LUTS: Lower Urinary Tract Symptoms最新文献

{"title":"Ion Channels as Therapeutic Targets in Overactive Bladder: A Narrative Review of Mechanisms, Translational Evidence, and Current Gaps","authors":"Berkay Demirçi,&nbsp;Gülsüm Helvacı,&nbsp;Elif Nur Barut,&nbsp;Seçkin Engin","doi":"10.1111/luts.70080","DOIUrl":"10.1111/luts.70080","url":null,"abstract":"<div>\u0000 \u0000 <p>Overactive bladder (OAB) is a prevalent syndrome whose first-line pharmacotherapy with antimuscarinics and β₃-adrenoceptor agonists is limited by suboptimal efficacy and poor tolerability, underscoring the unmet need for novel molecular targets. As key regulators of detrusor smooth muscle excitability and bladder afferent signaling, ion channels have emerged as a compelling target class capable of modulating bladder function with high spatial precision. This review summarizes current evidence on the role of cation and anion channels in OAB pathophysiology and critically appraises their therapeutic potential, covering the principal channel families implicated in detrusor and afferent dysfunction, including voltage-gated Ca²⁺ and Na⁺ channels, K⁺ channel subfamilies, HCN, TRP, and PIEZO channels, ligand-gated cation channels, ENaC/ASIC, and Cl⁻ channels, with preclinical and clinical evidence integrated throughout. Despite this strong mechanistic rationale, clinical translation has been hampered by ubiquitous channel expression, patient heterogeneity, and the absence of stratifying biomarkers. Although the supporting evidence remains uneven, spanning genetic, ex vivo, and early-phase clinical studies, future progress will likely depend on tissue-selective compounds, biomarker-defined subphenotypes, and emerging targets such as TMEM16A, TRPM4, and PIEZO channels, which represent particularly promising avenues for next-generation OAB pharmacotherapy.</p>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Long-Term Outcomes of Rezūm Therapy for Large-Volume Benign Prostatic Hyperplasia: A Multicenter Cohort Study","authors":"Liberty Liu,&nbsp;Mario Henrique Bitar Siqueira,&nbsp;Naeem Bhojani,&nbsp;Bilal Chughtai,&nbsp;Kevin C. Zorn,&nbsp;Luca Cindolo,&nbsp;Giovanni Ferrari,&nbsp;Katherine Lajkosz,&nbsp;Eviatar Fields,&nbsp;Dean Elterman","doi":"10.1111/luts.70079","DOIUrl":"10.1111/luts.70079","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in aging men. Patients with large prostates (≥ 80 mL) often experience more severe symptoms and have limited minimally invasive treatment options. Water vapor thermal therapy (Rezūm) has demonstrated efficacy in moderate-sized glands, and emerging evidence including multicenter cohorts and systematic reviews suggests efficacy in larger glands. However, long-term real-world multicenter data remain limited. This study evaluates the effectiveness of Rezūm therapy in men urinary status outcomes, sexual function, and prostate size in a large, multicenter real-world cohort with extended follow-up.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We performed a retrospective analysis of a prospectively maintained multicenter registry including patients treated with Rezūm therapy between April 2019 and August 2025 at two high-volume centers in Canada and Italy. Eligible patients had a baseline prostate volume ≥ 80 mL. Outcomes were assessed at baseline and follow-up intervals of 6, 12, 24, and 36 months. Primary outcomes included changes in International Prostate Symptom Score (IPSS), quality of life (QoL), BPH Impact Index (BPHII), maximum urinary flow rate (&lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;max&lt;/sub&gt;), and postvoid residual (PVR). Sexual function was evaluated using the International Index of Erectile Function (IIEF-15) and the Male Sexual Health Questionnaire (MSHQ). Changes in prostate volume at 12 months were also analyzed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 321 patients were included with a mean age of 68.7 years and median prostate volume of 107 mL. Median lobe enlargement was present in 80.1% of patients. Mean IPSS improved from 21.7 ± 6.9 at baseline to 9.9 ± 6.8 at 12 months and 8.4 ± 7.0 at 36 months (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), representing a symptom reduction of up to 62%. QoL scores improved from 4.5 ± 1.1 to 1.6 ± 1.2 at 36 months (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Qmax increased from 8.1 ± 6.5 mL/s at baseline to 14.6 ± 6.7 mL/s at 6 months, while PVR decreased from 144 ± 136 mL to 48 ± 63 mL at 12 months. Erectile and ejaculatory function remained stable during follow-up, with retrograde ejaculation reported in 6.2% of patients. Among 172 patients with imaging follow-up, mean prostate volume decreased by 35.2 mL (29.9%) at 12 months.