OBJECTIVE: To investigate the effect of inverted-Y urethral function-preserving holmium laser enucleation of the prostate (HoLEP) on stress urinary incontinence after surgery in patients with BPH. METHODS: We retrospectively analyzed the clinical data on 109 cases of BPH treated in our hospital from June 2022 to May 2023 by traditional HoLEP with preservation of the apical prostatic urethral valve (group A, n = 52) or inverted-Y urethral function-preserving HoLEP (group B, n = 57). We recorded the intra- and post-operative parameters, evaluated the urinary incontinence status and post-void symptoms according to the International Continence Society standards, and analyzed the effect of inverted-Y versus traditional HoLEP in improving the postoperative urinary incontinence of the patients. RESULTS: The incidence rate of stress urinary incontinence after catheter removal was significantly lower in group B than in A (10.52% vs 26.92%, P = 0.027), and so was it at 2 weeks after surgery (1.75% vs 11.54%, P = 0.037), and at 1 month postoperatively (0% vs 7.69%, P = 0.033). CONCLUSION For the treatment of BPH, inverted-Y urethral function-preserving HoLEP is superior to traditional HoLEP with preservation of the apical prostatic urethral valve in improving stress urinary incontinence after surgery.
Humans ; Male ; Retrospective Studies ; Lasers, Solid-State/therapeutic use* ; Prostatic Hyperplasia/surgery* ; Urethra/surgery* ; Postoperative Complications/prevention & control* ; Urinary Incontinence, Stress/etiology* ; Prostatectomy/adverse effects* ; Aged ; Urinary Incontinence ; Prostate/surgery*

OBJECTIVE: To explore the application value of joint detection of serum neutrophil-to-lymphocyte ratio (NLR), prostate-specific antigen (PSA) and MMP26 in differentiating prostate cancer (PCa) from benign prostatic hyperplasia (BPH). METHODS: A total of 61 PCa patients (PCa group) and 63 BPH patients (BPH group) who were treated in The Affiliated Huaian Hospital of Xuzhou Medical University from May 2022 to May 2024 were retrospectively included. The relevant clinical data of all subjects were collected with the serum NLR, PSA and MMP26 levels being detected. Multivariate logistic regression analysis was used to analyze the influencing factors in differentiating PCa from BPH. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of serum NLR, PSA and MMP26 in differentiating PCa from BPH. RESULTS: The levels of TC and LDL-C in the PCa group were higher than those in the BPH group. And the level of HDL-C in the PCa group was lower than that in the BPH group (P<0.05). The serum levels of NLR, PSA and MMP26 in the PCa group were higher than those in the BPH group (P<0.05). The results of multivariate logistic regression analysis showed that NLR, PSA and MMP26 were risk factors for the diagnosis of PCa in patients (P<0.05). The ROC results showed that the area under the curve (AUC) of NLR, PSA MMP26 and joint diagnosis in the identification of PCa was 0.804, 0.800, 0.809 and 0.905, respectively. The comparison results of AUC showed that the joint diagnosis was superior to the single diagnosis (Z=2.262, 2.177, 2.002, P<0.05). CONCLUSION The joint detection of serum NLR, PSA and MMP26 has significant application value in the differentiation of PCa and BPH, which is expected to become an effective tool for early screening and diagnosis of PCa.
Humans ; Male ; Prostatic Hyperplasia/blood* ; Prostate-Specific Antigen/blood* ; Diagnosis, Differential ; Prostatic Neoplasms/blood* ; Retrospective Studies ; Neutrophils ; Lymphocytes ; ROC Curve ; Aged ; Middle Aged

