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Mauro Gacci,1 Matteo Salvi,1 Arcangelo Sebastianelli,1 Linda Vignozzi,2 Giovanni Corona,3 Kevin T McVary,4 Steven A Kaplan,5 Mario Maggi,2 Marco Carini,1 Matthias Oelke6 1Department of Urology, University of Florence, Florence, 2Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, 3Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy; 4Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, 5Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY, USA; 6Department of Urology, Hannover Medical School, Hannover, Germany Abstract: A strong and independent association between lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) and erectile dysfunction (ED) has been widely evidenced in several clinical epidemiologic studies. Preclinical animal models have provided a great deal of information on potential common pathogenic mechanisms underlying these two clinical identities. Although the efficacy of the most commonly used treatments for LUTS/BPH is well defined, the negative impact of these treatments on sexual function – in particular, on ED – has triggered the search for new treatment options. In this regard, a new role for phosphodiesterase type 5 inhibitors in the treatment of LUTS/BPH and ED has been claimed. Tadalafil is one of the most extensively investigated phosphodiesterase type 5 inhibitors for this new indication. All evidence reported to date suggests that tadalafil 5 mg once daily is a safe and effective treatment option for both LUTS/BPH and ED. Keywords: phosphodiesterase type 5 inhibitor, LUTS/BPH, ED, sexual function, Cialis

Hemifacial spasm (HFS) is characterized by involuntary synchronous contractions or spasms of one side of the face, usually beginning around the eye. They are typically brief, irregular clonic movements but are occasionally tonic. We present a case of a 41-year-old female who presented to the neurology clinic with complaints of recurrent right facial spasms. These involuntary spontaneous movements had affected her quality of life. The neuroimaging revealed the vascular malformation right cranial nerves (CN) VII/VIII complex. It was considered to be responsible for the patient's HFSs. The patient responded well symptomatically to the botox injections without any neurovascular decompression.

Objective: We evaluated 5-year safety, efficacy and prostate volume data from BPH patients treated with finasteride or dutasteride. Methods: A retrospective analysis of 378 consecutive men treated with 5[alpha]-reductase inhibitor monotherapy between January 2004 and September 2009 (197 on finasteride and 211 on dutasteride) in a single clinic was performed. Efficacy assessments included International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), postvoid residual urine volume (PVR), prostate-specific antigen (PSA) and prostate volume (PV). Safety assessments included International Index of Erectile Function (IIEF) and adverse events. Patients were evaluated at 3 months, 1 year and yearly thereafter. Results: Mean age of the group was 58.7 ± 6.7 years. Maintenance of therapy at 5 years was 57.4% and 42.5% for the finasteride and dutasteride groups respectively. Changes in IPSS, Qmax, PVR, PV and PSA were similar for both groups at 5 years. The incidence of erectile dysfunction, ejaculatory dysfunction and decreased libido resulting in discontinuation from therapy was significantly (p < 0.01) higher in the dutasteride (5.1%, 2.4%, 2.7% respectively) compared with the finasteride (2.1%, 1.8%, 1.4% respectively) group. In addition, the incidence of self-reported breast tenderness and/or enlargement was significantly (p < 0.01) greater in the dutasteride (3.5%) compared with the finasteride (1.2%) group. Conclusions: In this retrospective analysis of data from consecutive patients treated at a single clinic, both finasteride and dutasteride were effective therapies for the management of lower urinary tract symptoms. However, dutasteride resulted in significantly more sexual side effects and breast complications than finasteride. [ABSTRACT FROM AUTHOR]

Context: Saw palmetto fruit extracts are widely used for treating lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH); however, recent clinical trials have questioned their efficacy, at least at standard doses (320 mg/d).Objective: To determine the effect of saw palmetto extract (Serenoa repens, from saw palmetto berries) at up to 3 times the standard dose on lower urinary tract symptoms attributed to BPH.Design, Setting, and Participants: A double-blind, multicenter, placebo-controlled randomized trial at 11 North American clinical sites conducted between June 5, 2008, and October 10, 2010, of 369 men aged 45 years or older, with a peak urinary flow rate of at least 4 mL/s, an American Urological Association Symptom Index (AUASI) score of between 8 and 24 at 2 screening visits, and no exclusions.Interventions: One, 2, and then 3 doses (320 mg/d) of saw palmetto extract or placebo, with dose increases at 24 and 48 weeks.Main Outcome Measures: Difference in AUASI score between baseline and 72 weeks. Secondary outcomes included measures of urinary bother, nocturia, peak uroflow, postvoid residual volume, prostate-specific antigen level, participants' global assessments, and indices of sexual function, continence, sleep quality, and prostatitis symptoms.Results: Between baseline and 72 weeks, mean AUASI scores decreased from 14.42 to 12.22 points (-2.20 points; 95% CI, -3.04 to -1.36) [corrected]with saw palmetto extract and from 14.69 to 11.70 points (-2.99 points; 95% CI, -3.81 to -2.17) with placebo. The group mean difference in AUASI score change from baseline to 72 weeks between the saw palmetto extract and placebo groups was 0.79 points favoring placebo (upper bound of the 1-sided 95% CI most favorable to saw palmetto extract was 1.77 points, 1-sided P = .91). Saw palmetto extract was no more effective than placebo for any secondary outcome. No clearly attributable adverse effects were identified.Conclusion: Increasing doses of a saw palmetto fruit extract did not reduce lower urinary tract symptoms more than placebo.Trial Registration: clinicaltrials.gov Identifier: NCT00603304. [ABSTRACT FROM AUTHOR]

