPSS increased from a pre-COVID value of 2 to 10 during COVID (p < 0.001). In the subgroup analysis based on age

Female sexual dysfunction and erectile dysfunction (FSD/ED) have been linked with lower urinary tract symptoms (LUTS), from both epidemiological data and basic research studies, but few studies have been conducted in Latin America addressing these issues and most of them do not include the young population. To determine the prevalence of FSD/ED and its association with LUTS in Colombia. Sub-analysis of a cross-sectional, population-based study conducted in subjects ≥18 years old to evaluate LUTS/OAB. The estimated sample size was 1,054. ED was defined as ≤21 points in the SHIM and FSD as ≤19 in the FSFI-6. For LUTS/OAB, we used the 2002 ICS and 2010 IUGA/ICS definitions and validated questionnaires. Descriptive and inferential statistics were employed. Prevalence of FSD/ED and association of FSD/ED and LUTS. We included 1,060 participants; the median age was 40 (IQR 27–54) years. Fifty-seven (11.4%) men and 182 (32.7%) women were sexually inactive. The prevalence of FSD/ED in sexually active participants was 47% (men 52.9%, women 38.9%). The most common FSD/ED symptoms were diminished/absent lubrication in women (42%) and diminished erection maintenance after penetration in men (13%). Individuals with FSD/ED had higher rates of various LUTS. The multivariable logistic regression model found that the city of residence (OR = 0.4, 95% CI 0.2–0.9), diabetes mellitus (DM) (OR = 8.4, 95% CI 1.4–48.7), menopause (OR=3.5, 95% CI 1.9–6.2), urge urinary incontinence (UUI) (OR=1.9, 95% CI 1.1–3.3) and nocturia ≥2 (OR = 2.2, 95% CI 1.2–4.2) were associated with FSD. In men, age 40–59 (OR = 2.3, 95% CI 1.4–3.7) and ≥60 (OR = 5.5, 95% CI 2.4–12.5), the city of residence (OR = 0.2, 95% CI 0.1–0.3), less than a high-school diploma vs higher education (OR = 2.0, 95% CI 1.2–3.2), depression (OR = 4.6, 95% CI 1.8–11.5), UUI (OR = 3.2, 95% CI 1.1–10.2) and feeling of incomplete bladder emptying (OR = 2.1, 95% CI 1.3–3.5) were associated with ED. This study underlines the importance of assessing LUTS in women and men of all affected age groups who present with symptoms of FSD/ED and vice versa, which could help achieve a better approach for these patients. This is the first study in Colombia and one of the few in Latin America that addresses both FSD/ED and LUTS in men and women aged 18 years and older. Limitations include being a sub-analysis of a study aiming to determine the prevalence of LUTS/OAB and not FSD/ED. Regardless of age, LUTS were observed more frequently in patients with FSD/ED. Various LUTS were associated with FSD/ED. Bravo-Balado A, Trujillo CG, Caicedo JI, et al. Assessment of Female Sexual Dysfunction and Erectile Dysfunction and Its Association with Lower Urinary Tract Symptoms in Women and Men Over 18 Years Old: Results From the COBaLT Study. J Sex Med 2021;18:1065–1074. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the functional outcomes as they relate to the preservation of urinary continence and sexual function after treatment with the temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Israel); a novel minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Methods: Men with symptomatic BPH (IPSS ≥ 10, Qmax < 12 ml/s, and prostate volume (PV) < 120 ml) were invited to participate in this single-arm, prospective multicenter study (MT06). Patients were not washed out of BPH medications before the procedure. The iTind was implanted through a 22F rigid cystoscope under intravenous sedation and was removed 5–7 days later through a 22F Foley catheter under local anesthesia. Post-operative VAS and complications (Clavien Dindo-Grading System) were recorded. Preservation of urinary continence and erectile and ejaculatory function were assessed according to ISI, MSHQ-EjD and SHIM questionnaires. Post-operative IPSS, QoL, Qmax and PVR were also assessed at 1, 3, and 6 months post-operatively. Results: This interim report includes data out to 6 months on the first 70 patients enrolled in the study. The median age was 62.31 years, and the mean prostate volume was 37.68 ml (15–80 ml). Baseline and follow-up data are reported in Table 1. No intraoperative complications were observed, the average post-operative VAS score was 3.24 ± 2.56. On average patients returned to daily life after 4.3 days following the retrieval procedure. Sexual function and urinary continence were preserved in all subjects according to the ISI, SHIM and MSHQ-EjD questionnaires and significant improvements (p < 0.0001) from baseline levels were recorded in IPSS, QoL and peak flow. Conclusion: iTind is a well-tolerated, minimally invasive treatment for BPH-related LUTS which preserves sexual function and urinary continence, offers a rapid recovery and return to daily life, and a significant improvement of symptoms and urinary flow at 6-month follow-up. [ABSTRACT FROM AUTHOR]

The pandemic of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or Coronavirus Disease 2019 (COVID-19) is still ongoing. The outbreak of this new emerging contagious disease has impacted a wide range of sectors including health and economics. Much information about COVID-19 has been discovered by many laboratories, and action taken in various ways as quickly as possible to inhibit the outbreak. It was found that COVID-19 is a ribonucleic acid virus (RNA virus) that can cause infection among humans. Moreover, it can mutate and spread contagiously mainly through the respiratory system. The most common symptoms are cough and fever. Many patients could develop to either pneumonitis or respiratory failure. The SARS-CoV-2 virus can infect various organs, the main infections being in lungs and rectum. In these cases, many laboratories can isolate the virus from oropharyngeal and nasopharyngeal swab and then apply the reverse transcription polymerase chain reaction (RT-PCR) test to identify the COVID-19 virus. Many of the viral infections can cause cystitis by immunologic response. There is a study that showed the SARS-CoV-2 virus could be isolated from the urine sample. The patients had significant changes in urinary storage for frequency, urgency, and urinary incontinence during infected period, which improved after the disease resolved. Moreover, there is a study that reported that the COVID-19 patients who had the International Prostate Symptom Score (IPSS) scores of 20 to 35 had significantly longer hospital stays, more frequent intensive care requirements, and higher mortality rates. Therefore, physician and medical personnel should be aware of the irritative voiding symptoms that might be the presenting symptoms of COVID-19. Furthermore, as many studies have shown that the virus can be excreted in urine, thus, the virus could be contagious via urinary contamination. [ABSTRACT FROM AUTHOR]

