OBJECTIVES:To synthesize published placebo-controlled trials of vibegron monotherapy for overactive bladder (OAB) and quantify posterior probabilities of benefit and decision-threshold exceedance. METHODS:We extracted published placebo-adjusted least-squares mean differences at Week 12 from three randomized, double-blind, placebo-controlled Phase III trials evaluating vibegron monotherapy (Japan Phase III trial, Korea bridging study [50 mg], and EMPOWUR trial [75 mg]) for four voiding-diary endpoints: micturitions/day, urgency episodes/day, urgency urinary incontinence (UUI) episodes/day, and voided volume (mL). For each endpoint, a Bayesian normal-normal random-effects model estimated the pooled mean effect and between-trial heterogeneity and calculated posterior probabilities of benefit and of exceeding thresholds predefined in this analysis. RESULTS:Pooled mean effects (95% credible intervals) favored vibegron across all four voiding-diary endpoints: micturitions/day (-0.76, -1.33 to -0.28), urgency episodes/day (-0.69, -1.35 to -0.22), UUI episodes/day (-0.44, -0.93 to -0.03), and voided volume (+24.09 mL, 15.78-32.51). The posterior probabilities of benefit were 99.5%, 99.3%, 98.0%, and > 99.9%, respectively. The probabilities of exceeding thresholds were as follows: for micturitions/day, ≤ -0.5: 90.3% and ≤ -1.0: 14.2%; for urgency episodes/day, ≤ -0.5: 82.8% and ≤ -1.0: 12.7%; for UUI episodes/day, ≤ -0.3: 81.8% and ≤ -0.5: 35.4%; and for voided volume, ≥ +10 mL: 99.5%, ≥ +20 mL: 88.4%, and ≥ +30 mL: 5.8%. CONCLUSIONS:Bayesian cross-trial synthesis demonstrates a high probability that vibegron improves key OAB voiding-diary outcomes at Week 12. By explicitly quantifying the probability of exceeding clinically interpretable decision thresholds, this approach provides a transparent assessment of both the direction and magnitude of treatment effects, facilitating clinically interpretable decision-making.
INTRODUCTION:To investigate the nationwide trends in pharmacological treatment for overactive bladder among Japanese adults, specifically focusing on the β3-agonists to anticholinergics prescribed tablet ratio (BAPR) and how this ratio differs by sex and age. METHODS:National Database Open Data from fiscal year 2015 to 2023 were utilized and the prescription volumes of β3-agonists (mirabegron and vibegron) and anticholinergics (propiverine, solifenacin, imidafenacin, and fesoterodine) were aggregated. The data were categorized by sex and 10-year age groups to analyze prescribed tablet trends per 1000 population for each demographic. We calculated the BAPR by dividing the number of prescribed tablets for β3-agonists by those for anticholinergics and investigated the annual trends for younger and older men and women using an ordinary least squares linear regression model. RESULTS:During the study period, the total number of prescribed tablets for β3-agonists, anticholinergics, and overall total showed changes of +285.3%, -24.7%, and +59.3%, respectively. Total and β3-agonist prescriptions rose annually across all groups, whereas anticholinergic use declined beginning in fiscal year 2018. Additionally, nearly all drugs showed an increase in prescribed tablets per 1000 population as age progressed. Although the BAPR increased significantly in all groups, there were significant differences in the rates of change between groups (p < 0.001), with older men exhibiting the highest rate of increase. CONCLUSIONS:A nationwide shift in overactive bladder treatment, where the growth in β3-agonist prescriptions outweighed the decline in anticholinergics, was observed across all demographic groups in Japan.