Aims: Understanding the patient's experience and symptom descriptions is critical to assess outcomes. Thus, there is a need for qualitative research to better understand how patients describe their symptoms and treatment expectations. Methods: Eight focus groups were conducted in two research phases: Phase 1 focused on eliciting patient's descriptions of urinary symptoms, and Phase 2 assessed patient perspectives on treatment outcomes. Participants with a range of lower urinary tract symptoms (LUTS) were recruited from urology clinics and community settings in the United States. All interviews were audio recorded and transcribed. Content and descriptive analyses were performed. Results: A total of 33 men and 30 women participated. Mean ages for men and women were 55 and 61 in Phase 1, and 57 and 61 in Phase 2, respectively. About 73% of participants were white people, and most had a high school education or greater. A wide range of LUTS were emergently described, and the words, concepts and phrases were generally similar across groups. Most participants identified with the word 'bother', and thought it was important to assess both the frequency and bother of each symptom. Reasons for seeking care included symptom bother and fears about cancer and bladder infections. Most participants thought that a 50% improvement in a single symptom or group of symptoms would be a meaningful treatment outcome. Conclusion: This qualitative research provides a better understanding on how men and women describe their LUTS and their perspectives on treatment outcomes. This research can be used to inform the development of a new LUTS outcomes' tool. [ABSTRACT FROM AUTHOR]

BACKGROUND: Participation in Internet gambling is growing rapidly, as is concern about its possible effects on the public's health. This article reports the results of the first prospective longitudinal study of actual Internet casino gambling behaviour. METHODS: Data include 2 years of recorded Internet betting activity by a cohort of gamblers who subscribed to an Internet gambling service during February 2005. We examined computer records of each transaction and transformed them into measures of gambling involvement. The sample included 4222 gamblers who played casino games. RESULTS: The median betting behaviour was to play casino games once every 2 weeks during a period of 9 months. Subscribers placed a median of 49 bets of euro4 each playing day. Subscribers lost a median of 5.5% of total monies wagered. We determined a group of heavily involved bettors whose activity exceeded that of 95% of the sample; these players bet every fifth day during 17.5 months. On each playing day, these most involved bettors placed a median of 188 bets of euro25. Their median percent of wagers lost, 2.5%, was smaller than that lost by the total sample. CONCLUSION: Our findings suggest that Internet casino betting behaviour results in modest costs for most players, while some, roughly 5%, have larger losses. The findings also show the need to consider time spent as a marker of disordered gambling. These findings provide the evidence to steer public health debates away from speculation and toward the creation of empirically-based strategies to protect the public health. [ABSTRACT FROM AUTHOR]

Context: Men with overactive bladder and other lower urinary tract symptoms may not respond to monotherapy with antimuscarinic agents or alpha-receptor antagonists.Objective: To evaluate the efficacy and safety of tolterodine extended release (ER), tamsulosin, or both in men who met research criteria for both overactive bladder and benign prostatic hyperplasia.Design, Setting, and Participants: Randomized, double-blind, placebo-controlled trial conducted at 95 urology clinics in the United States involving men 40 years or older who had a total International Prostate Symptom Score of 12 or higher and, an International Prostate Symptom Score quality-of-life (QOL) item score of 3 or higher, a self-rated bladder condition of at least moderate bother, and a bladder diary documenting micturition frequency (>or=8 micturitions per 24 hours) and urgency (>or=3 episodes per 24 hours), with or without urgency urinary incontinence. Patients were recruited between November 2004 and February 2006, and the study was completed May 2006.Interventions: Patients were randomly assigned to receive placebo (n = 222), 4 mg of tolterodine ER (n = 217), 0.4 mg of tamsulosin (n = 215), or both tolterodine ER plus tamsulosin (n = 225) for 12 weeks.Main Outcome Measures: Patient perception of treatment benefit, bladder diary variables, International Prostate Symptom Scores, and safety and tolerability were assessed.Results: A total of 172 men (80%) receiving tolterodine ER plus tamsulosin reported treatment benefit by week 12 compared with 132 patients (62%) receiving placebo (P<.001), 146 (71%) receiving tamsulosin (P=.06 vs placebo), or 135 (65%) receiving tolterodine ER (P=.48 vs placebo). Patients receiving tolterodine ER plus tamsulosin compared with placebo experienced significant reductions in urgency urinary incontinence (-0.88 vs -0.31, P=.005), urgency episodes without incontinence (-3.33 vs -2.54, P=.03), micturitions per 24 hours (-2.54 vs -1.41, P<.001), and micturitions per night (-0.59 vs -0.39, P.02). Patients receiving tolterodine ER plus tamsulosin demonstrated significant improvements on the total International Prostate Symptom Score (-8.02 vs placebo, -6.19, P=.003) and QOL item (-1.61 vs -1.17, P=.003). All interventions were well tolerated. The incidence of acute urinary retention requiring catheterization was low (tolterodine ER plus tamsulosin, 0.4%; tolterodine ER, 0.5%; tamsulosin, 0%; and placebo, 0%).Conclusions: These results suggest that treatment with tolterodine ER plus tamsulosin for 12 weeks provides benefit for men with moderate to severe lower urinary tract symptoms including overactive bladder. Clinical Trials Registration clinicaltrials.gov Identifier: NCT00147654. [ABSTRACT FROM AUTHOR]

