Echinacoside attenuates glandular fibrosis in benign prostatic hyperplasia via inhibiting MKK6/MK2 signaling pathway

Background:Lower urinary tract symptoms commonly occur in the elderly population and seriously constrain the quality of life.Glandular fibrosis is an important pathobiological process in benign prostatic hyperplasia and is also a main inducing factor for benign prostatic hyperplasia-associated lower urinary tract symptoms.Cistanches species is an important herbal medicine resource and is traditionally used in ameliorating renal and prostatic defects.Methods:This study was to investigate the potential protective function of echinacoside(a bioactive compound from Cistanches)against prostatic fibrosis in mice and human benign prostatic hyperplasia epithelial-1 cell models.Results:It was found that echinacoside attenuated testosterone-induced prostatic hyperplasia and collagen deposition in mice,relieved prostate local inflammation and oxidative damage,and ameliorated prostatic epithelial-mesenchymal transition.Additionally,echinacoside inhibited the activation of the MKK6/MK2 signaling pathway both in vivo and in vitro.Conclusion:This study added new evidence for the anti-fibrotic function of echinacoside on the prostate and provided new insights for understanding its possible pharmacological mechanisms.

Alleviatory effect of isoquercetin on benign prostatic hyperplasia via IGF-1/PI3K/Akt/mTOR pathway

We evaluated the effect of isoquercetin(quercetin-O-3-glucoside-quercetin,IQ)as a functional component of Abeliophyllum disistichum Nakai ethanol extract(ADLE)on prostate cell proliferation and apoptosis and its effects on the IGF-1/PI3K/Akt/mTOR pathway in benign prostatic hyperplasia(BPH).Metabolites in ADLE were analyzed using UHPLC-qTOF-MS and HPLC.IQ was orally administered(1 or 10 mg/kg)to a testosterone propionate-induced BPH rat model,and its effects on the prostate weight were evaluated.The effect of IQ on androgen receptor(AR)signaling was analyzed in LNCaP cells.Whether IGF-1 and IQ affect the IGF-1/PI3K/Akt/mTOR pathway in BPH-1 cells was also examined.The metabolites in ADLE were identified and quantified,which confirmed that ADLE contained abundant IQ(20.88 mg/g).IQ significantly reduced the prostate size in a concentration-dependent manner in a BPH rat model,and significantly decreased the expression of AR signaling factors in the rat prostate tissue and LNCaP cells in a concentration-dependent manner.IQ also inhibited the PI3K/AKT/mTOR pathway activated by IGF-1 treatment in BPH-1 cells.In BPH-1 cells,IQ led to G0/G1 arrest and suppressed the expression of proliferation factors while inducing apoptosis.Thus,IQ shows potential for use as a pharmaceutical and nutraceutical for BPH.

Alterations of gut microbiota diversity, composition and metabonomics in testosterone-induced benign prostatic hyperplasia rats

Background: Studies had shown many diseases affect the stability of human microbiota, but how this relates to benign prostatic hyperplasia(BPH) has not been well understood. Hence, this study aimed to investigate the regulation of BPH on gut microbiota composition and metabonomics.Methods: We analyzed gut samples from rats with BPH and healthy control rats, the gut microbiota composition and metabonomics were detected by 16S rDNA sequencing and liquid chromatography tandem mass spectrometry(LC–MS/MS).Results: High-throughput sequencing results showed that gut microbiota beta-diversity increased(P<0.01) in the BPH group vs. control group. Muribaculaceae(P<0.01), Turicibacteraceae(P<0.05), Turicibacter(P<0.01) and Coprococcus(P<0.01) were significantly decreased in the BPH group, whereas that of Mollicutes(P<0.05) and Prevotella(P<0.05)were significantly increased compared with the control group. Despite profound interindividual variability, the levels of several predominant genera were different. In addition, there were no statistically significant differences in several bacteria. BPH group vs. control group: Firmicutes(52.30% vs. 57.29%, P>0.05), Bacteroidetes(46.54% vs. 41.64%,P>0.05), Clostridia(50.89% vs. 54.66%, P>0.05), Ruminococcaceae(25.67% vs. 20.56%, P>0.05). LC–MS/MS of intestinal contents revealed that differential metabolites were mainly involved in cellular processes, environmental information processing, metabolism and organismal systems. The most important pathways were global and overview maps, lipid metabolism, amino acid metabolism, digestive system and endocrine system. Through enrichment analysis, we found that the differential metabolites were significantly enriched in metabolic pathways, steroid hormone biosynthesis,ovarian steroidogenesis, biosynthesis of unsaturated fatty acids and bile secretion. Pearson correlation analysis(R=0.94) showed that there was a strong correlation between Prevotellaceae, Corynebacteriaceae, Turicibacteraceae,Bifidobacteriaceae and differential metabolites.Conclusions: Our findings suggested an association between the gut microbiota and BPH, but the causal relationship between the two groups is unclear. Thus, further studies are warranted to elucidate the potential mechanisms and causal relationships between BPH and gut microbiota.

Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasiad-a single-center experience

Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.

Fournier’s gangrene after insertion of thermo-expandable prostatic stent for benign prostatic hyperplasia:A case report

BACKGROUND Thermo-expandable urethral stent(Memokath 028)implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction.Following prostatic urethral stent implantation,minor complications such as urinary tract infection,irritative symptoms,gross hematuria,and urethral pain have been observed;however,there are no reports of life-threatening events.Herein,we report a critical case of Fournier’s gangrene that occurred 7 years after prostatic stenting.CASE SUMMARY An 81-years-old man with benign prostatic hyperplasia(volume,126 ccs;as measured by transrectal ultrasound)had undergone insertion of a thermoexpandable urethral stent(Memokath 028)as he was unfit for surgery under general anesthesia.However,the patient had undergone a suprapubic cystostomy for recurrent acute urinary retention 4 years after the insertion of prostatic stent(Memokath 028).We had planned to remove the Memokath 028;however,the patient was lost to follow-up.The patient presented to the emergency department 3 years after the suprapubic cystostomy with necrotic changes from the right scrotum to the right inguinal area.In digital rectal examination,tenderness and heat of prostate was identified.Also,the black skin color change with foulsmelling from right scrotum to right inguinal area was identified.In computed tomography finding,subcutaneous emphysema was identified to same area.He was diagnosed with Fournier’s gangrene based on the physical examination and computed tomography findings.In emergency room,Fournier’s gangrene severity index value is seven points.Therefore,he underwent emergent extended surgical debridement and removal of the Memokath 028.Broad-spectrum intravenous antibiotics were administered and additional necrotic tissue debridement was performed.However,the patient died 14 days after surgery due to multiorgan failure.CONCLUSION If Memokath 028 for benign prostatic hyperplasia is not working in older patients,its rapid removal may help prevent severe complications.

Top 50 most cited articles on prostatic artery embolization for benign prostatic hyperplasia:A bibliometric review

BACKGROUND Bibliometric analysis can be used to assess the current state of the literature and publication trends on a given topic.There has not been a review of this kind on prostatic artery embolization(PAE)for benign prostatic hyperplasia(BPH).PAE is a relatively new and somewhat controversial treatment option for BPH.Given the novelty and controversy,there has been much research published on the topic recently.AIM To survey the current state of research on PAE for BPH by using bibliometric analysis to analyze the top 50 most highly cited articles.METHODS A cross-sectional study was performed using the Web of Science database to identify the most cited articles published on PAE for BPH as of June 2022.Articles that did not primarily focus on PAE or BPH as an indication were eliminated.The 50 most cited articles were carried forward for analysis.RESULTS All but 6 articles were published in the last decade with contributions from 15 countries.Fifty-two percent of the studies had a C level of evidence.The majority were published in the Journal of Vascular and Interventional Radiology and Cardiovascular and Interventional Radiology.Twenty percent(n=10)of the articles were published in urologic journals.On average,articles published in urologic journals tended to be more recent.The mean year of publication for an article in a urological journal was 2016.6 compared to 2013.9 in a non-urologic journal(P=0.02).Seventy percent of the articles focused on clinical outcomes,while only 2%focused on practice guidelines.Self-citations accounted for 11.4 citations perarticle on average,corresponding to 14.7%of all citations analyzed.CONCLUSION The most influential papers on this topic represent a fairly recent body of work with contributions from a wide variety of countries and journals.The fact that articles in urologic journals were published significantly more recently than articles on the list in non-urologic journals may suggest that the field of urology is starting to accept PAE for a wider range of indications.Finally,while there has been much high-quality research published,more influential studies on practice guidelines and technique may be beneficial.

