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Keywords = lower urinary tract symptoms (LUTS)

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10 pages, 414 KiB  
Article
Prevalence and Phenotype of Lower Urinary Tract Symptoms in Fibromyalgia: A Retrospective Observational Study at a Single Tertiary Medical Center
by Jackson McClain, Gustavo Capo, Martha Terris, Pablo Santamaria and Noelle A. Rolle
J. Clin. Med. 2025, 14(15), 5584; https://doi.org/10.3390/jcm14155584 - 7 Aug 2025
Abstract
Background: Fibromyalgia syndrome (FMS) is a complex condition with poorly understood pathophysiology, characterized by widespread pain and an increasing recognition of its associations with genitourinary symptoms. The objective of this study was to characterize the prevalence, phenotype, and common comorbidities of lower [...] Read more.
Background: Fibromyalgia syndrome (FMS) is a complex condition with poorly understood pathophysiology, characterized by widespread pain and an increasing recognition of its associations with genitourinary symptoms. The objective of this study was to characterize the prevalence, phenotype, and common comorbidities of lower urinary tract symptoms (LUTS) in women with FMS. Methods: A retrospective observational study was conducted using electronic medical records of 440 women diagnosed with FMS at a single institution between 1 January 2018, and 1 January 2024. Study subjects were evaluated for diagnoses associated with LUTS, including interstitial cystitis (IC), overactive bladder (OAB), and stress urinary incontinence (SUI), alongside comorbidities such as irritable bowel syndrome (IBS), generalized anxiety disorder (GAD), and major depressive disorder (MDD). Multivariate analyses were performed to assess predictors of conditions associated with LUTS. Results: LUTS were identified in 37.0% of FM patients. GAD and IBS were significantly associated with conditions associated with LUTS (OR = 4.62; OR = 8.53, p < 0.001). SUI was present in 17.05% of patients, falling between survey-based and confirmed prevalence rates in the general population. IC was diagnosed in 2.95% of FMS patients. OAB was observed in 6.8% of patients and associated with GAD (OR = 5.98, p < 0.001). Conclusions: This study highlights a substantial burden of diagnoses associated with LUTS in patients with FMS. There is relatively high prevalence of SUI and IC in this dataset. IBS and GAD were commonly found to co-occur with one or more LUTS-associated condition. Future prospective studies are needed to investigate a multimodal approach to the treatment of LUTS in these patients. Full article
(This article belongs to the Section Nephrology & Urology)
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10 pages, 3851 KiB  
Case Report
Secondary Prostate Lymphoma Mimicking Prostate Cancer Successfully Managed by Transurethral Resection to Relieve Urinary Retention
by Lorand-Tibor Reman, Ovidiu Malau, Daniel Porav-Hodade, Calin Chibelean, Arpad-Oliver Vida, Ciprian Todea, Veronica Ghirca, Alexandru Laslo, Raul-Dumitru Gherasim, Rares Vascul, Orsolya-Brigitta Katona, Raluca-Diana Hagău and Orsolya Martha
Pathophysiology 2025, 32(3), 38; https://doi.org/10.3390/pathophysiology32030038 - 2 Aug 2025
Viewed by 123
Abstract
Secondary lymphoma of the prostate is described as the involvement of the prostate gland by lymphomatous spread from a primary site. This condition is exceedingly rare and often presents diagnostic and therapeutic challenges. The symptoms often mimic those of benign prostatic hyperplasia or [...] Read more.
Secondary lymphoma of the prostate is described as the involvement of the prostate gland by lymphomatous spread from a primary site. This condition is exceedingly rare and often presents diagnostic and therapeutic challenges. The symptoms often mimic those of benign prostatic hyperplasia or prostate cancer, including LUTS (lower urinary tract symptoms) and even complete urinary retention. Here, we present a rare case of a 62-year-old male patient undergoing chemotherapy for stage IV mantle cell stomach lymphoma and subsequently secondary prostatic involvement. The patient presented with complete urinary retention, accompanied by biochemical (PSA = 11.7 ng/mL) and imaging (Magnetic Resonance Imaging-PIRADS V lesion) suspicion for prostate cancer. Histopathologic analysis of the MRI-targeted prostate fusion biopsy revealed secondary prostatic lymphoma. The chosen treatment was transurethral resection of the prostate (TUR-P) for relief of symptoms, which significantly improved urinary function (postoperative IPSS = 5 and Qmax = 17 mL/s). This case underscores the importance of considering prostatic lymphoma in the differential diagnosis of bladder outlet obstruction, especially in patients with a known lymphoma history. This report also provides a focused review of the literature on secondary prostatic lymphoma, highlighting the diagnostic challenges, treatment options, and clinical outcomes. Full article
(This article belongs to the Collection Feature Papers in Pathophysiology)
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13 pages, 4424 KiB  
Case Report
A Literature Review of Phantom Bladder Perforation: The Curious Case of Bladder Lipoma
by Surina Patel, Mehreet Kaur Chahal, Scott Durham, Haitham Elsamaloty and Puneet Sindhwani
Uro 2025, 5(3), 15; https://doi.org/10.3390/uro5030015 - 1 Aug 2025
Viewed by 118
Abstract
Introduction: Although lipomas are common benign tumors found in adults, lipomas of the bladder are extremely rare. Bladder lipomas are infrequently reported in the urologic literature, with only 19 cases published worldwide. These can present as a mass on cystoscopy and cause irritative [...] Read more.
