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Zusammenfassung: Obstruktive und irritative Symptome des unteren Harntraktes («lower urinary tract symptoms», LUTS) betreffen grosse Teile der über-40-jährigen Bevölkerung und umfassen Blasenentleerungs- und Blasenspeicherstörungen. Als Ursache liegt der Blasenentleerungsstörung meist eine Obstruktion der Harnröhre durch eine gutartige Vergrösserung der Prostata zugrunde (benigne Prostatahyperplasie, BPH). In diesem Fall spricht man von einer benignen Prostataobstruktion (BPO). Durch den demografischen Wandel der Gesellschaft steigt zunehmend die Prävalenz benigner Prostataerkrankungen, bei mit dem Lebensalter steigender Inzidenz. Ein individualisierter Therapieansatz ist bei unterschiedlicher Ausprägung der Symptomatik zwingend erforderlich. Dieser reicht dabei von kontrolliertem Zuwarten, über die medikamentöse Therapie bis hin zum chirurgischen Eingriff. Im medikamentösen Therapieansatz stehen vor allem die akute Linderung der Symptomatik mit einer Steigerung der Lebensqualität sowie die Reduktion des Krankheitsprogresses im Vordergrund. Liegt der Symptomschwerpunkt auf Blasenentleerungsstörungen finden α1-Adrenozeptorantagonisten und 5α-Reduktaseinhibitoren (ggf. auch als Kombinationstherapien) Verwendung. Bei Blasenspeicherstörungen finden weitere Substanzklassen Anwendung, wie Muskarinrezeptorantagonisten oder β3-Agonisten. Unbehandelt, können LUTS zu schwerwiegenden Folgen und Komplikationen, aber auch zu einer stark reduzierten Lebensqualität führen.

Zusammenfassung: Laser haben ein umfangreiches Anwendungsspektrum in der endourologischen Therapie. Nicht nur in der Therapie von Steinen, auch in der Behandlung des benignen Prostatasyndroms (BPS) nimmt ihr Stellenwert immer weiter zu. Auf die endourologische Behandlung der BPS mit verschiedenen Laser-Techniken wird im weiteren Verlauf näher eingegangen. Dabei werden zuerst die physikalischen Unterschiede der einzelnen Laser erklärt, im weiteren Verlauf die Behandlungsmöglichkeiten an sich, die mit einem Laser durchgeführt werden können. Hauptaugenmerk soll auf dem konkreten Vergleich der Behandlungsmethoden vor allem im klinischen Kontext liegen. Insbesondere die OP-Dauer, Hospitalisierungsdauer, das Nachblutungsrisiko, die DK(Dauerkatheter)-Zeit, das Risiko eines Harnverhalts und das Risiko für postoperative Komplikationen wie retrograde Ejakulation, BH (Blasenhals)-Sklerose, HR (Harnröhren)-Striktur, Adenomrezidive sollen für die wichtigsten Methoden aufgeführt und miteinander verglichen werden. Dennoch liegt weiterhin die Verteilung von TURP zu Laser mit 30:1 zu Gunsten der TURP [1].

Radiomics promises to enhance the discriminative performance for clinically significant prostate cancer (csPCa), but still lacks validation in real-life scenarios. This study investigates the classification performance and robustness of machine learning radiomics models in heterogeneous MRI datasets to characterize suspicious prostate lesions for non-invasive prediction of prostate cancer (PCa) aggressiveness compared to conventional imaging biomarkers.A total of 142 patients with clinical suspicion of PCa underwent 1.5T or 3T biparametric MRI (7 scanner types, 14 institutions) and exhibited suspicious lesions [prostate Imaging Reporting and Data System (PI-RADS) score ≥3] in peripheral or transitional zones. Whole-gland and index-lesion segmentations were performed semi-automatically. A total of 1,482 quantitative morphologic, shape, texture, and intensity-based radiomics features were extracted from T2-weighted and apparent diffusion coefficient (ADC)-images and assessed using random forest and logistic regression models. Five-fold cross-validation performance in terms of area under the ROC curve was compared to mean ADC (mADC), PI-RADS and prostate-specific antigen density (PSAD). Bias mitigation techniques targeting the high-dimensional feature space and inherent class imbalance were applied and robustness of results was systematically evaluated.Trained models showed mean area under the curves (AUCs) ranging from 0.78 to 0.83 in csPCa classification. Despite using mitigation techniques, high performance variability of results could be demonstrated. Trained models achieved on average numerically higher classification performance compared to clinical parameters PI-RADS (AUC =0.78), mADC (AUC =0.71) and PSAD (AUC =0.63).Radiomics models' classification performance of csPCa was numerically but not significantly higher than PI-RADS scoring. Overall, clinical applicability in heterogeneous MRI datasets is limited because of high variability of results. Performance variability, robustness and reproducibility of radiomics-based measures should be addressed more transparently in future research to enable broad clinical application.

