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Guidelines for pharmacological treatment of benign prostatic hyperplasia/lower urinary tract symptoms in elderly males(2025 edition)

Journal of Modern Urology.2025;30(12):1015-1026. doi:10.3969/j.issn.1009-8291.2025.12.001

Developed by a multidisciplinary expert team organized by the Urology Committee of Beijing Association of the Integrating of Traditional and Western Medicine, these guidelines aim to address the clinical challenges in pharmacotherapy arising from the increasing prevalence of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in elderly males against the backdrop of China's aging population. Based on systematic reviews, randomized controlled trials, cohort studies, and clinical practice experience, the guidelines employed a graded evidence evaluation system (levels A, B, C) and adopted the Delphi method to form expert consensus, thus ensuring the validity and independence of the recommendations. The literature reviews comprehensively covered major Chinese and English databases, focusing on pharmacotherapy studies for BPH/LUTS in men aged ≥65 years. The guidelines systematically elaborated on the clinical application of eight major drug categories, including α_1-blockers,5α-reductase inhibitors, plant-based preparations, muscarinic receptor antagonists, β3-adrenergic receptor agonists, phosphodiesterase type 5 inhibitor, desmopressin, drug combination therapy, and traditional Chinese medicine (TCM) based on syndrome differentiation. It also specifically analyzed the risks associated with multimorbidity and polypharmacy in elderly patients. The guideline put forward seven core recommendations:① Conduct a comprehensive assessment of comorbidities and medications to prevent drug-drug interactions.② The α_1-blockers are recommended as first-line therapy, with caution required for orthostatic hypotension.③ The 5α-reductase inhibitors are suitable for patients with enlarged prostate volume.④ Muscarinic receptor antagonists or β3-agonists may be considered for patients with concomitant overactive bladder (OAB).⑤ Tadalafil can be considered for patients with erectile dysfunction, but it is contraindicated with nitrates. ⑥ Desmopressin can be used for significant nocturia, with monitoring required for hyponatremia.⑦ TCM treatment should follow syndrome differentiation principles, and monitoring of liver and kidney function is necessary.

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Research progress on the neural mechanisms of detrusor-sphincter dyssynergia and prospect of treatment strategies

Lei PANG ; Yuxin ZHANG ; Weilun ZHANG

Journal of Modern Urology.2025;30(12):1027-1032. doi:10.3969/j.issn.1009-8291.2025.12.002

Detrusor-sphincter dyssynergia (DSD) is a lower urinary tract dysfunction syndrome caused by disorders of the neural regulatory pathways for micturition. Its core feature is that the urethral sphincter fails to relax coordinately during detrusor contraction; instead, the persistent abnormal contraction leads to a series of severe complications such as dysuria, elevated intravesical pressure, and upper urinary tract damage.DSD is common in patients with central nervous system lesions, such as spinal cord injury and multiple sclerosis. This paper systematically reviews the latest research progress on the neural mechanisms of DSD, including ① loss of central regulation and excessive excitation of the spinal cord center, i.e., the loss of supraspinal inhibition leading to sacral spinal reflex hyperactivity; ② imbalance of key neurotransmitters and receptors, involving excessive glutamatergic excitation, weakened gamma-aminobutyric acid ergic/glycinergic inhibition, and the involvement of purinergic and endocannabinoid systems; ③ neuroimmunity and inflammatory response, where the activation of microglia and astrocytes after spinal cord injury releases pro-inflammatory factors, exacerbating neuronal excitability and circuit remodeling; ④ peripheral nerve and gut-bladder axis mechanisms, where sphincter structural remodeling and the gut microbiota-neuroimmunity crosstalk form a vicious cycle. The paper focuses on the sacral Onuf's nucleus as the“core hub”and key therapeutic target of DSD, discussing the central role of its dysfunction in the occurrence of synergistic disorders. In terms of therapeutic strategies, the paper summarizes existing traditional methods, such as drugs, botulinum toxin injection and neuromodulation, and envisions the cutting-edge directions of targeted intervention, such as precise strategies including gene therapy and neurotrophic support, as well as the challenges faced in clinical translation. Finally, the paper discusses the application prospects of precision medicine and artificial intelligence in the diagnosis and treatment of DSD, including precise classification based on multi-omics data, artificial intelligence-assisted recommendation of individualized treatment plans, and the development of dynamic closed-loop regulation systems. This paper aims to provide a theoretical basis and research direction for in-depth understanding of the neural mechanisms of DSD, and to promote the precise diagnosis, treatment and neural function remodeling.

