Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a m...Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.展开更多
To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate （PKEP） for the treatment of symptomatic benign prostatic hyperplasia （BPH） compared with 160-W lithium triboride laser photoselectiv...To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate （PKEP） for the treatment of symptomatic benign prostatic hyperplasia （BPH） compared with 160-W lithium triboride laser photoselective vaporization of the prostate （PVP）. From February 2011 to July 2012, a prospective nonrandomized study was performed. One-hundred one patients underwent PKEP, and 110 underwent PVP. No severe intraoperative complications were recorded, and none of the patients in either group required a blood transfusion. Shorter catheterization time （38.14 ± 23.64 h vs 72.54 ± 28.38 h, P 〈 0.001） and hospitalization （2.32 ± 1.25 days vs 4.07±1.23 days, P 〈 0.001） were recorded in the PVP group. At 12-month postoperatively, the PKEP group had a maintained and statistically improvement in International Prostate Symptom Score （IPSS） （4.07 ±2.07 vs 5.00 ±2.10; P〈 0.001）, quality of life （QoL） （1.08 ± 0.72 vs 1.35 ± 0.72; P= 0.007）, maximal urinary flow rate （Qmax） （24.75±5.87 ml s^-1 vs 22.03 ±5.04 ml s^-1; P 〈 0.001）, postvoid residual urine volume （PVR） （14,29 ± 6,97 ml vs 17.00±6.11 ml; P = 0,001）, and prostate-specific antigen （PSA） value （0.78 ±0.57 ng ml^-1 vs 1.27 ±1.07 ng ml^-1; P 〈 0.001）. Both PKEP and PVP relieve low urinary tract symptoms （LUTS） due to BPH with low complication rates. PKEP can completely remove prostatic adenoma while the total amount of tissue removed by PVP is less than that can be removed by PKER Based on our study of the follow-up, PKEP provides better postoperative outcomes than PVP.展开更多
In this study, we examined the relationship between sex hormone levels and lower urinary tract symptoms （LUTS） in men with benign prostatic hyperplasia （BPH） who underwent transurethral surgery. The study was cond...In this study, we examined the relationship between sex hormone levels and lower urinary tract symptoms （LUTS） in men with benign prostatic hyperplasia （BPH） who underwent transurethral surgery. The study was conducted in 158 patients who came to our hospital for surgery. Clinical conditions were assessed by body mass index （BMI）, digital rectal examination, International Prostate Symptom Score （IPSS） and transrectal ultrasound （TRUS）. The levels of sex hormones （including total testosterone （TT）, estradiol （E2）, progesterone （P）, luteinizing hormone （LH）, follicle-stimulating hormone （FSH） and prolactin （PRL）） and prostate-specific antigen （PSA） were reviewed. Correlations were determined through statistical analysis. The mean age was 72.06 _＋ 8.68 years. The total IPSS was significantly associated with the TT level （r = -0.21, P = 0.01）. Other sex hormone levels were not correlated with total IPSS. However, some ratios such as E2/TT （r = 0.23, P = 0o00） and FSH/LH （r = -0.17, P = 0.04） were associated with total IPSS. Further analysis showed that the nocturia was associated with age （r = 0.16, P = 0.04）, BMI （r = 0.21, P = 0.01）, and TT （r = -0.19, P = 0.02）. Moreover, we divided the patients into two subgroups based on IPSS severity （〈20 or 〉20）. The mean TT level was in the normal range, but it was significantly related to the presence of severe LUTS. In summary, our study has shown that the severity of LUTS is associated with TT, EJTT and FSH/LH in men who underwent prostate surgery. Increasing nocturia was observed in lower testosterone patients. Additional larger studies are needed to elucidate the potential mechanisms.展开更多
This study was designed to investigate the association between immune inflammation and androgen receptor （AR） expression in benign prostatic hyperplasia （BPH）. We retrospectively analyzed 105 prostatectomy specime...This study was designed to investigate the association between immune inflammation and androgen receptor （AR） expression in benign prostatic hyperplasia （BPH）. We retrospectively analyzed 105 prostatectomy specimens. An immune inflammation score for each specimen was defined by combining three immunohistochemical markers （CD4, CD8 and CD20）. The immunohistochemical markers were CD4 and CD8 for T lymphocytes, CD20 for B lymphocytes and AR antibody for the AR in BPH samples. Rates of CD4, CD8, CD20 and AR expression in BPH were 20 （19.0%）, 21 （20.0%）, 101 （96.2%） and 48 （45.7%）, respectively. Total prostate volume （TPV） was higher in the immune inflammation group than in the non-immune inflammation group （62.7 ml vs. 49.2 ml, t=-2.482, P〈0.05）. Patients in the immune inflammation group had a higher serum prostate-specific antigen （PSA） than those in the non-inflammation group （7.5 ng m1-1 vs. 5.4 ng m1-1, t=-2.771, P〈0.05）. Specifically, the immune inflammation group showed a higher rate of AR expression than the non-inflammation group （56.1% vs. 28.2%, χ2=7.665, P〈0.05）. Our study revealed a strong association between immune inflammation and TPV, serum PSA and AR expression in BPH tissue. Prostate hyperplasia caused by an immune inflammatory process may contribute to BPH progression over time. Therefore, the inflammatory response involved in BPH may be a prime therapeutic target.展开更多
A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） ...A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.展开更多
Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethra...Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.展开更多
In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate （PK-TURP） for patients with benign prostatic hyperplasia （BPH） with ac...In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate （PK-TURP） for patients with benign prostatic hyperplasia （BPH） with acute urinary retention （AUR）. We conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1126 BPH patients were divided into AUR （n = 348） and non-AUR groups （n = 778）. After the urethral catheters were removed, the urine white blood cell （WBC） count in the AUR group significantly increased compared with the non-AUR group （P〈 0.01）. However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group （P 〈 0.001）. A total of 87.1% （303/348） patients in the AUR group and 84.1% （654/778） patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group （P 〈 0.01）. The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3-12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-PK-TURP. In conclusion, immediate PK-TURP surgery on patients accompanied by AUR was safe and effective.展开更多