OBJECTIVE To compare perioperative management and functional outcome of spinal anesthesia (SpA) to general anesthesia (GA) in high-risk patients treated for lower urinary tract symptoms with Holmium laser enucleation of the prostate (HoLEP). METHODS In the current retrospective analysis, a propensity-score-matching of patients treated for lower urinary tract symptom with HoLEP (n = 300) in SpA with ASA>2 (n = 100), GA with ASA>2 (GA-high-risk) (n = 100) or GA with ASA≤2 (GA-low-risk) (n = 100) was performed. The impact of anesthesiologic mode on perioperative anesthesiologic outcome, early functional outcome and treatment related adverse events (according to Clavien Dindo), was evaluated. RESULTS Hypotensive episodes were significantly less frequent in the SpA-cohort (9%) compared to the GA-high-risk cohort (32%) and the GA low-risk cohort (22%) (each P

Purpose To investigate the expression of the receptor protein ACE-2 alongside the urinary tract, urinary shedding and urinary stability of SARS-CoV-2 RNA. Methods Immunohistochemical staining was performed on tissue from urological surgery of 10 patients. Further, patients treated for coronavirus disease (COVID-19) at specialized care-units of a university hospital were assessed for detection of SARS-CoV-2 RNA in urinary samples via PCR, disease severity (WHO score), inflammatory response of patients. Finally, the stability of SARS-CoV-2 RNA in urine was analyzed. Results High ACE-2 expression (3/3) was observed in the tubules of the kidney and prostate glands, moderate expression in urothelial cells of the bladder (0–2/3) and no expression in kidney glomeruli, muscularis of the bladder and stroma of the prostate (0/3). SARS-CoV-2 RNA was detected in 5/199 urine samples from 64 patients. Viral RNA was detected in the first urinary sample of sequential samples. Viral RNA load from other specimen as nasopharyngeal swabs (NPS) or endotracheal aspirates revealed higher levels than from urine. Detection of SARS-CoV-2 RNA in urine was not associated with impaired WHO score (median 5, range 3–8 vs median 4, range 1–8, p = 0.314), peak white blood cell count (median 24.1 × 1000/ml, range 5.19–48.1 versus median 11.9 × 1000/ml, range 2.9–60.3, p = 0.307), peak CRP (median 20.7 mg/dl, 4.2–40.2 versus median 11.9 mg/dl, range 0.1–51.9, p = 0.316) or peak IL-6 levels (median: 1442 ng/ml, range 26.7–3918 versus median 140 ng/ml, range 3.0–11,041, p = 0.099). SARS-CoV-2 RNA was stable under different storage conditions and after freeze–thaw cycles. Conclusions SARS-CoV-2 RNA in the urine of COVID-19 patients occurs infrequently. The viral RNA load and dynamics of SARS-CoV-2 RNA shedding suggest no relevant route of transmission through the urinary tract.

