This systematic review assessed the potential effectiveness and safety of Serenoa repens (saw palmetto) for benign prostatic disorders, mainly benign prostatic hyperplasia and associated lower urinary tract symptoms. Following PRISMA guidance (PROSPERO: CRD420251032255), we searched PubMed, Cochrane and ScienceDirect for human studies from January 2020 to May 2025. Sixteen studies (>3000 participants) met criteria, including randomized trials, observational cohorts, a post hoc analysis, an open-label comparative study and a pharmacovigilance analysis. Overall, S. repens was associated with improvements in symptom severity (International Prostate Symptom Score) in several trials, with variable effects on urinary flow, post-void residual volume, and patient-reported quality of life. Signals of benefit appeared more consistently with hexanic lipidosterolic extracts and β-sitosterol-enriched preparations, and some real-world and head-to-head comparisons suggested outcomes comparable to alpha-blockers with fewer adverse events. Combination therapy, especially with the addition of alpha-blockers, showed larger symptom reductions in select populations, particularly with more pronounced baseline symptoms or prostatic inflammation. However, heterogeneity in extract formulations, dosing, study design, and outcome reporting limited cross-study comparability. Safety findings were generally favourable, with mostly mild gastrointestinal events and fewer sexual adverse effects than reported for conventional pharmacotherapies. Taken together, recent evidence supports S. repens as a potentially useful, well-tolerated option for benign prostatic hyperplasia-related symptoms - especially in certain formulations and as part of combination strategies - whilst underscoring the need for standardized, adequately powered trials to clarify which patients benefit most, optimal dosing, and durability of effects.

Water vapor thermal therapy (WVTT) has emerged as a widely adopted minimally invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia/obstruction (BPH/BPO), with excellent functional outcomes and a favorable safety profile. However, life-threatening real-world complications are likely underreported. The aim of this study was to describe severe (Clavien-Dindo > = 4) complications after WVTT and discuss possible mechanisms, risk factors, and preventive strategies. During an international WVTT meeting (Madrid, June 2025), experienced surgeons from high-volume centers were invited to retrospectively report life-threatening complications after WVTT. Anonymized demographic, clinical, perioperative, and postoperative data were collected using a standardized template and were qualitatively analyzed. Contributors reported a small multicenter series of life-threatening events occurring despite negative preoperative urine cultures and standard antibiotic prophylaxis. Most complications were infectious, including septic shock with intraprostatic abscess and bacteremia, often requiring intensive care, vasopressor support, and prolonged intravenous antibiotics. Some fatal events were recorded, mainly due to sepsis caused by multidrug-resistant pathogens. Apart from infectious events, other complications were destructive orchitis requiring orchiectomy, severe urethral stricture with extensive intraprostatic necrosis requiring endoscopic treatment, and thermal injury to a redundant sigmoid colon. Several patients had relevant comorbidities, prior catheterization, or unrecognized anatomic variants. Although WVTT is generally safe, rare but dramatic life-threatening complications do occur, even in expert hands. Strict infection control, careful patient selection, adherence to recommended injection schemes, attention to bowel history and anatomy, and comprehensive counseling, particularly in frail and multimorbid patients, are essential to mitigate risk. Systematic, standardized reporting of severe adverse events is needed to refine perioperative strategies and improve patient safety.

Introduction: The main objective of the study was to demonstrate the noninferiority of the morcellation efficiency (ME) of the Multicut (c) morcellator compared with the Piranha (c) morcellator following anatomical endoscopic enucleation of the prostate (AEEP). Patients and Methods: The present study is a prospective, randomized, controlled, and single-center trial. Patients with an indication for obstructive prostate surgery via AEEP were prospectively included in the study. To assess ME, the time in minutes required for morcellation was recorded and divided by the weight in grams of morcellated prostatic tissue obtained from the pathology report. A comparative analysis of ME was also performed between cases with >60 g and <60 g of morcellated tissue. Results: A total of 137 patients were included, 68 in the Multicut group and 69 in the Piranha group. The average ME was higher in the Piranha group, with 9.33 g/minute compared with 7.34 g/minute in the Multicut group (p = 0.012). When analyzing cases with <= 60 g of morcellated tissue, the MEs were 7.32 g/minute for Multicut and 11.31 g/minute for Piranha (p = 0.004). For cases with >60 g of tissue, the efficiencies were 7.4 g/minute and 8.0 g/minute (p = 0.220), respectively. The incidence of beach balls was slightly higher in the Multicut group than in the Piranha group, 14.7% vs 7.2% (p = 0.261). We observed a 4.4% and 0% incidence of bladder mucosa injury with the Multicut and Piranha, respectively. Conclusions: In terms of ME, the Multicut is inferior to the Piranha. This difference appears to be more pronounced in smaller prostates. It seems that the Piranha might experience more malfunctions, whereas the Multicut might be associated with more bladder injuries and might require more auxiliary procedures to complete the retrieval of the prostatic tissue.

