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Medicina
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Recent Advances in Lower Urinary Tract Symptoms and Benign Prostatic...
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Recent Advances in Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Urology & Nephrology".

Deadline for manuscript submissions: 5 October 2026 | Viewed by 4214

Special Issue Editors

Prof. Dr. Apostolos Apostolidis

E-Mail Website
Guest Editor
Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56429 Thessaloniki, Greece
Interests: neuroUrology; LUTS; functional urology and urodynamics; urinary biomarkers
Dr. Efstathios Papaefstathiou

E-Mail Website
Guest Editor Assistant
Urology Department 424 Military Hospital, Ring Road Efkarpia, 56429 Thessaloniki, Greece
Interests: andrology; female and functional urology; reconstructive urology

Special Issue Information

Dear Colleagues,

It is our pleasure to invite you to contribute to the upcoming Special Issue of Medicina entitled “Recent Advances in Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia”. This issue will focus on the latest clinical and research developments in the diagnosis, management, and treatment of LUTS and BPH—conditions that continue to have a profound impact on patient quality of life and healthcare systems worldwide.

In recent years, significant progress has been made in understanding the pathophysiology, progression, and optimal therapeutic approaches for LUTS and BPH. Innovations in medical technology, imaging, minimally invasive procedures, and pharmacological therapies are transforming the standard of care. Furthermore, the integration of artificial intelligence, molecular biomarkers, and personalized medicine is paving the way for more accurate diagnosis and targeted treatment strategies.

This Special Issue aims to showcase original research articles, comprehensive reviews, and clinical studies that highlight these cutting-edge developments. Topics of interest include, but are not limited to, the following:

  • Advances in diagnostic tools and imaging techniques for LUTS or BPH;
  • Novel pharmacologic and surgical treatments;
  • Role of biomarkers and genetics in disease stratification;
  • Impact of lifestyle and comorbidities on LUTS or BPH progression;
  • Minimally invasive and robotic interventions;
  • AI and digital health tools in urology practice.

We warmly welcome your contributions and encourage you to share this opportunity with colleagues who may be interested. If you plan to submit a manuscript, please send us a working title and a brief abstract to facilitate a preliminary suitability check.

The submission deadline is 20 January 2026.

We look forward to your valuable contributions to this Special Issue.

Prof. Dr. Apostolos Apostolidis
Guest Editor

Dr. Efstathios Papaefstathiou
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • LUTS
  • BPH
  • minimally invasive treatment
  • digital health tools
  • biomarkers
  • microbiome

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Review

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14 pages, 323 KB  
Review
5 Alpha Reductase Inhibitors (5ARIs) Monotherapy and Combinations: Current Role in Benign Prostatic Hyperplasia (BPH) Management
by Christos Roidos, Petros Sountoulides, Konstantinos Papathanasiou, Asterios Symeonidis and Ioannis Mykoniatis
Medicina 2026, 62(5), 975; https://doi.org/10.3390/medicina62050975 (registering DOI) - 17 May 2026
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Abstract
Background and Objectives: Benign prostatic hyperplasia (BPH) is a progressive, androgen-dependent condition driven by dihydrotestosterone (DHT). 5α-reductase inhibitors (5-ARIs), including finasteride and dutasteride, target this pathway and provide disease-modifying effects. Materials and Methods: This narrative review summarizes evidence from randomized trials, [...] Read more.
Background and Objectives: Benign prostatic hyperplasia (BPH) is a progressive, androgen-dependent condition driven by dihydrotestosterone (DHT). 5α-reductase inhibitors (5-ARIs), including finasteride and dutasteride, target this pathway and provide disease-modifying effects. Materials and Methods: This narrative review summarizes evidence from randomized trials, meta-analyses, and observational studies evaluating the efficacy, timing, and safety of 5-ARIs in the management of LUTS due to BPH. Results: 5-ARI therapy reduces prostate volume by 18–28% and serum PSA by approximately 50% within 6–12 months. Landmark trials (MTOPS, CombAT) demonstrate significant reductions in acute urinary retention (AUR) and BPH-related surgery (>50% RR reduction). Combination therapy with α-blockers provides superior symptom control and greater prevention of clinical progression, particularly in men with prostate volume ≥ 30–40 mL or PSA ≥ 1.5 ng/mL. Early initiation of combination therapy improves long-term outcomes, while α-blocker withdrawal may be feasible in selected patients. Adverse events are mainly sexual, with emerging data suggesting a possible association with depression. Conclusions: 5-ARIs are central to BPH management, offering sustained clinical benefits and prevention of progression. Optimal outcomes depend on appropriate patient selection, early treatment in high-risk individuals, and individualized long-term strategies. Full article
(This article belongs to the Special Issue Recent Advances in Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia)
15 pages, 711 KB  
Review
The Role of the Aging Bladder in Lower Urinary Tract Symptoms: Pathophysiology and Therapeutic Implications in Patients with Benign Prostatic Hyperplasia
by Dimitrios Papanikolaou, Christos Diamantopoulos, Ioannis Sokolakis, Merkourios Kolvatzis, Georgios Antoniadis, Kyriakos Moysidis, Konstantinos Hatzimouratidis and Michael Samarinas
Medicina 2026, 62(4), 685; https://doi.org/10.3390/medicina62040685 - 3 Apr 2026
Viewed by 768
Abstract
Background and Objectives: Lower urinary tract symptoms (LUTS) are highly prevalent among aging men and have traditionally been attributed primarily to benign prostatic hyperplasia (BPH) and bladder outlet obstruction (BOO). However, growing evidence suggests that bladder-related mechanisms play a critical and often [...] Read more.
Background and Objectives: Lower urinary tract symptoms (LUTS) are highly prevalent among aging men and have traditionally been attributed primarily to benign prostatic hyperplasia (BPH) and bladder outlet obstruction (BOO). However, growing evidence suggests that bladder-related mechanisms play a critical and often underrecognized role. This review aims to summarize current evidence on the contribution of the aging bladder to LUTS pathophysiology and to explore the therapeutic implications in men with BPH. Materials and Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science for studies published between January 2010 and April 2025. Search terms included combinations of “aging bladder”, “detrusor dysfunction”, “LUTS”, “BPH”, “bladder outlet obstruction”, “ischemia”, “overactive bladder”, and “detrusor underactivity”. Eligible studies included narrative reviews, systematic reviews, meta-analyses, clinical studies, and translational research addressing bladder aging and its clinical implications. A narrative synthesis approach was used due to heterogeneity in study design and outcomes. Results: A total of 43 studies were included in the qualitative synthesis. The evidence indicates that LUTS in older men result from multifactorial processes involving not only prostatic enlargement but also bladder dysfunction. Aging-associated changes include detrusor remodeling, impaired compliance, neural alterations, and vascular insufficiency, particularly chronic ischemia and oxidative stress. These mechanisms contribute to both detrusor overactivity and underactivity, providing a unifying framework for storage and voiding symptoms. Importantly, the severity of LUTS does not consistently correlate with prostate size or degree of obstruction. Conclusions: LUTS in aging men should be considered a complex condition involving both bladder and outlet factors. A bladder-centered perspective may improve patient stratification and therapeutic outcomes. Integrating bladder-targeted therapies with conventional BPH management supports a more personalized and effective approach to care. Full article
(This article belongs to the Special Issue Recent Advances in Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia)
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Other

