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Dutasteride, an inhibitor of 5α-reductase in the prostate, was tested in a large, randomized trial to determine its ability to prevent prostate cancer. Over the 4 years of the trial, dutasteride, as compared with placebo, reduced the relative risk of biopsy-detected prostate cancer by 23%. The reduction was limited mainly to tumors with Gleason scores of 5 or 6; by year 4, there were 12 tumors with Gleason scores of 8 to 10 in the dutasteride group but only 1 in the placebo group. Dutasteride, an inhibitor of 5α-reductase in the prostate, reduced the relative risk of biopsy-detected prostate cancer by 23%; however, the reduction was limited mainly to tumors with Gleason scores of 5 or 6. The 5α-reductase inhibitors that are used to treat benign prostatic hyperplasia block the conversion of testosterone to dihydrotestosterone and may reduce the risk of prostate cancer. 1 The results of the Prostate Cancer Prevention Trial showed that finasteride, as compared with placebo, reduced the risk of prostate cancer by 25%, but among the tumors that were detected, there was a 27% increase in the number of those that had Gleason scores of 7 to 10. 2 (The Gleason score is the sum of the two most common histologic patterns or grades in a prostate tumor, each of which is graded on a . . .

Evidence indicating Prostatic Urethral Lift (PUL) delivers significant improvement in symptomatic BPH with low morbidity is based on subjects with lateral lobe (LL) enlargement only. MedLift was an FDA IDE extension of the L.I.F.T. randomized study designed to examine safety and efficacy of PUL for treatment of obstructive middle lobes (OML). Inclusion criteria for this non-randomized cohort were identical to the L.I.F.T. randomized study, except for requiring an OML: ≥ 50 years of age, IPSS ≥ 13, and Qmax ≤ 12 ml/s. Primary endpoint analysis quantified improvement in IPSS over baseline and rate of post-procedure serious complications. Quantification of symptom relief, quality of life, flow rate, and sexual function occurred through 12 months. Outcomes were compared to historical L.I.F.T LL results and were combined to demonstrate the full effectiveness of PUL. Of the 71 screened subjects, 45 were enrolled. At 1, 3, 6, and 12 months, mean IPSS improved from baseline at least 13.5 points (p < 0.0001). Quality of life and BPHII were similarly improved (>60% and >70%, respectively at 3, 6, and 12 months, p < 0.0001). Mean Qmax improvement ranged from 90 to 129% (p < 0.0001). At 1 month, 86% (CI 73–94%) reported ≥70 on the Quality of Recovery scale, 80% (CI 66–89%) reported being “much” or “very much better,” and 89% (CI 76–95%) would recommend the procedure. Compared to LL subjects, OML subjects’ symptoms improved at least as much at every time point (OML range 13.5–15.9, LL range 9.9–11.1, p ≤ 0.01). On combining OML with LL data, >70% (range CI 63–81%) of subjects demonstrated ≥ 8 point improvement in IPSS through 12 months. Analysis of the combined dataset indicates ≥ 40% (CI 30–51%) of sexually active men improved the minimal clinically important difference in erectile function through 12 months. Prostates, including those with middle lobe obstruction, can be treated with the PUL procedure safely and effectively.

PurposeTo compare the perioperative and functional outcomes of holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) for the treatment of large-volume benign prostatic hyperplasia (BPH) (> 80 ml).MethodsA total of 116 consecutive patients with BPH were randomized to be treated surgically with either HoLEP (n = 58) or ThuLEP (n = 58), following the classical three-lobe enucleation technique. Follow-up was assessed at 1, 3, 6, 12 and 18 months after surgery.ResultsAt 18 months, the lower urinary tract symptom index was improved significantly in both groups compared with the baseline values. The operative time (78.4 ± 8.0 vs. 71.4 ± 6.4 min) and enucleation time (61.2 ± 5.4 vs. 56.4 ± 8.4 min) were significantly shorter for ThuLEP compared to HoLEP (both p < 0.001). There were no significant differences between the two groups regarding morcellation time, resected weight, hemoglobin decrease, catheter time and hospital stay (p > 0.05). The HoLEP and ThuLEP groups had equivalent International Prostate Symptom Scores (3 [3–3] vs. 3 [3–3], p = 0.776), quality of life (1 [1–2] vs. 2 [1–2], p = 0.809), Qmax (25.3 ± 4.8 ml/s vs. 24.7 ± 4.4 ml/s, p = 0.470), postvoid residual urine (PVR) (6.1 [2.6–20.8] vs. 7.7 [3.1–22.8] ml, p = 0.449) and PSA (0.84 ± 0.32 vs. 0.90 ± 0.34 ml, p = 0.309) at 18 months postoperatively.ConclusionBoth HoLEP and ThuLEP relieve lower urinary tract symptoms in a comparable way with high efficacy and safety. ThuLEP was statistically superior to HoLEP in operation time and enucleation time, although the differences were clinically negligible.