Although several minimally invasive therapies are currently available or under investigation for the treatment of patients with lower urinary tract symptoms secondary to BPH, rates of symptomatic and objective improvement, morbidity, long-term efficacy, costs, and reimbursement vary widely. [ABSTRACT FROM AUTHOR]

While TURP remains the gold standard approach to BPH, new therapies continue to evolve as technology improves. This review of minimally invasive treatments encapsulates the component devices and overall effectiveness of each technique. [ABSTRACT FROM AUTHOR]

There are various reasons for sexual dysfunction in women. Read about diagnostic and therapeutic tools that you can use to help your patients overcome these common problems. [ABSTRACT FROM AUTHOR]

The more longstanding the sexual dysfunction, the more difficult it becomes to treat. Since urologists will be seeing an increasing number of women with either overt or covert sexual dysfunction, it becomes prudent to best learn how to treat or refer appropriately. [ABSTRACT FROM AUTHOR]

Abstract Background Teaching the steps of evidence-based practice (EBP) has become standard curriculum for health professions at both student and professional levels. Determining the best methods for evaluating EBP learning is hampered by a dearth of valid and practical assessment tools and by the absence of guidelines for classifying the purpose of those that exist. Conceived and developed by delegates of the Fifth International Conference of Evidence-Based Health Care Teachers and Developers, the aim of this statement is to provide guidance for purposeful classification and development of tools to assess EBP learning. Discussion This paper identifies key principles for designing EBP learning assessment tools, recommends a common taxonomy for new and existing tools, and presents the Classification Rubric for EBP Assessment Tools in Education (CREATE) framework for classifying such tools. Recommendations are provided for developers of EBP learning assessments and priorities are suggested for the types of assessments that are needed. Examples place existing EBP assessments into the CREATE framework to demonstrate how a common taxonomy might facilitate purposeful development and use of EBP learning assessment tools. Summary The widespread adoption of EBP into professional education requires valid and reliable measures of learning. Limited tools exist with established psychometrics. This international consensus statement strives to provide direction for developers of new EBP learning assessment tools and a framework for classifying the purposes of such tools.

Abstract Background Improved outcomes with expanding treatment options for patients with pulmonary arterial hypertension present the opportunity to consider additional end-points in approaching therapy, including factors that influence health-related quality of life. However, comparatively little is known about health-related quality of life and its determinants in patients with pulmonary arterial hypertension. Methods Health-related quality of life was evaluated in a cross sectional study of 155 outpatients with pulmonary arterial hypertension using generic and respiratory-disease specific measurement tools. Most patients had either World Health Organization functional Class II or III symptoms. Demographic, hemodynamic and treatment variables were assessed for association with health-related quality of life scores. Results Patients with pulmonary arterial hypertension suffered severe impairments in both physical and emotional domains of health-related quality of life. Patients with idiopathic ("primary") pulmonary arterial hypertension had the best, and those with systemic sclerosis the worst health-related quality of life. Greater six-minute walk distance correlated with better health-related quality of life scores, as did functional Class II versus Class III symptoms. Hemodynamic measurements, however, did not correlate with health-related quality of life scores. No differences in health-related quality of life were found between patients who were being treated with calcium channel antagonists, bosentan or continuously infused epoprostenol at the time of quality of life assessment. Conclusion Health-related quality of life is severely impaired in patients with pulmonary arterial hypertension and is associated with measures of functional status. Specific associations with impaired health-related quality of life suggest potential areas for targeted intervention.

Abstract Background The effects of pulmonary arterial hypertension on brain function are not understood, despite patients' frequent complaints of cognitive difficulties. Using clinical instruments normally administered during standard in-person assessment of neurocognitive function in adults, we assembled a battery of tests designed for administration over the telephone. The purpose was to improve patient participation, facilitate repeated test administration, and reduce the cost of research on the neuropsychological consequences of acute and chronic cardiorespiratory diseases. We undertook this study to validate telephone administration of the tests. Methods 23 adults with pulmonary arterial hypertension underwent neurocognitive assessment using both standard in-person and telephone test administration, and the results of the two methods compared using interclass correlations. Results For most of the tests in the battery, scores from the telephone assessment correlated strongly with those obtained by in-person administration of the same tests. Interclass correlations between 0.5 and 0.8 were observed for tests that assessed attention, memory, concentration/working memory, reasoning, and language/crystallized intelligence (p ≤ 0.05 for each). Interclass correlations for the Hayling Sentence Completion test of executive function approached significance (p = 0.09). All telephone tests were completed within one hour. Conclusion Administration of this neurocognitive test battery by telephone should facilitate assessment of neuropsychological deficits among patients with pulmonary arterial hypertension living across broad geographical areas, and may be useful for monitoring changes in neurocognitive function in response to PAH-specific therapy or disease progression.

