Recent Advancements in Prostate Catheters and Stents for Management of Benign Prostatic Hyperplasia.

PURPOSE OF REVIEW: The prevalence of benign prostatic hyperplasia (BPH) is rising, however, current treatment options present severe complications and limit patient's quality of life. Accordingly, advancements in prostatic catheter and stent designs for use in treating lower urinary tract symptoms (LUTS) in BPH patients have largely expanded in the past five years and we aim to provide an exhaustive summary of recent outcomes. RECENT FINDINGS: The dual dilation and paxlitaxel eluting Optilume BPH Catheter System enhances promise in catheter-based treatments, providing the longest sustained increase in max urinary flow rate and decrease in post-void residual volume compared to alternative MISTs. Additionally, use of iTiND, along with recent advancements in temporary (EXIME, Prodeon Urocross) and permanent (Zenflow Spring, Butterfly, and ClearRing) stent designs, have demonstrated rapid, lasting, and low-cost LUTS relief with sustained sexual function. Minimally invasive solutions that offer in-office treatment, rapid symptom relief, shorter recovery times, and preservation of sexual function hold great promise in improving outcomes in managing BPH patients with LUTS.

Predictors of symptomatic relief in water vapor thermal therapy for prostatic hyperplasia: 36-month prospective study.

PURPOSE: Existing literature lacks an analysis of factors predicting the achievement of minimum clinically important differences (MCID) after water vapor thermal therapy (WVTT) for prostatic hyperplasia. This study aims to identify these predictors over a 36-month post-WVTT period. METHODS: This prospective single surgeon case series assessed male patients receiving WVTT. Eligibility criteria included being at least 45 years old, having an estimated prostate volume (EPV) of 30-80 cc, an International Prostate Symptom Score (IPSS) of 12 points or more, and a maximum urinary flow rate (Qmax) under 16 mL/sec. MCID, representing the smallest symptomatic improvement perceived by patients, was calculated using the distribution-based method, considering half a standard deviation of baseline IPSS scores. Correlation and linear regression analyses assessed MCID attainment. Multivariable logistic regression evaluated MCID achievement, considering multicollinearity, heteroskedasticity, and normality. RESULTS: Of 206 men with a median 29.1-month follow-up (Range: 24-36), 13.6% didn't achieve MCID for IPSS, and 7.2% for QoL scores. Significant hindrances to MCID attainment for IPSS were a large median lobe (> 10 mm protrusion) (OR = 3.01, 95% CI: 2.3-3.72), increased median lobe treatments (OR = 1.73, 95% CI: 1.23-2.35), and high preoperative irritative IPSS scores (OR = 1.25, 95% CI: 1.13-1.38). Factors for QoL MCID non-achievement included age over 75 (OR = 1.25, 95% CI: 1.13-1.38), a large median lobe (OR = 1.87, 95% CI: 1.62-2.01), and EPV over 60 cc (OR = 1.55, 95% CI: 1.16-1.97). A 6.3% surgical re-intervention rate was noted. CONCLUSIONS: The characteristics of the median lobe as well as the severity of lower urinary tract symptoms are crucial for treatment success. These should be integral to preoperative assessments and patient discussions on treatment options.

Comparative assessment of attitudes and expectations: Iranian patients versus urologists in the management of benign prostatic hyperplasia.