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Rezūm therapy provides significant and durable improvements in urinary symptoms and functional outcomes in men with large prostates (≥ 80 mL), while ","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretreatment Factors Associated With Pain Improvement After Cernitin Pollen Extract Therapy in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Post Hoc Analysis","authors":"Yoshihisa Matsukawa,&nbsp;Yushi Naito,&nbsp;Satoshi Inoue,&nbsp;Tomokazu Kimura,&nbsp;Momokazu Gotoh,&nbsp;Shusuke Akamatsu","doi":"10.1111/luts.70078","DOIUrl":"10.1111/luts.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Cernitin pollen extract is used for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but pretreatment factors associated with pain improvement remain unclear. This study explored baseline factors associated with clinically meaningful pain relief after cernitin therapy in men with CP/CPPS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This exploratory post hoc analysis was based on a single-center, open-label, randomized prospective trial conducted between July 2017 and December 2018. Men with persistent CP/CPPS despite at least 12 weeks of α1-blocker therapy were randomized to receive add-on cernitin pollen extract or tadalafil for 12 weeks. The present analysis included 42 men assigned to cernitin. Good responders were defined as patients with a ≥ 50% improvement in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) pain subscore. Baseline variables were compared, and exploratory logistic regression analysis with a limited number of covariates was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 42 patients, 21 were good responders and 21 were poor responders. The NIH-CPSI pain subscore improved by 67.0% in good responders and by 28.9% in poor responders (<i>p</i> &lt; 0.001). Baseline serum total testosterone was significantly lower in good responders than in poor responders (4.5 ± 2.9 vs. 6.3 ± 2.4 ng/mL; <i>p</i> = 0.006). In exploratory multivariable analysis, lower serum total testosterone remained the only factor associated with clinically meaningful pain improvement (odds ratio 0.53, 95% confidence interval 0.30–0.95; <i>p</i> = 0.033).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lower pretreatment serum total testosterone was associated with clinically meaningful pain improvement after cernitin therapy. These findings are hypothesis-generating and require validation in larger prospective cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Age, BMI, and Parity on 3D MRI-Derived Morphology of Pelvic Floor Muscle and Levator Ani Hiatus in Women With Stress Urinary Incontinence","authors":"Muhammad Arslan Ghaffar,&nbsp;Bareera Ajmal,&nbsp;Abdourahaman Ibrahim M. Bakour,&nbsp;Armaghan Khalid,&nbsp;Haihong Jiang","doi":"10.1111/luts.70075","DOIUrl":"10.1111/luts.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To measure the morphology of the pelvic floor muscle and levator ani hiatus (LAH) using 3D MRI segmentation in females with (SUI) and to assess correlations with age, body mass index (BMI), and parity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study includes 80 patients with SUI who underwent 3.0 T pelvic MRI. Patients were grouped based on age, BMI, and parity. Manual segmentation and 3D modeling of the pelvic floor muscle and LAH were performed to get volumetric and dimensional measurements. Statistical analysis included Kruskal–Wallis, Mann-Witney, and post hoc testing to evaluate group variations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included patients from 20 to 90 years old (mean 53.9 ± 11.7), with a mean BMI of 25.3 ± 3.4 and a mean parity of 1.85 ± 1.03. Significant variations in LAM surface (H(2) = 6.650, <i>p</i> = 0.036), flatness (H(2) = 6.471, <i>p</i> = 0.039), median intensity (H(2) = 8.218, <i>p</i> = 0.016), and curvature mean (H(2) = 7.382, <i>p</i> = 0.025) among age groups. The greatest LAM surface rankings were found in the 50–65 age range, whereas the highest LAM flatness ranks were found in those over 65 years old. BMI demonstrated a limited association, with overweight/obese participants exhibiting 11.3% larger LAM surface area compared to normal/underweight individuals (<i>p</i> = 0.044, <i>r</i> = 0.225). No significant associations were found between parity and any pelvic floor morphometric parameters (all <i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identifies age-dependent morphological changes in levator ani muscle architecture as the primary determinant of pelvic floor structural adaptation in women with stress urinary incontinence. These quantitative shape-based parameters offer novel diagnostic and therapeutic insights, advancing precision medicine approaches in urogynecological assessment and management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tizanidine as an Adjunct to Alpha-Blockers in Adults With Dysfunctional Voiding/Poor Relaxation of the External Sphincter: A Retrospective Review","authors":"Mayank Mohan Agarwal,&nbsp;Ved Bhaskar,&nbsp;Shailendra Kumar Gupta,&nbsp;Saumya Singh,&nbsp;Shakti Kumar Chowdhary,&nbsp;Vikrant Mishra,&nbsp;Rahul Agnihotri,&nbsp;Devendra Kumar Rathore","doi":"10.1111/luts.70077","DOIUrl":"10.1111/luts.