Purpose: Radical prostatectomy represents the most popular method of prostate cancer treatment, including cases with high-risk and locally advanced cancer. Besides, men with this disease often experience lower urinary tract symptoms (LUTS) and report high International Prostate Symptom Scores (IPSS), pathological post-void residual (PVR) urine volumes and low levels of maximum urinary flow rates (Qmax). In this study we assessed the effect of radical prostatectomy on the above parameters in patients with high-risk and locally advanced disease. Methods: A number of 240 individuals were enrolled in the study. Patients that required any post-operative manipulation up to the completion of 12 months after surgery were excluded. All patients were assessed pre- and post-operatively at 3, 6 and 12 months. Evaluation included IPSS, Qmax and PVR. Results: Mean age was 66.8 years. Mean PSA value was 12.7 ng/ml and mean Gleason score was 7.9. At baseline 41.3% of the patients had Qmax ⩽10 and 42.5% had IPSS >8. There was a significant increase in Qmax during the follow-up (median value was 12 at baseline and increased to 21 at 12 months). Also, IPSS and PVR decreased significantly during the follow-up. IPSS median value decreased from 9 at baseline to 5 at 12 months. Improvement was observed in all grades of symptoms. [ABSTRACT FROM AUTHOR]

Background: To determine real-world outcomes of prostatic urethral lift (UroLift) procedures conducted in hospitals across England.Methods: A retrospective observational cohort was identified from Hospital Episode Statistics data including men undergoing UroLift in hospitals in England between 2017 and 2020. Procedure uptake, patient demographics, inpatient complications, 30-day accident and emergency re-attendance rate, requirement for further treatment and catheterization were captured. Kaplan-Meier and hazard analysis were used to analyse time to re-treatment.Results: 2942 index UroLift procedures from 80 hospital trusts were analysed; 85.3% conducted as day-case surgery (admitted to hospital for a planned surgical procedure and returning home on the same day). In-hospital complication rate was 3.4%. 93% of men were catheter-free at 30 days. The acute accident and emergency attendance rate within 30 days was 12.0%. Results of Kaplan Meier analysis for subsequent re-treatment (including additional UroLift and endoscopic intervention) at 1 and 2 years were 5.2% [95% CI 4.2 to 6.1] and 11.9% [10.1 to 13.6] respectively.Conclusions: This real-world analysis of UroLift shows that it can be delivered safely in a day-case setting with minimal morbidity. However, hospital resource usage for catheterization and emergency hospital attendance in the first 30 days was substantial, and 12% required re-treatment at 2 years. [ABSTRACT FROM AUTHOR]

Background: MRI-guided transurethral ultrasound ablation (TULSA) offers minimally invasive thermal ablation of benign and malignant prostate tissue, using directional high-intensity ultrasound and real-time, magnetic resonance thermometry feedback control. Feasibility of TULSA for alleviating lower urinary tract symptoms (LUTSs) associated with benign prostatic hyperplasia (BPH) is retrospectively assessed in a subgroup of men from a localized prostate cancer study who also had LUTSs. Patients and Methods: TULSA was used to ablate 90% of the prostate gland in 30 men with localized prostate cancer, without plans to spare ejaculatory ducts. Mean ± standard deviation treatment time was 37 ± 10 minutes. Retrospective analysis was conducted on a subpopulation of nine patients who also suffered from LUTSs (International Prostate Symptom Score [IPSS] ≥ 12 at baseline) as well as a smaller subgroup of five patients with IPSS >12 and peak urinary flow (Qmax) <15 mL/second. Urinary symptom relief, continence, and erectile function were assessed using IPSS, International Index of Erectile Function (IIEF), and uroflowmetry. Results: At 12 months post-TULSA, IPSS improved significantly by 58% to 6.3 ± 5.0 (p = 0.003), with at least a moderate (≥6 points) reduction in eight of nine patients. IPSS quality of life improved in eight of nine patients. Erectile function (IIEF-EF) remained stable from 14.6 ± 9.3 at baseline to 15.7 ± 9.0 at 12 months. The proportion of patients with erections sufficient for penetration (IIEF Q2 ≥2) was unchanged. Full urinary continence (pad free and leak free) was achieved at 12 months in all patients. In five men who suffered from more severe symptoms, Qmax increased from 11.6 ± 2.6 mL/second to 22.5 ± 14.2 mL/second at 12 months (p = 0.126). Perfused prostate volume, measured on MRI, decreased 70% to 13.6 ± 4.6 mL (p = 0.003) at 12 months. All adverse events were mild to moderate (Common Terminology Criteria for Adverse Events [CTCAE] Grade 1–2) with no serious events reported. Conclusions: This retrospective analysis demonstrates promising safety and feasibility of TULSA to relieve LUTSs, with improvement in IPSS comparable with modern, minimally invasive surgical therapies. Larger controlled studies with BPH-specific ablation plans in men seeking treatment for LUTSs are warranted. [ABSTRACT FROM AUTHOR]