OBJECTIVE: To explore the impact factors and the clinical significance of the urination intermittences in benign prostatic hyperplasia (BPH) patients. METHODS: A retrospective study was performed in BPH patients who underwent urodynamic studies in Beijing Jishuitan Hospital form January 2016 to June 2021. The patients were aged 45 to 84 years with a median age of 63 years, and all the patients had no previous history of neurological disease and had no positive findings in neurological examinations. All the patients had free uroflometry followed by urethral catheterization and urodynamic tests. The voiding work of bladder was calculated using the detrusor power curve method, and the voiding power of bladder and the voiding energy consumption were also calculated. The frequency of urination intermittences generated in uroflometry was also recorded and the patients were divided into different groups according to it. The detrusor pressure at maximal flow rate (P_detQ_max), the maximal flow rate (Q_max), the bladder contractile index (BCI), the bladder outlet obstruction index (BOOI), the voiding work, the voiding power, and the voiding energy consumption were compared among the different groups. Multiva-riate analyses associated with presence of urination intermittences were performed using step-wise Logistic regressions. RESULTS: There were 272 patients included in this study, of whom, 179 had no urination intermittence (group A), 46 had urination intermittence for only one time (group B), 22 had urination intermittence for two times (group C), and 25 had urination intermittence for three times and more (group D). The BCI were 113.4±28.2, 101.0±30.2, 83.3±30.2, 81.0±30.5 in groups A, B, C, and D, respectively; The voiding power were (29.2±14.8) mW, (16.4±9.6) mW, (14.5±7.1) mW, (8.5±5.0) mW in groups A, B, C, and D, respectively, and the differences were significant (P < 0.05). The BOOI were 41.6±29.3, 46.4±31.0, 41.4±29.0, 42.7±22.8 in groups A, B, C, and D, respectively; The voiding energy consumption were (5.41±2.21) J/L, (4.83±2.31) J/L, (5.02±2.54) J/L, (4.39±2.03) J/L in groups A, B, C, and D, respectively, and the differences were insignificant (P>0.05). Among the patients, 179 cases were negative in presence of urination intermittences and 93 cases were positive. Step-wise Logistic regression analysis showed that bladder power (OR=0.814, 95%CI: 0.765-0.866, P < 0.001), BCI (OR=1.023, 95%CI: 1.008-1.038, P=0.003), and bladder work (OR=2.232, 95%CI: 1.191-4.184, P=0.012) were independent risk factors for urination intermittences in the BPH patients. CONCLUSION The presence of urination intermittences in the BPH patients was mainly influenced by bladder contractile functions, and was irrelevant to the degree of bladder outlet obstruction. The increase of frequency of urination intermittences seemed to be a sign of the decrease of the bladder contractile functions in the BPH patients.
Prostatic Hyperplasia/physiopathology* ; Humans ; Male ; Urodynamics ; Urination ; Retrospective Studies ; Middle Aged ; Aged ; Aged, 80 and over ; Urinary Bladder/physiopathology* ; Urination Disorders/etiology*

Benign prostatic hyperplasia (BPH) is one of the most common diseases in elderly men, the incidence of which gradually increases with age and leads to lower urinary tract symptoms (LUTS), which seriously affects the quality of life of patients. Chinese herbal medicines (CHMs) are widely used for the treatment of BPH in China and some other countries. To explore the molecular mechanisms of CHMs for BPH, we conducted a review based on peer-reviewed English-language publications in PubMed and Web of Science databases from inception to December 31, 2023. This article primarily reviewed 32 papers on the use of CHMs and its active compounds in the treatment of BPH, covering animal and cell experiments, and identified relevant mechanisms of action. The results suggest that the mechanisms of action of CHMs in treating BPH may involve the regulation of sex hormones, downregulation of cell growth factors, anti-inflammatory and antioxidative effects, inhibition of cell proliferation, and promotion of apoptosis. CHMs also exhibit α-blocker-like effects, with the potential to relax urethral smooth muscle and alleviate LUTS. Additionally, we also reviewed 4 clinical trials and meta-analyses of CHMs for the treatment of BPH patients, which provided initial evidence of the safety and effectiveness of CHMs treatment. CHMs treatment for BPH shows advantages as a multi-component, multi-target, and multi-pathway therapy, which can mitigate the severity of the disease, improve LUTS, and may become a reliable treatment option in the future.
Prostatic Hyperplasia/drug therapy* ; Humans ; Drugs, Chinese Herbal/pharmacology* ; Male ; Animals