OBJECTIVES:To evaluate the impact of preoperative urinary retention on perioperative and early postoperative outcomes following Holmium Laser Enucleation of the Prostate (HoLEP), using a balanced comparison between catheterized and non-catheterized patients. METHODS:This retrospective cohort study included patients who underwent HoLEP for benign prostatic hyperplasia at a tertiary center between January 2024 and July 2025. Patients were stratified into two groups based on the presence of acute or chronic urinary retention requiring preoperative catheterization. Propensity score matching (1:1) was performed using age, BMI, coronary artery disease, PSA, INR, platelet count, anticoagulant/antiplatelet use, and prostate volume, yielding 57 matched patients per group. Perioperative parameters, complications (Clavien-Dindo), and early functional outcomes were compared. RESULTS:A total of 114 matched patients were analyzed. Baseline demographic and clinical characteristics were comparable between groups. Catheterized patients demonstrated significantly longer operative (p = 0.013) and enucleation times (p = 0.012). Postoperative hematocrit decline (p = 0.016), catheterization duration (p = 0.001), and hospitalization time (p = 0.012) were all greater in catheterized patients. The overall complication rate was higher in the catheterized group (p = 0.041), although individual adverse events were infrequent. Despite these differences, one-month functional outcomes (IPSS, Qmax, PVR) were similar between groups (all p > 0.05). CONCLUSIONS:Preoperative urinary retention is associated with increased operative complexity and higher rate of early complications after HoLEP; however, early functional recovery remains comparable to that of non-catheterized patients. HoLEP remains an effective treatment across varying obstruction severities, though catheter-dependent patients may benefit from optimized perioperative management.
OBJECTIVES:To describe early physiologic deobstruction after contemporary 980-nm diode-laser contact vaporization of the prostate (CVP) in patients with evaluable paired preoperative and 3-month postoperative pressure-flow studies (PFS). METHODS:This single-center retrospective cohort included 94 consecutive men who underwent CVP between March 2023 and August 2025. Paired full PFS was evaluable in 48 patients. Baseline characteristics were compared between patients with and without evaluable paired PFS. Perioperative outcomes, symptom scores, and complications were summarized in the full cohort, whereas paired PFS parameters were analyzed in the paired PFS cohort. RESULTS:In the full cohort, IPSS total and voiding scores and QOL improved from 1 month postoperatively, whereas storage symptom improvement was more gradual. OABSS showed transient mild worsening at 1 month, followed by improvement. In the paired PFS cohort, voiding parameters improved markedly, with significant reductions in BOOI, PdetQmax, and PVR and increases in Qmax and voided volume. In contrast, filling-phase parameters, including first desire to void, normal desire to void, maximum cystometric capacity, and bladder compliance, showed limited short-term changes. Postoperative complications occurred in 31/94 patients (33.0%), accounting for 37 events. The most common complications were transient urinary retention and urinary tract infection, each occurring in 12/94 patients (12.8%). CONCLUSIONS:CVP was associated with substantial early outlet relief on paired PFS, accompanied by improvements in patient-reported symptoms. Early filling-phase changes were limited, suggesting that bladder storage recovery may lag behind outlet relief. Prospective comparative studies with longer follow-up are needed.
ABSTRACT Objectives To evaluate whether frailty at treatment initiation is associated with treatment‐related adverse events in patients with newly diagnosed overactive bladder (OAB). Methods This retrospective, single‐center cohort study included 122 patients who initiated pharmacotherapy for OAB between April 2024 and January 2026. Frailty was evaluated using the Frailty Screening Index and classified as robust, prefrail, or frail. The primary outcome was treatment‐related adverse events within 3 months, and independent predictors were identified using multivariable logistic regression. Longitudinal changes in OAB symptoms were examined using linear mixed‐effects models. Results During follow‐up, adverse events occurred in 52 patients (42.6%), rising with frailty (4.7%, 40.0%, and 57.3% in robust, prefrail, and frail groups, respectively; p < 0.01 for trend). In multivariable analysis, frailty (odds ratio [OR] 2.97 per status increase, 95% confidence interval [CI] 1.45–6.52; p < 0.01), anticholinergic use (OR 7.96, 95% CI 2.94–24.46; p < 0.01), and baseline post‐void residual volume (OR 1.22 per 10 mL increase, 95% CI 1.01–1.34; p = 0.02) were independently associated with adverse events; chronological age was not. Symptom improvement over time did not differ significantly by frailty status. Conclusions Frailty, rather than chronological age, was associated with short‐term treatment‐related adverse events among patients starting pharmacotherapy for OAB. Frailty assessment may help identify patients at higher risk of adverse events and support individualized, safety‐conscious treatment decisions.