When sexual dysfunction occurs in women, several diagnostic and therapeutic strategies can help determine whether the problem is new or chronic and its origin in order to treat. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to gather initial safety and efficacy data with the Optilume ® BPH Catheter System for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH)., Methods: A total of 80 men with moderate-to-severe LUTS secondary to BPH were enrolled and treated with the Optilume BPH Catheter System. Symptoms were evaluated using the International Prostate Symptom Score (IPSS) and Benign Prostatic Hyperplasia-Impact Index (BPH-II). Improvement in urinary flow and relief of obstruction was evaluated by way of peak urinary flow rate (Qmax) and postvoid residual urine volume (PVR). Subjects were prospectively queried for adverse events at each study visit, and relatedness to the study device was evaluated by the investigators, as well as centrally adjudicated by the study principal investigator., Results: Previous reports of symptom improvement in this cohort were maintained through four-year followup, with a significant reduction in IPSS and IPSS quality of life maintained through four years (-12.1, -2.8, respectively). Clinically meaningful improvement in Qmax was maintained in the majority of subjects, with an average improvement from baseline of +5.6 mL/sec. No treatment-related adverse events were reported in the long-term followup period., Conclusions: Long-term followup through four years for subjects treated with the Optilume BPH Catheter System indicates durable outcomes in symptom improvement and functional improvement in flow rate. These results indicate the unique mechanism of action for Optilume BPH successfully achieves an immediate mechanical effect that is maintained long-term through incorporation of paclitaxel to maintain patency.

Background: Outcomes of radical prostatectomy (RP) in men with history of lower urinary tract symptoms related to benign prostatic enlargement (LUTS/BPE) surgery represents a controversial issue. We performed an updated systematic review and meta- analysis evaluating oncological and functional outcomes of RP in this subset of patients., Methods: Eligible studies were identified from MEDLINE, Web of Science and the Scopus databases. The following outcomes were evaluated: incidence of positive surgical margins (PSM), incidence of biochemical recurrence (BCR), 3-mo and 1-year urinary continence (UC) rates, incidence of nerve-sparing (NS) procedures, 1-year erectile function (EF) recovery rates. We estimated pooled Odds ratios (OR) and 95% confidence intervals (CI) using random effects models. Sub-analyses were performed according to the type of RP and LUTS/BPE surgery., Results: Twenty-five retrospective studies including 11,101 patients undergoing RP were included in the analysis (2113 with history of LUTS/BPE surgery, and 8898 controls). PSM rate was significantly higher in patients with history of LUTS/BPE surgery (OR 1.39, 95% CI 1.18-1.63, p < 0.001). No statistically significant difference in terms of BCR emerged between patients with or without history of LUTS/BPE surgery (OR 1.46, 95% CI 0.97-2.18, p = 0.066). Three-months and 1-year UC rates were significantly lower in patients with previous LUTS/BPE surgery (OR 0.48, 95% CI 0.34-0.68, p < 0.001 and OR 0.44, 95% CI 0.31-0.62, p < 0.001; respectively). Although not statistically significant differences between the two groups emerged in terms of adoption of NS procedures (OR 0.59, 95% CI 0.32-1.12, p = 0.107), 1-year EF recovery was significantly lower in patients with history of LUTS/BPE procedures (OR 0.60, 95% CI 0.40-0.89, p = 0.010)., Conclusions: In conclusions, RP in patients with history of previous LUTS/BPE surgery is associated with increased incidence of PSM, lower UC rates at both 3-months and 1-year follow-up as well as lower rates of EF recovery at 1-year follow-up., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Patient outcomes were assessed 2 years after treatment with the Optilume BPH Catheter System, a minimally invasive surgical therapy for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH)., Methods: One-hundred forty-eight adult males with symptomatic BPH were enrolled and randomized in a 2:1 fashion to Optilume BPH or Sham (100 Optilume BPH; 48 Sham). Long-term measures include International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), Post-Void Residual Urine (PVR), quality of life measures and sexual function. Follow-up beyond one year was limited to those treated with Optilume BPH., Results: At 2 years, 67.5% (56/83 CI 56.3%, 77.4%) of participants in the Optilume BPH arm were symptomatic responders as defined by ≥30% improvement in IPSS without medical or surgical retreatment. IPSS significantly improved from 23.4 ± 5.5 (n = 100) to 11.0 ± 7.0 (n = 74). Qmax improved by 116.8.% (8.9 ± 2.2 (n = 97) to 19.0 ± 16.3 (n = 65)), while PVR showed a slight reduction (83.7 ± 70.3 (n = 99) to 65.9 ± 74.5 (n = 65)). Improvement in uroflowmetry measures was consistent across all prostate volumes. BPH-II improved from 7.0 ± 2.9 (n = 98) to 2.3 ± 2.5 at 1 year (n = 89) and remained consistent at 2.3 ± 2.9 at the 2-years (n = 74), representing a 53.9% improvement. IPSS QoL also improved from 4.6 ± 1.3 (n = 100) at baseline to 2.2 ± 1.5 (n = 74). The most common adverse events reported in the Optilume BPH arm were hematuria and urinary tract infection (UTI). No device and/or treatment related serious adverse events were reported occurring beyond 12 months post-procedure. There was no impact to sexual function., Conclusions: In the PINNACLE study, participants treated with the Optilume BPH Catheter System demonstrated continued and durable results at 2 years, affirming tolerability, safety, and the enduring effectiveness. The Optilume BPH Catheter System provides lasting results that are comparable to the more invasive therapies, while preserving the advantages with being a minimally invasive therapy., Registration: ClinicalTrials.gov NCT04131907., (© 2024. The Author(s).)

