Intentionally unilateral prostatic artery embolization:Patient selection,technique and potential benefits

BACKGROUND Prostatic artery embolization(PAE)is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia.Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries(PAs)and with the systematic attempts to catheterize the PAs of both pelvic sides.Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE.The authors hypothesized that,in selected patients,these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.AIM To describe the authors’approach for intentionally unilateral PAE(IU-PAE)and its potential benefits.METHODS This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years.IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA(subgroup A),or with markedly asymmetric prostatic enlargement,with the dominant prostatic lobe occupying at least two thirds of the entire gland(subgroup B).All patients treated with IU-PAE also fulfilled at least one of the following criteria:Severe tortuosity or severe atheromatosis of the pelvic arteries,non-visualization,or visualization of a tiny(<1 mm)contralateral PA on preprocedural computed tomographic angiography.Intraprocedural contrast-enhanced ultrasonography(iCEUS)was applied to monitor prostatic infarction.IU-PAE patients were compared to a control group treated with bilateral PAE.RESULTS IU-PAE was performed in a total 13 patients(subgroup A,n=7;subgroup B,n=6).Dose-area product,fluoroscopy time and operation time in the IU-PAE group(9767.8μGy∙m^(2),30.3 minutes,64.0 minutes,respectively)were significantly shorter(45.4%,35.9%,45.8%respectively,P<0.01)compared to the control group.Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group.In the 2 clinical failures of IU-PAE(both in subgroup A),the extent of prostatic infarction(demonstrated by iCEUS)was significantly smaller compared to the rest of the IU-PAE group.CONCLUSION In selected patients,IU-PAE is associated with comparable outcomes,but with lower radiation exposure and a shorter procedure compared to bilateral PAE.iCEUS could facilitate patient selection for IU-PAE.

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.

Metformin:A promising clinical therapeutical approach for BPH treatment via inhibiting dysregulated steroid hormones-induced prostatic epithelial cells proliferation

The occurrence of benign prostate hyperplasia(BPH)was related to disrupted sex steroid hormones,and metformin(Met)had a clinical response to sex steroid hormone-related gynaecological disease.However,whether Met exerts an antiproliferative effect on BPH via sex steroid hormones remains unclear.Here,our clinical study showed that along with prostatic epithelial cell(PEC)proliferation,sex steroid hormones were dysregulated in the serum and prostate of BPH patients.As the major contributor to dysregulated sex steroid hormones,elevated dihydrotestosterone(DHT)had a significant positive relationship with the clinical characteristics of BPH patients.Activation of adenosine 5'-monophosphate(AMP)-activated protein kinase(AMPK)by Met restored dysregulated sex steroid hormone homeostasis and exerted antiproliferative effects against DHT-induced proliferation by inhibiting the formation of androgen receptor(AR)-mediated Yes-associated protein(YAP1)-TEA domain transcription factor(TEAD4)heterodimers.Met’s anti-proliferative effects were blocked by AMPK inhibitor or YAP1 overexpression in DHT-cultured BPH-1 cells.Our findings indicated that Met would be a promising clinical therapeutic approach for BPH by inhibiting dysregulated steroid hormone-induced PEC proliferation.

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.

Secondary rectal linitis plastica caused by prostatic adenocarcinoma-magnetic resonance imaging findings and dissemination pathways:A case report

BACKGROUND Secondary rectal linitis plastica(RLP)from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread,characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation.This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies.This case series underscores the critical role of magnetic resonance imaging(MRI)in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer.CASE SUMMARY Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features.The first patient,a 76-year-old man with advanced prostate cancer,had rectal pain and incontinence.MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic"target sign"pattern.The second,a 57-year-old asymptomatic man with elevated prostatespecific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI,with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread.The third patient,an 80-year-old post-radical prostatectomy,presented with refractory constipation.MRI revealed a neoplastic mass infiltrating the rectal wall.In all cases,MRI consistently showed stratified thickening,concentric signal changes,restricted diffusion,and contrast enhancement,which were essential for diagnosing secondary RLP.Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum.CONCLUSION Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.