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Skeletal muscle relaxants (SMR), particularly baclofen, have been used in patients with dysfunctional voiding (DV) and poor relaxation of the external sphincter (PRES) with variable efficacy and notable side effects. Tizanidine, a centrally acting <i>α</i>2-adrenergic agonist, may offer comparable benefits with a more favorable tolerability profile. However, data regarding its use in DV remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective analysis included adults diagnosed with DV/PRES between July 2017 and January 2025. Data comprised demographics, lower urinary tract symptoms (LUTS), urodynamic parameters, pre, and posttreatment uroflowmetry values, and subjective response to alpha-blockers with pelvic floor relaxation exercises, and subsequent addition of tizanidine. Uroflowmetry indices included Qmax, Qave, and volume-normalized flow indices (VQImax, VQIave). Clinical outcomes were assessed via patient-reported symptom improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 114 patients, 62.2% showed no response to alpha-blockers alone. Following addition of tizanidine (median dose 6 mg/day), 69.3% reported symptomatic improvement (45% ≥ 50% improvement, 24.6% &lt; 50% improvement; <i>p</i> &lt; 0.00001). VQImax improved by ≥ 50% in 52% of patients, and clinical improvement significantly correlated with changes in VQImax (<i>p</i> = 0.004) and VQIave (<i>p</i> = 0.009). Women demonstrated greater improvement in flow parameters than men (<i>p</i> &lt; 0.05), although symptom relief was similar across sexes. Tizanidine was generally well tolerated, with sedation being the most common dose-limiting side effect (25%). Median follow up duration was 12 months (IQR 9–22).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Addition of tizanidine to alpha-blocker and pelvic relaxation is associated with clinically significant improvement in LUTS and uroflometry parameters in adults with pelvic floor dysfunction. We acknowledge that causal inference is limited by the study design and randomized placebo-controlled studies are required for deriving stronger conclusions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Bladder Ischemia Enhances Mechanosensitive Afferent C-Fiber Activity: Insights From a Newly Developed Female Rat Model","authors":"Naoki Aizawa,&nbsp;Hiroki Natsuya,&nbsp;Hidenori Akaihata,&nbsp;Yen Po Wang,&nbsp;Munemasa Sugimoto,&nbsp;Tomoe Fujita,&nbsp;Yoshiyuki Kojima","doi":"10.1111/luts.70076","DOIUrl":"10.1111/luts.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to develop and validate an atherosclerosis-induced chronic bladder ischemia (CBI) model in female rats and to evaluate mechanosensitive single-unit afferent activity (SAA) in bladder-innervating fibers in both male and female CBI models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sprague–Dawley rats of both sexes were divided into sham and CBI groups. The CBI group underwent balloon-induced endothelial injury of the iliac arteries and received a 2% cholesterol diet for 8 weeks. Sham rats underwent bilateral inguinal incisions without arterial injury and were fed a regular diet. In female rats, iliac arterial wall thickening, 24-h voiding behavior, cystometric parameters, bladder blood flow, and fibrosis were assessed to evaluate CBI-induced bladder dysfunction. SAAs were recorded under urethane anesthesia. Bladder-innervating fibers were identified via electrical stimulation of the left pelvic nerve and bladder distension. Fibers were classified as Aδ- or C-fibers based on conduction velocity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Female CBI rats showed thickening of the common iliac arteries, increased voiding frequency, shortened intercontraction intervals, reduced bladder blood flow, and detrusor smooth muscle fibrosis, consistent with previous studies in male rats. In both sexes, the CBI group showed significantly higher SAAs in C-fibers than the sham group. No significant differences were found in SAAs of Aδ-fibers, although there was a tendency for female CBI rats to show higher activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study successfully established arteriosclerosis-induced CBI accompanied by frequent voiding in female rats, similar to males. In addition, the present findings suggest that C-fiber, but not Aδ-fiber, afferent activity is selectively facilitated under CBI conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Free-Flow Uroflowmetry as an Adjunct in Management of Urinary Tract Dysfunction for Children “At-Risk” for Neurogenic Bladder","authors":"Akash Mishra,&nbsp;Kanika Sharma,&nbsp;Sarita Chawdhary,&nbsp;Pranaya Kumar Panigrahi,&nbsp;Sameer Trivedi,&nbsp;Shiv Prasad Sharma","doi":"10.1111/luts.70074","DOIUrl":"10.1111/luts.