Alexander Tamalunas,1 Philipp Lenau,1 Leo Federico Stadelmeier,1 Jan-Niclas Mumm,1 Theresa Vilsmaier,2 Henrik Höhn,2 Maja-Lena Mumm,3 Raphaela Waidelich,1 Jozefina Casuscelli,1 Giuseppe Magistro,1 Alexander Buchner,1 Thomas Kolben,2 Christian Stief,1 Martin Hennenberg1 1Department of Urology, University Hospital, LMU Munich, Munich, Germany; 2Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany; 3Department of Political and Social Sciences, Institute for Media and Communication Studies, Freie Universität Berlin, Berlin, GermanyCorrespondence: Alexander Tamalunas, Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, Munich, 81377, Germany, Tel +49 89 4400 – 0, Email alexander.tamalunas@med.uni-muenchen.dePurpose: The present study aimed to investigate the influence of patients’ and urologists’ gender when choosing a urologist. With rising population diversity through immigration and generational differences, patient-centered healthcare has recently moved to the focus of European healthcare systems. As healthcare in urology often concentrates on sensitive topics, and often involves gender-specific diseases, research on the influence of gender on decision-making processes is of high importance. Understanding influence of gender on patients’ choices in real life would provide patients, and physicians alike, with the means to provide better resources to achieve greater satisfaction from visits to a urologist.Patients and Methods: A questionnaire was prepared, and patients at our tertiary referral center were given the opportunity to voluntarily participate in our survey. We collected questionnaires from 1012 patients during their visits from June 2021 to October 2021.Results: Patients were divided into groups according to their gender: male (n=763), female (n=246), and non-binary (n=3). Our patient cohort consisted of more men than women (75% vs 24%), with only three patients identifying as non-binary. Irrespective of the patients’ own gender, patients preferred a male urologist when problems were considered embarrassing, limiting daily activities, or when worrisome. When problems were considered painful, all patients preferred a female urologist. When patients had had a previous positive experience with a female or male urologist, they preferred to be treated by a female or male urologist, respectively. Overall, 65% of patients stated a gender preference for at least one given situation, or consultation scenario.Conclusion: As the majority of our patients stated a gender preference, urological departments should be considerate of potential patients’ preferences for urologist gender that may be based on the individual patient’s history, taking a comprehensive approach to fulfill the patients’ need for same gender urologists in educational hospitals and health care services.Keywords: gender, sex, urologist, health economics, health services research, medical research, patient-centered care, person-centered medicine, public health, decision making

The COVID (coronavirus disease 2019) pandemic has shown impressively that infectious diseases can have an enormous impact on the healthcare system and beyond. In the specialty of urology, patients present in daily practice with viral infections that are associated with numerous diseases.The aim of this review is to describe viral infections relevant for urology, and in particular to emphasize vaccination prevention. A selective literature search was carried out on the subjects of "COVID and urology", "urogenital viral infections", "viral urological infections in transplant medicine", and "vaccination prevention of viral diseases".Coronaviruses have already caused two local epidemics: SARS (severe acute respiratory syndrome) epidemic and MERS (Middle East respiratory syndrome) epidemic. The fact that the SARS-CoV‑2 (SARS coronavirus 2) disease is contagious even without symptoms has essentially led to the rapid spread and global pandemic. A large number of viruses, which can also induce viremia, have been detected in the ejaculate and are thus associated with a possible urogenital infection. These include the mumps virus, Coxsackie viruses or enteroviruses, among others. It has also been shown that a Zika virus infection can also be sexually transmitted via the sperm as a carrier. Viruses therefore also play an important role in reproduction. When performing kidney transplants, urologists are often confronted with viral infections. The most effective weapon against viruses is prevention by vaccination.In terms of ethiopathogenesis, the genitourinary tract is most often affected by viruses, in the context of viremia or through reactivation due to immunosuppression. Immunomodulation and vaccination prophylaxis play a leading role in therapy.EINLEITUNG: Die COVID-19-Pandemie („coronavirus disease 2019“) hat eindrucksvoll gezeigt, dass Infektionskrankheiten enorme Auswirkungen auf das Gesundheitswesen und darüber hinaus haben können. In der Urologie spielen Viren bei spezifischen Entitäten eine Rolle, wo sich der Urologe mit Viruserkrankungen beschäftigen muss.Diese Übersichtsarbeit hat zum Ziel in der Urologie relevante Virusinfektionen zu beschreiben und insbesondere die Impfprävention hervorzuheben. Es erfolgte eine selektive Literaturrecherche zu den Themen „COVID und Urologie“, „Urogenitale Virusinfektionen“, „Virale urologische Infektionen in der Transplantationsmedizin“ sowie „Impfprävention von Viruserkrankungen“.Coronaviren sind Viren, die bereits 2‑mal lokale Epidemien verursacht haben (SARS- [„severe acute respiratory syndrome“] und MERS-Epidemie [„middle east respiratory syndrome“]). Die Tatsache, dass die SARS-CoV-2-Erkrankung („severe acute respiratory syndrome coronavirus 2“) auch ohne Symptome ansteckend ist, hat im Wesentlichen zu der raschen Ausbreitung und weltweiten Pandemie geführt. Eine Vielzahl von Viren, die auch eine Virämie induzieren können, wurde im Ejakulat nachgewiesen und wird damit mit einer etwaigen urogenitalen Infektion in Verbindung gebracht. Hierzu zählen u. a. das Mumps‑, Coxsackie-Viren oder Enteroviren. Es wurde auch gezeigt, dass auch eine Zika-Virusinfektion sexuell über die Spermien als Carrier übertragen werden kann. Somit spielen Viren auch eine wichtige Rolle in der Reproduktion. Bei der Nierentransplantation sind Urologen häufig mit viralen Infektionen konfrontiert. Die effektivste Waffe gegenüber Viren stellt die Impfprävention dar.Äthiopathogenetisch ist der Urogenitaltrakt im Rahmen einer Virämie oder über eine Reaktivierung durch eine Immunsuppression am häufigsten mitbetroffen. Therapeutisch kommt der Immunmodulation sowie der Impfprophylaxe eine führende Rolle zu.