Objective This study aimed to evaluate the effectiveness of acupuncture for benign prostatic hyperplasia(BPH).Methods We searched PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,Chinese National ...Objective This study aimed to evaluate the effectiveness of acupuncture for benign prostatic hyperplasia(BPH).Methods We searched PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,Chinese National Knowledge Infrastructure,Wanfang Data,and China Science and Technology Journal Database from their inceptions to February 1,2022.The language was restricted to English and Chinese.Two researchers independently screened the literature,extracted data,and evaluated the risk bias of the included study according to the Cochrane Handbook 5.1.0.A meta-analysis was performed using Review Manager version 5.3.Results Twenty-two studies with 1,765 participants were selected to be incorporated in the meta-analysis.The experimental groups(EGs)showed greater benefit on therapeutic effects(relative risk[RR]:1.23,95%CI:1.16,1.3;P<0.00001),International Prostate Score Scale(mean difference[MD]:-2.06,95%CI:-3.17,-0.96;P=0.0002),maximum urinary flow rate(MD:1.7,95%CI:0.89,2.52;P<0.0001),postvoid residual urine volume(MD:-8.25,95%CI:-12.14,-4.36;P<0.0001),quality of life(MD:-0.55,95%CI:-0.8,-0.29;p<0.0001)compared with the control groups,whereas for prostate volume(MD:-0.87,95%CI:-2.66,0.92;P=0.34)was not significantly improved in the EGs.Nevertheless,no statistical variation in the reduction of adverse reactions was observed.Conclusion Acupuncture therapy,a wildly applied complementary–alternative treatment,may help in the management of BPH.展开更多
Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelin...Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.展开更多
Objective:This study aims to investigate the potential molecular mechanism of Salvia miltiorrhiza in treating benign prostatic hyperplasia(BPH)based on network pharmacology.Methods:Active components of Salvia miltiorr...Objective:This study aims to investigate the potential molecular mechanism of Salvia miltiorrhiza in treating benign prostatic hyperplasia(BPH)based on network pharmacology.Methods:Active components of Salvia miltiorrhiza were screened via the TCMSP database,and their potential targets were predicted using Swiss Target Prediction.BPH-related targets were obtained from Gene Cards and OMIM databases.Common targets between the herb and BPH were used to con-struct a protein-protein interaction(PPI)network via STRING and visualized using Cytoscape.Core targets were identifi ed,and Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were conducted(P≤0.01).Results:A total of 57 active components and 818 targets of Salvia miltiorrhiza were identifi ed.Intersection analysis yielded 458 potential targets associated with BPH.PPI network analysis revealed core targets including SRC,PIK3R1,and PIK3CA.GO enrichment analysis indicated that the targets were primarily associated with biological processes(BP)such as calcium ion homeostasis,cellular components(CC)including focal adhesions,and molecular functions(MF)such as tyrosine kinase activity.KEGG pathway analysis indicated that Salvia miltiorrhiza may exert therapeutic effects through pathways including MAPK,PI3K-Akt,and calcium signaling(P≤0.01).Conclusion:Salvia miltiorrhiza may regulate BPH through a multi-component,multi-target,and multi-pathway network,providing a theoretical basis for its clinical application.展开更多
Background:The burden of common urologic diseases,including benign prostatic hyperplasia(BPH),urinary tract infections(UTI),urolithiasis,bladder cancer,kidney cancer,and prostate cancer,varies both geographically and ...Background:The burden of common urologic diseases,including benign prostatic hyperplasia(BPH),urinary tract infections(UTI),urolithiasis,bladder cancer,kidney cancer,and prostate cancer,varies both geographically and within specific regions.It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.Methods:We obtained data on incidence,prevalence,mortality,and disability-adjusted life-years(DALYs)for the aforementioned urologic diseases by age,sex,location,and year from the Global Burden of Disease(GBD)2021.We analyzed the burden associated with urologic diseases based on socio-demographic index(SDI)and attributable risk factors.The trends in burden over time were assessed using estimated annual percentage changes(EAPC)along with a 95%confidence interval(CI).Results:In 2021,BPH and UTI were the leading causes of age-standardized incidence rate(ASIR)and age-standardized prevalence rate(ASPR),with rates of 5531.88 and 2782.59 per 100,000 persons,respectively.Prostate cancer was the leading cause of both age-standardized mortality rate(ASMR)and age-standardized DALYs rate(ASDR),with rates of 12.63 and 217.83 per 100,000 persons,respectively.From 1990 to 2021,there was an upward trend in ASIR,ASPR,ASMR,and ASDR for UTI,while urolithiasis showed a downward trend.The middle and low-middle SDI quintile levels exhibited higher incidence,prevalence,mortality,and DALYs related to UTI,urolithiasis,and BPH,while the high and high-middle SDI quintile levels showed higher rates for the three cancers.The burden of these 6 urologic diseases displayed diverse age and sex distribution patterns.In 2021,a high body mass index(BMI)contributed to 20.07%of kidney cancer deaths worldwide,while smoking accounted for 26.48%of bladder cancer deaths and 3.00%of prostate cancer deaths.Conclusions:The global burden of 6 urologic diseases presents a significant public health challenge.Urgent international collaboration is essential to advance the improvement of urologic disease management,encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.展开更多
Benign prostatic hyperplasia(BPH)represents a prevalent etiology of lower urinary tract symptoms(LUTS)in the male population,clinically defined by a nonmalignant proliferation of prostatic tissue.While BPH exhibits a ...Benign prostatic hyperplasia(BPH)represents a prevalent etiology of lower urinary tract symptoms(LUTS)in the male population,clinically defined by a nonmalignant proliferation of prostatic tissue.While BPH exhibits a high prevalence among older male populations globally,the precise underlying mechanisms contributing to its development remain incompletely elucidated.Mitochondria,essential organelles within eukaryotic cells,are critical for cellular bioenergetics,the regulation of reactive oxygen species(ROS)generation,and the modulation of cell death pathways.The maintenance of mitochondrial homeostasis involves a complex interplay of processes.By synthesizing previous literature,this review discusses mitochondrial homeostasis in prostate glands and the role of mitochondrial dysfunction in the context of BPH.Furthermore,the review delved into each dimension of mitochondrial dysfunction in the specific etiology of BPH,highlighting its impact on cell survival,apoptosis,ferroptosis,oxidative stress and androgen receptor(AR).Overall,this review aims to unveil the crosstalk between mitochondrial dysfunction and BPH and identify intrinsic mechanisms.展开更多