Recently, soil dielectric constant detection has been used in the irrigation of vastly differing farming conditions. Soil monitoring has seen a push toward fifth generation (5G) telecommunications technology, due to the higher speed and bandwidth required to connect a huge number of sensor nodes simultaneously. A novel architecture for a fully integrated, unequal arms dipole antenna is presented in this article. The proposed on‐chip antenna is implemented using UMC180 nm CMOS technology. A dipole radiator is added on the upper metal layer, a ground sheet set at the lower metal layer and a patch layer is added on the intermediate metal layer. This configuration has improved the antenna impedance bandwidth by 38%. In addition, it increased the electrical length of the dipole antenna to reduce the antenna resonant frequency by 10 GHz. The proposed antenna has a total area 1300 × 250 μm, and its wide bandwidth extends from 21 to 40 GHz at reflection coefficient |S11| < –7 dB, which makes it suitable for on‐chip wireless sensor network applications in 5G technology. All Simulations are completed by using the Ansys HFSS (high‐frequency structure simulator) ver.15 and the simulated results show a good comparison with measurements. To investigate the proposed antenna's performance in different environmental conditions, practical measurements for soil dielectric constant in different compositions with variable moisture ratios are applied. The resulting values are used in antenna simulation and have ultimately proved the antenna's improved capability to sense soil moisture in different conditions. [ABSTRACT FROM AUTHOR]

Purpose: Anatomic changes that coincide with aging including benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) negatively impact quality of life. Use of MRI with its exquisite soft tissue contrast, full field-of-view capabilities, and lack of radiation is uniquely suited for quantifying specific lower urinary tract features and providing comprehensive measurements such as total bladder wall volume (BWV), bladder wall thickness (BWT), and prostate volume (PV). We present a technique for generating 3D anatomical renderings from MRI to perform quantitative analysis of lower urinary tract anatomy. Methods: T2-weighted fast-spin echo MRI of the pelvis in 117 subjects (59F;58 M) aged 30–69 (49.5 ± 11.3) without known lower urinary tract symptoms was retrospectively segmented using Materialise software. Virtual 3D models were used to measure BWV, BWT, and PV. Results: BWV increased significantly between the 30–39 and 60–69 year age group in women (p = 0.01), but not men (p = 0.32). BWV was higher in men than women aged 30–39 and 40–49 (p = 0.02, 0.05, respectively) ,but not 50–59 or 60–69 (p = 0.18, 0.16, respectively). BWT was thicker in men than women across all age groups. Regional differences in BWT were observed both between men and women and between opposing bladder wall halves (anterior/posterior, dome/base, left/right) within each sex in the 50–59 and 60–69 year groups. PV increased from the 30–39 to 60–69 year groups (p = 0.05). BWT was higher in subjects with enlarged prostates (> 40cm3) (p = 0.05). Conclusion: Virtual 3D MRI models of the lower urinary tract reliably quantify sex-specific and age-associated changes of the bladder wall and prostate. [ABSTRACT FROM AUTHOR]

Objectives: With holmium laser enucleation of the prostate (HoLEP) a size‐independent method for surgical treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) has been introduced. HoLEP offers durable long‐term results with reduced perioperative morbidity. As the risk of disease progression increases with age, the main goals, when offering surgery to an elderly population, are reducing perioperative morbidity and preserving quality of life (QoL). We therefore analyzed the impact of age on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS at our tertiary referral center. Methods: We retrospectively collected data of 487 patients who underwent HoLEP for LUTS secondary to BPO between 2018 and 2019. Patients were divided into group 1 (<70 years), group 2 (70‐79 years), and group 3 (≥80 years). Perioperative parameters, safety, and short‐term functional outcomes were assessed and analyzed. Results: Perioperative Clavien‐Dindo grade ≥II complications were seen in 4.1% of patients (20/487). There was no difference in perioperative complications between all age groups (P =.176). Functional outcome was assessed 30 days post surgery. There was significant improvement in median International Prostate Symptom Score of 14, 10, and 8 points for groups 1, 2, and 3 (P <.001), respectively, with constant improvement of median QoL of 3 points for all groups. Median maximum flow rate (Qmax) showed significant improvement of 14.5, 10.5, and 13 mL/s for groups 1 to 3 (P =.467), respectively. Conclusion: HoLEP offers acceptable perioperative complication rates even in the oldest patient cohort (≥80 years). Therefore, HoLEP is a safe and efficient option even in oldest patients. [ABSTRACT FROM AUTHOR]

Objective: A range of ketamine‐induced uropathy (KIU) issues have been typically described in ketamine misusers. Conversely, more knowledge is needed in terms of medicinal ketamine‐related urological disturbances, since ketamine prescribing is being increasingly considered for a range of medical and psychopathological conditions. Methods: To assess medicinal KIU issues, we aimed at analyzing both the 2005–2017 European Medicines Agency (EMA) and the 2006–2018 UK Yellow Card Scheme (YCS) pharmacovigilance databases. Results: A total number (eg, all categories) of 11 632 EMA ketamine‐related adverse drug reaction (ADR) reports were here identified. Out of these, some 9971 ADRs (eg, 85.7% of the total) were judged as "suspect" and were here analyzed. Some 1758 ADRs (17.7% of 9971, corresponding to 194 individual patients) referred to urological issues, relating to either kidney/ureter (922 ADRs) or bladder/urethra (837 ADRs). Ketamine was the sole drug administered in 156/194 (80.4%) cases/patients. Although most cases occurred in the 1 month‐1 year time frame following the start of ketamine prescribing, in 30 cases the ADR occurred within 48 hours. Most ADR‐related cases resolved, although both sequelae (18 cases) and fatalities (79/1758; 4.5%) were recorded. Overall, YCS data were consistent with EMA findings, with some 50/217 (23%) ADRs referring to renal/urinary disorders. Conclusions: Current data may only represent a gross underestimate of the KIU real prevalence issues. It is here suggested that chronic treatment involving higher doses/repeated exposure to ketamine be restricted to the context of controlled trials or clinical audits. [ABSTRACT FROM AUTHOR]