To evaluate the effects of electroacupuncture (EA) on the International Prostate Symptom Score (IPSS), postvoid residual urine (PVR), and maximum urinary flow rate (Qmax), and explore the difference between EA at acupoints and non-acupoints in patients with moderate to severe benign prostate hyperplasia (BPH). Men with BPH and IPSS ≥8 were enrolled. Participants were randomly allocated to receive EA at acupoint (treatment group, n = 50) and EA at non-acupoint (control group, n = 50). The primary outcome measure includes the change of IPSS at the 6th week and the secondary outcome measures include changes of PVR and Qmax at the 6th week and change of IPSS at the 18th week. 100/192 patients were included. At the 6th week, treatment group patients had a 4.51 (p<0.001) and 4.12 (p<0.001) points greater decline in IPSS than the control group in the intention to treat (ITT) and per-protocol (PP) populations. At the 18th week, a 3.2 points (p = 0.001) greater decline was found in IPSS for the treatment. No significant differences were found between the two groups in Qmax at the 6th week (p = 0.819). No significant difference was observed in PVR (P = 0.35). Acupoint EA at BL 33 had better effects on IPSS, but no difference on PVR and Qmax as compared with non-acupoint EA. The results indicate that EA is effective in improving patient's quality of life and acupoint may have better therapeutic effects than non-acupoints in acupuncture treatments of BPH. ClinicalTrials.gov NCT01218243.

Introduction and objectives To compare the perioperative and functional outcomes of low-power and high-power thulium:YAG VapoEnucleation (ThuVEP) of the prostate for the treatment of large-volume benign prostatic hyperplasia (BPH) (> 80 ml). Patients and methods A prospective analysis of 80 patients with symptomatic BPO and prostatic enlargement (more than 80 ml) was conducted. They were divided randomly into two groups (40 patients in each group). One group was treated with low-power ThuVEP, and the other group was treated with high-power ThuVEP. All patients were assessed preoperatively and early postoperatively, and 12-month follow-up data were analyzed. The complications were noted and classified according to the modified Clavien classification system. Results The mean age at surgery was 68 (± 6.1) years, and the mean prostate volume was 112 (± 20.1) cc, and there were no differences between the groups ( p  = 0.457). The mean operative time was 88.4 ± 11.79 min for group A and 93.4 ± 16.34 min for group B, while the mean enucleation time was 59.68 ± 7.24 min for group A and 63.13 ± 10.75 min for group B. There were no significant differences between the groups regarding catheterization time and postoperative stay. The quality of life (QoL), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoiding residual urine (PVR), and prostate volume improved significantly after treatment and were not significantly different between those treated with the different energies. The incidence of complications was low and did not differ between both the groups. Conclusion Low-power ThuVEP is feasible, safe, and effective with comparable results with high-power ThuVEP in the treatment of BPO.

Objective To compare the safety and efficacy of low-power (LP) and high-power (HP) holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic small-volume benign prostatic hyperplasia (BPH). Methods In this prospective, multicenter, single-blind, randomized controlled trial, men with symptomatic BPH (prostate volume <40 mL, peak urinary flow rate [Qmax] <10 mL/s, International Prostate Symptom Score [IPSS] ≥18) underwent either LP (24 W) or HP HoLEP (80 W). The primary outcome was IPSS at 6 months postoperatively. Secondary outcomes included the surgical duration, total laser energy, enucleated prostate weight, patient-reported outcomes, and Clavien–Dindo classification of complications at 1, 3, and 6 months after surgery. Results Eighty-one participants completed the study. LP HoLEP used significantly less energy (22.4 ± 10.4 kJ vs. 58.6 ± 17.8 kJ). Postoperative pain was lower in the LP group at 24 and 48 hours. Both groups displayed significant improvements in outcomes versus baseline including IPSS and Qmax. The incidence of intraoperative complications was similar, though minor capsular perforation occurred exclusively in the HP group (9.8%). Conclusion LP HoLEP produced comparable clinical outcomes as HP HoLEP for small-volume BPH while using less energy, supporting its use for smaller glands.