OBJECTIVES:To compare minimally invasive surgical therapies (MISTs) for benign prostatic obstruction (BPO) using probabilistic multicriteria decision analysis that integrates heterogeneous clinical outcomes under varying stakeholder priorities. METHODS:This secondary analysis was derived from a published network meta-analysis. Three treatments-monopolar transurethral resection of the prostate (mTURP), prostatic urethral lift (PUL), and water vapor thermal therapy (WVTT)-were compared across six criteria: International Prostate Symptom Score (IPSS), IPSS Quality of Life, maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and two domains of the Male Sexual Health Questionnaire Short Form. Treatment effects were sampled using a Monte Carlo simulation (50 000 iterations) and mapped to a 0-1 scale using clinically interpretable anchors. Five weighting scenarios produced preference probabilities and net advantages with 95% uncertainty intervals (UI). Anchor perturbation and correlation sensitivity analyses assessed robustness. RESULTS:Under equal weights, WVTT had the highest P(best) (54.1%), followed by mTURP (25.8%) and PUL (20.1%); all pairwise UIs crossed zero. Under efficacy weights, mTURP had the highest P(best) (88.0%; net advantage vs. PUL: 0.124, 95% UI: 0.034-0.214), driven by superiority in Qmax and PVR. Under sexual function weights, mTURP was rarely preferred (P[best] < 0.1%), whereas PUL and WVTT achieved P(best) of 45.3% and 54.7%, respectively. Rankings were robust in both anchor perturbation and correlation sensitivity analyses. CONCLUSION:Within short-term (3-6 month) data, MIST preference for BPO depends on clinical priorities. mTURP is favored when urodynamic outcomes are emphasized; PUL and WVTT are preferred when preservation of sexual function is prioritized. This framework supports preference-sensitive shared decision-making, although the findings are provisional pending long-term data.
OBJECTIVES:To evaluate sexual function and clinical outcomes following Rezūm water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH), with a dedicated focus on patients with large prostate volumes (> 80 mL). METHODS:A systematic search on PubMed, Scopus, and EBSCOhost was conducted through June 23, 2026. Studies reporting validated patient-reported outcome measures for erectile (IIEF) and ejaculatory (MSHQ-EjD) functions were included. Methodological quality was appraised using the Newcastle-Ottawa Scale (NOS) for 27 cohorts and the Cochrane RoB 2 tool for three randomized controlled trials (RCTs). RESULTS:Thirty studies (N = 4635 patients) met inclusion criteria. Across gland sizes (30-150 mL), Rezūm demonstrated a consistent trend toward preservation of erectile and ejaculatory function. Although several studies reported statistically significant improvements in IIEF scores, these generally did not reach established thresholds for clinical significance. Ejaculatory function was preserved in the majority of patients, contrasting with high rates of ejaculatory dysfunction reported for resective comparators. Ten studies provided data for prostates > 80 mL; in this subgroup, Rezūm provided significant relief of lower urinary tract symptoms (LUTS) with sexual function outcomes that appeared comparable to those in standard-sized glands. Adverse events were predominantly Clavien-Dindo Grade I-II, with Grade ≥ III complications occurring in < 1% of patients. Overall, methodological quality was limited, with a high prevalence of low-to-moderate quality evidence, and all RCTs judged at high risk of bias. CONCLUSIONS:Current evidence suggests that Rezūm preserves erectile and ejaculatory function while providing meaningful relief of urinary symptoms, including in large-volume prostates. However, confidence in these findings remains limited by the predominance of low-quality evidence and a high risk of bias.
INTRODUCTION:Overactive bladder (OAB) is a prevalent condition, particularly among women, and is associated with substantial economic and quality-of-life burdens. Although stress urinary incontinence during and after pregnancy is well documented, the association between childbirth and OAB symptoms remains unclear. This study aimed to investigate the relationship between childbirth history and OAB symptoms among Japanese women using a large-scale internet-based survey. METHODS:A total of 4800 Japanese women aged 40 years and older were recruited through an online survey platform. Participants were stratified by age and completed the Overactive Bladder Symptom Score (OABSS) questionnaire. Subjects were grouped based on childbirth history (parous vs. nulliparous), and OABSS scores were compared between the groups. Subgroup analyses were conducted for women aged 40-60 years and for parous women based on delivery mode (vaginal vs. cesarean). RESULTS:The OABSS total score and scores for nocturia, urgency, and urgency incontinence were significantly higher in the parous group compared to the nulliparous group (all p < 0.001). These trends persisted in the 40-60-year-old subgroup. No significant differences in OABSS scores were found between women who had vaginal deliveries and those who had cesarean sections. BMI showed minimal correlation with OABSS, while symptom severity increased with age. CONCLUSION:A history of childbirth may be associated with more severe OAB symptoms among Japanese women, independent of age. These findings highlight childbirth as a potential risk factor for OAB and underscore the need for long-term urinary health monitoring in women.