Competing Interests: Declaration of Competing Interest Alexis Te is a paid consultant to Procept; the remaining authors declare that they have no conflict of interest.

Job boredom is one of the most common negative affective states experienced in the workplace, yet also among the least well-understood. One stream of research suggests that employees frequently react to job boredom by engaging in counterproductive work behaviors (CWB). However, recent studies show the converse-that engaging in CWB relates to job boredom. As studies on the job boredom-CWB relationship primarily have been cross-sectional and at the between-person level of analysis, the directionality between these constructs remains in question. Therefore, research examining the within-person dynamics of job boredom and CWB within a short timeframe is needed. In the current study, we explore whether job boredom influences subsequent changes in CWB and vice versa. We examined these relationships using latent change score (LCS) modeling with 10-day experience sampling data ( N  = 120 individuals providing 1,161 observations). Findings supported a reciprocal relationship. Employees' level of job boredom on a given day was associated with a subsequent increase in CWB on the next day, and the level of CWB on a given day was associated with a subsequent increase in job boredom on the next day. We discuss the implications of our findings, study limitations, and future research directions., Competing Interests: Competing InterestThe authors declare no competing interests., (© The Author(s) 2024.)

Objective: To examine how representative 24-hour data collection is of the overall patient experience utilizing a home uroflow device in men with benign prostatic hyperplasia (BPH)., Materials and Methods: Home uroflow data were collected with the iO Urology CarePath device from men at a single urology clinic and retrospectively analyzed. Void characteristics were summarized for data collected over 24 hours compared to data collected over several days or weeks with the device (overall study excludes the 24-hour data). A linear mixed-effects model was used to evaluate differences in average Qmax from voids collected during a single 24-hour period compared to the overall study., Results: A total of 486 men (mean age 67.4) used the device resulting in 465 included in the analysis with a total of 15,521 voids in the overall study and 4347 voids in the single-day analysis. Average Qmax from the model was 11.2 mL/s (95% CI: 10.80, 11.65) and 11.2 mL/s (95% CI: 10.81, 11.64) in the 24-hour and overall study groups, respectively. Both groups had similar between (20.3% vs 20.4%) and within-subject (12.0% vs 11.9%) variance. The difference in Qmax was not significantly different (P = .970). A subgroup analysis including voids >150 mL yielded similar results., Conclusion: Data show variability in voiding parameters, but similar average Qmax collected in 24 hours as compared to several days/weeks. The combination of home uroflowmetry with frequency-volume chart information can provide objective data and a unique perspective on uroflow variability (UFV) for clinician review to support the development of individualized patient treatment plans., Competing Interests: Declaration of Competing Interest Steven A. Kaplan is investigator, investor in iO Urology; Gabriela C. Molnar and Jianzhao Shen are paid consultants to iO Urology; Gregg R. Eure: no conflict. This was a retrospective data analysis; iO Urology had no role in the study design, in the collection, final analysis or interpretation of the data, in the writing of the manuscript, or in the decision to submit the manuscript for final publication. Void segments were processed utilizing iO Urology’s proprietary algorithm., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To report real-world experience of 4-year safety and efficacy outcomes of Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH)., Methods: This is a prospective single-center, observational study evaluating the outcomes of robotic-assisted Aquablation therapy for moderate-to-severe BPH between December 2019 and December 2023. Patient-level data included age, prostate volume, IPSS score, peak urinary flow rate (Qmax), post-void residual (PVR) were evaluated at 3 M, 6 M, and Years 1-4. Primary outcomes included change