Prostatic Adenomectomy and Comorbidities: Frequency and Management at the Urology Department of the Ignace Deen National Hospital in Conakry

Goal: To determine the type of comorbidity and highlight the complications of adenomectomy and comorbidities. Material and Methods: This is a prospective, descriptive, cross-sectional study lasting six (6) months, from July 1, 2022 to December 31, 2022. Patients with BPH on comorbidity condition taken care of during the study period AND have agreed to participate in the study. Results: During our study, 49 cases of benign prostatic hypertrophy with comorbidities were collected, representing a frequency of 29%. The average age ranges for the patients were 43 - 70 years. The age group most affected was 70 to 79 years old (38.80%). Nocturnal urinary frequency was the main reason for consultation present in all our patients. The most frequent comorbidity was hypertension, i.e. 83.70%. The PSA rate between 4 and 10 was the most represented, i.e. 42.86%. The prostate volume was between 61 and 100 ml in 40.82% of patients. Histology showed that it was a benign adenomatous hypertrophy of the prostate in 85.70% and a prostatic adenomyoma in 14.29%. Trans-bladder adenomectomy alone was the most performed technique, i.e. 49%, followed by trans urethral resection of the prostate, i.e. 38.80%. Retention of urine after removal of the catheter was the most observed complication, i.e. 12.20%. Conclusion: Benign prostatic hypertrophy with comorbidities constitutes a frequent association. Because their presence can affect effectiveness and lead to complications.

Tumor necrosis factor-alpha, transforming growth factor-beta, degree of lower urinary tract symptoms as predictors of erectile dysfunction in benign prostatic hyperplasia patients

Objective: Erectile dysfunction (ED) is a condition of insufficient penile erection, consistently or recurrently, for sexual activity. Tumor necrosis factor-alpha (TNF-α) induces transforming growth factor-beta (TGF-β), which causes the transition of epithelial cells into mesenchymal cells that affect ED. This study aimed to evaluate the roles of TNF-α, TGF-β, degree of lower urinary tract symptoms, and prostatic volume for the presence of ED in benign prostatic hyperplasia (BPH) patients.Methods: Our study performed an analytic observational retrospective cohort study using secondary data from four hospitals in Bali, Indonesia, including medical records and other administrative data. The sample was BPH patients with several history qualifications.Results: Our sample was 83 respondents, ranging from 50 years to 80 years, 61 respondents with ED and 22 with non-ED. The International Prostate Symptom Score showed a significant result, which indicates that ED is more common in patients with higher International Prostate Symptom Score (p=0.002). Moreover, the TNF-α of ≥43.9 pg/mg and TGF-β of ≥175.8 pg/mL were significantly associated with the presence of ED in BPH patients (p<0.0001). Despite these results, prostate volume is not significant with ED (p=0.947).Conclusion: TNF-α, TGF-β, and lower urinary tract symptoms severity can predict the occurrence of ED in BPH, while prostatic volume was not significant.

Transurethral Resection of the Prostate (TRUP) for the Treatment of Benign Prostatic Hyperplasia (BPH) in Central Cote D’Ivoire: Indications and Results

Background: Benign prostatic hyperplasia (BPH) is defined histologically as adenomyofromatous hyperplasia of the transitional zone of the prostate. It remains the most common benign tumour in men over the age of 50, and transurethral resection of the prostate (TURP) remains the surgical treatment of choice. Objectives: To determine the indications and present our results of transurethral resection of the prostate. Patients and Methods: After obtaining approval from the ethics committee of the private hospital and the university hospital of Bouaké (Côte d’Ivoire), we conducted a cross-sectional study of transurethral resection of the prostate (TURP) to treat benign prostatic hyperplasia (BPH) between January 2021 and April 2023. All patients and their families were informed beforehand and had signed an informed consent form. All patients with benign prostatic hyperplasia (BPH) with ultrasound weight of less than 80 grams were included. The following parameters were studied: age, reason for consultation, ultrasound prostate weight of benign prostatic hyperplasia, indication for TURP, duration of operation, blood loss, duration of post-PRT urinary drainage, length of hospital stay, morbidity and mortality, and outcome. Results: 39 patients with a mean age of 58.3 years (57-77 years) underwent transurethral resection of the prostate (TURP). TURP was indicated in 46.15% (n = 18) of cases of refractory acute urinary retention with failure of the urinary catheter removal test, 17.94% (n = 7) of cases of lower urinary tract disorders that were incapacitating despite treatment, 15.38% (n = 6) of cases of refractory or recurrent urinary tract infection, 10.25% (n = 4) of cases of failure of medical treatment and 10.25% (n = 4) of cases of iterative hematuria. The mean duration of TURP was 53.68 min (48-57), the mean weight of the resected prostate was 58.7 g (35 and 83 g), blood loss was minimal in 92.30% (n = 36), the mean duration of irrigation-washing was 2. 5 days (1-3 days), the mean time for urinary catheterisation was 2.45 days (3 and 4 days), 5.12% (n = 2) of patients presented complications such as hemorrhage compensated by a blood transfusion. One patient developed orchiepididymitis (2.56%). The average hospital stay was 3.75 days (3-5 days). Pathological examination was in favour of BPH in 92.3% (n = 36) and the coexistence of BPH and prostate adenocarcinoma in 7.69% (n = 3). The results of TURP were considered good in 94.87% (n = 37). Mortality was nil. Conclusion: In view of our results, TURP is a reliable, elegant minimally invasive technique with low morbidity and mortality.