Introduction: Although lipomas are common benign tumors found in adults, lipomas of the bladder are extremely rare. Bladder lipomas are infrequently reported in the urologic literature, with only 19 cases published worldwide. These can present as a mass on cystoscopy and cause irritative voiding symptoms, depending on their location. Upon transurethral resection, seeing fat can be concerning for a perforation, as lipoma can be mistaken for extravesical fat. Hence, familiarity with this rare entity is of paramount importance for urologists to prevent unnecessary investigations and interventions that are needed in case of a true bladder perforation. Case presentation: This study presents a case of bladder lipoma in a 73-year-old male with end-stage renal disease who presented for pretransplant urologic evaluation due to microscopic hematuria and irritative lower urinary tract symptoms (LUTS). During cystoscopy, a bladder mass was seen, and a transurethral resection of the bladder tumor (TURBT) revealed bright yellow adipose tissue immediately underneath the bladder mucosa. Concerns about perforation were obviated when seeing intact detrusor muscle underneath, visually confirming the integrity of the bladder wall. The resection was completed, and the CT scan was re-read with the radiologist, which confirmed the presence of a lipoma that was missed pre-operatively due to patient’s oliguria and collapsed bladder. No catheter drainage or cystogram was performed based on these findings. Outcome: The patient healed without any complications. Histopathology confirmed the diagnosis of a mature lipoma. The patient was cleared for transplant from a urologic standpoint and had a successful renal transplantation without delay. Discussion: This case documents the anomalous occurrence of a lipoma within the bladder and supports maintaining a broad differential, including liposarcoma, angiomyolipoma, and other non-malignant fatty tumors during the evaluation of a bladder mass. Full article
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16 pages, 694 KiB  
Review
Modulating Benign Prostatic Hyperplasia Through Physical Activity—The Emerging Role of Myokines: A Narrative Review
by Saad Alshahrani
Medicina 2025, 61(8), 1362; https://doi.org/10.3390/medicina61081362 - 28 Jul 2025
Viewed by 342
Abstract
Benign prostatic hyperplasia (BPH) is a multifactorial condition that is highly prevalent and affects aging males. It frequently results in lower urinary tract symptoms (LUTS) and a reduced quality of life. While hormonal dysregulation and chronic inflammation have long been implicated in BPH [...] Read more.
Benign prostatic hyperplasia (BPH) is a multifactorial condition that is highly prevalent and affects aging males. It frequently results in lower urinary tract symptoms (LUTS) and a reduced quality of life. While hormonal dysregulation and chronic inflammation have long been implicated in BPH pathogenesis, recent evidence highlights the role of physical activity in modulating prostate health. In this narrative review, evidence from quantitative studies examining the effect of exercise on BPH risk and symptom severity was first synthesized. Collectively, these studies suggest that regular physical activity is associated with a lower incidence and reduced progression of BPH. The potential mechanisms through which exercise may exert protective effects on the prostate were then explored. These include modulation of sympathetic nervous system activity, alterations in hormonal profiles (e.g., testosterone and insulin), suppression of chronic inflammation and oxidative stress, and the promotion of autophagy within prostatic tissue. Central to these mechanisms is the role of myokines—signaling molecules secreted by skeletal muscle during exercise. Key myokines, such as irisin, interleukin-6 (IL-6), brain-derived neurotrophic factor (BDNF), and myostatin, are reviewed in the context of prostate health. These molecules regulate inflammatory pathways, metabolic processes, and tissue remodeling. For instance, exercise-induced reductions in myostatin are linked to improved insulin sensitivity and decreased fat accumulation, while elevated irisin and BDNF levels may exert anti-inflammatory and metabolic benefits relevant to BPH pathophysiology. Although direct causal evidence linking myokines to BPH is still emerging, their biological plausibility and observed systemic effects suggest a promising avenue for non-pharmacological intervention. Future research should focus on identifying the specific myokines involved, elucidating their molecular mechanisms within the prostate, and evaluating their therapeutic potential in clinical trials. Full article
(This article belongs to the Section Urology & Nephrology)
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10 pages, 2059 KiB  
Article
An Emerging Trend of At-Home Uroflowmetry—Designing a New Vibration-Based Uroflowmeter with Artificial Intelligence Pattern Recognition of Uroflow Curves and Comparing with Other Technologies
by Vincent F. S. Tsai, Yao-Chou Tsai, Stephen S. D. Yang, Ming-Wei Li, Yuan-Hung Pong and Yu-Ting Tsai
Diagnostics 2025, 15(14), 1832; https://doi.org/10.3390/diagnostics15141832 - 21 Jul 2025
Viewed by 311
Abstract
Background/Objectives: For aging men experiencing lower urinary tract symptoms (LUTS), bladder diaries (BD) and uroflowmetry (UFM) are commonly used non-invasive diagnostic tools. However, bladder diaries often suffer from subjectivity and incomplete data, while traditional hospital-based uroflowmetry lacks convenience and repeatability. Therefore, there [...] Read more.