Objectives: To determine if lower urinary tract symptoms (LUTS) involve seasonal variation and how this affects the severity of LUTS. Methods: A total of 3163 men aged 50 to 70 years were mailed a questionnaire on urinary symptoms. The overall response rate was 65.3% (2064 out of 3163 men). The men were asked whether their urinary symptoms showed variation in degree of difficulty according to time of year and if yes, when LUTS were the worst and the mildest. Ten different LUTS were evaluated with four response options for the severity of symptoms. Mean symptom scores and the proportions of symptomatic men were evaluated according to the presence of seasonal changes in different symptoms. Results: Overall, 17.1% of men reported seasonal variation in severity of LUTS, older men more frequently than younger men. Worse LUTS during winter were reported by 81% of the men reporting seasonal variation, and 93% reported that LUTS were relieved in summer. More seasonal variation was reported by men with comorbidities (stroke, neurological disease) and those with medical treatment for LUTS or operative treatment for benign prostatic hyperplasia. Men with more severe LUTS were more likely to report seasonal changes. Conclusions: One out of six men reported seasonal changes in LUTS, with winter worsening and summer relieving the symptoms. Men with seasonal variation in LUTS had more severe LUTS in all 10 symptom groups that were investigated. [ABSTRACT FROM AUTHOR]

Purpose of Review: Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is a disease complex with enormous societal burden and yet the pathogenesis of LUTS/BPH is poorly understood. We set out to review the literature on the relationship between depression, marijuana usage, and erectile dysfunction (ED) to LUTS/BPH. Recent Findings: LUTS/BPH has independent associations with depression as well as with ED. In each case, the causality and mechanistic relationship is unknown. The impact of marijuana, as it increasingly pervades the general population, on the disease complex of LUTS/BPH is not well studied but recent results support short-term benefit and long-term caution. Summary: Depression, a form of central nervous dysfunction, and ED, which is likely mediated via endothelial dysfunction, are independently associated with LUTS/BPH. The presence of cannabinoid receptors in urologic organs, coupled with recent population studies, supports a modulatory effect of marijuana on voiding although an enormous knowledge gap remains. [ABSTRACT FROM AUTHOR]

Objectives: The use of non-intubated uroflowmetry, PVR, prostate volume, and I-PSS are the most commonly used tools for the evaluation of patients with BPH. In this prospective study, we elucidated the correlation between BOO as rated by pressure-flow study in men with LUTS attributed to BPH and those parameters. Methods: Over a period of 2 years 460 men above the age of 45 years old (mean age 60.46 ± 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, prostate-specific antigen, and transrectal ultrasound were done. The urodynamic evaluation included uroflowmetry, filling cystometry, and voiding cystometry with the plotting of pressure-flow study according to Lin-PURR (Schäfer's nomogram). The correlation coefficient was calculated between these variables. Results: The correlation of other objective parameters with total score was not much better. The Spearman's correlation coefficient were − 0.09, 0.07 and − 0.1 for prostate weight, post voiding residual urine and maximum free flow rate respectively. Correlations between Schäfer's grade and Qmax, PVR and prostate volume were found to be weak to fair correlation (r values were − 0.4, 0.18, and 0.39 respectively). Conclusion: Objective non-invasive parameters most commonly used in the evaluation of men with LUTS attributed to BPH have limited correlation with obstruction, as diagnosed by pressure flow nomogram. [ABSTRACT FROM AUTHOR]

Background: The current study was designed to explore the effectiveness of Saw Palmetto as monotherapy or supplementation with tamsulosin in the treatment of patients with lower urinary tract symptoms consistent with benign prostatic hyperplasia. Method: The present study is diagnosed patient with moderate to severe symptomatic BPH. (60) Patients were divided into 3 groups; Group (1) treated with Saw Palmetto cap (320 mg); Group (2) treated with Saw Palmetto cap (320 mg) and tamsulosin (0.4mg); Group (3) treated with tamsulosin (0.4mg), daily for 3 months. The assessment is done based on the change in urological IPSS, urodynamic activity, urine flow, voiding quantity measures, and prostate volume. Also, some measurement such as erection function, urinary incontinence, sleeps quality, and quality of life. Results: Saw Palmetto supplementation with tamsulosin revealed a significant decrease in the IPSS score (P<0.01), a significant increase in the urine flow rate and the voided volume, a significant decrease in the post-void residual volume and prostate volume (P<0.01), and decrease in serum PSA level (P<0.01). Additionally, improved erection function decreased urinary incontinence score, improvement in sleep quality, and improvement in the quality of life score among the Saw Palmetto supplementation group was noticed (P<0.01). Conclusion: The phytotherapy with saw palmetto alone or as supplement collectively produced marked improvement in objective and subjective measurements in men with lower urinary tract symptoms consistent with BPH: [ABSTRACT FROM AUTHOR]

Penile paraffinoma is a rare condition after penile injection of liquid paraffin or other mineral oils, with well-documented debilitating complications. Nevertheless, such injections are still performed by people of Eastern European and Asian descent for cosmetic penile augmentation. We report a case of penile paraffinoma in an otherwise healthy, 30-year-old male, with obstructive lower urinary tract symptoms (LUTS) as the sole complaint at presentation in the emergency department and a conservative approach. This case report describes an unusual presentation of penile paraffinoma in a young man and aims to raise public and physician awareness regarding disease manifestation to prevent high morbidity from delayed diagnosis and treatment.

Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms (LUTS) in men, which is characterized by a noncancerous enlargement of the prostate. BPH troubles the vast majority of aging men worldwide; however, the pathogenetic factors of BPH have not been completely identified. The heat shock protein 70 (HSP70) subfamily, which mainly includes HSP70, glucose-regulated protein 78 (GRP78) and GRP75, plays a crucial role in maintaining cellular homeostasis. HSP70s are overexpressed in the course of BPH and involved in a variety of biological processes, such as cell survival and proliferation, cell apoptosis, epithelial/mesenchymal transition (EMT) and fibrosis, contributing to the development and progress of prostate diseases. These chaperone proteins also participate in oxidative stress, a cellular stress response that takes place under stress conditions. In addition, HSP70s can bind to the androgen receptor (AR) and act as a regulator of AR activity. This interaction of HSP70s with AR provides insight into the importance of the HSP70 chaperone family in BPH pathogenesis. In this review, we discuss the function of the HSP70 family in prostate glands and the role of HSP70s in the course of BPH. We also review the potential applications of HSP70s as biomarkers of prostate diseases for targeted therapies.

Benign prostatic hyperplasia (BPH) is a common cause of male lower urinary tract symptoms (LUTS) that can reduce quality of life. Even if several drugs can be used in its treatment, the development of adverse drug reactions (ADRs) represents the most common cause of low adherence. In the present study, we evaluate both the efficacy and the safety of a new nutrient fixed combination of Pollen Extract plus Teupolioside, named Xipag®, in patients with LUTS. We conduct a pilot single center open label clinical study between 1 March 2020 and 30 June 2020 in patients with BPH referred to general practitioner’s ambulatories. Male patients > 45 years, sexually active, with clinical symptoms of LUTS and with a diagnosis of HPB were enrolled and received one tablet/day of Xipag® (T0), for three months (T1: end of treatment). The IPSS and IIEF-5 questionnaires were carried out at T0 and T1 and represent the first end point, whereas the primary safety end point was considered the absence of ADR or of drug–drug interactions related to Xipag® administration. During the study period, 25 subjects aged 43 to 76 years (mean 62.7 ± 9) were enrolled and completed the study. The clinical evaluation in T1 documented that Xipag® induced a statistically significant improvement (p < 0.01) in symptoms, as documented by the IPSS questionnaire (range 22.7–88.9; mean 55.2 ± 23.6), without the development of ADRs. In conclusion, this is the first real-world study that showed the efficacy and the safety of Xipag® in the BPH patients with LUTS.

Background: Lower Urinary Tract Symptoms (LUTS) affect a person's quality of life significantly and are highly prevalent in aging male. However, appropriate tools for evaluating their severity and progression are lacking. There has been no tool to appropriately and sufficiently evaluate and validate their severity and progression. Objective: To evaluate the validity and reliability of the Thai version of International Consultation on Incontinence Questionnaire-male lower urinary tract symptoms-long form (ICIQ-MLUTS-LF) questionnaire. Materials and Methods: Questionnaire translation and validation were conducted according to the ICIQ website protocol. Content validity, internal consistency, and stability were assessed. Results: Sixty-three men were included in the present study. The mean age of the participants was 68, with a range from 44 to 96 years. For reliability, Cronbach's alpha value was 0.954 and considered to have internal consistency. For test-retest reliability, the questionnaires were again filled by all participants two to four weeks later. The intraclass correlation was 0.974, demonstrating stability. Nocturia was the most prevalent symptom (98%). Urinary frequency was the most bothersome symptom. Conclusion: The Thai version of ICIQ-MLUTS-LF is a valid and reliable tool for clinical application and research. [ABSTRACT FROM AUTHOR]

The International Prostate Symptom Score (IPSS), the quality of life (QoL) score, and the benign prostatic hyperplasia impact index (BII) are three different scales commonly used to assess the severity of lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH-LUTS). Based on a phase II clinical trial including 403 patients with moderate to severe BPH-LUTS, the objectives of this study were to (i) develop traditional pharmacometric and bounded integer (BI) models for the IPSS, QoL score, and BII endpoints, respectively; (ii) compare the power and type I error in detecting drug effects of BI modeling with traditional methods through simulation; and (iii) obtain quantitative translation between scores on the three abovementioned scales using a BI modeling framework. All developed models described the data adequately. Pharmacometric modeling using a continuous variable (CV) approach was overall found to be the most robust in terms of type I error and power to detect a drug effect. In most cases, BI modeling showed similar performance to the CV approach, yet severely inflated type I error was generally observed when inter-individual variability (IIV) was incorporated in the BI variance function (g()). BI modeling without IIV in g() showed greater type I error control compared to the ordered categorical approach. Lastly, a multiple-scale BI model was developed and estimated the relationship between scores on the three BPH-LUTS scales with overall low uncertainty. The current study yields greater understanding of the operating characteristics of the novel BI modeling approach and highlights areas potentially requiring further improvement. [ABSTRACT FROM AUTHOR]

Background & objectives: The lower urinary tract symptoms(LUTS) represent one of the most common clinical complaints in elderly population. Approximately one in five adults report moderate-to-severe LUTS and it substantially reduces quality of life. LUTS represent an increasing problem in community because of increasing life expectancy. By assessing the magnitude of LUTS, it helps in implementing strategies enabling us to control the disease and to improve the Quality of Life (QOL) among elderly. There are few studies to assess the prevalence of LUTS in elderly population in India. With this background this present study was undertaken to find out the prevalence of LUTS among adults aged above 50 years in central Kerala. Methods: The study was done in Aarpookara panchayath of Kottayam district. Four hundred and eighty subjects were selected using cluster sampling technique from 16 wards of Aarpookara panchayath where each ward was considered as a cluster. Identification of ward and households was done with the help of Junior Public Health Nurse/ASHA worker. Thirty eligible subjects satisfying the inclusion and exclusion criteria from each ward were recruited into the study. Selection of lane and 1st house in each ward was done by random selection by using the procedure discussed in cluster sampling technique used for evaluation of universal immunization coverage. Results: 66.8% subjects were found to have LUTS of which 56.7% had mild, 42.5% had moderate and 0.8% had severe symptoms. Storage LUTS(66.5%) was the most common complaint seen followed by post-micturition(5.6%) and voiding LUTS(5%). The most prevalent symptoms seen were nocturia(62.9%)followed by urgency(26%)and frequency (12.1%). Study also showed that severity of LUTS increased with increasing age (p=0.001), poor education (p=0.01)and decrease in socioeconomic status(p=0.01). There is significant relationship between LUTS and QoL(p=0.001). Conclusions: In the community studied, both males and females were equally affected with LUTS. Severity of LUTS increased with age and decreased with increase in education and socioeconomic status of subject. Most prevalent were storage LUTS followed by voiding and post-micturition LUTS.Nocturia was the most common symptom seen.LUTS and QoL have significant direct relationship. [ABSTRACT FROM AUTHOR]