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Invasive urodynamic study(UDS) remains the gold-standard test for diagnosing and characterizing the neurogenic bladder. UDS being an invasive test is difficult to implement as a screening test for children who are predisposed for neurogenic bladder. An observational study was conducted to evaluate the urodynamic features of lower urinary tract dysfunction (LUTD) in follow-up pediatric surgical (nonurological primary etiology) cases “at-risk” for neurogenic bladder and the efficacy of noninvasive uroflowmetry was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective study was done from November 2019 to December 2022. All the postoperative patients with a history of primary non-urological congenital anomalies, aged less than 15 years presenting with LUTD were included. Noninvasive free-flow uroflowmetry and invasive UDS were done for these patients. Abnormal UDS defined in terms of voiding pattern was compared with abnormal uroflowmetry defined as inadequate Qmax and nonbell shaped flow curve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-four children with primary diagnosis of spina-bifida (<i>n</i> = 12), anorectal malformation (<i>n</i> = 20), and sacrococcygeal teratoma (<i>n</i> = 2) were included, who presented with LUTD at a mean age of 4.76 ± 1.60 years. 29.4% children had acontractile bladder at presentation. Abnormal findings of uroflowmetry were comparable to abnormal findings of UDS (<i>p</i> &gt; 0.05; kappa &gt; 0.7). Uroflowmetry had sensitivity of 88.2% and specificity of 82.3% in diagnosing neurogenic bladder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Delayed presentation of neurogenic bladder with irreversible detrusor changes in predisposed cases highlights the need for stringent follow-up. Noninvasive uroflowmetry has high sensitivity and specificity with respect to invasive UDS in identifying neurogenic bladder in predisposed cases; it can be implemented as a routine screening test in predisposed cases to identify the at-risk cases in advance of clinical symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BOOI-Defined Obstruction Stratifies Early Outcomes After ThuLEP in Men With Detrusor Underactivity: A Retrospective Complete-Case Cohort Study","authors":"Wei Ding,&nbsp;Lin Li,&nbsp;Heqian Liu,&nbsp;Yingqing Liu,&nbsp;Jiawei Wang,&nbsp;Zhonglang Wang,&nbsp;Lingsong Tao","doi":"10.1111/luts.70073","DOIUrl":"10.1111/luts.70073","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The benefit of transurethral outlet surgery in men with benign prostatic enlargement/benign prostatic obstruction (BPE/BPO) and detrusor underactivity (DU) remains uncertain, particularly when bladder outlet obstruction (BOO) is not demonstrated by pressure-flow testing.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To evaluate early outcomes after transurethral thulium laser enucleation of the prostate (ThuLEP) in men with DU and BPE/BPO-related voiding dysfunction, and to examine whether BOOI-defined obstruction status stratifies early postoperative improvement.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We retrospectively reviewed 189 ThuLEP records from a single centre and constructed a 100-patient complete-case cohort with interpretable preoperative pressure-flow studies and 3-month follow-up. DU was defined as bladder contractility index (BCI) &lt; 100. BOO status was classified using bladder outlet obstruction index (BOOI) as definite BOO, equivocal BOO or no BOO. Functional, symptom, catheter-removal, anatomical and safety outcomes were compared descriptively across BOO strata.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Ninety-one patients (91.0%) had DU: 56 had definite BOO, 25 had equivocal BOO and 10 had no BOO. In the DU cohort, mean &lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;max&lt;/sub&gt; increased from 3.88 ± 1.76 mL/s at baseline to 9.98 ± 3.68 mL/s at 1 month and 11.03 ± 4.02 mL/s at 3 months (both &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Mean PVR decreased from 267.8 ± 167.4 to 142.6 ± 115.3 mL and 124.7 ± 103.4 mL, respectively (both &lt;i&gt;p&lt;/i&gt; &lt; 0.001). IPSS and QoL also improved. Because enucleated specimen weight was unavailable, postoperative prostate volume was analyzed as an anatomical surrogate; mean 3-month postoperative prostate volume was 18.8 ± 4.3 mL, corresponding to an absolute volume reduction of 38.0 ± 14.2 mL and a percentage reduction of 65.4% ± 6.3% in the DU cohort. Catheter-removal success was 83.9% in definite BOO, 68.0% in equivocal BOO and 40.0% in no BOO patients (descriptive &lt;i&gt;p&lt;/i&gt; = 0.009).