Background/Objectives: For aging men experiencing lower urinary tract symptoms (LUTS), bladder diaries (BD) and uroflowmetry (UFM) are commonly used non-invasive diagnostic tools. However, bladder diaries often suffer from subjectivity and incomplete data, while traditional hospital-based uroflowmetry lacks convenience and repeatability. Therefore, there is a growing need for a user-friendly, artificial intelligence (AI)-powered at-home uroflow monitoring solution. This study aims to develop a novel, vibration-based home uroflowmetry system capable of recognizing uroflow curve patterns and measuring voiding parameters, and to compare its performance with other existing home-based uroflowmetry methods. Methods: Seventy-six male participants, all of whom provided informed consent, underwent uroflowmetry to assess voiding symptoms. An accelerometer affixed to the uroflowmeter’s urine container captured vibration signals, which were used to calculate the root mean square (RMS) values and maximum amplitude (Mmax). Simultaneously, the uroflowmeter recorded standard voiding parameters and generated uroflow curves. These vibration signals were then analyzed using a convolutional neural network (CNN) to classify six distinct uroflow curve patterns, aiding in diagnostic evaluation. Results: Seventy-six participants’ voiding volume ranged from 50 mL to 690 mL (median [Q1, Q3]: 160 [70.00, 212.50] mL). The correlation analysis revealed positive correlations between the vibration signals and voiding parameters, including the voided volume and RMS (R = 0.768, p < 0.001), Qmax and Mmax (R = 0.684, p < 0.001), voiding time and signal time (R = 0.838, p < 0.001), time to Qmax and time to Mmax (R = 0.477, p < 0.001). AI pattern recognition demonstrated high accuracy with all three indicators (precision, recall, and F1 score) surpassing 0.97. Conclusions: This AI-assisted vibration-based home uroflowmetry enables accurate voiding parameter measurement and uroflow pattern recognition, showing high precision, recall, and F1-score. It might offer a convenient solution for continuous and subjective bladder monitoring outside clinical settings. Full article
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14 pages, 607 KiB  
Article
Quantification of the Role of Teupol® 25P and Graminex® G96 Compared to Hexanic Extract of Serenoa repens in Patients Affected by Lower Urinary Tract Symptoms During Treatment with Silodosin
by Yazan Al Salhi, Damiano Graziani, Andrea Fuschi, Fabio Maria Valenzi, Manfredi Bruno Sequi, Paolo Pietro Suraci, Alice Antonioni, Onofrio Antonio Rera, Cosimo De Nunzio, Riccardo Lombardo, Paolo Benanti, Giuseppe Candita, Eleonora Rosato, Filippo Gianfrancesco, Giorgio Martino, Giovanni Di Gregorio, Luca Erra, Giorgio Bozzini, Antonio Carbone and Antonio Luigi Pastore
Medicina 2025, 61(7), 1225; https://doi.org/10.3390/medicina61071225 - 6 Jul 2025
Viewed by 357
Abstract
Background and Objectives: While α1-blockers like silodosin are the mainstay for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), combination therapy with phytotherapeutics may provide enhanced symptom control. Xipag® is a novel formulation containing Graminex® G96 [...] Read more.