Intraductal Prostatic Carcinoma: Epidemiological and Anatomopathological Aspects in Dakar

Introduction: Intraductal carcinoma is often associated with high-grade, high-stage adenocarcinoma. Its frequency is variable and it is considered a poor prognostic factor. In our context, when prostatic carcinoma is diagnosed, pathologists do not always report the presence of this anatomopathological entity. We therefore conducted a study to determine the epidemiological and anatomopathological profile of patients with this lesion in Dakar. Materials and Methods: This is a retrospective descriptive study covering a 1-year period from January to December 2022. It focused on cases of intraductal carcinoma diagnosed among prostatic carcinomas collected in the anatomopathology laboratories of Hôpital Général Idrissa Pouye (HOGIP) and Hôpital Militaire de Ouakam (HMO). It was based on archives of anatomopathological reports, blocks and slides. A total of 200 cases of prostatic carcinoma were collated and reviewed to identify those presenting with intraductal carcinoma according to the diagnostic criteria of Guo and Epstein. Results: 87 cases of intraductal carcinoma were found, representing 43.5% of prostatic carcinomas. The mean age was 71 years. Patients in their seventh decade were the most represented, i.e. 42.5%. The majority of samples examined were biopsies (72.4%). The mean PSA level was 965.91 ng/ml, with extremes ranging from 0.03 to 10,000 ng/ml. Histologically, 96.5% of cases (N = 84) were invasive prostatic carcinoma. Gleason score 8 (4 + 4) was the most common, accounting for 42.53% (N = 37). On average, the study found four (04) foci of intraductal carcinoma per specimen, with extremes ranging from 1 to 30. Dense cribriform architecture accounted for 78.16%, loose cribriform for 11.5%, solid for 8.04% and micropapillary for 2.3%. Six cases (6.9%) showed foci of comedonecrosis. The vast majority of radical prostatectomies (87.5%) were classified as pT3. Node invasion and perineural sheathing were observed in 12.5% and 52.32% of cases respectively. Conclusion: Intraductal carcinoma is a poor prognostic factor that must be systematically reported in the anatomopathological report. In Senegal, it is often associated with advanced stage, high-grade carcinoma and high PSA levels.

Contribution of Anti-p63 Antibodies in the Interpretation of Benign Label Prostatic Biopsies

Introduction: Prostate cancer is the second most common cancer in men. The diagnosis is most often based on the prostate biopsies’ analysis and on histological criteria recognizable on standard coloring. In some cases, the use of immunohistochemistry is important. Objectives: This paper aims to specify the p63 phenotypic profile of lesions diagnosed benign, with minimal suspect foci, difficult to interpret, HGPIN (high grade intraepithelial neoplasia) and LGPIN (low-grade prostatic intraepithelial neoplasia) and evaluate the manual technique of p63 immunohistochemistry. Patients and Method: This was a retrospective, descriptive study of prostate biopsies recorded in the PAC service of the HALD from January 1st, 2018 to December 31st, 2018. It was completed by a manual immunohistochemical study of the blocks enrolled from November 19th to December 4th, 2020 in the PAC department of the HPD. The studied parameters were: registry number, age, clinical stage, prostate volume, PSA level, microscopic appearance and p63 immunohistochemical profile. Results: Our study included 60 prostate biopsies. The ages of our patients varied from 45 to 77 years, with an average of 64.2 years and a standard deviation of 6.2. The majority of patients were at clinical stage cT2b (33%) with a prostate volume varying between 33.15 and 169.4 cc. The minimum value of PSA in our series is 5 ng/ml, the maximum being 100 ng/ml with an average level of 24.1 ng/ml and a standard deviation of 21.2. Our series included 50 adenomyomatous hyperplasias, 7 adenomyomatous hyperplasias associated with chronic prostatitis, 2 HGPIN and 1 LGPIN. After re-reading we found 5 discordant cases, which corresponded to minimal suspect foci (kappa = 0.5098). The p63 marking was informative in 53 cases, i.e. 88%, and non-informative in 7 cases, i.e. 12%. Among the uninformative markings, 2 were due to lack of tissue adhesion to the slides. Among the informative markings, 11 were negative. p63 immunohistochemistry was useful in all suspected foci and detected 6 other minimal foci of adenocarcinoma. Conclusion: The immunostaining with the anti-p63 antibody in the prostate cancer diagnosis is of considerable benefit. It made it possible to correct 11.3% of benign diagnosis in minimal malignant focus in our context. Despite the difficulties associated with the manual technique, it is possible to have an informative rate, similar to the automatic technique.