5α-reductase inhibitors （5α-RIs）, including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia （BPH）. Many studies reported that preoperative 5α-RI had impact on i...5α-reductase inhibitors （5α-RIs）, including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia （BPH）. Many studies reported that preoperative 5α-RI had impact on intraoperative haemorrhage during surgery for BPH, but it was still in controversial. So, we conducted a systematic review of the effects and mechanisms of 5α-RIs on intraoperative bleeding for BPH. MEDLINE, EMBASE, the Cochrane Controlled Trail Register of Controlled Trials and the reference lists of retrieved studies were searched in the analysis. Sixteen publications involving 15 different randomized controlled trials （RCTs） and a total of 1156 patients were used in the analysis, including 10 RCTs for finasteride and five RCTs for dutasteride. We found that preoperative finasteride treatment decreases microvessel density （MVD） in resected prostate specimens. Total blood loss, blood loss per gram of resected prostate tissue and decreases in haemoglobin were all greatly reduced in the finasteride group as compared to controls. Dutasteride appeared to have no effect on bleeding. This meta-analysis shows that preoperative finasteride treatment could decrease intraoperative haemorrhage during surgery for BPH. Preoperative dutasteride had no effect on intraoperative haemorrhage, but further high-qualitv prospective studies are still needed to confirm this observation.展开更多
Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprap...Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.展开更多
Background:Benign prostatic hyperplasia(BPH)is the most common disease in elderly men.There is increasing evidence that periodontitis increases the risk of BPH,but the specific mechanism remains unclear.This study aim...Background:Benign prostatic hyperplasia(BPH)is the most common disease in elderly men.There is increasing evidence that periodontitis increases the risk of BPH,but the specific mechanism remains unclear.This study aimed to explore the role and mechanism of the key periodontal pathogen Porphyromonas gingivalis(P.gingivalis)in the development of BPH.Methods:The subgingival plaque(Sp)and prostatic fluid(Pf)of patients with BPH concurrent periodontitis were extracted and cultured for 16S r DNA sequencing.Ligature-induced periodontitis,testosterone-induced BPH and the composite models in rats were established.The P.gingivalis and its toxic factor P.gingivalis lipopolysaccharide(P.gLPS)were injected into the ventral lobe of prostate in rats to simulate its colonization of prostate.P.g-LPS was used to construct the prostate cell infection model for mechanism exploration.Results:P.gingivalis,Streptococcus oralis,Capnocytophaga ochracea and other oral pathogens were simultaneously detected in the Sp and Pf of patients with BPH concurrent periodontitis,and the average relative abundance of P.gingivalis was found to be the highest.P.gingivalis was detected in both Sp and Pf in 62.5%of patients.Simultaneous periodontitis and BPH synergistically aggravated prostate histological changes.P.gingivalis and P.gLPS infection could induce obvious hyperplasia of the prostate epithelium and stroma(epithelial thickness was 2.97-fold and 3.08-fold that of control group,respectively),and increase of collagen fibrosis(3.81-fold and 5.02-fold that of control group,respectively).P.gingivalis infection promoted prostate cell proliferation,inhibited apoptosis,and upregulated the expression of inflammatory cytokines interleukin-6(IL-6;4.47-fold),interleukin-6 receptor-α(IL-6Rα;5.74-fold)and glycoprotein 130(gp130;4.47-fold)in prostatic tissue.P.g-LPS could significantly inhibit cell apoptosis,promote mitosis and proliferation of cells.P.g-LPS activates the Akt pathway through IL-6/IL-6Rα/gp130 complex,which destroys the imbalance between proliferation and apoptosis of prostate cells,induces BPH.Conclusion:P.gingivalis was abundant in the Pf of patients with BPH concurrent periodontitis.P.gingivalis infection can promote BPH,which may affect the progression of BPH via inflammation and the Akt signaling pathway.展开更多
Background:Fibrosis constitutes a significant pathophysiological mechanism in the clinical progression of benign prostatic hyperplasia(BPH)and represents a contributing factor to the ineffectiveness of prevailing phar...Background:Fibrosis constitutes a significant pathophysiological mechanism in the clinical progression of benign prostatic hyperplasia(BPH)and represents a contributing factor to the ineffectiveness of prevailing pharmacological treatments.Emerging evidence suggests a close association between microbial presence and the development of fibrosis.Nonetheless,the potential involvement of microbes within prostatic tissue in the pathogenesis of BPH and prostatic fibrosis,along with the underlying mechanisms,remains unexplored.Methods:Utilizing immunohistochemistry and microbial sequencing,we analyzed the microbes of prostate tissues from BPH patients with different degrees of prostate fibrosis and found that Salmonellaenterica(S.enterica)was enriched in the high degree of prostate fibrosis.We developed prostate cell and animal models infected with the lipopolysaccharide of S.enterica(S.e-LPS)to assess its impact on prostate fibrosis.To elucidate the underlying functional mechanisms,we employed molecular biology techniques,including RNA degradation assays,N6-methyladenosine(m6A)dot blotting,RNA immunoprecipitation,and m6A immunoprecipitation.Results:Microbial diversity differed between low-and high-fibrosis groups,with S.enterica showing the highest mean abundance among the 4 species that differed significantly.S.e-LPS was detected in S.enterica-rich prostate tissue and was found to significantly promote cell proliferation,cell contractility,lipid peroxidation,and the induction of ferroptosis.Animal experiments demonstrated that S.e-LPS infection led to pronounced hyperplasia of the prostatic epithelium,with epithelial thickness increasing to 1.57 times that of the sham group,and collagen fibrosis increasing to 2.84 times that of the sham group,thereby exacerbating prostatic tissue fibrosis in rats.Invitro experiments further revealed that S.e-LPS promoted prostate cell fibrosis by inducing ferroptosis.Mechanistically,it was determined that S.e-LPS regulates ferroptosis via AlkB homolog 5(ALKBH5)-mediated m6A modification,which affects the stability of glutathione peroxidase 4(GPX4)mRNA,thereby affecting prostatic fibrosis.Conclusion:The findings of this study suggest that S.enterica promotes prostatic fibrosis through ALKBH5-m6A-GPX4-mediated ferroptosis.This research offers novel insights for the development of new therapeutic targets and personalized strategies for the prevention and treatment of BPH from the perspectives of microbes and epigenetics.展开更多