Background and Objectives: While α1-blockers like silodosin are the mainstay for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), combination therapy with phytotherapeutics may provide enhanced symptom control. Xipag® is a novel formulation containing Graminex® G96 (pollen extract) and Teupol® 25P (teupolioside), offering anti-inflammatory and antiandrogenic effects. This study aimed to evaluate the efficacy of Xipag® versus hexanic extract of Serenoa repens (HESr), both in combination with silodosin, in patients with LUTS/BPH. Materials and Methods: We conducted a single-center, prospective, observational, comparative study involving male patients with moderate-to-severe LUTSs undergoing treatment with silodosin. Patients were allocated to receive either Xipag® or HESr in addition to silodosin, with follow-up every 3 months for 12 months. Primary outcomes included changes in symptom scores such as IPSS, QoL, and functional improvements such as peak urinary flow rate (Qmax). Multivariable regression analyses were used to assess predictors of the response. Results: Patients receiving Xipag® showed significantly greater improvements in Qmax at all follow-up points (p < 0.05), with earlier and more sustained benefits compared to the HESr group. QoL index scores and PSA levels were also significantly better in the Xipag® group starting from month six onward. IPSS scores improved in both groups but were significantly lower in the Xipag® group only at 12 months (p = 0.04). No differences in erectile function (IIEF-5) or adverse events were observed. Conclusions: Xipag® in combination with silodosin provides superior improvement in urinary flow, symptom-related QoL, and PSA reduction compared to HESr plus silodosin, with a favorable safety profile. These findings support the use of multi-target nutraceuticals like Xipag® as a valuable adjunct in the management of LUTS/BPH. Larger randomized trials are warranted to confirm these results and explore underlying mechanisms. Full article
(This article belongs to the Section Urology & Nephrology)
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32 pages, 1820 KiB  
Systematic Review
Association and Prevalence of Lower Urinary Tract Symptoms in Individuals with Sarcopenia: A Systematic Review and Meta-Analysis
by Lek-Hong Tan and Eric Chieh-Lung Chou
Medicina 2025, 61(7), 1214; https://doi.org/10.3390/medicina61071214 - 3 Jul 2025
Viewed by 472
Abstract
Background and Objectives: Sarcopenia and lower urinary tract symptoms (LUTSs) are both prevalent among older adults and may share underlying pathophysiological mechanisms. However, their association has not been systematically quantified. This systematic review and meta-analysis aimed to evaluate the association between sarcopenia [...] Read more.
Background and Objectives: Sarcopenia and lower urinary tract symptoms (LUTSs) are both prevalent among older adults and may share underlying pathophysiological mechanisms. However, their association has not been systematically quantified. This systematic review and meta-analysis aimed to evaluate the association between sarcopenia and LUTSs, including the pooled estimates of prevalence and odds ratios (ORs), and to explore the influence of diagnostic definitions and study-level factors. Materials and Methods: A comprehensive literature search was conducted using PubMed and Embase for studies published between 1 January 2000 and 26 April 2025. This study adhered to PRISMA and MOOSE guidelines and was registered in PROSPERO (CRD420251037459). Eligible observational studies reported LUTS prevalence or ORs in individuals with sarcopenia, low muscle strength (LMS), low lean mass (LLM), low gait speed (LGS), or sarcopenia risk identified by SARC-F (score ≥4). Pooled ORs and prevalence rates were calculated using a random-effects model. Subgroup analyses were performed based on sarcopenia definitions—Asian Working Group for Sarcopenia (AWGS) and European Working Group on Sarcopenia in Older People (EWGSOP)—as well as LUTS subtypes and diagnostic components. Univariate meta-regression assessed associations with age, BMI, sex distribution, WHO region, and risk of bias. Results: Twenty-five studies comprising 84,484 participants were included. Sarcopenia was significantly associated with LUTSs (pooled OR = 1.78; 95% CI: 1.29–2.45; p < 0.001), with a pooled LUTS prevalence of 43.2% (95% CI: 26.9–61.0%). Stronger associations were observed in studies using AWGS diagnostic criteria (OR = 2.24; 95% CI: 1.41–3.56; p = 0.001), in those evaluating severe sarcopenia (OR = 1.66; 95% CI: 1.03–2.68; p = 0.038), and in institutionalized populations (OR = 3.68; 95% CI: 2.18–6.24; p < 0.001) compared to community-dwelling populations (OR = 1.43; 95% CI: 1.06–1.92; p = 0.018). Sarcopenia risk identified by SARC-F (score ≥4) showed the strongest association with LUTSs (OR = 3.20; 95% CI: 1.92–5.33; p < 0.001). Significant associations were also found for LLM (OR = 1.52; 95% CI: 1.19–1.95; p = 0.001) and LGS (OR = 1.37; 95% CI: 1.06–1.76; p = 0.015), but not for LMS (OR = 0.94; 95% CI: 0.47–1.89; p = 0.871). Exploratory analyses comparing LLM diagnostic modalities—including standardized criteria (ASMI, ASM/BMI), imaging-based methods (SMI, PMA), and surrogate measures (calf circumference)—revealed no significant differences (all p > 0.05). Heterogeneity was high (I2 > 90%). Egger’s test indicated no evidence of publication bias (p = 0.838), and trim-and-fill analysis did not affect the pooled estimates. Conclusions: Sarcopenia—particularly in its severe forms—is significantly associated with LUTSs. Additionally, individuals who screened positive for sarcopenia using the SARC-F tool demonstrated a heightened risk of LUTSs. Subgroup analyses revealed a stronger association in institutionalized populations, suggesting that care setting may modify risk. These findings underscore the importance of assessing muscle health in older adults with urinary symptoms. Standardization of diagnostic criteria and longitudinal studies are needed to clarify causality and guide targeted interventions. Full article
(This article belongs to the Section Urology & Nephrology)
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20 pages, 2167 KiB  
Review
To Rezūm or Not to Rezūm: A Narrative Review of Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia
by Aris Kaltsas, Ilias Giannakodimos, Evangelos N. Symeonidis, Dimitrios Deligiannis, Marios Stavropoulos, Asterios Symeonidis, Konstantinos Adamos, Zisis Kratiras, Andreas Andreou and Michael Chrisofos
J. Clin. Med. 2025, 14(12), 4254; https://doi.org/10.3390/jcm14124254 - 15 Jun 2025
Viewed by 1525
Abstract
Background/Objectives: Benign prostatic hyperplasia (BPH) is a common urological condition that can significantly impair quality of life in aging men by causing lower urinary tract symptoms (LUTS), including nocturia, weak stream, and incomplete emptying. While pharmacotherapy and surgical approaches such as transurethral [...] Read more.