Benign prostatic hyperplasia (BPH) is a prevalent condition among the elderly male population, characterised by prostate enlargement and bothersome urinary symptoms. Holmium Laser Enucleation of the Prostate (HoLEP) is a minimally invasive surgical option that is preferred for larger prostates due to its precision and minimal complications. Although high-power HoLEP is an efficacious procedure, recent studies indicate that low-power settings may offer comparable benefits with diminished postoperative discomfort. This study compares the efficacy of low-power (LP) and high-power (HP) HoLEP in a prospective, multicentre, randomised controlled trial involving 102 men with prostates larger than 80 ml. The participants were randomly assigned to either the LP or HP groups and were followed for a period of six months following the operation. The primary outcome measure was the international prostate symptom score (IPSS), with secondary outcomes including perioperative and postoperative parameters and Qmax, PVR, and Clavien-Dindo classification of complications at one, three, and six months post-surgery. Both LP and HP HoLEP resulted in significant improvements in IPSS, Qmax, and PVR compared to the baseline ( p  < 0.05). The LP group demonstrated a longer laser application time ( p  < 0.001) and required a greater volume of irrigation fluid ( p  < 0.001), yet exhibited a reduction in total energy usage ( p  = 0.01). Additionally, they reported significantly diminished postoperative pain at 24 and 48 h ( p  < 0.05). No significant differences were observed between the groups with regard to the incidence of complications, the duration of catheterisation, or the length of hospital stay. The results demonstrate that LP-HoLEP is as efficacious as HP-HoLEP in improving urinary symptoms, with the additional benefit of reduced postoperative discomfort. These findings support the use of LP-HoLEP as a viable option for the treatment of large prostates, although further research is required to confirm long-term outcomes.

Background The top-down holmium laser enucleation of the prostate (HoLEP) technique recently emerged as a safe and effective modification of traditional HoLEP. In our randomized controlled trial, we compared intraoperative and postoperative outcomes of traditional and top-down HoLEP for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate size ≥80 g. Methods One-hundred patients with BPH and a prostate volume ≥80 cc participated in this prospective randomized controlled trial. Outcome measures were collected and compared, including IPSS, QoL, flow rate, PVR, IIEF-15, PSA, and TRUS prostate volume changes. Perioperative complications were also recorded. All patients were followed up at 1, 3, 6, and 12 months. Results There were no significant differences in preoperative baseline characteristics between the two surgical groups. The median prostate volume for the traditional and top-down HoLEP groups was 107 and 102 cc, respectively. The operative parameters and postoperative outcomes were comparable for both cohorts. The median enucleation time for traditional HoLEP was 60 min, which was not significantly longer than that of top-down HoLEP (52 min) ( p  = 0.07). At 3 months follow-up, there was no statistically significant difference in transient stress urinary incontinence (SUI) in the traditional HoLEP (4.1%) versus the top-down HoLEP group (2.2%), ( p  = 0.61). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. Conclusions The HoLEP procedure significantly improves patients’ urinary functional outcomes and has comparable postoperative outcomes regardless of the technique utilized.

PurposeWe compared the perioperative and postoperative characteristics of thulium vapoenucleation and holmium laser enucleation of the prostate for the treatment of large volume benign prostatic hyperplasia.Materials and methodsA total of 94 patients with benign prostatic hyperplasia and a median prostate size of 80 (IQR 46.75–100) cc were either randomized to thulium vapoenucleation or holmium laser enucleation of the prostate. Patients were assessed preoperatively, 1 and 6 months postoperatively.ResultsThe median operative time was 60 (IQR 41–79) min without significant differences between the groups. There were no significant differences between the groups regarding catheter time [2 (IQR 2–2) days] and postoperative stay [2 (IQR 2–3) days]. Clavien 1 (13.8%), 2 (3.2%), 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. At 6-month follow-up, median maximum flow rate (10.7 vs. 25.9 ml/s), post-void residual urine (100 vs. 6.5 ml), I-PSS (20 vs. 5), quality of life (4 vs. 1), PSA (4.14 vs. 0.71 µg/l), and prostate volume (80 vs. 16 ml) had improved significantly (p < 0.001) compared to baseline without significant differences between the groups. Median PSA decrease was 79.7% (58.8–90.6%) and prostate volume reduction was 74.5% (68.57–87.63%) without differences between the groups. The reoperation rate was zero at 6-month follow-up.ConclusionsThulium vapoenucleation and holmium laser enucleation of the prostate are safe and effective procedures for the treatment of large volume benign prostatic hyperplasia. Both procedures give satisfactory micturition improvement with low morbidity and sufficient prostate volume reduction at 6-month follow-up.

Extracts of the saw palmetto berry are widely used for symptoms of benign prostatic hypertrophy. This one-year randomized trial showed that saw palmetto was no more effective than placebo in ameliorating symptoms and signs of benign prostatic hypertrophy. This one-year randomized trial showed that saw palmetto was no more effective than placebo in ameliorating symptoms and signs of benign prostatic hypertrophy. Extracts of the saw palmetto berry are widely used for the treatment of benign prostatic hyperplasia, often as an alternative to pharmaceutical agents. In a national survey conducted in 2002, 1.1 percent of the adult population in the United States, or approximately 2.5 million adults, reported using saw palmetto. 1 The herb is widely used in Europe, where half of German urologists prefer prescribing plant-based extracts to synthetic drugs. 2 Although most prior randomized trials of saw palmetto have reported small improvements in the symptoms of benign prostatic hyperplasia or in urinary flow rates, these studies are limited by the small numbers . . .