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Long-term efficacy of artificial urinary sphincter implantation for post-traumatic urethral injury-related urinary incontinence:a single center retrospective study

Wei GUO ; Fan ZHANG ; Limin LIAO

Journal of Modern Urology.2025;30(12):1033-1037. doi:10.3969/j.issn.1009-8291.2025.12.003

Objective To investigate the long-term efficacy and postoperative complications of artificial urinary sphincter (AUS) implantation in patients with stress urinary incontinence caused by traumatic urethral injury, so as to provide reference for the treatment of this condition. Methods A retrospective study was conducted on the clinical data of 26 patients treated at our center during Apr.2002 and Dec.2024. All patients had severe persistent urinary incontinence due to traumatic urethral injury and underwent AUS implantation. The daily pad usage and visual analog scale (VAS) scores before surgery and 6 months to 1 year after surgery were compared to evaluate the efficacy. Complications were recorded and analyzed, and the survival was analyzed using the Kaplan-Meier method. Results The patients included 25 males and 1 female, with a mean age (41.8± 16.0) years, median disease duration of 10.0 (2.0,16.0) years and follow-up of (11.7±5.9) years. One month postoperatively, all patients successfully activated the AUS device. At the latest follow-up (Jun.2025),20 devices (including 3 revised) were functioning. The social continence rate was 61.5% (16/26), and complete continence rate 38.5% (10/26). Daily pad usage decreased significantly from a preoperative median of 3.5 (3.0,5.0) pads/day to 0.5 (0,1.0) pads/day (P<0.05). The median VAS score decreased from 8.0 (7.0,8.0) to 1.0 (0,1.0) (P<0.05). Complications occurred in 34.6% (9/26) patients, including urethral erosion (4 cases), fluid leakage (3 cases) and infection (2 cases). There was a significantly difference in age between patients with complications and those without complications [ (33.1±12.3) years vs. (46.4±16.1) years, P<0.05]. The median survival was 16 years, with the 5-year,10-year, and 15-year survival probabilities of 75.8%, 75.8% and 58.3%. Conclusion AUS implantation demonstrates good long-term efficacy and durability, and is a recommended treatment option.

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Efficacy of modified pelvic floor reconstruction in non-nerve-sparing robot-assisted radical prostatectomy

Xuexing FAN ; Gen LI ; Jincheng LI ; Jiasong LI ; Yuhao YU ; Pugui LI ; Xiaopeng CHEN ; Zhiguo LU ; Geng ZHANG ; Yong WANG

Journal of Modern Urology.2025;30(12):1038-1042,1063. doi:10.3969/j.issn.1009-8291.2025.12.004