Background/Objectives: Benign prostatic hyperplasia (BPH) is a common urological condition that can significantly impair quality of life in aging men by causing lower urinary tract symptoms (LUTS), including nocturia, weak stream, and incomplete emptying. While pharmacotherapy and surgical approaches such as transurethral resection of the prostate (TURP) remain cornerstone treatments, minimally invasive surgical therapies (MISTs) have emerged to bridge the gap between long-term medication use and invasive surgery. This narrative review assesses Rezūm therapy (water vapor thermal therapy, WVTT) by examining its mechanism of action, clinical efficacy, safety profile, and place in the BPH treatment algorithm. Methods: This narrative review synthesizes evidence from randomized controlled trials (RCTs), prospective studies, real-world cohorts, and published systematic reviews with meta-analyses to provide a comprehensive evaluation of Rezūm therapy for BPH. Key outcomes assessed include changes in International Prostate Symptom Score (IPSS), urinary flow rates, retreatment rates, adverse events, and sexual function preservation. Results: Across multiple studies, Rezūm significantly reduces IPSS (typically by ≥50%) and increases peak urinary flow by 4–5 mL/s. These improvements are durable, with five-year follow-up data showing low retreatment rates of approximately 4–5% and sustained symptom relief. The procedure, performed under local or minimal anesthesia, has a favorable safety profile: most adverse events are mild or transient, and notable complications, such as bleeding requiring transfusion or persistent sexual dysfunction, are rare. Importantly, Rezūm preserves both erectile and ejaculatory function in most patients, setting it apart from many traditional surgical interventions associated with higher sexual side effect rates. Conclusions: Rezūm is an effective and minimally invasive alternative for men with moderate prostatic enlargement who desire durable symptom improvement while avoiding the morbidity and sexual side effects associated with more invasive surgery. Future research should aim to further refine patient selection and assess long-term outcomes in broader populations. Full article
(This article belongs to the Special Issue Urologic Surgery: From Bench to Bedside)
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12 pages, 488 KiB  
Article
Association Between Endogenous Equol Production and the Onset of Overactive Bladder in Postmenopausal Women
by Hiroyuki Honda, Tomohiro Matsuo, Hidenori Ito, Shota Kakita, Shintaro Mori, Kyohei Araki, Kensuke Mitsunari, Kojiro Ohba, Yasushi Mochizuki and Ryoichi Imamura
J. Clin. Med. 2025, 14(12), 4183; https://doi.org/10.3390/jcm14124183 - 12 Jun 2025
Viewed by 705
Abstract
Objectives: Equol, a gut-derived metabolite of soy isoflavones with estrogenic activity, may influence bladder aging. However, the association between overactive bladder (OAB), which is closely linked to bladder aging, and the estrogenic effects of equol remains unknown. Therefore, this study investigated the [...] Read more.
Objectives: Equol, a gut-derived metabolite of soy isoflavones with estrogenic activity, may influence bladder aging. However, the association between overactive bladder (OAB), which is closely linked to bladder aging, and the estrogenic effects of equol remains unknown. Therefore, this study investigated the association between endogenous equol production and onset and severity of OAB in postmenopausal women. Methods: The study included 128 postmenopausal women, newly diagnosed with OAB, who were categorized into equol- and non-equol-producing groups based on urinary equol levels as measured by enzyme-linked immunosorbent assay. Patient clinical characteristics, OAB Symptom Score (OABSS), and urodynamic parameters were assessed. Propensity score matching was performed to minimize confounding factors related to the timing of lower urinary tract symptom (LUTS) onset. Results: Equol producers exhibited a significantly later onset of LUTS than non-producers (68.7 ± 10.9 vs. 62.7 ± 10.7 years, p = 0.002). Equol producers were more prevalent in the late-onset group (58.6% vs. 31.0%, p = 0.002), which had significantly higher urinary equol concentrations than the early-onset group (p = 0.014). No significant differences were observed in total OABSS or subscale scores between the groups, suggesting that equol did not affect symptom severity. Propensity score-matched analysis (n = 104) confirmed that equol non-production was an independent risk factor for early-onset LUTS (OR, 1.930; 95% CI, 1.248–4.049; p = 0.014). Conclusions: Endogenous equol production was significantly associated with the delayed onset of OAB in postmenopausal women. Thus, equol may serve as a protective factor and non-invasive biomarker to guide individualized prevention and early intervention strategies in urological care for women. Full article
(This article belongs to the Topic Gynecological Endocrinology Updates)
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12 pages, 2082 KiB  
Article
Prostate Artery Embolization (PAE) in the Treatment of Benign Prostatic Hyperplasia: A Case Series and Narrative Review
by Vincenzo Iossa, Ernesto Punzi, Savio Domenico Pandolfo, Gianluca Spena, Pierluigi Russo, Carlo Giulioni, Achille Aveta, Lorenzo Spirito, Giulio Lombardi and Vittorio Imperatore
J. Clin. Med. 2025, 14(11), 3775; https://doi.org/10.3390/jcm14113775 - 28 May 2025
Viewed by 711
Abstract
Background/Objectives: Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), particularly in high-risk surgical candidates. This study aims to evaluate the efficacy, safety, and clinical outcomes of PAE, [...] Read more.