Benign prostatic hyperplasia(BPH)is a common condition affecting the quality of life and health status of elderly men.Its incidence increases with age and is often accompanied by symptoms such as urinary frequency,urg...Benign prostatic hyperplasia(BPH)is a common condition affecting the quality of life and health status of elderly men.Its incidence increases with age and is often accompanied by symptoms such as urinary frequency,urgency,nocturia,difficulty voiding,and even urinary retention.While conventional Western medicine can alleviate symptoms,it frequently carries risks of side effects and disease recurrence.Traditional Chinese Medicine approaches this condition based on the characteristic patterns observed in the elderly population:predominantly deficiency and blood stasis,with chronic conditions leading to blood stasis.The Yiqi Huoxue method—aimed at tonifying Qi and activating blood circulation—has been shown to improve urinary symptoms,enhance quality of life,and promote overall health in elderly BPH patients.This article explores the application of the Yiqi Huoxue therapeutic principle in managing benign prostatic hyperplasia.展开更多
Lower urinary tract symptoms suggestive of benign prostate hyperplasia(LUTS/BPH)and depression are both increasing in Chinese aging males.However,the relationship still remains unknown.To explore their relationship,a ...Lower urinary tract symptoms suggestive of benign prostate hyperplasia(LUTS/BPH)and depression are both increasing in Chinese aging males.However,the relationship still remains unknown.To explore their relationship,a retrospective cohort study based on propensity score matching(PSM)was conducted by analyzing the China Health and Retirement Longitudinal Study dataset.After data cleaning,a total of 5125 participants were enrolled and subjected to PSM;1351 pairs were matched and followed for 2 years.Further logistic regression and restricted cubic spline(RCS)were performed to evaluate,model and visualize the relationship between depression and LUTS/BPH.Moreover,subgroup analyses and sensitivity analyses were adopted to verify the robustness of the conclusions.Before PSM,depressive patients showed higher odds of LUTS/BPH in all three models adjusting for different covariates(P<0.001).After PSM,univariate logistic regression revealed that depressive patients had higher risks for LUTS/BPH than participants in the control group(odds ratio[OR]=2.10,P<0.001).The RCS results indicated a nonlinear(P<0.05)and inverted U-shaped relationship between depression and LUTS/BPH.In the subgroup analyses,no increased risks were found among participants who were not married or cohabitating,received an education,had an abnormal body mass index(<18.5 kg m−2 and≥28 kg m−2),slept more than 6 h,did not smoke,and drank less than once a month(all P>0.05).The results of sensitivity analyses indicated identical increased risks of LUTS/BPH in all four models(all P<0.001).In conclusion,depression enhances the risks of LUTS/BPH in aging males.展开更多
Enhanced recovery after surgery(ERAS)measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia(BPH).This study was performed on patients with BPH who required surgical int...Enhanced recovery after surgery(ERAS)measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia(BPH).This study was performed on patients with BPH who required surgical intervention.From July 2019 to June 2020,the ERAS program was applied to 248 patients,and the conventional program was applied to 238 patients.After 1 year of follow-up,the differences between the ERAS group and the conventional group were evaluated.The ERAS group had a shorter time of urinary catheterization compared with the conventional group(mean±standard deviation[s.d.]:1.0±0.4 days vs 2.7±0.8 days,P<0.01),and the pain(mean±s.d.)was significantly reduced through postoperative hospitalization days(PODs)0-2(POD 0:1.7±0.8 vs 2.4±1.0,P<0.01;POD 1:1.6±0.9 vs 3.5±1.3,P<0.01;POD 2:1.2±0.7 vs 3.0±1.3,P<0.01).No statistically significant difference was found in the rate of postoperative complications,such as postoperative bleeding(P=0.79),urinary retention(P=0.40),fever(P=0.55),and readmission(P=0.71).The hospitalization cost of the ERAS group was similar to that of the conventional group(mean±s.d.:16927.8±5808.1 Chinese Yuan[CNY]vs 17044.1±5830.7 CNY,P=0.85).The International Prostate Symptom Scores(IPSS)and quality of life(QoL)scores in the two groups were also similar when compared at 1 month,3 months,6 months,and 12 months after discharge.The ERAS program we conducted was safe,repeatable,and efficient.In conclusion,patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.展开更多
Erectile dysfunction is a common side effect of finasteride and dutasteride treatments. The objective of this study was to investigate the structural changes in the penis using a benign prostatic hyperplasia （BPH） r...Erectile dysfunction is a common side effect of finasteride and dutasteride treatments. The objective of this study was to investigate the structural changes in the penis using a benign prostatic hyperplasia （BPH） rodent model treated with dutasteride or finasteride. Sixty male rats were divided into the following groups： C, untreated control rats; C ＋ D, control rats receiving dutasteride; C ＋ F, control rats receiving finasteride; H, untreated spontaneously hypertensive rats （SHRs）; H ＋ D, SHRs treated with dutasteride; and H ＋ F, SHRs treated with finasteride. Treatments were performed for 40 days, and penises were collected immediately thereafter. The organs were analyzed using histomorphometric methods to determine the cross-sectional penile area, as well as the surface density （Sv） of smooth muscle fibers, connective tissue, elastic system fibers, and sinusoidal spaces of the corpus cavernosum. The results were compared using a one-way ANOVA with Bonferroni＇s posttest. Groups C ＋ D and C ＋ F had a significantly smaller penile cross-sectional area, but more elastic system fiber Sv compared to Group C. Group C ＋ D showed less smooth muscle Sv, and Group H showed more connective tissue but a smaller sinusoidal space Sv in the corpus cavernosum compared to Group C. Groups H ＋ D and H ＋ F had less smooth muscle Sv than Group H. Group H ＋ D also had more connective tissue and elastic system fiber Sv than Group H. Both dutasteride and finasteride promoted penile modifications in the control rat penis, although this affect was ~reater in Group H animals. In this rodent model, dutasteride was the drug that most affected the corpus cavernosum.展开更多
文摘Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.