Overactive bladder (OAB) is a prevalent syndrome whose first-line pharmacotherapy with antimuscarinics and β3-adrenoceptor agonists is limited by suboptimal efficacy and poor tolerability, underscoring the unmet need for novel molecular targets. As key regulators of detrusor smooth muscle excitability and bladder afferent signaling, ion channels have emerged as a compelling target class capable of modulating bladder function with high spatial precision. This review summarizes current evidence on the role of cation and anion channels in OAB pathophysiology and critically appraises their therapeutic potential, covering the principal channel families implicated in detrusor and afferent dysfunction, including voltage-gated Ca2+ and Na+ channels, K+ channel subfamilies, HCN, TRP, and PIEZO channels, ligand-gated cation channels, ENaC/ASIC, and Cl- channels, with preclinical and clinical evidence integrated throughout. Despite this strong mechanistic rationale, clinical translation has been hampered by ubiquitous channel expression, patient heterogeneity, and the absence of stratifying biomarkers. Although the supporting evidence remains uneven, spanning genetic, ex vivo, and early-phase clinical studies, future progress will likely depend on tissue-selective compounds, biomarker-defined subphenotypes, and emerging targets such as TMEM16A, TRPM4, and PIEZO channels, which represent particularly promising avenues for next-generation OAB pharmacotherapy.
OBJECTIVES:Cernitin pollen extract is used for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but pretreatment factors associated with pain improvement remain unclear. This study explored baseline factors associated with clinically meaningful pain relief after cernitin therapy in men with CP/CPPS. METHODS:This exploratory post hoc analysis was based on a single-center, open-label, randomized prospective trial conducted between July 2017 and December 2018. Men with persistent CP/CPPS despite at least 12 weeks of α1-blocker therapy were randomized to receive add-on cernitin pollen extract or tadalafil for 12 weeks. The present analysis included 42 men assigned to cernitin. Good responders were defined as patients with a ≥ 50% improvement in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) pain subscore. Baseline variables were compared, and exploratory logistic regression analysis with a limited number of covariates was performed. RESULTS:Among 42 patients, 21 were good responders and 21 were poor responders. The NIH-CPSI pain subscore improved by 67.0% in good responders and by 28.9% in poor responders (p < 0.001). Baseline serum total testosterone was significantly lower in good responders than in poor responders (4.5 ± 2.9 vs. 6.3 ± 2.4 ng/mL; p = 0.006). In exploratory multivariable analysis, lower serum total testosterone remained the only factor associated with clinically meaningful pain improvement (odds ratio 0.53, 95% confidence interval 0.30-0.95; p = 0.033). CONCLUSIONS:Lower pretreatment serum total testosterone was associated with clinically meaningful pain improvement after cernitin therapy. These findings are hypothesis-generating and require validation in larger prospective cohorts.
OBJECTIVE:To measure the morphology of the pelvic floor muscle and levator ani hiatus (LAH) using 3D MRI segmentation in females with (SUI) and to assess correlations with age, body mass index (BMI), and parity. METHODS:This study includes 80 patients with SUI who underwent 3.0 T pelvic MRI. Patients were grouped based on age, BMI, and parity. Manual segmentation and 3D modeling of the pelvic floor muscle and LAH were performed to get volumetric and dimensional measurements. Statistical analysis included Kruskal-Wallis, Mann-Witney, and post hoc testing to evaluate group variations. RESULTS:The cohort included patients from 20 to 90 years old (mean 53.9 ± 11.7), with a mean BMI of 25.3 ± 3.4 and a mean parity of 1.85 ± 1.03. Significant variations in LAM surface (H(2) = 6.650, p = 0.036), flatness (H(2) = 6.471, p = 0.039), median intensity (H(2) = 8.218, p = 0.016), and curvature mean (H(2) = 7.382, p = 0.025) among age groups. The greatest LAM surface rankings were found in the 50-65 age range, whereas the highest LAM flatness ranks were found in those over 65 years old. BMI demonstrated a limited association, with overweight/obese participants exhibiting 11.3% larger LAM surface area compared to normal/underweight individuals (p = 0.044, r = 0.225). No significant associations were found between parity and any pelvic floor morphometric parameters (all p > 0.05). CONCLUSION:This study identifies age-dependent morphological changes in levator ani muscle architecture as the primary determinant of pelvic floor structural adaptation in women with stress urinary incontinence. These quantitative shape-based parameters offer novel diagnostic and therapeutic insights, advancing precision medicine approaches in urogynecological assessment and management.