BACKGROUND: Benign prostatic hyperplasia (BPH) is common and presents as lower urinary tract symptoms (LUTS). Understanding patient concerns and treatment preferences is essential for effective management. This study aimed to investigate the attitudes, preferences, and expectations of Iranian patients with BPH, and compare them with those of urologists in addressing this condition. METHODS: A cohort of patients diagnosed with BPH underwent assessment during their initial visit. Before any counseling, their attitudes, concerns, and expectations regarding benign prostate enlargement were evaluated using semi-structured interviews. Patient responses were analyzed based on educational levels and age. Additionally, correspondence was initiated with thirty urologists who graduated within the past twelve years to assess their attitudes toward BPH, concerns, and treatment approaches. Interview questions were constructed using the Delphi method, and their validity was confirmed. Responses from both groups were analyzed and compared. Descriptive statistics, independent t-test, Chi-squared test, Mann-Whitney U, and principal component analysis (PCA) with varimax rotation were used for statistical analysis. RESULTS: The study comprised 261 patients and 30 urologists. Findings revealed that 86.2% of patients and 86.7% of urologists perceived a lack of sufficient patient knowledge about BPH. Patients across all educational levels and age groups expressed a desire for more information about their condition. Primary concerns among patients included exacerbation of urinary symptoms, potential malignancy, and sexual dysfunction. While patients generally preferred pharmacological treatments, those older than 75 years showed a significantly higher preference for surgical options. Conversely, urologists exhibited greater concern for long-term clinical complications associated with BPH. Results indicated significant parallels between the attitudes of urologists and patients in assessing the multifaceted impact of BPH on patient well-being. CONCLUSION: This study enhances our understanding of patient attitudes and concerns regarding BPH, thereby facilitating more effective treatment strategies. Our findings encourage urologists to enhance patient perspectives by delivering comprehensive information. Furthermore, the comparison between patient and urologist attitudes towards BPH underscores the importance of tailored care and patient-centered approaches in optimizing outcomes for individuals with BPH.

Non-inferiority, randomised, open-label clinical trial on the effectiveness of transurethral microwave thermotherapy compared to prostatic artery embolisation in reducing severe lower urinary tract symptoms in men with benign prostatic hyperplasia: study protocol for the TUMT-PAE-1 trial.

BACKGROUND: One-fourth of men older than 70 years have lower urinary tract symptoms (LUTS) that impair their quality of life. Transurethral resection of the prostate (TURP) is considered the gold standard for surgical treatment of LUTS caused by benign prostatic hyperplasia (BPH) that cannot be managed conservatively or pharmacologically. However, TURP is only an option for patients fit for surgery and can result in complications. Transurethral microwave thermotherapy (TUMT) and prostatic artery embolisation (PAE) are alternative minimally invasive surgical therapies (MISTs) performed in an outpatient setting. Both treatments have shown to reduce LUTS with a similar post-procedure outcome in mean International Prostate Symptom Score (IPSS). It is however still unknown if TUMT and PAE perform equally well as they have never been directly compared in a randomised clinical trial. The objective of this clinical trial is to assess if PAE is non-inferior to TUMT in reducing LUTS secondary to BPH. METHODS: This study is designed as a multicentre, non-inferiority, open-label randomised clinical trial. Patients will be randomised with a 1:1 allocation ratio between treatments. The primary outcome is the IPSS of the two arms after 6 months. The primary outcome will be evaluated using a 95% confidence interval against the predefined non-inferiority margin of + 3 points in IPSS. Secondary objectives include the comparison of patient-reported and functional outcomes at short- and long-term follow-up. We will follow the patients for 5 years to track long-term effect. Assuming a difference in mean IPSS after treatment of 1 point with an SD of 5 and a non-inferiority margin set at the threshold for a clinically non-meaningful difference of + 3 points, the calculated sample size was 100 patients per arm. To compensate for 10% dropout, the study will include 223 patients. DISCUSSION: In this first randomised clinical trial to compare two MISTs, we expect non-inferiority of PAE to TUMT. The most prominent problems with MIST BPH treatments are the unknown long-term effect and the lack of proper selection of candidates for a specific procedure. With analysis of the secondary outcomes, we aspire to contribute to a better understanding of durability and provide knowledge to guide treatment decisions. TRIAL REGISTRATION: ClinicalTrials.gov NCT05686525. Registered on January 17, 2023, https://clinicaltrials.gov/study/NCT05686525 .

A comparative study of histotripsy parameters for the treatment of fibrotic ex-vivo human benign prostatic hyperplasia tissue.