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14 pages, 466 KB  
Systematic Review
Complication Profile and Safety Outcomes of Aquablation in the Management of BPH
by Panagiotis Triantafyllou, Polyvios Arseniou, Stamatios Katsimperis, Ioannis Kyriazis, Ioannis Manolitsis, Patrick Juliebø-Jones, Bhaskar Somani, Arman Tsaturyan, Theodoros Karagiotis, Titos Markopoulos, Lazaros Tzelves and Andreas Skolarikos
Medicina 2025, 61(12), 2076; https://doi.org/10.3390/medicina61122076 - 21 Nov 2025
Cited by 1 | Viewed by 2723
Abstract
Background and Objectives: Aquablation, a robot-assisted, heat-free resection technique, has emerged as a promising minimally invasive surgical therapy (MIST) for benign prostatic hyperplasia (BPH). Its precision and potential for preservation of sexual function distinguish it from traditional surgical options. This systematic review [...] Read more.
Background and Objectives: Aquablation, a robot-assisted, heat-free resection technique, has emerged as a promising minimally invasive surgical therapy (MIST) for benign prostatic hyperplasia (BPH). Its precision and potential for preservation of sexual function distinguish it from traditional surgical options. This systematic review aimed to evaluate the safety profile of Aquablation, with emphasis on perioperative complications and functional outcomes. Materials and Methods: We systematically searched PubMed/MEDLINE, Scopus, and the Cochrane Library through June 2025 in accordance with PRISMA 2020 guidelines (PROSPERO CRD420251074479). Eligible studies included randomized and non-randomized trials of Aquablation in men with BPH, reporting adverse events by type, frequency, or severity. Risk of bias was assessed with ROB-2 and ROBINS-I tools. Results: Forty-seven studies were included, spanning randomized controlled and prospective observational designs. Most complications were minor (Clavien-Dindo grade 1–2). Bleeding was the most frequent perioperative event, with transfusion required in 1–8% of cases, more often in large prostates. Severe complications (grade ≥ 3) were uncommon and usually related to bleeding or urinary retention. Long-term sequelae such as strictures or bladder neck contracture were rare. Compared with transurethral resection of the prostate, Aquablation yielded lower rates of ejaculatory dysfunction (10% vs. 36%), with continence and erectile function largely preserved. Outcomes were comparable to holmium laser enucleation, but Aquablation demonstrated superior ejaculatory preservation. Conclusions: Aquablation demonstrates a favorable safety profile across prostate sizes, with its greatest advantage being preservation of sexual function. While bleeding remains the principal perioperative concern, life-threatening events are rare. Further independent, long-term comparative studies are warranted. Full article
(This article belongs to the Special Issue Recent Advances in Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia)
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