BACKGROUND:Skeletal muscle relaxants (SMR), particularly baclofen, have been used in patients with dysfunctional voiding (DV) and poor relaxation of the external sphincter (PRES) with variable efficacy and notable side effects. Tizanidine, a centrally acting α2-adrenergic agonist, may offer comparable benefits with a more favorable tolerability profile. However, data regarding its use in DV remain limited. METHODS:This retrospective analysis included adults diagnosed with DV/PRES between July 2017 and January 2025. Data comprised demographics, lower urinary tract symptoms (LUTS), urodynamic parameters, pre, and posttreatment uroflowmetry values, and subjective response to alpha-blockers with pelvic floor relaxation exercises, and subsequent addition of tizanidine. Uroflowmetry indices included Qmax, Qave, and volume-normalized flow indices (VQImax, VQIave). Clinical outcomes were assessed via patient-reported symptom improvement. RESULTS:Of 114 patients, 62.2% showed no response to alpha-blockers alone. Following addition of tizanidine (median dose 6 mg/day), 69.3% reported symptomatic improvement (45% ≥ 50% improvement, 24.6% < 50% improvement; p < 0.00001). VQImax improved by ≥ 50% in 52% of patients, and clinical improvement significantly correlated with changes in VQImax (p = 0.004) and VQIave (p = 0.009). Women demonstrated greater improvement in flow parameters than men (p < 0.05), although symptom relief was similar across sexes. Tizanidine was generally well tolerated, with sedation being the most common dose-limiting side effect (25%). Median follow up duration was 12 months (IQR 9-22). CONCLUSIONS:Addition of tizanidine to alpha-blocker and pelvic relaxation is associated with clinically significant improvement in LUTS and uroflometry parameters in adults with pelvic floor dysfunction. We acknowledge that causal inference is limited by the study design and randomized placebo-controlled studies are required for deriving stronger conclusions.
OBJECTIVES:This study aimed to develop and validate an atherosclerosis-induced chronic bladder ischemia (CBI) model in female rats and to evaluate mechanosensitive single-unit afferent activity (SAA) in bladder-innervating fibers in both male and female CBI models. METHODS:Sprague-Dawley rats of both sexes were divided into sham and CBI groups. The CBI group underwent balloon-induced endothelial injury of the iliac arteries and received a 2% cholesterol diet for 8 weeks. Sham rats underwent bilateral inguinal incisions without arterial injury and were fed a regular diet. In female rats, iliac arterial wall thickening, 24-h voiding behavior, cystometric parameters, bladder blood flow, and fibrosis were assessed to evaluate CBI-induced bladder dysfunction. SAAs were recorded under urethane anesthesia. Bladder-innervating fibers were identified via electrical stimulation of the left pelvic nerve and bladder distension. Fibers were classified as Aδ- or C-fibers based on conduction velocity. RESULTS:Female CBI rats showed thickening of the common iliac arteries, increased voiding frequency, shortened intercontraction intervals, reduced bladder blood flow, and detrusor smooth muscle fibrosis, consistent with previous studies in male rats. In both sexes, the CBI group showed significantly higher SAAs in C-fibers than the sham group. No significant differences were found in SAAs of Aδ-fibers, although there was a tendency for female CBI rats to show higher activity. CONCLUSIONS:This study successfully established arteriosclerosis-induced CBI accompanied by frequent voiding in female rats, similar to males. In addition, the present findings suggest that C-fiber, but not Aδ-fiber, afferent activity is selectively facilitated under CBI conditions.