文摘To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate （PKEP） for the treatment of symptomatic benign prostatic hyperplasia （BPH） compared with 160-W lithium triboride laser photoselective vaporization of the prostate （PVP）. From February 2011 to July 2012, a prospective nonrandomized study was performed. One-hundred one patients underwent PKEP, and 110 underwent PVP. No severe intraoperative complications were recorded, and none of the patients in either group required a blood transfusion. Shorter catheterization time （38.14 ± 23.64 h vs 72.54 ± 28.38 h, P 〈 0.001） and hospitalization （2.32 ± 1.25 days vs 4.07±1.23 days, P 〈 0.001） were recorded in the PVP group. At 12-month postoperatively, the PKEP group had a maintained and statistically improvement in International Prostate Symptom Score （IPSS） （4.07 ±2.07 vs 5.00 ±2.10; P〈 0.001）, quality of life （QoL） （1.08 ± 0.72 vs 1.35 ± 0.72; P= 0.007）, maximal urinary flow rate （Qmax） （24.75±5.87 ml s^-1 vs 22.03 ±5.04 ml s^-1; P 〈 0.001）, postvoid residual urine volume （PVR） （14,29 ± 6,97 ml vs 17.00±6.11 ml; P = 0,001）, and prostate-specific antigen （PSA） value （0.78 ±0.57 ng ml^-1 vs 1.27 ±1.07 ng ml^-1; P 〈 0.001）. Both PKEP and PVP relieve low urinary tract symptoms （LUTS） due to BPH with low complication rates. PKEP can completely remove prostatic adenoma while the total amount of tissue removed by PVP is less than that can be removed by PKER Based on our study of the follow-up, PKEP provides better postoperative outcomes than PVP.
文摘In this study, we examined the relationship between sex hormone levels and lower urinary tract symptoms （LUTS） in men with benign prostatic hyperplasia （BPH） who underwent transurethral surgery. The study was conducted in 158 patients who came to our hospital for surgery. Clinical conditions were assessed by body mass index （BMI）, digital rectal examination, International Prostate Symptom Score （IPSS） and transrectal ultrasound （TRUS）. The levels of sex hormones （including total testosterone （TT）, estradiol （E2）, progesterone （P）, luteinizing hormone （LH）, follicle-stimulating hormone （FSH） and prolactin （PRL）） and prostate-specific antigen （PSA） were reviewed. Correlations were determined through statistical analysis. The mean age was 72.06 _＋ 8.68 years. The total IPSS was significantly associated with the TT level （r = -0.21, P = 0.01）. Other sex hormone levels were not correlated with total IPSS. However, some ratios such as E2/TT （r = 0.23, P = 0o00） and FSH/LH （r = -0.17, P = 0.04） were associated with total IPSS. Further analysis showed that the nocturia was associated with age （r = 0.16, P = 0.04）, BMI （r = 0.21, P = 0.01）, and TT （r = -0.19, P = 0.02）. Moreover, we divided the patients into two subgroups based on IPSS severity （〈20 or 〉20）. The mean TT level was in the normal range, but it was significantly related to the presence of severe LUTS. In summary, our study has shown that the severity of LUTS is associated with TT, EJTT and FSH/LH in men who underwent prostate surgery. Increasing nocturia was observed in lower testosterone patients. Additional larger studies are needed to elucidate the potential mechanisms.
文摘This study was designed to investigate the association between immune inflammation and androgen receptor （AR） expression in benign prostatic hyperplasia （BPH）. We retrospectively analyzed 105 prostatectomy specimens. An immune inflammation score for each specimen was defined by combining three immunohistochemical markers （CD4, CD8 and CD20）. The immunohistochemical markers were CD4 and CD8 for T lymphocytes, CD20 for B lymphocytes and AR antibody for the AR in BPH samples. Rates of CD4, CD8, CD20 and AR expression in BPH were 20 （19.0%）, 21 （20.0%）, 101 （96.2%） and 48 （45.7%）, respectively. Total prostate volume （TPV） was higher in the immune inflammation group than in the non-immune inflammation group （62.7 ml vs. 49.2 ml, t=-2.482, P〈0.05）. Patients in the immune inflammation group had a higher serum prostate-specific antigen （PSA） than those in the non-inflammation group （7.5 ng m1-1 vs. 5.4 ng m1-1, t=-2.771, P〈0.05）. Specifically, the immune inflammation group showed a higher rate of AR expression than the non-inflammation group （56.1% vs. 28.2%, χ2=7.665, P〈0.05）. Our study revealed a strong association between immune inflammation and TPV, serum PSA and AR expression in BPH tissue. Prostate hyperplasia caused by an immune inflammatory process may contribute to BPH progression over time. Therefore, the inflammatory response involved in BPH may be a prime therapeutic target.
文摘A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.
基金the National Key Research and Development Plan of China(Technology helps Economy 20202016YFC0106300)+1 种基金the National Natural Science Foundation of China(82174230)Major Program Fund of Technical Innovation Project of Department of Science and Technology of Hubei Province(2016ACAl52).
文摘Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.
文摘In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate （PK-TURP） for patients with benign prostatic hyperplasia （BPH） with acute urinary retention （AUR）. We conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1126 BPH patients were divided into AUR （n = 348） and non-AUR groups （n = 778）. After the urethral catheters were removed, the urine white blood cell （WBC） count in the AUR group significantly increased compared with the non-AUR group （P〈 0.01）. However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group （P 〈 0.001）. A total of 87.1% （303/348） patients in the AUR group and 84.1% （654/778） patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group （P 〈 0.01）. The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3-12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-PK-TURP. In conclusion, immediate PK-TURP surgery on patients accompanied by AUR was safe and effective.