Introduction: To compare holmium laser enucleation of the prostate (HoLEP) with transurethral resection of the prostate (TURP) in patients under continuous antithrombotic therapy with regard to ble...

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 (

Im Verlauf des letzten Jahrzehnts erlaubten uns neue molekulare Techniken Einblicke in die hoch komplexen Interaktionen des menschlichen Mikrobioms zu gewinnen, die einen entscheidenden Beitrag zur Gesundheit und Krankheitsentstehung leisten. Das Sterilitatskonzept des Harntraktes wurde nun langst verworfen und man verfolgt jetzt das Ziel, die unterschiedlichen mikrobiellen Signaturen zu entschlusseln, die mit bestimmten Erkrankungen assoziiert sind. Dabei ruckt immer mehr das Konzept der Dysbalance des Mikrobioms in den Vordergrund, wenn unausgeglichene mikrobielle Profile einhergehen mit krankhaften Storungen von Organsystemen. Unlangst kann dies auch eindrucklich fur maligne Erkrankungen wie das Prostata‑, Nierenzell-und Harnblasenkarzinom gezeigt werden. Sowohl neue praventive und therapeutische Angriffspunkte als auch neue Biomarkersysteme stehen nun in Aussicht. Fur benigne Erkrankungen wie die interstitielle Zystitis, die Dranginkontinenz oder die chronische Prostatitis/das chronische Beckenschmerzsyndrom galt bislang eine mikrobielle Genese als ausgeschlossen. Doch beweist die molekulare Analyse des Mikrobioms auch hier, dass der mikrobielle Beitrag fur die Pathogenese und den Krankheitsverlauf eine entscheidende Rolle einzunehmen scheint.

On 11 March 2020, the WHO declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic and COVID-19 emerged as one of the biggest challenges in public health and economy in the twenty-first century. The respiratory tract has been the centre of attention, but COVID-19-associated complications affecting the genitourinary tract are reported frequently, raising concerns about possible long-term damage in these organs. The angiotensin-converting enzyme 2 (ACE2) receptor, which has a central role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, is highly expressed in the genitourinary tract, indicating that these organs could be at a high risk of cell damage. The detection of SARS-CoV-2 in urine and semen is very rare; however, COVID-19 can manifest through urological symptoms and complications, including acute kidney injury (AKI), which is associated with poor survival, severe structural changes in testes and impairment of spermatogenesis, and hormonal imbalances (mostly secondary hypogonadism). The effect of altered total testosterone levels or androgen deprivation therapy on survival of patients with COVID-19 was intensively debated at the beginning of the pandemic; however, androgen inhibition did not show any effect in preventing or treating COVID-19 in a clinical study. Thus, urologists have a crucial role in detecting and managing damage of the genitourinary tract caused by COVID-19.

Aufgrund der Entwicklung neuer Hochdurchsatzsequenzierungstechniken wurde der Grundstein zur Erforschung des Mikrobioms gelegt, wodurch neue Perspektiven auf eine bisher nicht vorstellbare Komplexitat und Diversitat einer Vielzahl von Okosystemen des menschlichen Korpers eroffnet wurden. Eine der Haupterkenntnisse war, dass das seit Jahrzehnten bestehende Dogma eines sterilen Harntraktes nicht mehr haltbar ist. Wie fur alle Nischen des menschlichen Korpers ist auch hier ein ausgeglichenes Mikrobiom wichtiger Bestandteil fur die physiologische Funktionsweise des Harntraktes und somit Voraussetzung fur die Gesundheit. Die Dysbalance des Mikrobioms wird mittlerweile als wichtiger Einflussfaktor fur die Entstehung von Krankheiten angesehen. In der Urologie konnten bisher wichtige Erkenntnisse gewonnen werden sowohl zu benignen Erkrankungen wie der interstitiellen Zystitis, der Dranginkontinenz und der chronischen Prostatitis/chronischem Beckenschmerzsyndrom als auch zur Beteiligung an malignen Erkrankungen wie dem Prostatakarzinom. Auch Beschwerdekomplexe wie das benigne Prostatasyndrom sind mittlerweile in den Vordergrund der Forschungsbestrebungen geruckt und das Mikrobiom des Harntraktes scheint eine bisher ungeahnte Rolle fur die Pathogenese und Progression dieser Volkskrankheit zu spielen.