Background/Objectives: Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), particularly in high-risk surgical candidates. This study aims to evaluate the efficacy, safety, and clinical outcomes of PAE, combining a retrospective case series with a narrative review of the literature. Methods: A single-center retrospective analysis was conducted on 10 patients aged ≥ 70 years with moderate-to-severe LUTS due to BPH who underwent PAE between January 2021 and January 2024. Inclusion criteria included IPSS > 18, Qmax < 12 mL/s, prostate volume > 45 cc, and resistance to medical therapy. Embolization was performed using 300–500 µm tris-acryl gelatin microspheres via the PErFecTED technique. Follow-up included IPSS, Qmax, prostate volume (PV), PSA levels, and complications. A narrative review of 18 studies (n = 1539 patients) was also conducted to contextualize findings. Results: Technical success was achieved in all patients (100%), and clinical success (IPSS reduction ≥ 50%) in 90%. At 12 months, the following significant improvements were observed: mean IPSS decreased from 24 to 12 (p < 0.0001), Qmax increased from 8.7 to 12.6 mL/s (p < 0.0001), PV reduced from 66.4 to 49.4 cc (p < 0.0001), and PSA from 5.0 to 3.4 ng/mL (p < 0.0001). Outcomes remained stable up to 36 months. Two patients developed transient post-procedural fever; no major complications were recorded. Conclusions: PAE is a safe and effective treatment for LUTS related to BPH, offering durable symptom relief and minimal morbidity, particularly in elderly and comorbid patients. While the evidence supports its role as an alternative to TURP, larger prospective trials are necessary to confirm its long-term efficacy and optimize patient selection. Full article
(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Urologic Surgery)
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12 pages, 486 KiB  
Article
Cracking the LUTS Code: A Pre-Urodynamic Tool for DU vs. BOO Diagnosis in Female Patients with Non-Neurogenic LUTS
by Karolina Garbas, Łukasz Zapała, Aleksander Ślusarczyk, Tomasz Piecha and Piotr Radziszewski
J. Clin. Med. 2025, 14(11), 3674; https://doi.org/10.3390/jcm14113674 - 23 May 2025
Viewed by 524
Abstract
Background: Detrusor underactivity (DU) and bladder outlet obstruction (BOO) are common causes of voiding dysfunction in women with lower urinary tract symptoms (LUTS). However, differentiating between them remains challenging due to overlapping clinical presentations and a reliance on invasive urodynamic studies (UDS). [...] Read more.
Background: Detrusor underactivity (DU) and bladder outlet obstruction (BOO) are common causes of voiding dysfunction in women with lower urinary tract symptoms (LUTS). However, differentiating between them remains challenging due to overlapping clinical presentations and a reliance on invasive urodynamic studies (UDS). This study aimed to develop a non-invasive, office-based clinical prediction model to distinguish DU from BOO in women with non-neurogenic LUTS. Methods: We conducted a retrospective analysis of 88 women who underwent pressure-flow studies at two outpatient clinics between 2012 and 2022. DU was defined using a projected isovolumetric pressure 1 (PIP1) < 30 cm H2O, and BOO was defined by a Female-Specific Bladder Outlet Obstruction Index (BOOIf) > 18. Clinical symptoms, uroflowmetry (UFL) parameters, and pelvic organ prolapse staging (POP-Q) were evaluated. A multivariate logistic regression model was constructed using a stepwise selection procedure. Results: Of the 88 patients, 38 (43.2%) were diagnosed with DU and 50 (56.8%) with BOO. Four predictors were retained in the final model: hesitancy (OR = 2.06, p = 0.18), incomplete emptying (OR = 3.52, p = 0.02), POP-Q < 3 (OR = 0.15, p = 0.02), and longer time to Qmax on UFL (OR = 1.05, p = 0.004). The model achieved a Harrell’s Concordance Index (C-index) of 0.779. Using a probability cutoff of 0.3, the model demonstrated a sensitivity of 86.8%, specificity of 46.0%, positive predictive value of 55.0%, and negative predictive value of 82.1%. Conclusions: We present a novel non-invasive prediction model incorporating clinical symptoms, UFL metrics, and pelvic exam findings that may aid in differentiating DU from BOO in women with LUTS. Full article
(This article belongs to the Section Nephrology & Urology)
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9 pages, 1318 KiB  
Review
A Case Report and Literature Review of Prostatic Tuberculosis Masquerading as Prostate Cancer: A Diagnostic Challenge in a Tuberculosis-Endemic Region
by Yonathan William, Marto Sugiono, Patricia Diana Prasetiyo, Adelbertus Erico and Gilbert Sterling Octavius
Trop. Med. Infect. Dis. 2025, 10(5), 145; https://doi.org/10.3390/tropicalmed10050145 - 21 May 2025
Viewed by 594
Abstract
A male in his 60s presented with a four-month history of dysuria and lower urinary tract symptoms (LUTS). He had a history of elevated PSA and benign prostatic hyperplasia (BPH), previously treated with transurethral resection of the prostate (TURP). Multiparametric MRI (MP-MRI) revealed [...] Read more.