基金supported by Institute level project of the Second Affiliated Hospital of Xi’an Medical University(X2Y-R13)。
文摘Objective This study aimed to evaluate the effectiveness of acupuncture for benign prostatic hyperplasia(BPH).Methods We searched PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,Chinese National Knowledge Infrastructure,Wanfang Data,and China Science and Technology Journal Database from their inceptions to February 1,2022.The language was restricted to English and Chinese.Two researchers independently screened the literature,extracted data,and evaluated the risk bias of the included study according to the Cochrane Handbook 5.1.0.A meta-analysis was performed using Review Manager version 5.3.Results Twenty-two studies with 1,765 participants were selected to be incorporated in the meta-analysis.The experimental groups(EGs)showed greater benefit on therapeutic effects(relative risk[RR]:1.23,95%CI:1.16,1.3;P<0.00001),International Prostate Score Scale(mean difference[MD]:-2.06,95%CI:-3.17,-0.96;P=0.0002),maximum urinary flow rate(MD:1.7,95%CI:0.89,2.52;P<0.0001),postvoid residual urine volume(MD:-8.25,95%CI:-12.14,-4.36;P<0.0001),quality of life(MD:-0.55,95%CI:-0.8,-0.29;p<0.0001)compared with the control groups,whereas for prostate volume(MD:-0.87,95%CI:-2.66,0.92;P=0.34)was not significantly improved in the EGs.Nevertheless,no statistical variation in the reduction of adverse reactions was observed.Conclusion Acupuncture therapy,a wildly applied complementary–alternative treatment,may help in the management of BPH.
基金funded by National Natural Science Foundation of China(82072846 to Xu B).
文摘Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.
文摘Objective:This study aims to investigate the potential molecular mechanism of Salvia miltiorrhiza in treating benign prostatic hyperplasia(BPH)based on network pharmacology.Methods:Active components of Salvia miltiorrhiza were screened via the TCMSP database,and their potential targets were predicted using Swiss Target Prediction.BPH-related targets were obtained from Gene Cards and OMIM databases.Common targets between the herb and BPH were used to con-struct a protein-protein interaction(PPI)network via STRING and visualized using Cytoscape.Core targets were identifi ed,and Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were conducted(P≤0.01).Results:A total of 57 active components and 818 targets of Salvia miltiorrhiza were identifi ed.Intersection analysis yielded 458 potential targets associated with BPH.PPI network analysis revealed core targets including SRC,PIK3R1,and PIK3CA.GO enrichment analysis indicated that the targets were primarily associated with biological processes(BP)such as calcium ion homeostasis,cellular components(CC)including focal adhesions,and molecular functions(MF)such as tyrosine kinase activity.KEGG pathway analysis indicated that Salvia miltiorrhiza may exert therapeutic effects through pathways including MAPK,PI3K-Akt,and calcium signaling(P≤0.01).Conclusion:Salvia miltiorrhiza may regulate BPH through a multi-component,multi-target,and multi-pathway network,providing a theoretical basis for its clinical application.
基金supported(in part)by the National Key Research and Development Program(2022YFC3600700)the Fundamental Research Funds for the Central Universities(2042024YXA008)the Young Top-Notch Talent Cultivation Program of Hubei Province(for Prof.Xian-Tao Zeng).
文摘Background:The burden of common urologic diseases,including benign prostatic hyperplasia(BPH),urinary tract infections(UTI),urolithiasis,bladder cancer,kidney cancer,and prostate cancer,varies both geographically and within specific regions.It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.Methods:We obtained data on incidence,prevalence,mortality,and disability-adjusted life-years(DALYs)for the aforementioned urologic diseases by age,sex,location,and year from the Global Burden of Disease(GBD)2021.We analyzed the burden associated with urologic diseases based on socio-demographic index(SDI)and attributable risk factors.The trends in burden over time were assessed using estimated annual percentage changes(EAPC)along with a 95%confidence interval(CI).Results:In 2021,BPH and UTI were the leading causes of age-standardized incidence rate(ASIR)and age-standardized prevalence rate(ASPR),with rates of 5531.88 and 2782.59 per 100,000 persons,respectively.Prostate cancer was the leading cause of both age-standardized mortality rate(ASMR)and age-standardized DALYs rate(ASDR),with rates of 12.63 and 217.83 per 100,000 persons,respectively.From 1990 to 2021,there was an upward trend in ASIR,ASPR,ASMR,and ASDR for UTI,while urolithiasis showed a downward trend.The middle and low-middle SDI quintile levels exhibited higher incidence,prevalence,mortality,and DALYs related to UTI,urolithiasis,and BPH,while the high and high-middle SDI quintile levels showed higher rates for the three cancers.The burden of these 6 urologic diseases displayed diverse age and sex distribution patterns.In 2021,a high body mass index(BMI)contributed to 20.07%of kidney cancer deaths worldwide,while smoking accounted for 26.48%of bladder cancer deaths and 3.00%of prostate cancer deaths.Conclusions:The global burden of 6 urologic diseases presents a significant public health challenge.Urgent international collaboration is essential to advance the improvement of urologic disease management,encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.
文摘Benign prostatic hyperplasia(BPH)represents a prevalent etiology of lower urinary tract symptoms(LUTS)in the male population,clinically defined by a nonmalignant proliferation of prostatic tissue.While BPH exhibits a high prevalence among older male populations globally,the precise underlying mechanisms contributing to its development remain incompletely elucidated.Mitochondria,essential organelles within eukaryotic cells,are critical for cellular bioenergetics,the regulation of reactive oxygen species(ROS)generation,and the modulation of cell death pathways.The maintenance of mitochondrial homeostasis involves a complex interplay of processes.By synthesizing previous literature,this review discusses mitochondrial homeostasis in prostate glands and the role of mitochondrial dysfunction in the context of BPH.Furthermore,the review delved into each dimension of mitochondrial dysfunction in the specific etiology of BPH,highlighting its impact on cell survival,apoptosis,ferroptosis,oxidative stress and androgen receptor(AR).Overall,this review aims to unveil the crosstalk between mitochondrial dysfunction and BPH and identify intrinsic mechanisms.