Pathophysiology of clinical benign prostatic hyperplasia

A disease can be defined as an abnormal anatomy(pathology)and/or function(physiology)that may cause harm to the body.In clinical benign prostatic hyperplasis(BPH),the abnormal anatomy is prostate adenoma/adenomata,resulting in a varying degree of benign prostatic obstruction(BPO)that may cause harm to the bladder or kidneys.Thus clinical BPH can be defined as such and be differentiated from other less common causes of male lower urinary tract symptoms.Diagnosis of the prostate adenoma/adenomata(PA)can be made by measuring the intravesical prostatic protrusion(IPP)and prostate volume(PV)with non-invasive transabdominal ultrasound(TAUS)in the clinic.The PA can then be graded(phenotyped)according to IPP and PV.Multiple studies have shown a good correlation between IPP/PV and BPO,and therefore progression of the disease.The severity of the disease clinical BPH can be classified into stages from stage Ⅰ to Ⅳ for further management.The classification is based on the effect of BPO on bladder functions,namely that of emptying,normal if postvoid residual urine(PVRU)<100 mL;and bladder storage,normal if maximum voided volume(MVV)>100 mL.The effect of BPO on quality of life(QoL)can be assessed by the QoL index,with a score≥3 considered bothersome.Patients with no significant obstruction and no bothersome symptoms would be stage Ⅰ;those with no significant obstruction but has bothersome symptoms(QoL≥3)would be stage Ⅱ;those with significant obstruction(PVRU>100 mL;or MVV<100 mL),irrespective of symptoms would be stage Ⅲ;those with complications of the disease clinical BPH such as retention of urine,bladder stones,recurrent bleeding or infections would be stage Ⅳ.After assessment,further management can then be individualised.A low grade and stage disease can generally be watched(active surveillance)while a high grade and stage disease would need more invasive management with an option for surgery.The final decision making would take into account the patient’s age,co-morbidity,social economic background and his preferences/values. Proper understanding of pathophysiology of clinical BPH would lead to better selection of patients for individualised and personalised care andmore cost effective management.

Association of Increased Urine Brain Derived Neurotrophic Factor with Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia

Urinary brain-derived neurotrophic factor（BDNF）, an ubiquitous neurotrophin, was found to rise in patients with benign prostatic hyperplasia（BPH）. We hypothesized that the urinary level of BDNF could be a potential biomarker for lower urinary tract symptoms（LUTS） in patients with BPH. Totally, 76 patients with BPH-caused LUTS and 32 male control subjects without BPH were enrolled. International Prostate Symptom Score（IPSS） was applied to assess the symptom severity of LUTS. Urodynamic tests were performed for the diagnosis of underlying detrusor overactivity（DO） in the patients with BPH. Urine samples were collected from all subjects. Urinary BDNF levels were measured using enzyme-linked immunosorbent assays and normalized by urinary creatinine（Cr） levels. Seventy-six BPH patients were divided into moderate LUTS group（n=51, 720） according to the IPSS. Of the 76 BPH patients, DO was present in 34（44.7%） according to the urodynamic test. The urinary BDNF/Cr levels were significantly higher in BPH patients with moderate LUTS（8.29±3.635, P〈0.0001） and severe LUTS（11.8±6.44, P〈0.0001） than normal controls（1.71±0.555）. Patients with severe LUTS tended to have higher urinary BDNF/Cr levels than patients with moderate LUTS（11.8±6.44 vs. 8.29±3.635, P=0.000）. The conditions of BPH with LUTS correlated with elevated urinary BDNF levels, and urinary BDNF levels were even higher in BPH-DO patients. The results of this study have provided evidence to suggest that urinary BDNF level test could evaluate the severity of LUTS in BPH patients, and BDNF level can be used as a biomarker

Transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia

Objective To investigate the feasibility and efficacy of transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia ( BPH) . Methods One hundred and seven patients with BPH were treated by transurethral prostate enucleation with 2 μm la-

Significance of preoperative detrusor contractility to the postoperative assessment of prostatectomy for benign prostatic hyperplasia

Objective To study the value of preoperative detrusor contractility to the outcome assessment of prostatectomy for benign prostatic hyperplasia ( BPH) . Methods A total of 109 patients with BPH were analyzed. Their ages ranged from 62 to 83 years with a mean of

Clinical study of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia with overactive bladder

Objective To evaluate the efficacy and safety of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia ( BPH) with overactive bladder ( OAB) . Methods 82 patients with OAB and coexisting BPH were randomly divided into tamsulosin group ( n

Effect of self-management on lower urinary tract symptoms and life quality of benign prostatic hyperplasia patients

Objective To evaluate the efficacy of self-management to improve the lower urinary tract symptoms ( LUTS) and life quality in benign prostatic

Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia

Aim： To explore the feasibility and safety of greenlight photoselective vaporization of the prostate （PVP） on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia （BPH） and to evaluate their clinical and voiding outcome. Methods： A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score （IPSS）, quality of life score （QoL）, uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. Results： All patients got through the perioperative period safely. The chief advantages of PVP were： short operative time （25.6 ± 7.6 min）, little bleeding loss （56.8 ± 14.3 mL） and short indwelling catheterization （1.6 ± 0.8 d）. The IPSS and QoL decreased from （29.6 ± 5.4） and （5.4 ± 0.6） to （9.5 ± 2.6） and （1.3 ± 0.6）, respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data （P 〈 0.05）. No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. Conclusion： PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.

nfluence of immune inflammation on androgen receptor expression in benign prostatic hyperplasia tissue

This study was designed to investigate the association between immune inflammation and androgen receptor （AR） expression in benign prostatic hyperplasia （BPH）. We retrospectively analyzed 105 prostatectomy specimens. An immune inflammation score for each specimen was defined by combining three immunohistochemical markers （CD4, CD8 and CD20）. The immunohistochemical markers were CD4 and CD8 for T lymphocytes, CD20 for B lymphocytes and AR antibody for the AR in BPH samples. Rates of CD4, CD8, CD20 and AR expression in BPH were 20 （19.0%）, 21 （20.0%）, 101 （96.2%） and 48 （45.7%）, respectively. Total prostate volume （TPV） was higher in the immune inflammation group than in the non-immune inflammation group （62.7 ml vs. 49.2 ml, t=-2.482, P〈0.05）. Patients in the immune inflammation group had a higher serum prostate-specific antigen （PSA） than those in the non-inflammation group （7.5 ng m1-1 vs. 5.4 ng m1-1, t=-2.771, P〈0.05）. Specifically, the immune inflammation group showed a higher rate of AR expression than the non-inflammation group （56.1% vs. 28.2%, χ2=7.665, P〈0.05）. Our study revealed a strong association between immune inflammation and TPV, serum PSA and AR expression in BPH tissue. Prostate hyperplasia caused by an immune inflammatory process may contribute to BPH progression over time. Therefore, the inflammatory response involved in BPH may be a prime therapeutic target.