OBJECTIVE:Invasive urodynamic study(UDS) remains the gold-standard test for diagnosing and characterizing the neurogenic bladder. UDS being an invasive test is difficult to implement as a screening test for children who are predisposed for neurogenic bladder. An observational study was conducted to evaluate the urodynamic features of lower urinary tract dysfunction (LUTD) in follow-up pediatric surgical (nonurological primary etiology) cases "at-risk" for neurogenic bladder and the efficacy of noninvasive uroflowmetry was assessed. METHODS:A prospective study was done from November 2019 to December 2022. All the postoperative patients with a history of primary non-urological congenital anomalies, aged less than 15 years presenting with LUTD were included. Noninvasive free-flow uroflowmetry and invasive UDS were done for these patients. Abnormal UDS defined in terms of voiding pattern was compared with abnormal uroflowmetry defined as inadequate Qmax and nonbell shaped flow curve. RESULTS:Thirty-four children with primary diagnosis of spina-bifida (n = 12), anorectal malformation (n = 20), and sacrococcygeal teratoma (n = 2) were included, who presented with LUTD at a mean age of 4.76 ± 1.60 years. 29.4% children had acontractile bladder at presentation. Abnormal findings of uroflowmetry were comparable to abnormal findings of UDS (p > 0.05; kappa > 0.7). Uroflowmetry had sensitivity of 88.2% and specificity of 82.3% in diagnosing neurogenic bladder. CONCLUSIONS:Delayed presentation of neurogenic bladder with irreversible detrusor changes in predisposed cases highlights the need for stringent follow-up. Noninvasive uroflowmetry has high sensitivity and specificity with respect to invasive UDS in identifying neurogenic bladder in predisposed cases; it can be implemented as a routine screening test in predisposed cases to identify the at-risk cases in advance of clinical symptoms.
BACKGROUND:The benefit of transurethral outlet surgery in men with benign prostatic enlargement/benign prostatic obstruction (BPE/BPO) and detrusor underactivity (DU) remains uncertain, particularly when bladder outlet obstruction (BOO) is not demonstrated by pressure-flow testing. OBJECTIVE:To evaluate early outcomes after transurethral thulium laser enucleation of the prostate (ThuLEP) in men with DU and BPE/BPO-related voiding dysfunction, and to examine whether BOOI-defined obstruction status stratifies early postoperative improvement. METHODS:We retrospectively reviewed 189 ThuLEP records from a single centre and constructed a 100-patient complete-case cohort with interpretable preoperative pressure-flow studies and 3-month follow-up. DU was defined as bladder contractility index (BCI) < 100. BOO status was classified using bladder outlet obstruction index (BOOI) as definite BOO, equivocal BOO or no BOO. Functional, symptom, catheter-removal, anatomical and safety outcomes were compared descriptively across BOO strata. RESULTS:Ninety-one patients (91.0%) had DU: 56 had definite BOO, 25 had equivocal BOO and 10 had no BOO. In the DU cohort, mean Qmax increased from 3.88 ± 1.76 mL/s at baseline to 9.98 ± 3.68 mL/s at 1 month and 11.03 ± 4.02 mL/s at 3 months (both p < 0.001). Mean PVR decreased from 267.8 ± 167.4 to 142.6 ± 115.3 mL and 124.7 ± 103.4 mL, respectively (both p < 0.001). IPSS and QoL also improved. Because enucleated specimen weight was unavailable, postoperative prostate volume was analyzed as an anatomical surrogate; mean 3-month postoperative prostate volume was 18.8 ± 4.3 mL, corresponding to an absolute volume reduction of 38.0 ± 14.2 mL and a percentage reduction of 65.4% ± 6.3% in the DU cohort. Catheter-removal success was 83.9% in definite BOO, 68.0% in equivocal BOO and 40.0% in no BOO patients (descriptive p = 0.009). CONCLUSIONS:Preoperative BOOI-based stratification may help counsel men with DU regarding expected early functional improvement after ThuLEP. BOOI-defined no-BOO patients in this cohort were clinically selected after counseling, and the findings should be interpreted as exploratory because of the retrospective design, complete-case selection, short follow-up, and the small no-BOO subgroup.