Histotripsy is a noninvasive focused ultrasound therapy that mechanically fractionates tissue to create well-defined lesions. In a previous clinical pilot trial to treat benign prostatic hyperplasia (BPH), histotripsy did not result in consistent objective improvements in symptoms, potentially because of the fibrotic and mechanically tough nature of this tissue. In this study, we aimed to identify the dosage required to homogenize BPH tissue by different histotripsy modalities, including boiling histotripsy (BH) and cavitation histotripsy (CH). A method for histotripsy lesion quantification via entropy (HLQE) analysis was developed and utilized to quantify lesion area of the respective treatments. These data were correlated to changes in mechanical stiffness measured by ultrasound shear-wave elastography before and after treatment with each parameter set and dose. Time points corresponding to histologically observed complete lesions were qualitatively evaluated and quantitatively measured. For the BH treatment, complete lesions occurred with > = 30 s treatment time, with a corresponding maximum reduction in stiffness of -90.9 ± 7.2(s.d.)%. High pulse repetition frequency (PRF) CH achieved a similar reduction to that of BH at 288 s (-91.6 ± 6.0(s.d.)%), and low-PRF CH achieved a (-82.1 ± 5.1(s.d.)%) reduction in stiffness at dose > = 144 s. Receiver operating characteristic curve analysis showed that a > ~ 75% reduction in stiffness positively correlated with complete lesions observed histologically, and can provide an alternative metric to track treatment progression.

Autophagy in benign prostatic hyperplasia: insights and therapeutic potential.

Autophagy is a cellular homeostatic mechanism characterized by cyclic degradation. It plays an essential role in maintaining cellular quality and survival by eliminating dysfunctional cellular components. This process is pivotal in various pathophysiological processes. Benign prostatic hyperplasia (BPH) is a common urological disorder in middle-aged and elderly men. It frequently presents as lower urinary tract symptoms due to an increase in epithelial and stromal cells surrounding the prostatic urethra. The precise pathogenesis of BPH is complex. In recent years, research on autophagy in BPH has gained significant momentum, with accumulating evidence indicating its crucial role in the onset and progression of the disease. This review aims to outline the various roles of autophagy in BPH and elucidate potential therapeutic strategies targeting autophagy for managing BPH.

[Digital health applications in urology]. / Digitale Gesundheitsanwendungen in der Urologie.

BACKGROUND: Digital health applications (DiGA) were included in the German healthcare system in 2020. They are available for prescription and reimbursed by public and private insurance companies. For the specialty of urology, there are currently two DiGA available: for the treatment of erectile dysfunction and benign prostatic hyperplasia/overactive bladder (BPH/OAB). The legal basis, clinical results and practical implementation are presented. METHODS: Evaluation of websites and publications to show the regulatory requirements, mode of action, results of clinical trials and prescribing practice with DiGA. RESULTS: Since 2020, 63 DiGA have been listed in the register of the Federal Office for Drugs and Medical Devices (BfArM), 35 of them definitively. Two urological DiGA aim to treat erectile dysfunction and BPH/OAB. Randomized, controlled studies have shown a significant and clinically relevant patient benefit for both DiGA. Further urological DiGA are in clinical development. CONCLUSIONS: DiGAs offer multimodal therapy combinations that have not yet been used in clinical practice and show a multidimensional benefit for the patient.

[Comprehensive intervention combined with cognitive psychological care based on quality chain for patients with benign prostatic hyperplasia].