A male in his 60s presented with a four-month history of dysuria and lower urinary tract symptoms (LUTS). He had a history of elevated PSA and benign prostatic hyperplasia (BPH), previously treated with transurethral resection of the prostate (TURP). Multiparametric MRI (MP-MRI) revealed a PI-RADS 5 lesion, raising suspicion of malignancy. However, histopathological analysis from MRI fusion-targeted biopsies confirmed tuberculous prostatitis. The patient was treated with antituberculosis drugs, resulting in symptomatic improvement and a significant PSA decline. This case highlights the diagnostic challenge of distinguishing tuberculous prostatitis from prostate cancer, particularly in tuberculosis-endemic regions. Our literature review reveals that patients with tuberculous prostatitis undergoing MRI are at least 50 years old, originate from endemic areas, and exhibit PI-RADS scores ranging from 2 to 5, indicating inter-rater variability. Histopathological confirmation remains essential in cases with ambiguous imaging and clinical findings. Full article
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16 pages, 1847 KiB  
Systematic Review
Lower Urinary Tract Symptoms in Uterine Myoma: A Systematic Review and Meta-Analysis
by Lek-Hong Tan and Li-Hsien Tsai
Medicina 2025, 61(5), 890; https://doi.org/10.3390/medicina61050890 - 14 May 2025
Viewed by 799
Abstract
Background and Objectives: Lower urinary tract symptoms (LUTSs) are prevalent among patients with uterine myoma (UM); however, these health issues have not been systematically evaluated. To address this research gap, this systematic review and meta-analysis synthesizes existing findings on the prevalence estimates [...] Read more.
Background and Objectives: Lower urinary tract symptoms (LUTSs) are prevalent among patients with uterine myoma (UM); however, these health issues have not been systematically evaluated. To address this research gap, this systematic review and meta-analysis synthesizes existing findings on the prevalence estimates and odds ratios for LUTSs in patients with UM. Materials and Methods: A systematic literature search using PubMed and Embase was conducted for articles published between 1 January 2000 and 24 September 2023. The search and review processes followed the PRISMA and MOOSE guidelines. This study was registered in PROSPERO (CRD42023474156). Data on the prevalence and odds ratios of LUTSs—including storage symptoms (frequency, urgency, nocturia), voiding symptoms, and urinary incontinence (UI) subtypes such as stress incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI)—were extracted. Pooled prevalence estimates and odds ratios were calculated using random-effects meta-analysis. Subgroup analyses and univariate meta-regression were conducted to examine associations with age, BMI, parity, WHO region, and risk of bias. The impact of UM size was assessed using standardized mean differences. Results: Of the 572 articles screened, 20 met the inclusion criteria. The overall pooled prevalence of LUTSs in UM patients was 49% (95% CI, 26–72%), with substantial heterogeneity across studies (I2 = 99.8%). The pooled prevalence for urinary frequency, urgency, nocturia, voiding dysfunction, and overall UI, SUI, UUI, and MUI ranged from 15% to 54%. SUI and UUI were significantly associated with UM (OR = 2.0, 95% CI: 1.2–3.3; OR = 1.5, 95% CI: 1.1–2.0, respectively). Hysterectomy was not associated with an improvement in overactive bladder (OAB) symptoms (OR = 1.9, 95% CI: 0.6–5.7). A larger UM size was not linked to worsening LUTS. Fourteen studies (70%) had some concerns about the risk of bias, while six studies (30%) had a low risk of bias. Egger’s test showed no significant publication bias (p = 0.19). Conclusions: Approximately half of patients with UM experience LUTSs or UI. The findings emphasize the need to consider urinary symptoms in UM management. Further research is warranted to reduce heterogeneity and explore treatment-specific outcomes. Full article
(This article belongs to the Section Urology & Nephrology)
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20 pages, 770 KiB  
Systematic Review
Exploring Childhood Lower Urinary Tract Symptoms (LUTS), Urinary Tract Infections (UTIs) and the Microbiome—A Systematic Review
by Mauro Van den Ende, Laure Van de Steen, Karel Everaert, François Hervé and George Bou Kheir
Life 2025, 15(5), 730; https://doi.org/10.3390/life15050730 - 30 Apr 2025
Viewed by 647
Abstract
Pediatric lower urinary tract symptoms (LUTS) are influenced by age and coexist with nocturnal enuresis (NE) and bladder-bowel dysfunction (BBD). Urinary tract infections (UTIs) are common and linked to LUTS, though the causal relationship remains unclear. This systematic review aims to analyze microbiome [...] Read more.