OBJECTIVES: To develop risk prediction models for postoperative hypothermia after transurethral holmium laser enucleation of the prostate (HoLEP) using machine learning algorithms. METHODS: We retrospectively analyzed the clinical data of 403 patients from our center (283 patients in the training set and 120in the internal validation set) and 120 patients from Weifang People's Hospital (as the external validation set). The risk prediction models were built using logistic regression, decision tree and support vector machine (SVM), and model performance was evaluated in terms of accuracy, recall, precision, F1 score and AUC. RESULTS: Operation duration, prostate weight, intraoperative irrigation volume, and being underweight were identified as the predictors of postoperative hypothermia following HoLEP. Among the 3 algorithms, SVM showed the best precision rate and accuracy in all the 3 data sets and the best area under the ROC (AUC) in the training set and validation set, followed by logistic regression, which had a similar AUC in the two data sets. SVM outperformed logistic regression and decision tree models in the validation set in precision, accuracy, recall, F1 score, and AUC, and performed well in the external validation set with better precision rate and accuracy than logistic regression and decision tree models but slightly lower recall rate, F1 index, and AUC value than the decision tree model. SVM outperformed logistic regression and decision tree models in precision, accuracy, F1 score, and AUC in the training set, but had slightly lower recall rate than the decision tree. CONCLUSIONS Among the 3 models, SVM has the best performance and generalizability for predicting post-HoLEP hypothermia risk to provide support for clinical decisions.
Humans ; Male ; Retrospective Studies ; Machine Learning ; Transurethral Resection of Prostate/adverse effects* ; Hypothermia/etiology* ; Prostatic Hyperplasia/surgery* ; Algorithms ; Lasers, Solid-State ; Risk Assessment ; Postoperative Complications ; Decision Trees ; Logistic Models ; Aged ; Middle Aged ; Support Vector Machine

OBJECTIVE: To observe the clinical efficacy of electroacupuncture (EA) at "four points of sacral region" for mild-to-moderate benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). METHODS: A total of 58 patients with BPH/LUTS were randomly divided into a sacral four-point EA group (29 cases, 1 case dropped out) and a conventional EA group (29 cases, 1 case dropped out). EA was applied at bilateral points 0.5 cun lateral to the sacrococcygeal joint and Huiyang (BL35) in the sacral four-point EA group; and was applied at Guanyuan (CV4), Zhongji (CV3), Qugu (CV2) and bilateral Shuidao (ST28), Sanyinjiao (SP6), Zusanli (ST36) in the conventional EA group. Both groups received continuous wave, 2 Hz in frequency, 30 min a time, once every other day, 3 times a week for 4 weeks. Before treatment, after 2 and 4 weeks of treatment, and in follow-up of 1 month after treatment completion, the international prostate symptom score (IPSS), the overactive bladder symptom score (OABSS), the quality of life (QOL) score were observed; before and after treatment, the prostate volume (PV) was measured by abdominal ultrasound; and the clinical efficacy was evaluated after treatment in the two groups. RESULTS: Compared before treatment, the scores of IPSS, OABSS and QOL were decreased after 4 weeks of treatment and in follow-up in both groups (P<0.01, P<0.05). In the sacral four-point EA group, the scores of IPSS and QOL after 4 weeks of treatment and in follow-up were lower than those in the conventional EA group (P<0.05, P<0.01), and the OABSS score in follow-up was lower than that in the conventional EA group (P<0.05). After 4 weeks of treatment and in follow-up, the reductions of IPSS and OABSS scores compared before treatment in the sacral four-point EA group were larger than those in the conventional EA group (P<0.01, P<0.05); After 2, 4 weeks of treatment and in follow-up, the reductions of QOL score compared before treatment in the sacral four-point EA group were larger than those in the conventional EA group (P<0.01). No significant difference in PV was observed after treatment between the two groups (P>0.05). The total effective rate was 75.0% (21/28) in the sacral four-point EA group, which was higher than 39.3% (11/28) in the conventional EA group (P<0.01). CONCLUSION EA at "four points of sacral region" can effectively improve the LUTS, overactive bladder symptom and quality of life in patients with mild-to-moderate BPH, and has good short-term and long-term efficacy, although it can not reduce prostate volume.
Humans ; Male ; Electroacupuncture ; Prostatic Hyperplasia/complications* ; Aged ; Middle Aged ; Lower Urinary Tract Symptoms/physiopathology* ; Acupuncture Points ; Treatment Outcome ; Quality of Life