Penile paraffinoma is a rare condition after penile injection of liquid paraffin or other mineral oils, with well-documented debilitating complications. Nevertheless, such injections are still performed by people of Eastern European and Asian descent for cosmetic penile augmentation. We report a case of penile paraffinoma in an otherwise healthy, 30-year-old male, with obstructive lower urinary tract symptoms (LUTS) as the sole complaint at presentation in the emergency department and a conservative approach. This case report describes an unusual presentation of penile paraffinoma in a young man and aims to raise public and physician awareness regarding disease manifestation to prevent high morbidity from delayed diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Limited literature concerning nocturia in early postmenopausal women is available. However, due to the lack of endogenous estrogen in these women, an increased prevalence of nocturia is expected.Material and Methods: This prospective observational trial recruited 210 'early' postmenopausal women consulting the Ghent University menopause clinic. Postmenopausal status was biochemically confirmed. Women completed 3 questionnaires: the ICI questionnaire on nocturia (ICIQ-N); 'Targeting the individual's Aetiology of Nocturia to Guide Outcomes' (TANGO) and the Perceived Stress Scale (PSS). Moreover, information concerning women's age, anthropometrics and lifestyle was collected. Nocturia was defined as two or more nocturnal voids.Results: Nocturia was reported in 24.8% (52/210) of the postmenopausal women. Bother increased with every nocturnal void. Women with two or more nighttime voids were found to have significantly increased prevalence of urgency compared with women with only one (p < 0.001; 38.5% versus 22.7%). Trouble initiating sleep at the start of the night and insomnia during the night were significantly different in women with a different nocturnal frequency (initiating sleep p = 0.09, no voids 34.4 %, 1 void 39.2 %, ≥ 2 voids 53.8 %; insomnia p < 0.001; no voids 1.6%, 1 void 22.7 %, ≥ 2 voids 53.8 %). In addition to bladder and sleep dysfunctions, waist circumference was a risk factor for nocturia (OR 1.04; 95 % CI: 1.01-1.08).Conclusion: Nocturia is an important problem in early postmenopausal women, affecting a quarter of the questioned women. Etiology of nocturia in this population is multifactorial as estrogen withdrawal is accompanied by bladder and sleep dysfunctions. [ABSTRACT FROM AUTHOR]

Aims: Nocturia has been increasingly recognized as a potential manifestation of cardiovascular disease. However, the relationship between nocturia and electrocardiographic (ECG) abnormalities has not been studied. This study aims to characterize the diagnostic utility of nocturia in identifying left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and prolonged QTc on ECG. Methods: Retrospective analysis of nocturnal voiding frequency and contemporaneous ECG data from consecutive patients evaluated at a university‐based outpatient cardiology clinic. Three sets of three incremental binary multiple logistic regression models controlling for (1) age, (2) sex and race, and (3) body mass index, hypertension, diabetes mellitus, and diuretic utilization were performed to determine whether nocturia was predictive of LVH, LAE, and prolonged QTc. Results: Included patients (n = 143, 77.6% nocturia) were predominantly African‐American (89.5%), female (74.1%), and obese (61.5%), of whom 44.1%, 41.3%, and 27.3% had LVH, LAE, and prolonged QTc, respectively. Older age, African‐American race, obesity, hypertension, diuretic use, LVH, and LAE were significantly associated with nocturia on univariate analysis. No significant differences were observed in the strength of associations between nocturia and LVH, LAE, or QTc prolongation based on age. Nocturia independently predicted LVH in Models I–III (odds ratios [ORs], 2.99–3.20; relative risks [RRs], 1.18 for all, p ≤.046) and LAE in Models I–III (ORs, 4.24–4.72; RRs, 1.21 for all, p ≤.015). No significant associations were observed between nocturia and prolonged QTc. Conclusions: Nocturia may be a risk marker for underlying structural cardiac abnormalities. [ABSTRACT FROM AUTHOR]

Aim: To determine the feasibility of commercially available multielectrode cardiac electrophysiology catheters to detect electrical activity in the human bladder. Methods: Ten subjects requiring cystoscopy for the evaluation of lower urinary tract pathology were eligible for participation in our study. After routine rigid cystoscopy with a 70° cystoscope, various multielectrode cardiac electrophysiology catheters were introduced into the bladder. One of three catheters with different electrode configurations was used per subject. Electroanatomical images of the bladder were created and spontaneous electrical activity was recorded. Subjective response to electrical stimuli delivered across the electrodes (20 mA at 5 ms pulse width, rate 100 ms) was also recorded. The responses were qualitatively compared with that from a prior study. Results: Electrical activity recorded at the dome of the bladder was less than 0.5 mV and low frequency. Myopotentials resembling smooth muscle were detected at electrodes near or within the trigone. A sensory response was reported with the use of pacing stimuli, with the sensation in the trigone being reported more often than the dome of the bladder. Stimulation in the trigone triggered sensory urgency and voiding in a patient with a history of overactive bladder. Conclusions: The use of multielectrode catheters to measure human bladder electrophysiologic activity is feasible. Issues with noise reduction still exist, though to a lesser extent with the multielectrode basket design than simple quadripolar one. Sensory responses to pacing stimuli may be useful for diagnostic and therapeutic purposes in the future. [ABSTRACT FROM AUTHOR]