Pediatric lower urinary tract symptoms (LUTS) are influenced by age and coexist with nocturnal enuresis (NE) and bladder-bowel dysfunction (BBD). Urinary tract infections (UTIs) are common and linked to LUTS, though the causal relationship remains unclear. This systematic review aims to analyze microbiome alterations in pediatric LUTS and UTIs. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Embase, and CINAHL databases were searched for studies analyzing gut and urinary microbiomes in pediatric patients with LUTS and UTIs. Quality assessment was performed using the QUADOMICS checklist. Results: Nine studies published between 2018 and 2024 were included; seven out of nine studies employed prospective designs. Six hundred nineteen patients (44.3% pathology groups, 55.7% controls) were analyzed, with microbiome sequencing performed on stool samples in four studies and urine samples in five studies. UTIs and BBD were associated with reduced alpha diversity and distinct bacterial compositions, while beta diversity analyses revealed distinct clustering of microbiome compositions between affected and healthy groups. The gut microbiome of UTI patients showed alterations in Actinobacteria and Proteobacteria abundance, while voiding dysfunction (VD) was linked to the presence of Fusobacterium nucleatum, Clostridium difficile, and Bacteroides clarus without significant VDSS correlation. Conclusion: This systematic review reveals microbial alterations in pediatric LUTS and UTIs, with lower urinary diversity in UTI patients and sex-specific differences post-puberty. Microbiome-based interventions may offer novel therapeutic strategies for LUTS and UTIs. Full article
(This article belongs to the Special Issue Urinary Microbiome and Genitourinary System Disorders: 2nd Edition)
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15 pages, 412 KiB  
Systematic Review
Features and Management of Incidental Prostatic Lymphoma Obtained in Lower Urinary Tract Symptoms Surgery: A Systematic Review
by Jeremy Cheng, Samith Minu Alwis, Nathan Papa, Joseph Ischia, Damien Bolton and Dixon Woon
Soc. Int. Urol. J. 2025, 6(2), 28; https://doi.org/10.3390/siuj6020028 - 17 Apr 2025
Viewed by 479
Abstract
Background/Objectives: Prostatic lymphoma is a rare malignant tumour that frequently causes urinary tract obstruction. It is uncommon for patients to present with systemic features or B-symptoms. As a result, it is often diagnosed incidentally during surgical lower urinary tract symptoms (LUTS) treatment. [...] Read more.
Background/Objectives: Prostatic lymphoma is a rare malignant tumour that frequently causes urinary tract obstruction. It is uncommon for patients to present with systemic features or B-symptoms. As a result, it is often diagnosed incidentally during surgical lower urinary tract symptoms (LUTS) treatment. This systematic review aims to identify any common clinical features of prostatic lymphoma diagnosed incidentally during surgical LUTS treatment and summarise disease treatment and outcomes. Methods: The study protocol was registered with Prospective Register of Systematic Reviews (PROSPERO). A search was performed across the following electronic databases: MEDLINE, Embase, Web of Science, and Cochrane Database of Systematic Reviews. Full texts of eligible studies were analysed and data were extracted. The review was performed in accordance with PRISMA guidelines. Results: A total of 24 case reports compromising 25 cases were included. The median (IQR) age was 67 (61–73) years. All patients reported LUTS as their primary complaint, and the median duration of LUTS prior to diagnosis was 17 (4–44) months. Serum prostate-specific antigen (PSA) was normal in 10 cases and prostatomegaly present on imaging in 16 cases. A total of 10 different subtypes of lymphoma were reported. Extra-prostatic involvement was reported in eight patients. Chemotherapy, with or without adjuvant radiotherapy, was the mainstay of lymphoma treatment. The majority of articles reported positive outcomes, with complete remission in 17 cases. Conclusions: Prostatic lymphoma is a difficult clinical diagnosis due to its similar presentation to benign prostatic hyperplasia (BPH). Although rare, prostatic lymphoma may need to be considered as a diagnosis in patients with an atypical presentation of BPH. Prognosis is often favourable after prompt referral to haematology or oncology. Full article
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