Objective To evaluate the efficacy and safety of modified pelvic floor reconstruction in non-nerve-sparing robot-assisted radical prostatectomy (NNS RARP) for improving postoperative urinary control. Methods A retrospective analysis was conducted on the clinical data of 79 prostate cancer patients who underwent NNS RARP at Tangdu Hospital during Jan.2020 and Dec.2023, including 29 in the reconstruction group, and 50 in the non-reconstruction group. The baseline characteristics including age, body mass index, prostate-specific antigen (PSA) level, clinical stage, prostate volume, and biopsy Gleason score, and perioperative indexes including operation time, intraoperative blood loss, catheter indwelling time, complication rate, and positive rate of surgical margins were compared between the two groups. Additionally, urinary continence function was assessed before operation and 1,3,6, and 12 months after operation using the international consultation on incontinence questionnaire-short form (ICIQ-SF) and the incontinence quality of life questionnaire score (I-QoL). Results No statistically significant differences were observed in the baseline characteristics between the two groups (P>0.05). The operation time was significantly longer in the reconstruction group than in the non-reconstruction group [ (110.24±15.08) min vs. (101.80±9.89) min, P=0.010]. There were no significant differences in intraoperative blood loss, catheter indwelling time, complication rate, and positive rate of surgical margins between the two groups (P>0.05). The reconstruction group demonstrated significantly lower ICIQ-SF scores at 1 month [ (10.17±2.16) vs. (11.56±1.66), P=0.002],3 months [ (7.62±1.29) vs. (9.52±1.80), P<0.001], and 6 months postoperatively [ (4.93±1.22) vs. (6.18± 1.67), P=0.001]compared to the non-reconstruction group (adjusted P<0.0125). Conversely, the I-QoL scores were significantly higher in the reconstruction group at 1 month [ (73.32±10.30) vs. (63.88±9.55), P<0.001]and 3 months postoperatively [ (78.91±4.82) vs. (75.66±5.17), P=0.007] (adjusted P<0.0125). However, no significant differences were found in ICIQ-SF or I-QoL scores between the two groups preoperatively and 12 months postoperatively (adjusted P>0.0125). Conclusion The application of modified pelvic floor reconstruction technique in NNS RARP is safe and feasible. Although it slightly prolongs the operation time, it does not increase surgical risks; instead, it effectively promotes early recovery of postoperative urinary continence, thereby significantly enhancing patients'quality of life.

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Platelet-rich plasma in the treatment of interstitial cystitis/bladder pain syndrome:a single-center prospective study

Jin HUANG ; Rong LYU ; Wenjun MENG ; Tingting LYU ; Weilin FANG ; Jianwei LYU

Journal of Modern Urology.2025;30(12):1043-1048. doi:10.3969/j.issn.1009-8291.2025.12.005

Objective To investigate the clinical efficacy of platelet-rich plasma (PRP) therapy for interstitial cystitis/bladder pain syndrome (IC/BPS). Methods This single-center prospective study involved 97 IC/BPS patients treated in our hospital during Sep.2023 and Apr.2025, who underwent transurethral bladder injection of PRP. The injections were administered once a month for four sessions. The global response assessment (GRA) score,24-hour urinary frequency, maximum single voiding volume, visual analogue scale (VAS) score, O'Leary score, pelvic pain, urgency and frequency (PUF) score, and Zung self-rating anxiety scale (SAS) score were analyzed. Results All 97 patients completed four injections. The GRA score,24-hour urinary frequency, VAS score, O'Leary score and PUF score were improved significantly after treatment (P<0.007). Intraoperative bladder capacity with significant improvement were observed after the first injection (P<0.01), and the maximum urine output were observed after the fourth injection (P<0.007). The SAS score was not significantly improved. Conclusion Repeated PRP injections can effectively alleviate bladder pain, improve frequent and urgent urination symptoms, and increase the bladder capacity.

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Analyzing brain structural network topology and connectivity in patients with refractory overactive bladder using diffusion tensor imaging and graph theory analysis

Yangkun FENG ; Feng LU ; Siyi FU ; Yuwei ZHANG ; Yun ZHANG ; Deshui YU ; Xiuhong HUA ; Xi LIU ; Jianfeng SHAO ; Yi FAN ; Ye HUA

Journal of Modern Urology.2025;30(12):1049-1055. doi:10.3969/j.issn.1009-8291.2025.12.006