Purpose of Review: Rezum® is a novel convection-based thermal therapy for benign prostatic hyperplasia (BPH) induced lower urinary tract symptoms (LUTS). This review provides an overview of its safety, efficacy, cost, and potential role in the paradigm of BPH/LUTS therapies. Recent Findings: Data regarding Rezum® stems primarily from one large randomized controlled trial of 197 patients with 4 years of follow-up. The efficacy and safety of Rezum® is further supported by 4 additional studies including 1 prospective pilot study, 1 crossover study, and 2 retrospective studies. Durable improvements in IPSS (47–60%), QoL (38–52%), Qmax (45–72%), and PVR (11–38%) were seen without causing deterioration of sexual function. Summary: Rezum® offers a cost-effective and safe approach to treating BPH/LUTS and should be considered as a possible first-line therapy for patients with moderate to severe symptoms. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to determine the potential relationship between atherosclerotic cardiovascular disease (ASCVD) score, which equates to 10-year risk of atherosclerotic cardiovascular events, and functional bladder capacity (FBC) among men in the outpatient urology setting. Methods: We secondarily analyzed voiding diaries from men aged 40 to 79 years with nocturia. Patients with a history of cardiovascular disease or who had nocturnal polyuria were excluded. Patients were stratified by whether they met the high-risk ASCVD threshold (≥ 20%) following current cardiology consensus guidelines and assessed for the presence of small FBC (24-h maximum voided volume ≤ 200 ml). Logistic regression analyses were employed to explore associations between small FBC and ASCVD. Results: Eighty-four men (median ASCVD score 18.4 [IQR 12.8–26.9] %, age 66 [61–71] years, body mass index [BMI] 29.4 [26.4–32.7] kg/m2) were included, of whom 36 (42.9%) were high-risk and 48 (57.1%) fell below the high-risk threshold. High-risk patients were more likely to have small FBC (23 [63.9%] vs. 14 [29.2%], p = 0.002). ASCVD risk predicted small FBC on univariate analysis (p = 0.002). No such effect was observed with age (p = 0.116), BMI (p = 0.523), or benign prostatic obstruction (p = 0.180). The association between ASCVD risk and small FBC persisted on multivariate analysis after controlling for BMI and benign prostatic obstruction (p = 0.002). No significant predictors of small FBC were observed when age, a major determinant of ASCVD risk and independent correlate of small FBC, was substituted for ASCVD score (p = 0.108). Conclusions: Small FBC is related to a higher predicted cardiovascular event rate in men with nocturia. [ABSTRACT FROM AUTHOR]

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Benign prostatic hyperplasia (BPH) is an age-related debilitating prostatic disease that is frequently associated with prostatic inflammation and bothersome lower urinary tract symptoms (LUTS). Animal models have shown that formalin- and bacterial-induced prostatic inflammation can induce bladder dysfunction; however, the underlying mechanisms contributing to prostatic inflammation in BPH and bladder dysfunction are not clear. We previously reported that E-cadherin expression in BPH is downregulated in hyperplastic nodules compared with expression in adjacent normal tissues. Here, we explored the potential consequences of prostatic E-cadherin downregulation on the prostate and bladder in vivo using an inducible murine model of prostate luminal epithelial-specific deletion of Cdh1. The prostate-specific antigen (PSA)-CreERT2 transgenic mouse strain expressing tamoxifen-inducible CreERT2 recombinase driven by a 6-kb human PSA promoter/enhancer was crossed with the B6.129- Cdh1 tm2Kem/J mouse to generate bigenic PSA-CreERT2/ Cdh1 -/- mice. Deletion of E-cadherin was induced by transient administration of tamoxifen when mice reached sexual maturity (7 weeks of age). At 21 to 23 weeks of age, the prostate, bladder, and prostatic urethra were examined histologically, and bladder function was assessed using void spot assays and cystometry. Mice with Cdh1 deletion had increased prostatic inflammation, prostatic epithelial hyperplasia, and stromal changes at 21 to 23 weeks of age, as well as changes in bladder voiding function compared with age-matched controls. Thus, loss of E-cadherin in the murine prostate could result in prostatic defects that are characteristic of BPH and LUTS, suggesting that E-cadherin downregulation could be a driving force in human BPH development and progression. [ABSTRACT FROM AUTHOR]

A wide variety of minimally invasive surgical techniques are now being offered for treating voiding lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). These options offer an alternative to both medical therapy and traditional surgical options. Minimally invasive surgical treatments in LUTS/BPO boast both day case and local anaesthetic options, with a potentially reduced side effect profile compared to traditional surgical interventions matching the needs for a range of patients. We provide a narrative review of minimally invasive surgical treatments available for BPO in terms of the technology, efficacy, safety, institutional recommendations, cost and potential future developments. [ABSTRACT FROM AUTHOR]