OBJECTIVE: To investigate the application effect of comprehensive intervention combined with cognitive psychological care based on the quality chain in patients with BPH. METHODS: We prospectively selected 110 cases of BPH treated in our hospital from January 2022 to March 2023 and equally randomized them into groups A and B, the former given routine intervention, while the latter comprehensive intervention combined with cognitive psychological care based on the quality chain in addition. We analyzed the results of intervention, the patients' scores on Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), improvement of clinical indicators, self-efficacy, disease awareness and treatment compliance, and compared the data obtained between the two groups of patients. RESULTS: The effectiveness of intervention was significantly better in group B than in A (96.36% vs 65.45%, χ2 = 17.009, P<0.05). Compared with the baseline, the SAS and SDS scores were remarkably improved in the two groups after intervention (P<0.05), even more significantly in group B than in A (P<0.05). Group B also showed a markedly shorter duration of bladder spasm, lower frequency of bladder spasm per day, shorter urethral catheterization time and postoperative hospital stay, better emotion control and health management, more regular schedule, higher disease knowledge awareness, and better treatment compliance than group A (all P<0.05). CONCLUSION: Comprehensive intervention combined with cognitive psychological care based on the quality chain is significantly effective in improving BPH patients' clinical indicators, disease awareness and treatment compliance, reducing their depression and anxiety, and enhancing their self-efficacy management.

The clinical application value of psychological nursing intervention for patients with prostatic hyperplasia during treatment.

OBJECTIVE: To investigate the therapeutic utility of psychological nursing interventions for prostatic hyperplasia clients while they are receiving therapy. METHODS: Clinical data of 110 patients with prostate group hyperplasia who underwent treatment in our hospital were collected and analysed retrospectively, and the selected period was from October 2021 to October 2023. The 110 cases of prostate group hyperplasia patients were divided into a research group and a control group according to the different methods of care, and each group had 55 cases each. The research group received psychological nursing intervention based on the conventional nursing care given to the control group. The total treatment compliance rate and contentment with nursing were contrasted between the research and control groups, and changes in the Self Rating Anxiety Scale (SAS) score, Self Rating Depression Scale (SDS) score, Health Survey Short Form score, and sleep problems were observed between the research group and the control group. RESULTS: The research group's overall compliance rate was 94.55% (52/53), a substantial increase over the control group's rate, 69.09% (38/55), P < 0.01. Following nursing, the research group's SAS and SDS scores were considerably more reduced than those of the control group, and both groups' scores were substantially lower than they were prior to nursing (P < 0.05). CONCLUSION: This retrospective study found that psychological nursing intervention applied to patients with prostatic hyperplasia can effectively improve the patient's compliance with treatment, effectively reduce the occurrence of negative emotions, improve the patient's quality of life, and improve sleep problems. In addition, psychological nursing intervention can effectively alleviate the tension between nurses and patients, and is worthy of clinical application.

Evaluation of Vessel Tracking Software for Prostatic Artery Embolization.

PURPOSE: To evaluate Vessel Tracking software for determining the prostatic arteries feeding the prostate gland during prostatic artery embolization (PAE) using Conebeam-CT (CBCT). MATERIALS AND METHODS: EmboGuide is a software developed to assist interventional radiologists in performing embolization of hypervascular tumors in the liver. In this study, a single-center retrospective image collection of 120 intraprocedural CBCT of 60 patients with benign prostatic hyperplasia treated using PAE between May 2017 and January 2019 was evaluated. All patients received 1 intraprocedural CBCT per side for evaluation of vessel anatomy. The "reference standard" of the vascular anatomy was defined by segmentation of the prostatic gland and marking of the prostatic artery in conjunction with pre-embolization DSA series. The datasets were then anonymized. Three interventional radiologists with experience in PAE from different centers reviewed the images and used the automatic feeder detection to determine the prostatic artery. Finally, two clinical experts compared the feeding vessels indicated in the "reference standard" and those identified by the readers. Objectives of the study were to evaluate the clinical performance of the software based on sensitivity and the agreement between interventional radiologists. RESULTS: Sensitivity was estimated as 0.968 with a 90% confidence interval. Overall agreement was estimated as 0.801 with a 90% confidence interval. On both objectives (Sensitivity and Agreement), specifications were met. CONCLUSIONS: The results of this study suggest that EmboGuide can be used to determine the prostate arteries in PAE. The findings could be used to expand the intended use of EmboGuide to include PAE.