文摘5α-reductase inhibitors （5α-RIs）, including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia （BPH）. Many studies reported that preoperative 5α-RI had impact on intraoperative haemorrhage during surgery for BPH, but it was still in controversial. So, we conducted a systematic review of the effects and mechanisms of 5α-RIs on intraoperative bleeding for BPH. MEDLINE, EMBASE, the Cochrane Controlled Trail Register of Controlled Trials and the reference lists of retrieved studies were searched in the analysis. Sixteen publications involving 15 different randomized controlled trials （RCTs） and a total of 1156 patients were used in the analysis, including 10 RCTs for finasteride and five RCTs for dutasteride. We found that preoperative finasteride treatment decreases microvessel density （MVD） in resected prostate specimens. Total blood loss, blood loss per gram of resected prostate tissue and decreases in haemoglobin were all greatly reduced in the finasteride group as compared to controls. Dutasteride appeared to have no effect on bleeding. This meta-analysis shows that preoperative finasteride treatment could decrease intraoperative haemorrhage during surgery for BPH. Preoperative dutasteride had no effect on intraoperative haemorrhage, but further high-qualitv prospective studies are still needed to confirm this observation.
文摘Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.
基金supported(in part)by the National Natural Science Foundation of China(82200862,82370778)the Hubei Provincial Natural Science Foundation(2022CFB681,2023AFA061,2019CFB760)+4 种基金the Hubei Province Health and Family Planning Scientific Research Project(WJ2023M058,WJ2019H035)the Key Scientific Research Project of Education Department of Henan Province(22A320038)the Fundamental Research Funds for the Central Universities(2042023kf1019,2042023kf0051,2042022kf0072)the Zhongnan Hospital of Wuhan University,Science Technology and Innovation Seed Fund(CXPY2022074)the Young Top-notch Talent Cultivation Program of Hubei Province(for Prof.Zeng XT).
文摘Background:Benign prostatic hyperplasia(BPH)is the most common disease in elderly men.There is increasing evidence that periodontitis increases the risk of BPH,but the specific mechanism remains unclear.This study aimed to explore the role and mechanism of the key periodontal pathogen Porphyromonas gingivalis(P.gingivalis)in the development of BPH.Methods:The subgingival plaque(Sp)and prostatic fluid(Pf)of patients with BPH concurrent periodontitis were extracted and cultured for 16S r DNA sequencing.Ligature-induced periodontitis,testosterone-induced BPH and the composite models in rats were established.The P.gingivalis and its toxic factor P.gingivalis lipopolysaccharide(P.gLPS)were injected into the ventral lobe of prostate in rats to simulate its colonization of prostate.P.g-LPS was used to construct the prostate cell infection model for mechanism exploration.Results:P.gingivalis,Streptococcus oralis,Capnocytophaga ochracea and other oral pathogens were simultaneously detected in the Sp and Pf of patients with BPH concurrent periodontitis,and the average relative abundance of P.gingivalis was found to be the highest.P.gingivalis was detected in both Sp and Pf in 62.5%of patients.Simultaneous periodontitis and BPH synergistically aggravated prostate histological changes.P.gingivalis and P.gLPS infection could induce obvious hyperplasia of the prostate epithelium and stroma(epithelial thickness was 2.97-fold and 3.08-fold that of control group,respectively),and increase of collagen fibrosis(3.81-fold and 5.02-fold that of control group,respectively).P.gingivalis infection promoted prostate cell proliferation,inhibited apoptosis,and upregulated the expression of inflammatory cytokines interleukin-6(IL-6;4.47-fold),interleukin-6 receptor-α(IL-6Rα;5.74-fold)and glycoprotein 130(gp130;4.47-fold)in prostatic tissue.P.g-LPS could significantly inhibit cell apoptosis,promote mitosis and proliferation of cells.P.g-LPS activates the Akt pathway through IL-6/IL-6Rα/gp130 complex,which destroys the imbalance between proliferation and apoptosis of prostate cells,induces BPH.Conclusion:P.gingivalis was abundant in the Pf of patients with BPH concurrent periodontitis.P.gingivalis infection can promote BPH,which may affect the progression of BPH via inflammation and the Akt signaling pathway.
基金supported by the National Key Research and Development Program of China(2022YFC3600700)the National Natural Science Foundation of China(82370778)+2 种基金the Hubei Provincial Natural Science Foundation of China(2023AFA061)the Fundamental Research Funds for the Central Universities(2042024kf1043)the Young Top-Notch Talent Cultivation Program of Hubei Province(for Prof.Zeng XT).
文摘Background:Fibrosis constitutes a significant pathophysiological mechanism in the clinical progression of benign prostatic hyperplasia(BPH)and represents a contributing factor to the ineffectiveness of prevailing pharmacological treatments.Emerging evidence suggests a close association between microbial presence and the development of fibrosis.Nonetheless,the potential involvement of microbes within prostatic tissue in the pathogenesis of BPH and prostatic fibrosis,along with the underlying mechanisms,remains unexplored.Methods:Utilizing immunohistochemistry and microbial sequencing,we analyzed the microbes of prostate tissues from BPH patients with different degrees of prostate fibrosis and found that Salmonellaenterica(S.enterica)was enriched in the high degree of prostate fibrosis.We developed prostate cell and animal models infected with the lipopolysaccharide of S.enterica(S.e-LPS)to assess its impact on prostate fibrosis.To elucidate the underlying functional mechanisms,we employed molecular biology techniques,including RNA degradation assays,N6-methyladenosine(m6A)dot blotting,RNA immunoprecipitation,and m6A immunoprecipitation.Results:Microbial diversity differed between low-and high-fibrosis groups,with S.enterica showing the highest mean abundance among the 4 species that differed significantly.S.e-LPS was detected in S.enterica-rich prostate tissue and was found to significantly promote cell proliferation,cell contractility,lipid peroxidation,and the induction of ferroptosis.Animal experiments demonstrated that S.e-LPS infection led to pronounced hyperplasia of the prostatic epithelium,with epithelial thickness increasing to 1.57 times that of the sham group,and collagen fibrosis increasing to 2.84 times that of the sham group,thereby exacerbating prostatic tissue fibrosis in rats.Invitro experiments further revealed that S.e-LPS promoted prostate cell fibrosis by inducing ferroptosis.Mechanistically,it was determined that S.e-LPS regulates ferroptosis via AlkB homolog 5(ALKBH5)-mediated m6A modification,which affects the stability of glutathione peroxidase 4(GPX4)mRNA,thereby affecting prostatic fibrosis.Conclusion:The findings of this study suggest that S.enterica promotes prostatic fibrosis through ALKBH5-m6A-GPX4-mediated ferroptosis.This research offers novel insights for the development of new therapeutic targets and personalized strategies for the prevention and treatment of BPH from the perspectives of microbes and epigenetics.