Home-based tools and apps offer a potential valuable and practical approach to evaluating patients with voiding dysfunction and complement in-clinic assessments. These technologies could improve patient convenience, enhance data collection, increase patient engagement, and personalise care. Further research is needed to address concerns and evaluate the long-term impact on patient outcomes and health care costs.

BACKGROUND AND OBJECTIVE:The endoscopic surgical approach for treatment of benign prostatic obstruction (BPO) has evolved over time and differs across European countries. We report on variations and trends in Belgium, England, France, Germany, Spain, and Sweden between 2018 and 2023. METHODS:Publicly accessible procedure data were used, including procedural volumes, hospital length of stay (LOS), and the proportion of daycase procedures, where available. Procedure codes were categorised to allow cross-country comparison, where appropriate. General linear model and Poisson regression analyses were conducted to assess the statistical significance of differences in volumes, daycase rates, and LOS across procedure categories and countries over time. KEY FINDINGS AND LIMITATIONS:Data for 1 100 365 endoscopic surgical BPO procedures between 2018 and 2023 were included in the analysis. Surgical volumes, treatment choice, LOS, and daycase rates varied greatly across the six countries. From 2019 to 2023, the relative proportion of transurethral resection of the prostate (TURP) cases declined from 74% to 64.5% in countries with distinct codes for this procedure, while laser treatment and minimally invasive surgical treatment (MIST) cases increased by 8.2% and 1.11%, respectively, on average. LOS was significantly shorter after MIST than after TURP procedures (p < 0.001). The daycase rate was significantly higher for MIST and laser procedures in comparison to TURP (p < 0.001). Procedure code-based data were heterogeneous in terms of their availability, structure, and reporting. CONCLUSIONS AND CLINICAL IMPLICATIONS:European treatment choices for lower urinary tract symptoms secondary to BPO have evolved towards increasingly diversified endoscopic surgical options, including laser and MIST procedures alongside TURP. Data on LOS and daycase activity illustrate that laser and MIST procedures have a low impact on capacity in comparison to TURP. This may help in alleviating hospital capacity constraints, improving resource allocation, and reducing surgical waiting lists.

To describe the natural history of AML, the clinical results and the need for treatment during long-term follow-up of renal AML. Retrospective study of patients diagnosed with AML by computed tomography or nuclear magnetic resonance between 2001 and 2019, with at least two follow-up images. Clinical and imaging variables, need for intervention, complications and follow-up time were recorded. Statistical analysis was performed using SPSS 22.0. 111 patients and 145 AML were included. The median follow-up was 6.17 years (range 0.7–18.1, IQR 11.8–12.2). The median tumor size at diagnosis was 13 mm (IQR 7.5–30), with 24 (16.4

Background and objective Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium-aluminum-garnet (Ho:YAG) laser for anatomic enucleation of the prostate (AEEP) in men with lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). The aim was to compare the surgical outcomes of Ho:YAG and TFL for AEEP. Methods A literature search was conducted to identify reports published from inception until January 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The coprimary outcomes were the postoperative International Prostate Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), and peak urinary flow (Qmax). Key findings and limitations Five studies met our inclusion criteria, and data from 1287 and 1555 patients who underwent AEEP with Ho:YAG (holmium laser enucleation of the prostate [HoLEP]) and TFL (thulium fiber laser enucleation of the prostate [ThuFLEP]), respectively, were reviewed. ThuFLEP was associated with a better IPSS at 3 mo even if the difference was not clinically significant (mean difference [MD] 0.59, 95% confidence interval [CI]: 0.29–0.88; p < 0.001). No difference was found for IPSS at 6–12 mo (p = 0.9), and IPSS-QoL at 3 mo (p = 0.9) and 6–12 mo (p = 0.2). HoLEP was associated with a better Qmax at 3 mo (MD 1.41 ml/s, 95% CI: 0.51–2.30; p = 0.002) and ThuFLEP at 6–12 mo (MD –2.61 ml/s, 95% CI: –4.68 to 0.59; p = 0.01), but the differences were not clinically significant. No difference was found in the major (p = 0.3) and overall (p = 0.3) complication rates. HoLEP was associated with shorter enucleation (MD –11.86, 95% CI: –22.36 to 1.36; p = 0.03) but not total operative time (p = 0.5). Conclusions and clinical implications The present review provides the most updated evidence on the impact of Ho:YAG and TFL in AEEP, demonstrating that these two energy sources are effective in relieving bothersome LUTS in men with BPO. Patient summary Thulium fiber laser is a new energy source that can be used safely for performing endoscopic enucleation of the prostate in men with bothersome symptoms associated with benign prostatic enlargement.