in IPSS score, change in Qmax, change in PVR, preservation of antegrade ejaculation, and complications., Results: In this cohort of 330 men, mean prostatic volume was 110.3 mL (range 38-330 mL) at baseline. International Prostate Symptom Score (IPSS) improved from a baseline of 23.8 (SD 8.4) to 6.9 (SD 2.9) at 4 years. Mean peak urinary flow rate (Qmax) also demonstrated improvement and increased from 6.4 mL/sec (SD 4.2) to 17.4 mL/sec (SD 5.5) at 4 years. At 1 year, mean prostate volume reduction was 45.5 mL (-41.3%). Postoperative antegrade ejaculation was preserved in 249/250 men (99.6)% of men. Complications included urinary tract infection within first month after procedure in 37 (11.2%) and bleeding requiring blood transfusion in 11 (3.3%). Thirteen patients (3.9%) required a second procedure including 2 for post-operative bleeding, 1 for a bladder neck disruption and 10 (3.0%) for transurethral resection of residual anterior tissue., Conclusion: We demonstrate Aquablation to not only be safe but also providing durable outcomes at 4 years for men with BPH., Competing Interests: Declaration of Competing Interest Dr. Alexis E Te, paid consultant for Procept; the remaining authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The surgical landscape for Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) has evolved with the introduction of Minimally Invasive Surgical Therapies (MISTs), recognizing the impact of sexual function on patients' well-being, and prioritizing ejaculation-sparing approaches., Methods: This systematic review explored ejaculation sparing after classic endoscopic procedures and MISTs (iTind, Rezūm, Urolift, Aquablation, and TPLA) and a literature search yielded 41 studies., Results: While all procedures demonstrated efficacy in improving LUTS/BPH symptoms (IPSS, QoL, Qmax), a subset of studies evaluated ejaculatory function. Positive outcomes were noted, challenging the historical association of BPH surgeries with ejaculatory dysfunction. Variations in study design, patient cohorts, and limited long-term data present challenges. Notably, the lack of baseline specificity, use of alpha-blockers, and non-specific sexual function assessments underscore potential biases., Conclusions: Despite limitations, the review tentatively concluded that MISTs, including iTind, Rezūm, Urolift, Aquablation, and TPLA, appear comparable in sparing ejaculation. Long-term studies are essential to validate sustainability, and comparative research should assess trade-offs between MISTs and traditional surgeries. Incorporating patient-reported outcomes and quality of life assessments will enhance future investigations, refining MISTs as standard therapeutic options for LUTS/BPH., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: The Optilume BPH Catheter System is a novel drug/device combination minimally invasive surgical therapy for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. The PINNACLE study is a prospective, randomized, double-blind, sham-controlled clinical trial evaluating the safety and efficacy of Optilume BPH against a sham surgical procedure., Materials and Methods: Eligible patients were men 50 years or older with symptomatic benign prostatic hyperplasia and a prostate size between 20 and 80 g. Subjects were randomized 2:1 to receive treatment with Optilume BPH or a sham surgical procedure. Blinding was maintained for subjects in both arms and evaluating personnel through 1 year postprocedure. Follow-up assessments included the International Prostate Symptom Score, uroflowmetry, and other quality-of-life and sexual function assessments., Results: A total of 148 men were randomized (100 active, 48 sham) at 18 centers in the U.S. and Canada. Subjects randomized to receive Optilume BPH saw a reduction in International Prostate Symptom Score of 11.5±7.8 points at 1 year posttreatment, as compared to a reduction of 8.0±8.3 points at 3 months in the sham arm. Flow rate was dramatically improved after treatment with Optilume BPH, with an improvement of +10.3 mL/s from baseline to 1 year (+125%)., Conclusions: Treatment with Optilume BPH provides immediate and sustained improvements in obstructive symptoms and flow rate while preserving erectile and ejaculatory function. Treatment is well tolerated and can be done in an office or ambulatory setting.