Maintaining high-quality care for urological patients is a challenge during and after the Coronavirus disease 2019 (COVID-19) pandemic. We observe an increasing volume of postponed elective visits at our tertiary care hospital, holding the risk for deterioration of non-emergency disease conditions. As it is unclear for how long the pandemic will last, we propose to implement telehealth as a solution to provide regular symptom monitoring compatible with social distancing guidelines during the pandemic and beyond. Telemedical assessment and prioritizing of high-risk patients for individual consults at outpatient services will have to be aligned with available outpatient capacity and local outbreak severity. Electronic supplementary material The online version of this article (10.1007/s15010-020-01511-7) contains supplementary material, which is available to authorized users.

Purpose To assess the impact of previous transurethral surgery for benign prostate enlargement (BPE) and time interval between procedures on functional outcomes and health-related quality of life (HRQOL) after radical prostatectomy (RP). Methods A propensity score-matched patient cohort [n = 685, (513 without previous BPE surgery, 172 with BPE surgery)] was created and HRQOL was pre- and postoperatively assessed using validated questionnaires (EORTC QLQ-C30). Urinary continence was measured via ICIQ-SF questionnaire and pad usage. Multivariable analysis included binary logistic and Cox regression models (p Results Median follow-up was 18 months. There was no significant difference in recurrence-free survival in multivariate analysis (HR 0.66, 95%CI 0.40–1.07, p = 0.093). We observe higher mean ICIQ-SF scores (5.7 vs. 8.2, p p p p = 0.003). In multivariate analysis, continence recovery (OR 5.19, 95%CI 3.10–8.68, p p = 0.806) could be identified as independent predictors of good general HRQOL. There was no significant correlation between time interval between both surgeries and continence (p = 0.408), and HRQOL (p = 0.386) outcomes. Conclusions We observe favourable continence outcomes for patients without previous BPE surgery. Our results indicate that RP can be safely performed after transurethral BPE surgery, regardless of the time interval between both interventions.

To evaluate the diagnostic value of a high preoperative PSA level for the detection of incidental prostate cancer (iPCa) in LUTS patients with very large prostates (> 100 cc). We conducted a retrospective analysis of 1125 men treated for LUTS with holmium laser enucleation of the prostate (HoLEP). Patients were stratified according to a preoperative PSA level higher (high PSA; n = 365) or lower than 10 ng/ml (low PSA; n = 760). Preoperative and histopathological parameters were compared between both cohorts. Logistic regression models were used to identify independent predictors of iPCa. Demographic parameters were similar between both cohorts. The median PSA levels were 14.2 ng/ml (11.5–19.9) and 4 ng/ml (2.4–6.0). The prostate volume was significantly higher in the high PSA group (105 cc vs. 75 cc; p

Die chronische Prostatitis (CP; „chronic pelvic pain syndrome“, CPPS) ist definiert als chronischer Schmerz oder Missempfindung im Beckenbereich fur mindestens 3 Monate im Verlauf der letzten 6 Monate und wird haufig begleitet von Miktionsbeschwerden, psychosozialen Beeintrachtigungen und sexueller Dysfunktion. Aktuell stehen weder Biomarker noch klinische Testverfahren fur eine spezifische Diagnosestellung zur Verfugung. Die Basisdiagnostik verfolgt das Ziel, Differenzialdiagnosen fur Beckenschmerzen auszuschliesen und das individuelle Beschwerdebild des Patienten zu erfassen. Die UPOINTS-Klassifikation erfasst das individuelle klinische Profil der Patienten, zeigt die dazu notwendigen diagnostischen Schritte auf und ist Grundlage fur ein multimodales, symptomorientiertes und personalisiertes Therapiekonzept. Regelmasige Kontrollen sind notwendig, um das Therapieansprechen zu uberwachen und ggf. zu modifizieren.