Introduction: Bladder cancer (BC) is a common malignancy in Spain. The aims of this study were: to identify the proportion of patients diagnosed with BC incidentally or after sympto-matic presentation in a contemporary period in Spain; to compare demographic, clinical, and pathologic characteristics between these groups.Methods: This was a retrospective analysis of a multi-centre observational study of 26 hospitals in the Spanish National Health System of all BCs newly diagnosed in 2011. The study represented 21.5% of the Spanish population and hospitals were selected in proportion to Spain's regions to ensure a representative sample. Patients were categorized by whether the cancer was diagno-sed incidentally or after symptomatic presentation and baseline demographic, pathologic, and clinical characteristics were analyzed. Results: 2472 were newly diagnosed with BC at the 26 participating Spanish hospitals with 308 (12.5%) of cases diagnosed incidentally and 2164 (87.5%) diagnosed after symptoma-tic presentation. No differences were observed between patients diagnosed incidentally vs. symptomatically in terms of demographics or measured co-morbidities. Compared to sympto-matically diagnosed bladder tumours, those diagnosed incidentally were more likely to have a papillary appearance, to be significantly smaller, and less likely to have positive/suspicious cytology. Additionally, incidentally diagnosed bladder tumours were less likely to be muscle-invasive (11.7% vs. 25.0%, P < .01) nor aggressive at pathology, with 33.6% Grade 3 compared to 50.1%, (P < .01).Conclusions: We identified a significant percentage (12.5%) of new bladder cancer diagno-sis made incidentally in a representative sample of the Spanish population. These tumours exhibited less aggressive pathologic characteristics than their symptomatic counterparts. & COPY; 2022 AEU. Published by Elsevier Espania, S.L.U. All rights reserved.