Objective To investigate the regulatory mechanism of the central nervous system in patients with refractory overactive bladder (rOAB) using diffusion tensor imaging (DTI) and graph theory analysis. Methods A total of 43 rOAB patients (rOAB group) and 46 matched healthy controls (HC group) were recruited during May and Nov.2024. All participants were scanned with DTI, and surveyed with the overactive bladder symptom score (OABSS), and overactive bladder questionnaire (OAB-q). Their age, gender, height, weight, and educational years were collected.DTI plus graph theory analysis was employed to explore the alterations in global and local topological properties of the brain structural network in rOAB patients. Brain regions showing significant group differences in structural metrics [specifically, the right paracentral lobule (PCL.R) ]were further used as seed points for functional connectivity (FC) analysis. Correlations between the nodal clustering coefficient (NCp) of the identified region, FC strength, OABSS, and OAB-q score were investigated. Results The OABSS [8 (6,10) vs.0 (0,1) ]and OAB-q [71 (53,80) vs.20 (19,24) ]were higher in the rOAB group than the HC group (P<0.001). Graph theory analysis revealed no statistically significant differences in global network metrics between the two groups (P>0.05). However, the NCp was significantly higher in the PCL.R of rOAB group compared to HC group (P<0.05, FDR-corrected).FC analysis using the PCL.R as a seed region demonstrated significantly reduced FC value in the left cerebellar crus Ⅱ (Cerebelum_Crus2_L) of the rOAB group (P<0.05, FDR-corrected). Partial correlation analysis showed that the NCp of PCL.R was positively correlated with both OABSS (r=0.255, P=0.018) and OAB-q score (r=0.257, P=0.017). Conversely, the FC of Cerebelum_Crus2_L was significantly negatively correlated with OABSS (r=-0.545, P<0.001) and OAB-q score (r=-0.535, P<0.001). Conclusion Patients with rOAB exhibit distinct brain structural network alterations compared to healthy individuals, primarily manifestation in the NCp value of PCL.R increased, and the FC intensity of Cerebelum_Crus2_L is significantly weakened. These alterations in the topological properties of the structural network may be implicated in the pathogenesis of rOAB.

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Efficacy of intravesical electrical stimulation and extracorporeal shock wave therapy for female non-obstructive detrusor underactivity: a reinforcement learning optimization approach

Zhen WANG ; Zhongle XU ; Junhua XI ; Yanbin ZHANG

Journal of Modern Urology.2025;30(12):1056-1063. doi:10.3969/j.issn.1009-8291.2025.12.007

Objective To evaluate the efficacy of intravesical electrical stimulation (IVES) and low-intensity extracorporeal shock wave therapy (Li-ESWT) in improving bladder emptying function in female patients with non-obstructive detrusor underactivity (NODU), and to further assess the clinical value of an individualized integrated treatment strategy guided by reinforcement learning (RL) optimization. Methods A total of 98 female patients diagnosed with NODU by urodynamic testing at the Department of Urology, the Second People's Hospital of Hefei, duirng Jun.2023 and Feb.2025 were prospectively enrolled. Patients were randomly assigned (1∶1∶1) to three groups:the IVES group (n=33), the Li-ESWT group (n=35), and the RL group (n=30). Clinical outcomes before and after the 4-week treatment were compared among the three groups, including peak detrusor pressure during urination (PdetQmax), maximum urinary flow rate (Qmax), post-void residual (PVR), bladder contractility index (BCI), patient perception of bladder condition-scale (PPBC-S), incontinence impact questionnaire-short form 7 (IIQ-7), urogenital distress inventory-short form 6 (UDI-6), total efficiency and satisfaction.A RL model was trained based on clinical data, with a model structure diagram and reward convergence curve plotted to validate the utility of the RL system in optimizing individualized treatment parameters. Results There were no statistically significant differences in baseline characteristics among the three groups (P>0.05). After 4 weeks of treatment, all groups demonstrated significant improvements in PdetQmax, Qmax, and BCI, along with significant reductions in PVR, PPBC-S, IIQ-7, and UDI-6 scores (all P<0.01). Notably, the RL group exhibited significantly greater improvements in PdetQmax, Qmax, and BCI, and more pronounced reductions in PVR, PPBC-S, IIQ-7, and UDI-6 scores than the IVES and Li-ESWT groups (all P<0.05). Specifically, the RL group showed the most substantial improvements in Qmax, PVR, and BCI than the other two groups (all P<0.01). The total effective rate in the RL group was 90.0% (27/30), which was higher than that of the IVES group (81.8%,27/33) and the Li-ESWT group (77.1%,27/35), but the differences were not statistically significant (χ =2.63, P=0.27). The Li-ESWT group had a satisfaction rate of 51.4% (18/35), which was higher than that of the RL group (30.0%,9/30) and the IVES group (27.3%,9/33), but the differences were not statistically significant (χ =6.76, P=0.34). No serious adverse events were observed in any group. After approximately 200 iterations, the reward value of the RL agent stabilized, and the individualized treatment parameters recommended further optimized bladder emptying efficiency. Conclusion Compared to IVES and Li-ESWT, the RL-optimized individualized comprehensive treatment strategy can significantly improve the bladder emptying function in women with NODU.