Purpose: To evaluate the safety and efficacy of the Optilume BPH Catheter System for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH)., Methods: This open-label, single-arm study enrolled eighty subjects with LUTS secondary to BPH who were treated with the Optilume BPH Catheter System. Symptoms were recorded utilizing the International Prostate Symptom Score (IPSS) and Benign Prostatic Hyperplasia Impact Index (BPH-II). Functional improvement was measured utilizing peak urinary flow rate (Q max ) and post-void residual urine volume (PVR). Adverse events were systematically captured and reported at each follow-up visit., Results: Subjects treated with the Optilume BPH Catheter System experienced a significant improvement in LUTS from baseline through 2 years of follow-up, as measured by IPSS (22.3 vs 8.2, p < 0.001) and BPH-II (6.9 vs 2.3, p < 0.001). Functional improvement was also significant, with Q max improving from an average of 10.9 mL/s at baseline to 17.2 mL/s at the 2-year follow-up and PVR improving from 63.1 to 45.0 mL. Treatment-related adverse events were typically minor, with none occurring between 1- and 2-year post-treatment., Conclusions: The Optilume BPH Catheter System is a unique minimally invasive surgical therapy that combines mechanical and pharmaceutical aspects for the treatment of BPH. The functional and symptomatic improvements seen after treatment are significant and have been sustained through 2 years in this early feasibility study., Registration: NCT03423979, registered February 6, 2018., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Much of the thought content and mind-wandering literature examines self-reported thought content's relationship with performance criteria in limited ways. Furthermore, retrospective reports about thought content may be influenced by the quality of one's performance. We explored these method issues in a cross-sectional study of individuals competing in a trail race and an equestrian event. Our results demonstrated that self-reports of thought content differed based on the performance context: whereas runners' task-related and task-unrelated thoughts were negatively correlated, equestrians' thought content showed no relationship. Moreover, equestrians in general reported fewer task-related and task-unrelated thoughts than runners. Finally, objective performance predicted task-unrelated thought (but not task-related thought) among runners, and an exploratory mediation test suggested the effect was partially mediated by performance awareness. We discuss the applied implications of this research for human performance practitioners., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: To describe our clinical experience and surgical technique of transtibial amputation with fibulectomy and fibular collateral ligament-biceps reconstruction for management of, particularly short, transtibial amputations with proximal fibula prominence, overt instability, or inadequate soft-tissue coverage., Design: Retrospective review., Setting: Level II trauma center., Patients: Twelve consecutive patients who underwent transtibial amputation with fibulectomy and fibular collateral ligament-biceps reconstruction between 2008 and 2021., Intervention: We reviewed patient medical records, radiographs, and clinical photographs., Main Outcome Measurements: Complications, instability, and pain., Results: Eight patients underwent acute transtibial amputation with fibulectomy and reconstruction, whereas 4 patients underwent amputation revision with fibulectomy and reconstruction for chronic pain. All 12 patients were men, with a median age of 39 years (interquartile range, 33-46). All injuries were due to high-energy mechanisms, including improvised explosive device (n = 8), rocket-propelled grenade (n = 2), gunshot wound (n = 1), and motor vehicle accident (n = 1). After a median follow-up of 8.5 years (interquartile range, 3.4-9.3), there was one complication, a postoperative suture abscess. No patients had subjective lateral knee instability after the procedure, and the average pain scores decreased from 4.75 to 1.54 ( P = 0.01). All patients returned to regular prosthesis wear and maintained independent functioning with activities of daily living., Conclusions: Our experience with fibulectomy and fibular collateral ligament-biceps reconstruction demonstrated no subjective or clinical postoperative instability and may be a useful adjunct for managing transtibial amputations with fibular instability or prominence, pain, or skin breakdown at the fibular head., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Benign prostatic hyperplasia (BPH) is a common and progressive disease affecting aging men which has a significant impact on quality of life. The Optilume BPH Catheter System (Optilume BPH) is a prostatic dilation system that combines balloon dilation with a localized transfer of paclitaxel to maintain long term patency. Optilume BPH can be deployed using standard rigid cystoscopy without general anesthesia in an office setting. Prospective data indicate that Optilume BPH has favorable functional and sexual patient outcomes. Readers will familiarize themselves with Optilume BPH, significant historical studies and the technique for deploying Optilume BPH.

Introduction: A common indication for benign prostate hyperplasia (BPH) therapies is failure to improve with medical therapy. However, pivotal Federal Drug Administration (FDA) registered randomized clinical trials (RCTs) for minimally invasive surgical therapies (MISTs) are designed to be compared to either sham or placebo while off medical therapy at baseline, and as an alternative to medical therapy. There are few if any RCTs reporting the MISTS efficacy in patients with true medical therapy failure. We report on the efficacy of robotic water jet ablation therapy (RWT) and TURP in patients who have failed to improve with medical therapy., Materials and Methods: Data was obtained from the WATER and WATER II clinical trials. Both clinical trials did not implement a drug washout period. Only patients with reported BPH medical therapy such as alpha-blockers (AB) and 5-alpha-reductase inhibitors (5-ARIs) usage were included. Functional outcomes as post-void residual volume (PVR), peak urinary flow rate (Qmax), internal prostate symptom score (IPSS), and quality of life score (QoL) were analyzed., Results: AB and/or 5-ARIs usage at baseline were reported in 146 and 39 patients who underwent RWT (prostate sizes up to 150 cc) and transurethral resection of the prostate (TURP, prostate sizes up to 80 cc) respectively. Baseline median (IQR) IPSS, QoL, Qmax and PVR were 24 (18,28), 5 (4,5), 8.9 (6.4,11.5), and 95 (36,172), respectively. Functional outcomes did not statistically differ between Aquablation and TURP at baseline and at 36-month. In cohort of true medical failure, both RWT and TURP demonstrated group statistical improvements in PVR, Qmax, IPSS, and QoL at 36-month compared to baseline., Conclusions: RWT and TURP are effective BPH therapy in patients who truly failed medical therapy, and RWT demonstrated this in a much broader prostate size range.

Early in the pandemic, New York City's public hospital system partnered with multiple philanthropic foundations to offer an unconditional cash transfer program for low-income New Yorkers affected by COVID-19. The $1000 cash transfers were designed to help people meet their most immediate health and social needs and were incorporated into healthcare delivery and contact tracing workflows as a response to the public health emergency. To better understand program recipients' experiences, researchers conducted 150 telephone surveys with randomly sampled cash transfer recipients and 20 in-depth qualitative interviews with purposefully sampled survey participants. Survey participants were predominantly Latinx (87%) and women (65%). The most common reported uses of the $1000 were food and rent. Most participants (79%) reported that without the $1000 cash transfer they would have had difficulty paying for basic expenses or making ends meet, with specific positive effects reported related to food, housing, and ability to work. The majority of survey participants reported that receiving the cash assistance somewhat or greatly improved their physical health (83%) and mental health (89%). Qualitative interview results generally supported the survey findings., (© 2022. The New York Academy of Medicine.)