El cáncer de vejiga (CV) es una neoplasia frecuente en España. Los objetivos de este estudio fueron: identificar la proporción de pacientes diagnosticados de CV de forma incidental o tras la presentación de síntomas en un periodo contemporáneo en España; comparar las características demográficas, clínicas y patológicas entre estos grupos. El presente fue un análisis retrospectivo de un estudio observacional multicéntrico realizado en 26 hospitales del Sistema Nacional de Salud español, incluyendo a todos los nuevos diagnósticos de CV en 2011. El estudio representó 21,5% de la población española y los hospitales fueron seleccionados de forma proporcional a las regiones españolas para asegurar una muestra representativa. Los pacientes fueron categorizados según el diagnóstico de cáncer incidental o tras la presentación sintomática y se analizaron las características demográficas, patológicas y clínicas basales. En los 26 hospitales españoles incluidos en el estudio, se diagnosticaron 2.472 casos de CV, de los cuales 308 (12,5%) fueron diagnosticados de forma incidental y 2.164 (87,5%) tras la presentación de síntomas. No se observaron diferencias entre los pacientes diagnosticados incidentalmente frente a los sintomáticos en términos demográficos o de comorbilidades evaluadas. En comparación con los tumores de vejiga con diagnostico posterior a la presentación de síntomas, los diagnósticos incidentales tenían más probabilidades de ser tumores papilares, significativamente más pequeños y de tener una citología positiva/sospechosa. Además, los tumores de vejiga diagnosticados incidentalmente tenían menos probabilidades de ser músculo-invasivos (11,7 vs. 25%, p < 0,01) y de ser agresivos en el estudio patológico, con 33,6% de grado 3 vs. 50,1% (p < 0,01). Identificamos un porcentaje significativo (12,5%) de nuevos diagnósticos de CV realizados de forma incidental en una muestra representativa de la población española. Estos tumores presentaban características patológicas menos agresivas que aquellos diagnosticados tras la presentación de síntomas. Bladder cancer (BC) is a common malignancy in Spain. The aims of this study were: to identify the proportion of patients diagnosed with BC incidentally or after symptomatic presentation in a contemporary period in Spain; to compare demographic, clinical, and pathologic characteristics between these groups. This was a retrospective analysis of a multi-centre observational study of 26 hospitals in the Spanish National Health System of all BCs newly diagnosed in 2011. The study represented 21.5% of the Spanish population and hospitals were selected in proportion to Spain's regions to ensure a representative sample. Patients were categorized by whether the cancer was diagnosed incidentally or after symptomatic presentation and baseline demographic, pathologic, and clinical characteristics were analyzed. 2472 were newly diagnosed with BC at the 26 participating Spanish hospitals with 308 (12.5%) of cases diagnosed incidentally and 2164 (87.5%) diagnosed after symptomatic presentation. No differences were observed between patients diagnosed incidentally vs. symptomatically in terms of demographics or measured co-morbidities. Compared to symptomatically diagnosed bladder tumours, those diagnosed incidentally were more likely to have a papillary appearance, to be significantly smaller, and less likely to have positive/suspicious cytology. Additionally, incidentally diagnosed bladder tumours were less likely to be muscle-invasive (11.7% vs. 25.0%, P < .01) nor aggressive at pathology, with 33.6% Grade 3 compared to 50.1%, (P < .01). We identified a significant percentage (12.5%) of new bladder cancer diagnosis made incidentally in a representative sample of the Spanish population. These tumours exhibited less aggressive pathologic characteristics than their symptomatic counterparts.

El objetivo de este trabajo es conocer experiencia inicial con la terapia térmica con vapor de agua (TTVA) para hiperplasia benigna de próstata (HBP) en los hospitales universitarios españoles, así como describir las diferencias en cuanto a técnica y seguimiento observadas entre los centros. Este estudio multicéntrico observacional retrospectivo recogió características basales, datos quirúrgicos, posoperatorios y seguimiento a los uno, tres, seis, 12 y 24 meses, incluyendo cuestionarios validados, variaciones flujométricas, complicaciones y la necesidad de tratamiento farmacológico y quirúrgico tras el procedimiento. También se analizaron los posibles desencadenantes de retención aguda de orina (RAO) en el posoperatorio. Se incluyeron un total de 105 pacientes. No se observaron diferencias entre los grupos con y sin RAO con respecto a tiempo de sondaje (cinco y 4,3 días respectivamente, p = 0,178), ni volumen prostático (47,9 y 41,4 g, respectivamente, p = 0,147). La mejoría media a los tres, seis, 12 y 24 meses en cuanto de flujo máximo fue de 5,3, 5,2, 4,2 y 3,8 mL/s, respectivamente. En cuanto a la eyaculación, se observa una mejoría en la misma a partir de los tres meses de seguimiento que se mantiene en el tiempo. El tratamiento mínimamente invasivo de HBP con TTVA presenta buenos resultados funcionales a 24 meses de seguimiento, sin afectación significativa de la función sexual y con una baja incidencia de complicaciones. Existen pequeñas variaciones principalmente en cuanto al posoperatorio inmediato entre los hospitales participantes en el estudio. The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers. This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed. A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, p = 0.178), or prostate volume (47.9 gr and 41.4 gr respectively, p = 0.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8 ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time. Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative period.

To systematically review studies focused on the feasibility and outcomes of outpatient endoscopic enucleation of the prostate for benign prostatic obstruction. A literature search was conducted through December 2022 using PubMed/Medline, Web of Science, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Risk of bias assessment was performed according to the Newcastle–Ottawa Scale for case control studies. Of 773 studies, ten were included in the systematic review (n = 1942 patients) and four in the meta-analysis (n = 1228 patients). The pooled incidence of successful same-day discharge was 84

Aim: The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers. Materials and Methods: This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative Results: A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, p = 0.178), or prostate volume (47.9 gr and 41.4 gr respectively, p = 0.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8 ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and Conclusions: Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative (c) 2023 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.