Worldwide, multiresistant bacterial strains are emerging at unprecedented rates. This development seriously threatens the ability of humanity to treat even common infections, resulting in disability and death. Furthermore, this development endangers all medical achievements including cancer therapy or organ transplantations. Therefore, the World Health Organization has endorsed antimicrobial resistance as a great threat to humanity. To still allow effective treatment of patients, rapid, automated, and reliable antibiotic susceptibility testing (AST) of bacterial pathogens is essential. Thereby, speed and sensitivity of the AST results are crucial for improving patient care. Here, Raman spectroscopy as a nondestructive technique providing chemical-specific information is employed to monitor the deuterium uptake of metabolically active bacteria during antibiotic treatment, enabling fast and reliable AST. For this purpose, a bulk sample-preparation method was developed, allowing a high-throughput analysis of a significant number of cells. A protocol was developed for Gram-positive (Enterococcus faecalis) and Gram-negative (Escherichia coli) reference strains and was tested on 51 clinical isolates with well-characterized resistance phenotypes against ampicillin, ciprofloxacin, meropenem, and vancomycin. Borderline resistant and heteroresistant phenotypes were observed and further investigated. This is of critical importance as the sensitive detection of low-frequency heteroresistance in bacterial populations is a huge challenge. Such isolates seem susceptible but are resistant to treatment in vivo. Automatable analysis detects strong phenotypes within 3 h. On the basis of experimental and modeled data, heteroresistance is estimated to be detectable down to frequencies of 10-6 and investigated on clinical isolates as a proof-of-concept study, but requiring longer incubation time.

Objective To determine the impact of asymptomatic bacteriospermia on semen quality in subfertile men. Methods We conducted a retrospective, single-centre cohort study in 1300 subfertile men. In those diagnosed with asymptomatic bacteriospermia we performed univariate and multivariate logistic regression models to evaluate the strain-specific association with semen parameters. Results Asymptomatic bacteriospermia was diagnosed in 3.2% of patients. The microbiological semen analysis revealed a poly-microbial result in 60%. The most common bacterial species were coagulase-negative Staphylococci species (71.4%), Streptococcus viridans (50.0%) and Enterococcus faecalis (26.2%). Sexually transmitted pathogens were identified in 11.9% of semen samples. The detection of Streptococcus viridians or Haemophilus parainfluenzae correlated with impaired sperm morphology (p coagulase-negative Staphylococci species or Enterococcus faecalis was associated with pathological low counts of live spermatozoa (p Enterococcus faecalis showed a significant impact on sperm concentration (OR 4.48; 95% CI 1.06–22.10; p = 0.041). Conclusions Asymptomatic bacteriospermia has always been a subject of great controversy. There is still an ongoing debate whether to treat or not to treat. Here, we demonstrate that asymptomatic bacteriospermia is clearly associated with impaired semen quality. Our findings speak in favour of strain-specific interactions with semen parameters. Especially Enterococcus faecalis seriously affects sperm concentration.

Recently, the European Association of Urology recommended hexane-extracted fruit of Serenoa repens (HESr) in their guidelines on management of non-neurogenic male lower urinary tracts symptoms (LUTS). Despite previously lacking recommendations, Permixon® is the most investigated HESr in clinical trials, where it proved effective for male LUTS. In contrast, underlying mechanisms were rarely addressed and are only marginally understood. We therefore investigated effects of Permixon® on human prostate and detrusor smooth muscle contraction and on growth-related functions in prostate stromal cells.Permixon® capsules were dissolved using n-hexane. Contractions of human prostate and detrusor tissues were induced in organ bath. Proliferation (EdU assay), growth (colony formation), apoptosis and cell death (flow cytometry), viability (CCK-8) and actin organization (phalloidin staining) were studied in cultured human prostate stromal cells (WPMY-1).Permixon® inhibited αOur results provide a novel basis that allows, for the first time, to fully explain the ubiquitous beneficial effects of HESr in clinical trials. HESr may inhibit at least neurogenic, α

OBJECTIVES To evaluate the impact of prostate size on functional outcomes and perioperative morbidity, we analyzed patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms (LUTS). As LUTS secondary to benign prostatic obstruction (BPO) are a chronic progressive disease, prevalence and prostate size increase with age. HoLEP is a size-independent method for surgical treatment of LUTS/BPO and can be offered in medication-refractory patients with durable long-term results and reduced perioperative morbidity. METHODS We retrospectively collected data of 852 patients who underwent HoLEP for LUTS secondary to BPO between 2014-2018. Patients were divided into group 1 (≤60 cc), group 2 (>60