Lower urinary tract symptoms that significantly impair quality of life in men may result from benign prostatic hyperplasia, overactive bladder, or a combination of both conditions. The diagnosis of benign prostatic hyperplasia, a voiding dysfunction due to outlet obstruction, can be made with a thorough history and physical examination. A validated questionnaire should be used to make an accurate initial diagnosis and to monitor treatment effect over time. Selective alpha-1 blockers are an appropriate first-line drug choice for most patients; however, 5-alpha reductase inhibitors and phosphodiesterase type 5 inhibitors may also be used, alone or in combination with each other, depending on symptom severity and if alternative treatment options are needed. If medical therapy is ineffective, surgical and interventional procedures aimed at opening the prostatic urethra are available to ameliorate symptoms. Overactive bladder manifests with urinary urgency, frequency, and nocturia with or without incontinence. The diagnosis of this storage dysfunction due to detrusor overactivity can be made with a thorough history, physical examination, urinalysis, and assessment of the residual volume of urine in the bladder after voiding. First-line treatment for overactive bladder includes beta-3 agonists as well as pelvic floor physical therapy and behavioral interventions. If left untreated, benign prostatic hyperplasia and overactive bladder can result in significant social isolation and relationship strain.

With global population aging, benign prostatic hyperplasia (BPH) prevalence has risen, with one-quarter of patients showing inadequate treatment response or drug resistance (DR) and no reliable noninvasive diagnostic method currently available. Current methods rely on clinical experience, delaying precision management. We developed a nanoparticle-enhanced mass spectrometry platform to analyze serum and urine metabolomics in 224 BPH patients (104 DR, 120 drug-sensitive [DS]). Using gradient-boosted decision trees (GBDT), we integrated dual-biofluid metabolic fingerprints (serum and urine) to distinguish DR/DS subgroups. The platform enabled rapid analysis (<25 s/sample, 1 µL volume) with high reproducibility (CV < 10%). SMF yielded a five-feature panel including five putatively annotated DR-associated metabolites, achieving an AUC of 0.89 for DR detection. UMF analysis yielded 3 features (AUC = 0.81). Critically, combining SMF/UMF data (8-feature panel) enhanced diagnostic performance to AUC = 0.95 (95% CI: 0.91-0.96), outperforming single-biofluid models. This dual-biofluid metabolomic approach provides a noninvasive, rapid method for BPH-DR stratification, integrating systemic (serum) and local (urine) metabolic insights. The platform's scalability and 0.95 AUC highlight its potential for clinical translation, offering a foundation for personalized BPH management and reducing reliance on invasive procedures. Notably, multicenter external validation further supported the model's discriminative performance in an independent cohort.

Background and Clinical Significance: Sodium-glucose cotransporter-2 (SGLT2) inhibitors cause persistent glucosuria, which has been hypothesized to facilitate urinary tract infection (UTI) when urinary stasis or anatomic variants coexist; causality, however, remains unproven and almost certainly multifactorial. Case Presentation: A 72-year-old man treated with dapagliflozin 10 mg/day for 4 months presented with 3 days of dysuria and nocturia, without fever or systemic signs. One month before SGLT2 inhibitor initiation, urological work-up had been unremarkable: prostate ~50 cm[3], post-void residual (PVR) 0 mL, and a negative midstream culture. At presentation we obtained a midstream clean-catch specimen before antibiotics. Dipstick showed glucose 2+ (~100 mg/dL, as expected with SGLT2 inhibition), leukocyte esterase 3+ and nitrites negative; microscopy revealed 45 leukocytes/high-power field with pronounced bacteriuria. Quantitative culture grew Morganella morganii at 1 × 10[5] CFU/mL in pure culture. Antimicrobial susceptibility (VITEK[®] 2 Compact, EUCAST v14.0, 2024) demonstrated resistance to ampicillin, amoxicillin-clavulanate, ampicillin-sulbactam, ceftriaxone, ceftazidime, gentamicin and trimethoprim-sulfamethoxazole, with susceptibility (S) retained only to piperacillin-tazobactam, levofloxacin/norfloxacin, cefepime and carbapenems (ertapenem, meropenem). Imaging revealed a right duplicated ureter with distal fusion (single bladder insertion, no dilatation or obstruction) and benign prostatic hyperplasia with PVR ~100 mL; renal function was preserved, two blood culture sets (pre-antibiotic) were negative, and repeat urine culture on day 7 was sterile. Management/outcome: The episode was classified as a localized (cystitis-range) UTI per European Association of Urology (EAU) criteria (no fever, flank pain or bacteremia). Meropenem 1 g intravenously every 8 h (3 g/day) was given for 10 days after urology/infectious-disease review. Dapagliflozin was held at presentation and not restarted during the 3-month follow-up period; reintroduction was planned only after full urological reassessment with cardiology input. Transurethral resection of the prostate (TUR-P) was performed 18 days after completing antibiotics (28 days after presentation) for bladder outlet obstruction refractory to tamsulosin 0.4 mg daily, with complete resolution of symptoms, normalization of inflammatory markers and PVR 0 mL. No recurrence occurred during 3 months of follow-up after TUR-P. Conclusions: This single case illustrates a temporal association-not proven causation-between SGLT2-related glucosuria, incomplete emptying and a non-obstructive duplicated ureter that likely created a permissive milieu for opportunistic Morganella UTI. The narrative is hypothesis-generating; urinary stasis was the dominant modifiable factor. Culture-guided therapy, individualized decisions on SGLT2 continuation, and definitive correction of outlet obstruction are the practical takeaways.

