Journal of Clinical Medicine

Background: This retrospective matched-pair analysis compared functional outcomes and complications of prostate artery embolization (PAE) using 250 µm microparticles and holmium laser enucleation of the prostate (HoLEP) in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods: A total of 69 PAE patients were matched 1:1 to 69 HoLEP patients using propensity scores based on age, prostate volume (PV), and IPSS. Follow-up was standardized at six months for the PAE cohort, while HoLEP outcomes were assessed cross-sectionally (median 52.9 months). All comparisons were therefore interpreted as cross-sectional analyses rather than time-matched outcomes. Secondary endpoints were complications according to the Clavien–Dindo Classification. Results: At baseline, there were no significant differences between PAE and HoLEP regarding IPSS, QoL, or Qmax. Both interventions led to significant within-group improvements in IPSS, QoL, and Qmax (p < 0.001). Between-group comparisons demonstrated significantly greater improvement in IPSS, Qmax, and QoL following HoLEP (all p < 0.05). Erectile function remained stable after PAE and showed a non-significant decrease after HoLEP. Severe complications (Clavien–Dindo ≥ Grade III) were not observed after PAE. These findings should be interpreted considering the study’s main limitations, including the small cohort size, its retrospective matched-pair design, and variability in surgeons’ HoLEP experience. Conclusions: PAE with 250 µm microparticles and HoLEP are both effective and safe procedures. While PAE compared to HoLEP is less effective regarding functional outcome, it showed no difference in QoL improvement and is associated with no greater grade II complications.

Severe aortic stenosis represents a significant prognostic burden, particularly in symptomatic patients. The advent of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients previously considered ineligible for surgical aortic valve replacement (SAVR). TAVR provides a relatively safe intervention that leads to improvements in survival, symptoms, and functional status within months of implantation. A major complication following TAVR is the occurrence of paravalvular leaks (PVLs), which have been associated with increased mortality and higher rates of heart failure-related hospitalizations. PVLs refer to abnormal blood flow between the implanted valve and the aortic wall, which can compromise the functionality of the device. Careful pre-procedural planning enables the identification of patients at higher risk for PVL development. Although the incidence of PVLs has decreased with the introduction of newer-generation transcatheter valves, the condition remains clinically relevant. Due to the complex anatomy of the aortic valve apparatus and interference from the prosthetic frame, accurate evaluation of PVLs requires a multimodal diagnostic approach. Current evidence on PVL management is limited. In most cases, a conservative approach is adopted, while interventional strategies (such as pre- and post-dilatation, percutaneous PVL closure, and TAVR-in-TAVR) are reserved for selected patients. We performed a systematic literature review to summarize the incidence, predictors, diagnostic techniques, and management strategies of PVLs following TAVR.

Background: The increasing number of cesarean deliveries worldwide has led to a growing population of women eligible for vaginal birth after cesarean (VBAC). limited evidence exists regarding the natural progression of labor among secundiparous women experiencing their first vaginal delivery. Evidence regarding labor progression among women attempting VBAC remains inconclusive and with conflicting results. Clarifying these differences is essential for optimizing intrapartum management. Our objective was to compare the progression rate of the active phase of labor between secundiparous womne at their first VBAC and primiparous women who delivered vaginally. Methods: A retrospective cohort study was conducted at a tertiary university-affiliated medical center (January 2011–January 2021). Included were term singleton pregnancies in spontaneous labor resulting in vaginal delivery. Exclusion criteria included induction, augmentation, and operative vaginal delivery. Results: Among 13,983 primiparous and 736 VBAC patients, the VBAC group was older, used epidural more frequently, and had higher neonatal birth weight. The cervical dilatation rate during the active phase was faster in VBAC patients (3.26 vs. 2.85 cm/h, p = 0.011), with a shorter second stage (77.8 vs. 86.6 min, p < 0.001). The rate of prolonged second stage was higher in the primiparous group (9.5% vs. 7.1%, p = 0.029). In a multivariable analysis examining the association between VBAC and prolonged second stage, VBAC was found to be inversely associated with prolonged second stage (OR 0.541, 95% CI 0.388–0.753, p = 0.001). Conclusions: When compared to primiparous women, women at their first VBAC had significantly shorter active phase and increased progression rate as well as a shorter second stage of labor.