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Preoperative BOOI-based stratification may help counsel men with DU regarding expected early functional improvement after ThuLEP. BOOI-defined no-BOO patients in this cohort were clinically selected after counseling, and the findings should be interpreted as exploratory because of the retrospective design, complete-case selection, short follow-up, and the small no-BOO su","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148226208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Aquablation Therapy Improve Lower Urinary Tract Symptoms in Patients Aged ≥ 75 Years With Benign Prostatic Obstruction?","authors":"Shin Koike,&nbsp;Yu Ozawa,&nbsp;Sunao Nohara,&nbsp;Kei Ushijima,&nbsp;Keita Okamoto,&nbsp;Toshiaki Kayaba,&nbsp;Masumi Yamada,&nbsp;Keisuke Aoki,&nbsp;Yu Odagaki,&nbsp;Hideo Sakamoto,&nbsp;Dean Elterman,&nbsp;Kunihiko Yoshioka","doi":"10.1111/luts.70072","DOIUrl":"10.1111/luts.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Aquablation therapy is an effective treatment for benign prostatic obstruction. However, its functional outcomes in older patients remain underexplored. In this study, we aimed to compare improvements in lower urinary tract symptoms (LUTS) after Aquablation therapy in patients aged ≥ 75 and ≤ 74 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed data from 103 men with moderate-to-severe LUTS who underwent Aquablation between 2023 and 2025. Patients were stratified into two age groups (years): ≤ 74 (<i>n</i> = 72) and ≥ 75 (<i>n</i> = 31). Primary outcomes included changes in the International Prostate Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximum urinary flow rate (Qmax), and post-void residual (PVR) from baseline to 3 months postoperatively. Secondary outcomes included transfusion and complication rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After 3 months, both groups showed significant improvements in total IPSS (−10.46 and −7.38 in those aged ≤ 74 and ≥ 75 years, respectively), QoL (−2.32 vs. −2.33), Qmax (+8.67 vs. +6.03 mL/s), and PVR (−89.1 vs. −75.3 mL; all <i>p</i> &lt; 0.05). In the ≥ 75 group, voiding subscores, including incomplete emptying, intermittency, weak stream, and straining, improved significantly (<i>p</i> &lt; 0.05), whereas storage symptoms, including frequency, urgency, and nocturia, did not (<i>p</i> = 0.07, 0.6, and 0.7, respectively). In patients aged ≤ 74 years, both voiding and storage symptom subscores improved significantly. No significant differences in operative time, transfusion rate, or complication rate were observed between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Aquablation therapy is a safe and effective surgical option for patients aged ≥ 75 years. In this older population, although storage symptoms were less treatment-responsive, substantial improvements in voiding symptoms and overall QoL were achieved.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ejaculatory Hood-Sparing Photoselective Vaporization of the Prostate: A Retrospective Single-Center Pilot Study Evaluating Ejaculation Preservation With Bladder Neck Opening","authors":"Kazushi Hanawa,&nbsp;Nozomu Watanabe,&nbsp;Kenzo Nakamura,&nbsp;Takuji Tsukamoto,&nbsp;Yoshitaka Kuwahara,&nbsp;Takahiko Mitsui","doi":"10.1111/luts.70071","DOIUrl":"10.1111/luts.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the feasibility, safety, and short-term functional outcomes of adding bladder neck opening and ventral adenoma vaporization to ejaculatory hood (EH)-sparing photoselective vaporization of the prostate (PVP), aimed at preserving antegrade ejaculation in patients with benign prostatic obstruction (BPO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, single-center pilot study included 27 patients with BPO who underwent PVP at our institution with the purpose of preserving ejaculatory function. EH was defined as the area within approximately 1 cm proximal and lateral to the verumontanum, which was preserved during bladder neck opening and ventral adenoma vaporization to create an unobstructed cavity from the prostatic apex to the bladder neck. The primary endpoint was the preservation of antegrade ejaculation at 3 months postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 3 months postoperatively, 26 (96%) of 27 patients had preserved antegrade ejaculation, and one (4%) patient was suspected of retrograde ejaculation. The median International Prostate Symptom Score decreased from 21 to 7, and the quality-of-life score decreased from 5 to 2. Further, the maximum flow rate increased from 5.4 to 14.3 mL/s, and the postvoid residual urine volume decreased from 72.5 to 0 mL (all <i>p</i> &lt; 0.001). The median prostate volume decreased from 60 to 24 mL, and Clavien-Dindo grade III or higher adverse events were not observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EH-sparing PVP with bladder neck opening and ventral adenoma vaporization was feasible and safe in the short term and was associated with preserved antegrade ejaculation and improved urinary outcomes in patients with BPO. Further prospective studies with validated sexual function assessment and longer follow-up are necessary to confirm these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}