A Multifaceted Assessment of Benign Prostatic Hyperplasia Practice and AUA Guideline Adherence.

INTRODUCTION: Guidelines for benign prostatic hyperplasia (BPH) were initially formulated by the AUA to provide evidence-based reasoning for the management and care of men suffering from lower urinary tract symptoms due to BPH. Recommendations for a urinalysis and validated symptom questionnaire (AUA Symptom Score [AUASS]/International Prostate Symptom Score [IPSS]) have been long standing, making these data points a metric for examining guidelines adherence. METHODS: A survey assessed providers' awareness of AUA BPH guidelines and practice patterns, and was sent to a randomly selected portion of the AUA membership. The AUA Quality (AQUA) Registry was queried to assess testing and practice patterns. RESULTS: Of 4884 invitations sent, 404 responses were received. Most survey respondents (91.8%) indicate they intend to get a urinalysis at initial evaluation. AQUA data found urinalysis was obtained in only 22.8% of patients. Symptom questionnaire use increased with increasing guideline familiarity, with 95.7% of those who are "extremely familiar" routinely using AUASS/IPSS compared to only 69.4% who are "somewhat familiar" (P < .005). Utilization increased by a factor of 2.7 (P < .005) for each increment in familiarity. The lowest use of AUASS/IPSS was in the group within 5 years of finishing training (P = .069). CONCLUSIONS: Discrepancies are noted between our practice survey and AQUA data. The AUASS/IPSS is less commonly used by providers with less guideline familiarity and in providers with the least clinical experience. The intent to obtain urinalysis is high; however, actual testing is unfortunately infrequent. These findings could point toward the need for increasing education of providers with regard to clinical guidelines.

[Benign prostatic hyperplasia]. / Hiperplasia benigna de próstata.

Benign prostatic hyperplasia (BPH) is a histopathologic definition associated with enlargement of the prostate gland that causes obstruction of the lower urinary tract and manifests clinically with characteristic symptoms that are what bring patients for consultation. Urinary tract symptoms are common, especially in an increasingly aging population. Diagnosis and the decision on when and how to treat depend on the patient's quality of life and objective clinical parameters. An individualized, risk-based approach is necessary to guide conservative, pharmacologic, or surgical treatment.

Dual-energy computed tomography in supporting prostatic artery embolization for benign prostatic hyperplasia.

Objective: Our study aims to evaluate the value of 256-slice dual-energy computed tomography (DECT) in supporting prostatic artery embolization (PAE) under digital subtraction angiography (DSA) for benign prostatic hyperplasia (BPH). Methods: The study was conducted on 88 patients who underwent PAE to treat BPH from January 2022 to November 2023. Of these, 38 patients who had PAE without DECT were placed in group 1, while the other 50 patients with pre-interventional DECT were assigned to group 2. The results of DECT imaging of the prostate artery (PA) were compared with the results of DSA imaging. Test for statistically significant differences between the variables of the two research groups using the T - student test and Mann-Whitney test algorithms with p < 0.05 corresponding to a 95% confidence interval. The data were analyzed according to medical statistical methods using SPSS 20.0 software. Results: DECT can detect the PA origin in 96.1% of cases, identify atherosclerosis at the root of the artery with a sensitivity of 66.7% and a specificity of 89.5%, and present anastomosis with a sensitivity of 72.7% and a specificity of 72.2%. There is no statistically significant difference in PA diameter on DECT compared to DSA with 95% confidence. Group 2 used DECT for 3D rendering of the PA before PAE had procedure time reduced by 25.8%, fluoroscopy time reduced by 23.2%, dose-area product (DAP) reduced by 25.6%, contrast medium volume reduced by 33.1% compared to group 1 not using DECT, statistically significant with 95% confidence. Conclusion: DECT is a valuable method for planning before PAE to treat BPH. 3D rendering DECT of PA provides anatomical information that minimizes procedure time, fluoroscopy time, dose-area product, and contrast medium volume.

