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PDE5I in LUTS – how do they work – no proof yet

Phosphodiesterase type 5 (PDE5) inhibitors used in erectile dysfunction (ED) have been shown to improve lower urinary tract symptoms (LUTS) as well. The mechanism is not well understood. One of the hypotheses for benign prostatic hyperplasia (BPH) – LUTS is...

Surgical treatment of LUTS secondary to BPH

For the vast majority of patients an initial trial of medical therapy for the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is indicated [1]. In a substantial minority of cases however, a surgical intervention...

The assessment and medical treatment of LUTS secondary to BPH

The term benign prostatic hyperplasia (BPH) describes prostate enlargement due to non-cancerous processes. Several aetiological mechanisms are involved, including hormonal and vascular alterations; abnormal regulation of apoptosis; and prostatic inflammation, which may stimulate cellular proliferation. With ageing, prostate enlargement can...

Urethroplasty: a review of indications, techniques and outcomes

Urethral stricture is the most common cause of lower urinary tract obstruction in men aged between 20 and 40, carrying an estimated overall prevalence of 0.5% in the UK [1] and results in around 17,000 hospital admissions annually [2]. Endoscopic...

LUTS update

Case study A 70-year-old, generally fit and well male attends your outpatient clinic. He has experienced a gradual deterioration in his voiding over the last few months. Specifically, he reports hesitancy, poor flow and nocturia. He denies visible haematuria. His...

Smith’s Textbook of Endourology, 2 Volume Set, 4th Edition

Since the founding fathers of endourology first published this textbook in 1996, the surgical vista has been changed unrecognisably by technological advances. Laparoscopic approaches have become commonplace for renal, ureteric, bladder and prostatic surgery, and robotic-assisted techniques have developed with...

The role of dutasteride in the prevention of clinical progression in asymptomatic BPH

Following the old adage ‘prevention is better than cure’, this Canadian group performed a post hoc analysis of information gained from the multicentre Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study to evaluate whether dutasteride could decrease the incidence...

Transurethral enucleation is superior to resection for the management of LUTS secondary to BPH

This meta-analysis (Level 1b evidence) examined the efficacy and safety of two primary transurethral therapies used in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), enucleation (HoLEP – holmium laser enucleation of prostate, ThuLEP,...

Prostatic urethral lift provides good alternative to TURP for men with LUTS

Lower urinary tract symptoms (LUTS) due to prostatic enlargement resulting in bladder outflow obstruction are common. Transurethral resection of the prostate (TURP) remains the gold standard in operative management, however it is not without its risks. In this multicentre European...

Prognostic impact of preoperative neutrophil-to-lymphocyte ratio after radical prostatectomy

Neutrophil-to-lymphocyte ratio has been shown to be a prognostic factor in a number of different cancers. This is one of the largest studies to date to evaluate its effect on overall survival in patients who have undergone radical prostatectomy (RP)...

Post prostatectomy outcomes of patients with high-risk prostate cancer treated with neoadjuvant androgen blockade

This is an interesting paper reporting on the use of neoadjuvant androgen blockage in patients with high-risk prostate cancer undergoing radical prostatectomy. Previous work in the literature has shown an improvement in the rate of organ-confined disease and decreased positive...

Testicular prostheses satisfaction

This is a satisfaction survey in 40 patients who had underwent radical orchidectomy and had saline filled testicular prosthesis (TP) over a 3 year period in US, as the silicone implants are not in use since 1995 in US. No...