Volume of residual urine as an indication for surgical treatment of benign prostatic hyperplasia

Objective To study the volume of residual urine as related to the surgical indication for BPH. Methods Urodynamic study was carried out in 103 BPH patients who were assigned to group A(no residual urine), group B( residual urine【 60 ml) and group C( residual urine 60 - 100 ml). Results Qmax, URA, DR and DI were not significantly different between group C and group B (P 】 0.05) but significantly different between group C and A or between B and A(P【0.05). Conclusion The conventional conception that surgical intervention is indicated when the residual urine being 】 60 ml should be strictly followed. Early surgical intervention should be undertaken if the bladder outlet obstruction or bladder function deteriorated by BPH causing residual urine. Other causes such as neurogenic should be ruled out before surgery. 10 refs,2 tabs.

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function： a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.

Human benign prostatic hyperplasia heterotransplants as an experimental model

Benign prostatic hyperplasia is a nonmalignant adenomatous enlargement of the pefiurethral prostate gland. It is a common disease in older men. In addition to man,spontaneous benign prostatic hyperplasia occurs in chimpanzee and the dog. Alternatives to these spontaneous models are induced benign prostatic hyperplasia,xenografts and in vitro models. Xenografts may be induced by cells cultured in vitro or by the heterotransplantation of primary surgical specimens into immunosuppressed mice. The purpose of this review is to integrate data from more than 30 years of heterotransplantation research in the study of benign hyperplasia of the prostate. Heterotransplantation has provided data regarding the histopathology,morphology,tissue markers,androgen receptor expression,tissue kinetics,take rate and tissue vasculature for this prostate disease.There are advantages,as well as limitations,that have been identified for human prostate disease heterotransplants versus xenotransplantation of cultured cells.Overall,heterotransplanted tissue is better at retaining tissue morphology,pathology,secretory activity,expression of tissue markers and human vasculature of the patient＇s original specimen. Furthermore,heterotransplanted tissue preserves the three-dimensional tissular architecture of the prostate to maintain critical stromal-epithelial cell interactions.

Epidemiology of clinical benign prostatic hyperplasia

Clinical benign prostatic hyperplasia(BPH)is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms(LUTS).The prevalence of BPH increases after the age of 40 years,with a prevalence of 8%-60% at age 90 years.Some data have suggested that there is decreased risk among the Asians compared to the western white population.Genetics,diet and life style may play a role here.Recent reports suggest the strong relationship of clinical BPH with metabolic syndrome and erectile dysfunction,as well as the possible role of inflammation as a cause of the prostatic hyperplasia.Lifestyle changes including exercise and diet are important strategies in controlling this common ailment.

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia(2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

The role of the androgen receptor in prostate development and benign prostatic hyperplasia:A review

Benign prostatic hyperplasia(BPH)is a benign enlargement of the prostate in which incidence increases linearly with age,beginning at about 50 years old.BPH is a significant source of morbidity in aging men by causing lower urinary tract symptoms and acute urinary retention.Unfortunately,the etiology of BPH incidence and progression is not clear.This review highlights the role of the androgen receptor(AR)in prostate development and the evidence for its involvement in BPH.The AR is essential for normal prostate development,and individuals with defective AR signaling,such as after castration,do not experience prostate enlargement with age.Furthermore,decreasing dihydrotestosterone availability through therapeutic targeting with 5a-reductase inhibitors diminishes AR activity and results in reduced prostate size and symptoms in some BPH patients.While there is some evidence that AR expression is elevated in certain cellular compartments,how exactly AR is involved in BPH progression has yet to be elucidated.It is possible that AR signaling within stromal cells alters intercellular signaling and a“reawakening”of the embryonic mesenchyme,loss of epithelial AR leads to changes in paracrine signaling interactions,and/or chronic inflammation aids in stromal or epithelial proliferation evident in BPH.Unfortunately,a subset of patients fails to respond to current medical approaches,forcing surgical treatment even though age or associated co-morbidities make surgery less attractive.Fundamentally,new therapeutic approaches to treat BPH are not currently forthcoming,so a more complete molecular understanding of BPH etiology is necessary to identify new treatment options.