OBJECTIVE: To investigate the effect of holmium laser ω-shaped pre-transection of the prostate apex (PTPA) with preservation of the bladder neck on the urinary continence and sexual function of the patients with BPH after transurethral holmium laser enucleation of the prostate (HoLEP). METHODS: This retrospective study included 165 cases of BPH undergoing holmium laser ω-shaped PTPA with preservation of the bladder neck following HoLEP from January 2018 to January 2023. We recorded and compared the baseline, perioperative and 12-month follow-up data on the patients, and evaluated their urination function using IPSS, maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and quality of life (QOL) scores. For those who had had sexual activity and normal ejaculation before surgery, we further assessed their erectile and ejaculatory functions postoperatively. RESULTS: The mean surgical time was (70.35±12.27) min, the intraoperative blood loss (60.12±19.54) ml, and the weight of the excised gland (56.37±13.71) g. The hospital stay and postoperative catheter-indwelling time averaged (5.13±2.34) and (3.21±1.37) d, respectively. Significant improvements were observed in IPSS, QOL, PVR and Qmax at 3, 6 and 12 months after surgery compared with the baseline (P<0.05), which all remained stable throughout the follow-up period. At 3 months after surgery, stress urinary incontinence was found in 10.91% of the patients, and all but 1 case (0.6%) recovered within 12 months. There were no significant changes in the IIEF-5 and Erectile Hardness Scale (EHS) scores postoperatively (P>0.05). Retrograde ejaculation occurred in 19 (11.52%) of the patients, but none experienced painful ejaculation after surgery. CONCLUSION Holmium laser ω-shaped PTPA with preservation of the bladder neck is safe and effective for the treatment of BPH, which can effectively improve the urinary continence and protect the sexual function of the patient.
Humans ; Male ; Prostatic Hyperplasia/surgery* ; Lasers, Solid-State/therapeutic use* ; Retrospective Studies ; Quality of Life ; Urinary Bladder ; Urinary Incontinence ; Transurethral Resection of Prostate/methods* ; Prostate/surgery* ; Ejaculation ; Aged ; Middle Aged

OBJECTIVE: To investigate the risk factors for depression in middle-aged and elderly Chinese male patients with benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS). METHODS: Based on the data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), we included 8 426 male participants aged ≥ 45 years in this study, and explored the risk factors for depression in patients with BPH/LUTS by logistic regression analysis. RESULTS: Among the total number of participants, there were 1 447 cases of BPH/LUTS, with a prevalence rate of 17.2%, and 36.5% of the patients (529/1 447) were complicated by depression. Logistic regression analysis showed that underlying diseases were the risk factors for depression in patients with BPH/LUTS (OR = 1.29, 95% CI: 1.03－1.62), while the protective factors against the condition included high school education or above (OR = 0.52, 95% CI: 0.36－0.75), urban residence (OR = 0.75, 95% CI: 0.60－0.95), eastern region (OR = 0.61, 95% CI: 0.38－0.97), and 6－9 h/d sleep (OR = 0.52, 95% CI: 0.41－0.66). CONCLUSION Underlying diseases, education level, residential area, geographical region, and sleep duration are influencing factors for depression in middle-aged and elderly male patients with BPH/LUTS in China and deserve the attention of clinicians.
Humans ; Male ; Prostatic Hyperplasia/psychology* ; Risk Factors ; Depression/etiology* ; Aged ; Middle Aged ; Lower Urinary Tract Symptoms/psychology* ; China/epidemiology* ; Logistic Models ; Prevalence ; Longitudinal Studies