Advances in Outpatient Therapies and Treatment of Benign Prostatic Hyperplasia: A Comprehensive Review for Men's Health.

Benign prostate hyperplasia (BPH) affects a large number of men and can be treated with behavioral, medical, or surgical treatments. The newest addition to medical therapy is ß3-agonists for overactive lower urinary tract symptoms. Multiple new surgical treatments have become available in the past decade, including several clinic-based minimally invasive surgical techniques (eg, UroLift, Rezum, Optilume BPH), OR treatments (eg, Aquablation, single port robotics), and prostate artery embolization. The growth of options allows providers to better tailor BPH treatment to the specific disease factors and patient preferences.

Electroacupuncture for lower urinary tract symptoms in men with benign prostatic hyperplasia: study protocol for a randomised controlled trial.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a condition commonly seen among men aged over 40, significantly affecting their quality of life and typically accompanied by lower urinary tract symptoms (LUTS). Acupuncture presents a potentially effective treatment option; however, the exact effects remain uncertain. Therefore, we design this multicentre randomised trial to evaluate the efficacy and safety of electroacupuncture (EA) for relieving LUTS in men with BPH. METHODS AND ANALYSIS: A two-arm, sham-controlled, subject-blinded and assessor-blinded trial will be conducted in 11 hospitals in China to compare EA with sham electroacupuncture (SA) in treating moderate to severe LUTS of BPH among men aged 40-80. A total of 306 eligible male patients will be recruited and assigned at a 1:1 ratio to receive either EA or SA for 24 sessions over a succession of 8 weeks, with 24 weeks of follow-up. The primary outcome will be the proportions of participants with at least 30% reduction in the International Prostate Symptom Score total score from baseline at weeks 8 and 20. All statistical analyses will be conducted in accordance with the intention-to-treat principle, and a two-tailed p value less than 0.05 will be considered statistically significant. ETHICS AND DISSEMINATION: The trial has been approved by the institutional review board of Guang'anmen Hospital (2022-203-KY), as well as other recruitment centres. Each participant will receive the detailed information of the trial, and sign the written informed consent. The results of the trial are expected to be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05585450.

Effectiveness of Pranic Healing as complementary therapy on lower urinary tract symptoms and sleep: Single-blind randomized trial.

BACKGROUND: Benign Prostatic Hyperplasia (BPH) commonly affects older men, leading to lower urinary tract symptoms (LUTS) that affect sleep and quality of life. This study evaluates the effect of Pranic Healing (PH) as a complementary therapy for bothersome LUTS by normalising biofield energy centres called Chakras. METHODOLOGY: A single blind trial involving 76 men with LUTS was conducted, randomised into Medication-only (MED) and Medication-plus-Pranic Healing (MEDPH) groups. The MEDPH received PH sessions twice weekly for 5 weeks. RESULTS: The study compared MED (n = 30) and MEDPH (n = 36) participants, finding significant improvements in IPSS scores (p ≤ .001) in both groups. The MEDPH group showed a greater reduction in incomplete bladder emptying and intermittency. The post void residual volume increased significantly in the MED group (Wilcoxon Z = -2.335, p = .02), while the MEDPH group reduced non-significantly. Sleep quality index improved significantly (McNemar=.013) in the MEDPH group, while the MED group showed no significant change. Subjective sleep quality, duration, and latency improved significantly in the MEDPH group. Healers reported improved energy balance in chakras of MEDPH group. Perceived energy by healers in lower chakra relates to urinary parameters. CONCLUSION: PH could alleviate LUTS, enhancing quality of life due to urination, and improved sleep, among moderate BPH patients. TRIAL REGISTRATION: This study has been registered under the Clinical Trial Registry of India. (CTRI No: CTRI/2023/01/049004).