基金Hebei Provincial Administration of Traditional Chinese Medicine Scientific Research Project (2025576).
文摘Benign prostatic hyperplasia(BPH)is a common condition affecting the quality of life and health status of elderly men.Its incidence increases with age and is often accompanied by symptoms such as urinary frequency,urgency,nocturia,difficulty voiding,and even urinary retention.While conventional Western medicine can alleviate symptoms,it frequently carries risks of side effects and disease recurrence.Traditional Chinese Medicine approaches this condition based on the characteristic patterns observed in the elderly population:predominantly deficiency and blood stasis,with chronic conditions leading to blood stasis.The Yiqi Huoxue method—aimed at tonifying Qi and activating blood circulation—has been shown to improve urinary symptoms,enhance quality of life,and promote overall health in elderly BPH patients.This article explores the application of the Yiqi Huoxue therapeutic principle in managing benign prostatic hyperplasia.
基金This work was supported by the Natural Science Foundation of China(No.81871147 and No.81671453)Sichuan Science and Technology Program(2018TJPT0018)Chengdu Science and Technology Program(No.2019-YFYF-00087-SN).
文摘Lower urinary tract symptoms suggestive of benign prostate hyperplasia(LUTS/BPH)and depression are both increasing in Chinese aging males.However,the relationship still remains unknown.To explore their relationship,a retrospective cohort study based on propensity score matching(PSM)was conducted by analyzing the China Health and Retirement Longitudinal Study dataset.After data cleaning,a total of 5125 participants were enrolled and subjected to PSM;1351 pairs were matched and followed for 2 years.Further logistic regression and restricted cubic spline(RCS)were performed to evaluate,model and visualize the relationship between depression and LUTS/BPH.Moreover,subgroup analyses and sensitivity analyses were adopted to verify the robustness of the conclusions.Before PSM,depressive patients showed higher odds of LUTS/BPH in all three models adjusting for different covariates(P<0.001).After PSM,univariate logistic regression revealed that depressive patients had higher risks for LUTS/BPH than participants in the control group(odds ratio[OR]=2.10,P<0.001).The RCS results indicated a nonlinear(P<0.05)and inverted U-shaped relationship between depression and LUTS/BPH.In the subgroup analyses,no increased risks were found among participants who were not married or cohabitating,received an education,had an abnormal body mass index(<18.5 kg m−2 and≥28 kg m−2),slept more than 6 h,did not smoke,and drank less than once a month(all P>0.05).The results of sensitivity analyses indicated identical increased risks of LUTS/BPH in all four models(all P<0.001).In conclusion,depression enhances the risks of LUTS/BPH in aging males.
基金The study is funded by the National Key Research and Development Program of China(grant No.2021YFC2009304)the Project of Science and Technology Department of Chengdu(grant No.2021-YF05-00717-SN)the Project of Science and Technology Department of Sichuan Province(2021YFS0117).
文摘Enhanced recovery after surgery(ERAS)measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia(BPH).This study was performed on patients with BPH who required surgical intervention.From July 2019 to June 2020,the ERAS program was applied to 248 patients,and the conventional program was applied to 238 patients.After 1 year of follow-up,the differences between the ERAS group and the conventional group were evaluated.The ERAS group had a shorter time of urinary catheterization compared with the conventional group(mean±standard deviation[s.d.]:1.0±0.4 days vs 2.7±0.8 days,P<0.01),and the pain(mean±s.d.)was significantly reduced through postoperative hospitalization days(PODs)0-2(POD 0:1.7±0.8 vs 2.4±1.0,P<0.01;POD 1:1.6±0.9 vs 3.5±1.3,P<0.01;POD 2:1.2±0.7 vs 3.0±1.3,P<0.01).No statistically significant difference was found in the rate of postoperative complications,such as postoperative bleeding(P=0.79),urinary retention(P=0.40),fever(P=0.55),and readmission(P=0.71).The hospitalization cost of the ERAS group was similar to that of the conventional group(mean±s.d.:16927.8±5808.1 Chinese Yuan[CNY]vs 17044.1±5830.7 CNY,P=0.85).The International Prostate Symptom Scores(IPSS)and quality of life(QoL)scores in the two groups were also similar when compared at 1 month,3 months,6 months,and 12 months after discharge.The ERAS program we conducted was safe,repeatable,and efficient.In conclusion,patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.
文摘Erectile dysfunction is a common side effect of finasteride and dutasteride treatments. The objective of this study was to investigate the structural changes in the penis using a benign prostatic hyperplasia （BPH） rodent model treated with dutasteride or finasteride. Sixty male rats were divided into the following groups： C, untreated control rats; C ＋ D, control rats receiving dutasteride; C ＋ F, control rats receiving finasteride; H, untreated spontaneously hypertensive rats （SHRs）; H ＋ D, SHRs treated with dutasteride; and H ＋ F, SHRs treated with finasteride. Treatments were performed for 40 days, and penises were collected immediately thereafter. The organs were analyzed using histomorphometric methods to determine the cross-sectional penile area, as well as the surface density （Sv） of smooth muscle fibers, connective tissue, elastic system fibers, and sinusoidal spaces of the corpus cavernosum. The results were compared using a one-way ANOVA with Bonferroni＇s posttest. Groups C ＋ D and C ＋ F had a significantly smaller penile cross-sectional area, but more elastic system fiber Sv compared to Group C. Group C ＋ D showed less smooth muscle Sv, and Group H showed more connective tissue but a smaller sinusoidal space Sv in the corpus cavernosum compared to Group C. Groups H ＋ D and H ＋ F had less smooth muscle Sv than Group H. Group H ＋ D also had more connective tissue and elastic system fiber Sv than Group H. Both dutasteride and finasteride promoted penile modifications in the control rat penis, although this affect was ~reater in Group H animals. In this rodent model, dutasteride was the drug that most affected the corpus cavernosum.