OBJECTIVES: Postoperative hypothermia is a common clinical complication with a high incidence rate, potentially adversely affecting postoperative recovery. Transurethral holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure for benign prostatic hyperplasia (BPH). Offering advantages such as minimal bleeding, broad indications, and rapid postoperative recovery. However, research on risk factors for postoperative hypothermia following HoLEP remains limited, and predictive models for guiding clinical practice are lacking. This study aims to develop a predictive model for assessing the risk of postoperative hypothermia in HoLEP patients and to identify relevant risk factors. METHODS: Clinical data from patients who underwent HoLEP at affiliated Hospital of Shandong Second Medical University were retrospectively collected. Patients were categorized into a hypothermia group and a non-hypothermia group based on whether postoperative hypothermia occurred. Preoperative, intraoperative, and postoperative indicators were compared between the 2 groups. Least absolute shrinkage and selection operator (LASSO) regression combined with logistic regression analysis was used to analyze clinical data. A predictive model for assessing the risk of postoperative hypothermia after HoLEP was constructed and internally validated using bootstrap resampling. RESULTS: A total of 403 patients were included in the analysis, among whom 85 patients developed postoperative hypothermia, with an incidence rate of 21.1%. Logistic regression analysis identified operative duration (OR=1.009, 95% CI 1.003 to 1.015), underweight status (OR=9.881, 95% CI 4.038 to 24.910), and prostate weight (OR=1.021, 95% CI 1.012 to 1.030) as independent risk factors for postoperative hypothermia, and these variables were incorporated into the nomogram model. Internal validation showed strong discriminative ability of the nomogram, with an area under the receiver operating characteristic curve (AUC) of 0.755 (95% CI 0.686 to 0.820) and a C-index of 0.832 (95% CI 0.787 to 0.865). The calibration curve demonstrated good consistency between predicted and observed outcomes. Decision curve analysis showed that the nomogram provided greater clinical utility when the risk threshold for postoperative hypothermia was between 8% and 97%. CONCLUSIONS This study developed a nomogram model for predicting the risk of postoperative hypothermia in HoLEP patients, providing clinicians with a simple and effective predictive tool for individualized risk assessment and preoperative decision-making.
Humans ; Male ; Nomograms ; Prostatic Hyperplasia/surgery* ; Lasers, Solid-State/adverse effects* ; Risk Factors ; Retrospective Studies ; Transurethral Resection of Prostate/methods* ; Postoperative Complications/epidemiology* ; Hypothermia/epidemiology* ; Middle Aged ; Aged

OBJECTIVES: The conventional Fr26 resectoscope is difficult to use in patients with benign prostatic hyperplasia (BPH) complicated by urethral stricture. This study aims to evaluate the safety and efficacy of transurethral plasmakinetic resection of the prostate (PKRP) using a small-caliber (Fr18.5) plasmakinetic resectoscope combined with urethral dilation in patients with BPH and mild urethral stricture. METHODS: A retrospective analysis was conducted on 37 patients with BPH and mild urethral stricture treated at the Department of Urology, Hunan Provincial People's Hospital from January 2023 to December 2023. All patients underwent PKRP with a small-caliber plasmakinetic resectoscope, followed by routine placement of a Fr20 three-way Foley catheter for continuous bladder irrigation. International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q_max), post-voiding residual urine volume (PVR), and Quality of Life (QOL) scores were compared before and after surgery. Perioperative indicators (intraoperative bleeding, operative time, postoperative catheterization time, and postoperative hospital stay) and complications were recorded. RESULTS: The median age was 69 years, and the median duration of voiding difficulty was 36 months. Median total prostate specific antigen (T-PSA) was 2.095 ng/mL, free prostate specific antigen (F-PSA) 0.561 ng/mL, and F/T ratio 0.3. Median prostate diameter was 48 mm and volume 41 mL. All 37 surgeries were completed successfully: 11 had external meatal stricture, 19 had mild anterior urethral stricture, and 7 had mild posterior urethral stricture (1 patient with a 1 cm pseudo-blind tract near the membranous urethral). Operative time was (2.4±0.7) hours, blood loss was (40±29) mL, median catheterization duration was 7 days, and median hospital stay was 7 days. No cases of postoperative urinary incontinence, recurrent hematuria, or sepsis occurred, and patients were satisfied with the surgical outcome. At 3 to 6 months follow-up, IPSS, Q_max, PVR, and QOL scores significantly improved compared to preoperative levels (all P<0.01), with no cases of urethral stricture progression or new-onset stricture. CONCLUSIONS PKRP using a small-caliber plasmakinetic resectoscope is safe and effective for treating BPH with mild urethral stricture. It offers advantages such as minimal trauma, rapid postoperative recovery, and a lower risk recovery, and a lower risk of aggravating urethral injury.
Humans ; Male ; Prostatic Hyperplasia/complications* ; Urethral Stricture/complications* ; Retrospective Studies ; Aged ; Transurethral Resection of Prostate/instrumentation* ; Middle Aged ; Treatment Outcome ; Quality of Life ; Aged, 80 and over