Bipolar enucleation of the prostate (BipolEP) has emerged as an effective, safe, and cost-efficient surgical option for managing benign prostatic hyperplasia (BPH), particularly in large glands. The objective of this study was to analyze recent evidence on BipolEP and comparing it with other endoscopic enucleation techniques using holmium and thulium lasers. It was carried out a review through a search of articles published in PubMed between 2020 and 2025, and 35 relevant studies were included. Evidence analyzed demonstrate that BipolEP achieves complete adenoma removal, improves Qmax and IPSS, and reduces postvoid residual volume, with complication rates comparable to those of laser-based technologies. Its superior hemostatic profile lowers equipment costs that enable complete enucleation and adenoma resection with the mushroom technique without the need for a morcelator, while at the same time it eases a shorter learning curve, because urologists are accustomed to the bipolar resectocope and they support its implementation in resource-limited settings. However, although available data confirm its efficacy and reproducibility, it remains the need for multicenter studies with long-term follow-up to consolidate its durability and standardization.

Background Benign prostatic hyperplasia (BPH) is a highly prevalent cause of lower urinary tract symptoms (LUTS) in the aging male population. Photoselective vaporization of the prostate (PVP) and minimally invasive surgical treatments (MISTs) are established surgical alternatives to traditional resection, each with distinct mechanisms of action and clinical profiles. Objective The study aims to compare the perioperative parameters and functional outcomes of PVP versus MISTs in patients with moderate-to-severe LUTS secondary to BPH. Methods This was a retrospective observational cohort study conducted at a single tertiary center, including patients treated between October 2023 and January 2026. Ethics approval was obtained from the Research Ethics Committee at King's College Hospital NHS Foundation Trust, London, UK (approval reference number: 25/LO/8780); the requirement for individual written consent was waived given the retrospective, fully anonymized nature of the data. After removal of duplicate and incomplete records, 99 patients treated with PVP and 64 patients treated with MIST (water vapor thermal therapy (WVTT), n=58; prostatic urethral lift (PUL), n=5; temporarily implanted nitinol device (i-TIND), n=1) were analyzed. Baseline and three-month postoperative maximum urinary flow rate (Q-max), post-void residual volume (PVR), and International Prostate Symptom Score (IPSS) were compared within each cohort using paired-samples t-tests (available-case analysis, restricted to patients with both baseline and follow-up values recorded), and between cohorts using Welch's independent-samples t-test on change scores. Results Both cohorts showed statistically significant within-group improvement across all evaluated parameters. In the PVP cohort, Q-max improved by a mean of 6.55 ml/s (n=24, 95% CI 2.54-10.57, p=0.003), PVR decreased by 222.6 ml (n=28, 95% CI -356.1 to -89.2, p=0.002), and IPSS decreased by 8.13 points (n=15, 95% CI -15.83 to -0.43, p=0.040). In the MIST cohort, Q-max improved by 3.74 ml/s (n=33, 95% CI 1.17-6.30, p=0.006), PVR decreased by 68.9 ml (n=42, 95% CI -97.3 to -40.5, p<0.001), and IPSS decreased by 11.65 points (n=23, 95% CI -15.40 to -7.90, p<0.001). Direct between-group comparison of change scores showed a significantly greater reduction in PVR with PVP (difference of -153.7 ml, p = 0.028) but no significant between-group difference in Q-max change (p = 0.231) or IPSS change (p = 0.391). Mean baseline prostate volume was larger in the PVP group (61.6 vs. 50.0 cc, p < 0.001). Conclusions Both PVP and MIST produced statistically significant improvement in urinary flow, post-void residual volume, and symptom burden at three months. PVP demonstrated a significantly greater reduction in PVR, consistent with more complete anatomical resolution of obstruction, but showed no significant advantage over MIST in Q-max or IPSS improvement in this cohort. Treatment selection should be individualized to patient priorities, procedural setting, and anticipated recovery profile, rather than assuming uniform PVP superiority across all functional domains. Larger prospective studies with complete outcome capture are needed, including evaluation of sexual function, which was not assessed in this cohort.