Background and aims: Prostatic urethral lift (Urolift™) is a minimally invasive technique to treat male lower urinary tract symptoms (LUTSs) due to benign prostatic hyperplasia (BPH). The aim of the present study was to assess safety and medium- to long-term outcomes in the relief of urinary symptoms. Methods: We included 35 men, affected by severe symptomatic BPH evaluated by International Prostate Symptom Score (IPSS), with normal erectile function (EF) and ejaculatory function (EjF) evaluated by the International Index of Erectile Dysfunction (IIEF-5) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD-SF). Exclusion criteria were prostate larger than 70 cm3, bladder neck sclerosis, concomitant third prostatic lobe, and/or other cervical urethral obstruction or cancer. All patients, preoperatively, performed uroflowmetry (UFM) with peak flow (Q-max) and post void residual volume (PVR), digital rectal exam, transrectal prostate ultrasound to measure prostate volume, PSA, and cystoscopy. Follow-up was scheduled at 1–3–6 months, then yearly, evaluating UFM, IPSS, IIEF-5, and MSHQ-EjD-SF. Results: All procedures were performed by a single senior surgeon and follow-up was 33.8 ± 12 months. Preoperative PSA was 0.82 ± 0.4 ng/ml and mean operative time was 19.6 ± 10 min and 3 (2–4) implants per patient were used. Parameters reported at last follow-up schedule were: Q-max increase of 68% (p = 0.001), PVR reduction 68% (p = 0.005), and IPSS reduction 55% (p < 0.0001). EF and EjF were similarly preserved, and no patients presented retrograde ejaculation. A total of 88.6% of patients were satisfied with LUTSs improvement and 100% satisfied with EjF. Conclusion: Urolift can improve urinary disorders secondary to BPH, preserving EjF and EF. It is a safe and easy method, reproducible, and with low incidence of complications. Careful selection of patients is mandatory. The main reason for dissatisfaction is the higher expectation of better BPH symptoms relief although patients with high bladder neck and/or prostate volume >45 cm3 were aware of the possible failure. [ABSTRACT FROM AUTHOR]

Objective: The objective is to measure the change in overactive bladder (OAB) symptoms in patients undergoing flexible cystoscopy in the early postoperative period using a validated OAB-V8 tool., Patients and Methods: It was a prospective, cross-sectional, observational study conducted by a section of Urology at the Aga Khan University Hospital, Karachi. The total duration of the study was 12 months (July 2022 to June 2023). All adult patients who underwent flexible cystoscopy under local anesthesia for diagnostic and surveillance purposes were included in the study. OAB symptoms were evaluated using the validated eight-item OAB-V8 tool just before the cystoscopy and on postoperative days 1 and 4. Patients were categorized as either OAB-negative (<8) or OAB-positive (≥8) based on their sum scores. Mean sum scores of different variables and OAB subdomains were assessed., Results: Sixty-three patients were included in the final analysis with a predominantly male population. The mean pre-cystoscopy (screen) score was 7.46 + 5.58, which increased to 9.89 + 6.82 on day 1 (p<0.01) before decreasing back to 7.68 + 5.7 on day 4 (p=0.08). Twenty-one patients (33.3%) were labeled OAB positive on day 0. Following cystoscopy, this number increased to 32 patients (50.8%) as 11 patients (26.2 %) developed de-novo OAB symptoms. The sub-group analysis showed an insignificant impact of age (p=0.5), gender (p=0.51), indication (p=0.22), and use of alpha-blocker (p= 0.30) on change in OAB score., Conclusion:  OAB symptoms are frequently encountered in patients undergoing awake (flexible) cystoscopy. This procedure can also trigger de novo OAB symptoms, albeit transiently, which typically resolve over time. This information could help in patient counseling, management, and the need for intervention in the future., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Review Committee of Aga Khan University Hospital, Karachi, PAK issued approval 2022-7365-21844. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khan et al.)

Background: Nocturnal enuresis is generally considered a children's condition, yet it may persist 1%-2% in adolescence and early adulthood. Refractory patients often demand follow-up by multidisciplinary teams, which is only restricted to some of the expert tertiary centers. However, there are no standardized transition programs/guidelines when follow-up must be passed from pediatric to adult healthcare providers., Aim, Materials & Methods: To investigate this issue, we conducted a literature search on enuresis transition, which resulted in no articles. We, therefore, proceeded in a rescue search strategy: we explored papers on transition programs of conditions that may be related and/or complicated by enuresis, nocturia, or other urinary symptoms (chronic diseases, CKD, bladder dysfunction, kidney transplant, neurogenic bladder)., Results: These programs emphasize the need for a multidisciplinary approach, a transition coordinator, and the importance of patient and parent participation, practices that could be adopted in enuresis. The lack of continuity in enuresis follow-up was highlighted when we investigated who was conducting research and publishing on enuresis and nocturia. Pediatric disciplines (50%) are mostly involved in children's studies, and urologists in the adult ones (37%)., Discussion: We propose a stepwise approach for the transition of children with enuresis from pediatric to adult care, depending on the clinical subtype: from refractory patients who demand more complex, multidisciplinary care and would benefit from a transition coordinator up to children/young adults cured of enuresis but who persist in having or present lower urinary tract symptoms (LUTS)/nocturia later on. In any case, the transition process should be initiated early at the age of 12-14 years, with adequate information to the patient and parents regarding relapses or LUTS/nocturia occurrence and of the future treating general practitioner on the enuresis characteristics and comorbidities of the patient., (© 2024 Wiley Periodicals LLC.)

Objectives: To study the possible association between (sexual) abuse and lower urinary tract symptoms (LUTS) in men and women. To study the differences in this association between men and women, and between the timing of the abuse., Subjects and Methods: A Dutch observational population-based cross-sectional study was used, based on self-administered questionnaires. Respondents were included if they had answered all questions about abuse and LUTS. Logistic regression was used to analyse the data., Results: Included were 558 men and 790 women, of whom 29% and 37%, respectively, reported a history of one of more types of abuse. Abuse was significantly associated with LUTS in both men (odds ratio [OR] 1.7; 1.2-2.5) and women (OR 1.4; 1.1-2.1). This association, testing by two-way interaction, was significantly stronger in men. No association was found between childhood abuse or adulthood abuse and LUTS, in men or women. The association of sexual abuse with LUTS was significant in both men (2.7; 1.4-5.2) and in women (1.5; 1.1-2.2), and this association (testing by two-way interaction) was significantly much stronger in men., Conclusion: In men more than in women, a history of any type of abuse is associated with LUTS, regardless of whether the abuse occurred during childhood or adulthood. In both sexes, a history of sexual abuse is also associated with experiencing LUTS, with a much stronger association in men than in women. Patients, in particular male patients, presenting with LUTS should therefore be asked about sexual abuse in the past., (© 2024 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)