The nature of gig work and its growth have important implications for organizational justice theory. Aspects of gig work, including the transactional compensation arrangement, strict algorithmic rating system, and power asymmetry between drivers and customers, have implications for understanding how dimensions of distributive, informational, and interpersonal injustice manifest and impact job performance in the gig context. An understanding of this topic can inform justice theory more broadly and help explain inconsistent findings in the literature. Here, we report the results of two studies examining the unique effects of these respective dimensions of injustice on emotions and, ultimately, the driving performance and service quality in a ridesharing service context. In Study 1, we modeled the passenger-driver interaction of the ridesharing context using a driving simulator in a laboratory setting to differentiate the real-time and carry-over effects of specific dimensions of injustice. The results from 99 participants showed that perceptions of interpersonal injustice increased anger and unhappiness during the ride, in turn impairing driving and service performance. Antecedent-focused emotion regulation strategies (ERS) reduced felt unhappiness. Moreover, unexpectedly, perceived distributive injustice as caused by the customer rating had opposite (direct versus indirect) effects on service performance in the subsequent ride. Study 2 was an online simulation vignette scenario with 294 participants. The results replicated the findings of Study 1 and revealed two moderators of the unexpected distributive justice-performance relationship., Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-04215-3., Competing Interests: Conflict of interestOn behalf of all authors, the corresponding author states that there is no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: Water vapor thermal therapy (WVTT, i.e., Rezum ® ) and prostatic urethral lift (PUL, i.e., Urolift ® ) are minimally invasive surgical therapy (MIST) options for benign prostatic hyperplasia (BPH). Few studies have directly compared the two procedures. We examined the clinical characteristics and postoperative outcomes of patients undergoing WVTT and PUL at our high-volume urban academic center. Methods: We reviewed our institutional MIST database to identify patients with prostate sizes ≥30 and ≤80 cc who underwent WVTT or PUL for treatment of BPH between January 2017 and September 2021. Pre- and postoperative outcomes, including retreatment rates, American Urological Association symptom score (AUA-SS), maximum flow (Qmax), postvoid residual (PVR), medication usage, trial of void success rates, catheterization requirements, and postoperative complications within 90 days were extracted and compared between procedures. Results: Three hundred seven patients received WVTT and 110 patients received PUL with average follow-up times of 11.3 and 12.8 months, respectively. WVTT patients showed significant improvements in AUA-SS, Qmax, and PVR, whereas PUL patients showed improvements in only AUA-SS and Qmax. Both WVTT and PUL patients with longitudinal follow-up demonstrated improvements in AUA-SS, Qmax, and PVR. Postoperatively, alpha-blocker utilization was significantly decreased following both WVTT and PUL (WVTT: 73.9%-46.6%, PUL: 76.4%-38.2%, both p  < 0.001). Compared to patients receiving PUL, WVTT patients more frequently reported postoperative dysuria (22.8% vs 8.3%, p  = 0.001) and nonclot-related retention (18.9% vs 7.3%, p  = 0.005); PUL patients more frequently experienced postoperative clot retention (7.3% vs 2.6%, p  = 0.027). There were no differences in rates of postoperative bladder spasm, trial of void success, urinary tract infections, or emergency department visits. Postoperative erectile dysfunction and retrograde ejaculation were rare and occurred at similar rates. Conclusion: In the real-world setting, WVTT and PUL have similar medium-term efficacy in improving symptoms and decreasing medication utilization for patients with BPH. Differences in postoperative complication profiles should inform patient counseling.

Purpose: To create a prospective, multicenter coordinated registry network (CRN) of robust "real world" data for benign prostatic hyperplasia (BPH) that links surgical practices to objective and subjective outcomes of patients who undergo surgery for the improvement in lower urinary tract symptoms (LUTS) secondary to BPH., Methods: We gathered a group of BPH experts from various institutions to identify the minimum core data elements needed to assess BPH procedures. To achieve consensus on the data elements, we used a Delphi method adaptation, in which a series of surveys were answered by the expert panel individually and anonymously. Survey results were collected and analyzed. Questions for the following round were based on response analysis from the prior survey. This process was repeated until consensus was achieved., Results: Participation rates in the first and second rounds were 100% and 90%, respectively. The expert panel reached consensus on 148 data elements out of the 182 proposed, capturing patient medical and surgical history, procedure, discharge, short- and long-term follow-up, device factors, surgery, and surgeon factors., Conclusion: We have successfully developed a set of core data elements to support the study of BPH surgical therapies by gathering an expert panel on BPH and using the Delphi method. These data elements influence provider decisions about treatment and include important outcomes related to efficacy and safety., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)