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.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic, heterogeneous, and often debilitating condition. This condition is often misdiagnosed, as it overlaps significantly with other urinary infections, necessitating the development of new markers and targets to improve diagnosis and therapy. Tumor necrosis factor-α (TNF-α) participates in IC/BPS inflammation, but its role remains understudied. This study aimed to develop a diagnostic model for IC/BPS and its subtypes to uncover underlying mechanisms, new biomarkers, and TNF-α-targeted treatments. Patients with non-Hunner IC (NHIC, n = 196), Hunner IC (HIC, n = 56), and healthy controls (HC, n = 230) were enrolled in the study. A diagnostic model was developed based on key features identified by SHapley Additive exPlanations (SHAP) analysis. Molecular analysis using Gene Expression Omnibus (GEO) data and single-cell RNA sequencing (scRNA-seq) showed cellular heterogeneity and inflammatory networks. In silico TNF-α knockout was performed using scTenifoldKnk to investigate the function of TNF-α. Both NHIC and HIC subtypes present with severe clinical symptoms and dysregulated urinary biomarker profiles, with the HIC subtype showing significantly more severe symptoms and markedly increased levels of specific inflammatory mediators. A total of 127 machine learning (ML) models were constructed, of which most reached an AUC of 1.000 in training and external validation cohorts. Lasso+plsRglm was identified as the optimal diagnostic model. Core diagnostic features included nocturia frequency (NUF), visual analogue scale (VAS), functional bladder wall thickness (BWT), and TNF-α. Transcriptomics identified inflammation-related patterns and pathways between IC/BPS subtypes. scRNA-seq identified 12 cell types and an elevated inflammatory state. We discovered a TNF-α-driven inflammatory network influencing intergroup heterogeneity of IC/BPS, identified candidate diagnostic biomarkers to differentiate IC/BPS from HC, and highlighted possible therapeutic targets, thereby laying the groundwork for future clinical translation research.

Recent studies have reported a relationship between obstructive sleep apnea syndrome (OSAS) and benign prostatic hyperplasia (BPH). In this study, we investigated the association between continuous positive airway pressure (CPAP) therapy and changes in lower urinary tract symptoms, uroflowmetric parameters, nocturia-related quality of life, and prostate-specific antigen (PSA) levels in male patients with OSAS and BPH. The primary endpoint was the change in International Prostate Symptom Score (IPSS), while secondary endpoints included changes in International Consultation on Incontinence Questionnaire Nocturia Quality of Life Questionnaire (ICIQ-NQoL), Qmax, Qavg, post-void residual urine volume, and PSA levels. This retrospective single-center observational study screened 352 male patients diagnosed with OSAS. Of these, 38 patients diagnosed with BPH who regularly used CPAP therapy for at least 6 months and met the inclusion criteria were included in the study. ICIQ-NQoL, the IPSS, uroflowmetric measurements and PSA levels were evaluated in all patients before and after CPAP treatment. The mean age of the 38 patients was 61.03 ± 8.63 years and the age ranged between 47 and 78 years. The Apnea-Hypopnea Index was significantly correlated with PSA, IPSS, and ICIQ-NQoL scores (r = 0.400, P = .013; r = 0.397, P = .014; and r = 0.333, P = .041, respectively). Significant improvements were observed in IPSS, ICIQ-NQoL, Qmax, Qavg, and post-void residual urine volume following CPAP therapy (all P < .001), whereas no significant change was observed in PSA levels (P = .29). CPAP therapy may be associated with improvements in lower urinary tract symptoms, uroflowmetric parameters, and nocturia-related quality of life in patients with OSAS and BPH; however, no significant change was observed in PSA levels.