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Efficacy and safety of transcutaneous tibial nerve stimulation combined with Mirabegron in the treatment of drug-refractory overactive bladder

Jingde WU ; Jianlin XIE ; Qingwei ZHANG ; Wengang YANG ; Xiande HUANG

Journal of Modern Urology.2025;30(12):1064-1068. doi:10.3969/j.issn.1009-8291.2025.12.008

Objective To evaluate the efficacy and safety of Mirabegron combined with transcutaneous tibial nerve stimulation (TTNS) in the treatment of drug-refractory overactive bladder (OAB), so as to alleviate patients'symptoms, improve their quality of life with optimized treatment plan, and provide reference for clinical practice. Methods A retrospective analysis was conducted on 56 patients with drug-refractory OAB treated at the Department of Urology of Gansu Provincial Hospital during Jan.2023 and Dec.2024. Based on the treatment methods, the patients were divided into two groups:the TTNS group and the combined treatment group, with 28 patients in either group. The daytime urination frequency, nocturia frequency, urgency episodes, urinary incontinence, functional bladder capacity (FBC), OAB symptom scores (OABSS), and incontinence quality of life questionnaire (I-QoL) scores were collected before and after treatment. The therapeutic efficacy was evaluated using the Nimodipine method. Results After 12 weeks of treatment, the 24-hour urination indicators in both groups including daytime urination frequency, nocturia frequency, urgency episodes and FBC, as well as OABSS and I-QoL scores, showed a significant improvement compared to baseline (P<0.001). The combined treatment group exhibited fewer urgency episodes than the TTNS group [ (1.07±0.66) times/24 h vs. (1.64±0.62) times/24 h, P<0.05]. However, no statistically significant differences were observed between the two groups in other urinary parameters (P>0.05). The total effective rate in the combined treatment group was 96.43%, which was significantly higher than that in the TTNS group (82.14%, P<0.05). During treatment, one patient (3.57%) in the TTNS group experienced mild skin allergy, which recovered following symptomatic management. Conclusion The combination of TTNS and Mirabegron in drug-refractory OAB not only alleviates clinical symptoms and improves quality of life, but also shows superior efficacy in reducing urgency episodes. This approach is a safe and effective treatment option.

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Efficacy and safety of botulinum toxin type A injection combined with sacral neuro-modulation in the treatment of idiopathic non-obstructive urinary retention

Yongkun ZENG ; Qingwei WANG ; Wen ZHU ; Zikai LI ; Shuo XU ; Chuanyu WANG ; Ke JIN

Journal of Modern Urology.2025;30(12):1069-1074. doi:10.3969/j.issn.1009-8291.2025.12.009

Objective To evaluate the efficacy and safety of botulinum toxin A (BTX-A) injection into the external urethral sphincter in combination with sacral neuromodulation (SNM) for the treatment of idiopathic non-obstructive urinary retention (INOUR). Methods A total of 57 INOUR patients treated in our hospital during May 2022 and May 2024 were enrolled. Patients were divided into the BTX (n=30) and combined groups (n=27) according to whether they chose SNM after BTX-A injection. The baseline, postoperative 1-month and 6-month consecutive 3-day voiding diaries, quality of life score (QoL), and post-void residual (PVR), preoperative and postoperative 1-month urodynamic results, and postoperative complications were recorded and compared between the two groups. Results One month after surgery, the average number of voiding frequency per day and PVR were lower in both groups than those before surgery (P<0.05), while the average daily urine volume and maximum flow rate (MFR) were higher (P<0.05). There was no statistically significant difference between the maximum detrusor pressure during micturition in both groups before and after surgery (P>0.05). One month after surgery, the average number of voiding frequency per day, average daily urine volume, PVR, QoL, MFR, bladder compliance (BC), and maximum cystometric capacity (MCC) were better in the combined group than in the BTX group (P<0.05), and the efficiency was higher in the combined group (88.9% vs.63.3%, P<0.05). Six months after surgery, the efficacy of the BTX group returned to the baseline level with no statistically significant difference, whereas the efficacy of the combined group was stable (not different from the postoperative 1-month indicators, but better than the baseline level). During the follow-up, there was no difference in the incidence of complications between the BTX group and combined group [43.3% (13/30) vs. 48.1% (13/27), P>0.05]. Conclusion BTX-A injection into the external urethral sphincter combined with SNM improves the short-term outcomes of INOUR patients and maintains the efficacy 6 months postoperatively, which is a safe and reliable treatment option.