OBJECTIVES:Aquablation therapy is an effective treatment for benign prostatic obstruction. However, its functional outcomes in older patients remain underexplored. In this study, we aimed to compare improvements in lower urinary tract symptoms (LUTS) after Aquablation therapy in patients aged ≥ 75 and ≤ 74 years. METHODS:We retrospectively analyzed data from 103 men with moderate-to-severe LUTS who underwent Aquablation between 2023 and 2025. Patients were stratified into two age groups (years): ≤ 74 (n = 72) and ≥ 75 (n = 31). Primary outcomes included changes in the International Prostate Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximum urinary flow rate (Qmax), and post-void residual (PVR) from baseline to 3 months postoperatively. Secondary outcomes included transfusion and complication rates. RESULTS:After 3 months, both groups showed significant improvements in total IPSS (-10.46 and -7.38 in those aged ≤ 74 and ≥ 75 years, respectively), QoL (-2.32 vs. -2.33), Qmax (+8.67 vs. +6.03 mL/s), and PVR (-89.1 vs. -75.3 mL; all p < 0.05). In the ≥ 75 group, voiding subscores, including incomplete emptying, intermittency, weak stream, and straining, improved significantly (p < 0.05), whereas storage symptoms, including frequency, urgency, and nocturia, did not (p = 0.07, 0.6, and 0.7, respectively). In patients aged ≤ 74 years, both voiding and storage symptom subscores improved significantly. No significant differences in operative time, transfusion rate, or complication rate were observed between groups. CONCLUSIONS:Aquablation therapy is a safe and effective surgical option for patients aged ≥ 75 years. In this older population, although storage symptoms were less treatment-responsive, substantial improvements in voiding symptoms and overall QoL were achieved.
OBJECTIVES:To evaluate the feasibility, safety, and short-term functional outcomes of adding bladder neck opening and ventral adenoma vaporization to ejaculatory hood (EH)-sparing photoselective vaporization of the prostate (PVP), aimed at preserving antegrade ejaculation in patients with benign prostatic obstruction (BPO). METHODS:This retrospective, single-center pilot study included 27 patients with BPO who underwent PVP at our institution with the purpose of preserving ejaculatory function. EH was defined as the area within approximately 1 cm proximal and lateral to the verumontanum, which was preserved during bladder neck opening and ventral adenoma vaporization to create an unobstructed cavity from the prostatic apex to the bladder neck. The primary endpoint was the preservation of antegrade ejaculation at 3 months postoperatively. RESULTS:At 3 months postoperatively, 26 (96%) of 27 patients had preserved antegrade ejaculation, and one (4%) patient was suspected of retrograde ejaculation. The median International Prostate Symptom Score decreased from 21 to 7, and the quality-of-life score decreased from 5 to 2. Further, the maximum flow rate increased from 5.4 to 14.3 mL/s, and the postvoid residual urine volume decreased from 72.5 to 0 mL (all p < 0.001). The median prostate volume decreased from 60 to 24 mL, and Clavien-Dindo grade III or higher adverse events were not observed. CONCLUSIONS:EH-sparing PVP with bladder neck opening and ventral adenoma vaporization was feasible and safe in the short term and was associated with preserved antegrade ejaculation and improved urinary outcomes in patients with BPO. Further prospective studies with validated sexual function assessment and longer follow-up are necessary to confirm these findings.
OBJECTIVE:Early post-prostatectomy incontinence (PPI) remains a common concern after robot-assisted radical prostatectomy (RARP). Recovery patterns vary among individuals, and identifying patients at risk of delayed recovery is clinically important. We evaluated whether prior adult inguinal hernia (IH) repair is associated with early continence outcomes after RARP. METHODS:We retrospectively analyzed 305 consecutive patients who underwent RARP between 2021 and 2024. Continence was defined as pad-free status, and PPI as use of > 1 pad/day. Continence was assessed at 1 week and at 1, 3, and 6 months postoperatively. Multivariable logistic regression and generalized estimating equation (GEE) modeling were used to evaluate associations, adjusting for age and BMI. Kaplan-Meier and interval-censored Cox models were applied to assess time to continence. RESULTS:Twenty-seven patients (8.9%) had prior IH repair. These patients demonstrated significantly higher rates of PPI at all assessed time points. After adjustment for age and BMI, prior IH repair remained significantly associated with PPI (adjusted ORs 2.99-5.84, all p < 0.05). Longitudinal GEE analysis also suggested a slower recovery pattern in the IH group (adjusted OR 4.05, 95% CI 1.62-10.11, p = 0.003). Kaplan-Meier analysis demonstrated delayed return to continence (log-rank p < 0.001), and interval-censored Cox regression confirmed a significantly lower probability of continence recovery in this group (p = 0.001). CONCLUSIONS:Prior IH repair was associated with delayed early continence recovery within 6 months after RARP. Given the limited IH sample and follow-up duration, these findings should be interpreted cautiously as exploratory and hypothesis-generating. Larger prospective studies with longer follow-up are warranted.