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.

Prostatic Abscess Due to Idiopathic Granulomatous Disease: A Rare Complication of a Chameleon Disorder —Prostatic Abscess Due to Idiopathic Granulomatous Disease

Background: Prostatic abscesses are usually diagnosed in the setting of bacterial prostatitis. Rarely, they reveal or complicate granulomatous prostatitis (GP). Four cases of idiopathic xanthogranulomatous GP have been described previously and the present case report is the first of typical idiopathic variety. The case: A 60-year-old man presented with urine retention that was associated with pyuria and massively enlarged prostate. Cystoscopy revealed prostatic abscess (PA) that was opened. Urine and prostatic culture were negative for bacteria. Prostatic biopsy revealed multiple non-caseating granulomata surrounded by lymphocytes, plasma cells yet without foamy histiocytes, parasites and vasculitis. Special stains were negative for vasculitis, fungiand acid-fast organisms. The patient was treated with Solumedrol 1 g intravenously daily for 3 days followed by Prednisone 1 mg/kg/day for 1 month followed by gradual tapering till discontinuation by 3rd month. Moreover, he had received Mycophenolate mofetil (MMF) 1 g twice/daily. By the end of 2nd month;he was asymptomatic and without pyuria. Repeat cystourethroscopy and MRI scan of the prostate showed near normal prostate. In Conclusion: Idiopathic GP can present with PA that requires proper drainage and since it is a locally hyperimmune disease with genetic predisposition;MMF therapy will be maintained for a total of 2 years to prevent future disease-relapse.

Simultaneous Management of Inguinal Hernia and Benign Prostatic Hypertrophy in a Single Operation at the Chu D’abeche/Chad

Introduction: Benign prostatic hypertrophy and inguinal hernia are related and frequent pathologies in people over 50 years old. Their incidence is 15% to 25% according to the literature. The occurrence of hernia during benign prostatic hyperplasia is favored by disorders of the lower urinary tract. Simultaneous single-stage treatment of these two pathologies makes it possible to obtain satisfactory results that can reduce the cost of hospital stay and the multiple risk of anesthesia. The aim of our study was to: 1) Report the epidemiological, anatomo-clinical and para-clinical aspects of hernias during benign prostatic hypertrophy;2) Evaluate the feasibility and the results of the combined treatment of inguinal hernia and prostatic adenectomy in a single operation. Patients and Method: This was a retrospective descriptive study over a period of 7 years from March 2014 to February 2021, including patients operated on simultaneously at the University Hospital of Abeche for inguinal hernia and benign prostatic hypertrophy. The variables studied were: age, antecedents, favouring factors, clinical symptomatology, para-clinical elements, treatments and results: Results: 356 patients underwent surgery for benign prostatic hyperplasia, 36 of whom had an associated inguinal hernia. The mean age was 65.5 years, ranging from 50 to 93 years. The main reason for consultation was chronic urinary retention. The average consultation time was 10.2 months. The inguinal hernia was located on the right in 51% of cases and on the left in 18.4%. The mean prostatic volume measured by suprapubic ultrasound was 60.5 ± 25 cc. 14% and 10.2% of patients respectively were found to have struggle bladder and bilateral ureterohydronephrosis. Transvesical suprapubic adenectomy of the prostate was performed in all patients. The Bassini technique was the most commonly used (91%) for hernia repair. The average hospital stay was 7.5 days. Conclusion: Simultaneous treatment of benign prostatic hypertrophy and inguinal hernia reduces the number of hospital admissions in elderly patients, as well as the length of hospital stay.