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Effects of sacral neuromodulation on urodynamic parameters during the storage phase in patients with neurogenic bladder

Haichao LIU ; Guoqing CHEN ; Peng ZHANG ; Fan ZHANG ; Baihui WANG ; Fei ZHOU ; Yanhe JU

Journal of Modern Urology.2025;30(12):1075-1079. doi:10.3969/j.issn.1009-8291.2025.12.010

Objective To explore the effects of sacral neuromodulation (SNM) on urodynamic parameters during the storage phase in patients with neurogenic bladder (NB), so as to provide reference for evaluating the efficacy of SNM. Methods A total 49 NB patients undergoing SNM at our hospital during Oct.2012 and May 2025 were enrolled. Baseline data and video-urodynamic parameters were collected. Changes in maximum cystometric capacity, maximum detrusor pressure during storage phase, and bladder compliance before and after treatment were assessed. Improvements in detrusor overactivity (DO) and vesicoureteral reflux (VUR) were also analyzed. Results Among the 49 patients,27 were male and 22 were female, with a mean age of (37.41±15.15) years, a median disease duration of 5.0 (2.0,15.5) years, and a median follow-up of 11 (1,32) months. Up to 37 patients (75.5%) received permanent sacral nerve pulse generator implantation (permanent implant group), while the remaining 12 were classified as the non-permanent implant group. Before and after the test period, all patients showed a significant increase in maximum cystometric capacity [ (218.0 (93.0,358.5) mL vs.300.0 (238.5, 400.0) mL, P<0.001], a decrease in maximum detrusor pressure during the filling phase [32.0 (13.5,71.0) cmH_2 O vs. 20.0 (9.0,50.0) cmH_2 O, P<0.001], and an improvement in bladder compliance [11.8 (8.3,25.6) mL/cmH_2 O vs.26.7 (8.6,44.1) mL/cmH_2O, P<0.001]. In the permanent implant group, comparisons before and after the test period showed an increase in maximum bladder capacity [ (239.16±147.23) mL vs. (312.24±121.83) mL, P<0.001], a decrease in maximum detrusor pressure during filling[32.0 (15.0,58.0) cmH_2 O vs.15.0 (9.0,41.0) cmH_2 O, P<0.05], and improved bladder compliance [10.8 (8.3,23.6) mL/cmH_2 O vs.28.6 (8.6,41.4) mL/cmH_2 O, P<0.001]. No statistically significant differences in these parameters before and after the test period were observed in the non-permanent implant group (P>0.05). A total of 17 patients in the permanent implant group underwent follow-up video urodynamics. Compared to pre-test values, significant improvements were observed in maximum detrusor pressure during filling, and bladder compliance both at the end of the test period and at the last follow-up (P<0.05). However, no statistically significant differences were found in maximum cystometric capacity, maximum detrusor pressure during filling, and bladder compliance between the end of the test period and the last follow-up (P>0.05). Among the 49 patients,21 had DO and 20 had VUR. Both DO and VUR showed improvement after the test period and at the last follow-up. Conclusion SNM can effectively improve storage function in NB patients, ameliorate detrusor overactivity and bladder compliance, and relieve or eliminate VUR in some patients. Long-term follow-up confirms that SNM provides stable therapeutic effects, demonstrating significant clinical value.

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