Prostatic Adenomectomy by High Approach versus Millin: Our Results on a Series of 15 Cases

Background: In 2023, conventional surgery for benign prostatic hyperplasia (BPH) is still used despite the introduction of minimally invasive techniques in the therapeutic arsenal. Objective: To present our results of Millin prostatic adenomectomy in a preliminary series of 15 cases. Patients and Methods: Cross-sectional study conducted at the Urology Department of the Bouaké University Hospital from January 2022 to January 2023. It involved 15 patients with benign prostatic hyperplasia (BPH) who had undergone high adenomectomy using the Millin technique. Results: During the study period, 15 cases of benign prostatic hyperplasia were treated surgically by high adenomectomy using the Millin technique. The mean age of the patients was 63.6 years, ranging from 53 to 78 years. Nine (9) patients were consulted for progressive complications of benign prostatic hyperplasia (BPH), i.e. 60% (n = 9). The mean IPSS score was 28 (20 to 35), and seven (7) patients had a comorbidity (46.44%). The digital rectal examination (DRE) was in favour of benign prostatic hypertrophy in all patients, and the mean weight of the prostate at DRE was 75 g, ranging from 55 g to 100 g. From a paraclinical point of view, prostatic ultrasound revealed a mean BPH weight of 82.7 g with extremes of 55 to 100 g. Post-micturition residue was greater than 150 ml in 60% (n = 9). The mean prostate-specific antigen (PSA) level was 3.8 ng/ml, ranging from 1.4 to 15 ng/ml. There was one case of severe anaemia with a haemoglobin level of 6 g/dl on haemogram, treated by blood transfusion. The cytobacteriological examination of the urine (ECBU) revealed five cases of E. coli infection, i.e. 33.33% (n = 5). Millin prostatic adenomectomy was performed under antibiotic prophylaxis at induction. All patients underwent locoregional anaesthesia. The mean weight of the adenoma was 80 g with extremes of 55 to 155 g. Blood loss was minimal at less than 100 ml, i.e. 86.6% (n = 13). The average operating time was 56.9 minutes, ranging from 45 to 75 minutes. The Retzius space was drained in an average of 2.75 days, with extremes of 2 to 4 days. The average duration of postoperative bladder catheterisation was 8.7 days, with extremes of 7 to 10 days. The average duration of bladder irrigation-washing was 3.6 days. The average hospital stay was 8.55 days, with extremes of 8 to 10 days. Morbidity was represented by Orchi-epididymitis (66%, n = 1) and mortality was 6.66% (n = 1). 6 months later, the 14 patients had good micturition comfort with an RPM of less than 10 ml. Anatomo-pathological examination of the adenomectomy specimen was in favour of an adenomyofibroma of the prostate with no stigma of malignancy. Conclusion: Prostatic adenomectomy using the Millin technique is rarely performed, but a look at the results shows that it is still the least morbid and fatal technique.

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.

Clinical value of intravesical prostatic protrusion in the evaluation and management of prostatic and other lower urinary tract diseases

Intravesical prostatic protrusion(IPP)has emerged as a new prostatic morphometric parameter of significance to aid the clinicians in various aspects of managing the patients with some diseases of the lower urinary tract and the prostate.These include but may not be limited to its role in such conditions as:bladder outlet obstruction,trial without catheter,medical treatment effect,progression of lower urinary tract symptoms related to benign prostatic hypertrophy(LUTS/BPH),risk factor for bladder stone in BPH,overactive bladder,prostate carcinoma,and early urinary continence recovery after laparoscopic radical prostatectomy.In this review,I will try to summarize the different researchers’efforts on the potential practical application of this clinical tool.Technology is ever evolving to help us in the diagnosis and management of our patients.However,we as clinicians should contemplate their cost and possible suffering for the patient by wise and judicious utilization based on our clinical experience and tools.IPP seems to be one such promising clinical tool.

Future of prostate imaging:Artificial intelligence in assessing prostatic magnetic resonance imaging

Prostate cancer(Pca;adenocarcinoma)is one of the most common cancers in adult males and one of the leading causes of death in both men and women.The diagnosis of Pca requires substantial experience,and even then the lesions can be difficult to detect.Moreover,although the diagnostic approach for this disease has improved significantly with the advent of multiparametric magnetic resonance,that technology has certain unresolved limitations.In recent years artificial intelligence(AI)has been introduced to the field of radiology,providing new software solutions for prostate diagnostics.Precise mapping of the prostate has become possible through AI and this has greatly improved the accuracy of biopsy.AI has also allowed for certain suspicious lesions to be attributed to a given group according to the Prostate Imaging-Reporting&Data System classification.Finally,AI has facilitated the combination of data obtained from clinical,laboratory(prostate-specific antigen),imaging(magnetic resonance),and biopsy examinations,and in this way new regularities can be found which at the moment remain hidden.Further evolution of AI in this field is inevitable and it is almost certain to significantly expand the efficacy,accuracy and efficiency of diagnosis and treatment of Pca.

Update on minimally invasive surgery and benign prostatic hyperplasia

Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.