Benign prostatic hyperplasia (BPH), with its associated lower urinary tract symptoms (LUTS), can be a debilitating disease in the elderly male. Transurethral resection of the prostate (TURP) remains the gold standard; however, many patients will choose to avoid surgery if possible. Medical therapy is an effective alternative, however, new studies are showing that there may be more side effects than previously realized in the elderly male. Newer, novel minimally invasive techniques, including UroLift® and Rezūm™, are gaining favor as alternative office-based procedural techniques that do not require general anesthesia and may better preserve ejaculatory function. Though promising, at this point, these techniques are not approved for all patients. With a range of medical, procedural, and surgical options for treatment of BPH with LUTS, it is important to have a discussion with your patient regarding the short- and long-term risks and benefits, as well as alternatives, before deciding on a treatment plan for your patient with BPH.

INTRODUCTION AND OBJECTIVES: Uric acid bladder stones can be indicative of severe metabolic abnormalities. Men may be at increased risk for uric acid bladder stone recurrence secondary to obstruction and urinary metabolic derangements. The objective of this study is to evaluate for clinical and metabolic factors in the pathogenesis and prevention of recurrent uric acid bladder stones.METHODS: A database of patients who underwent bladder stone procedures from 2012 to 2018 (n[66) was analyzed to identify patients who formed uric acid bladder stones (n[27). Clinical features, metabolic abnormalities, and compliance to urinary alkalization were assessed between individuals who never reformed uric acid bladder stones (n[15) vs. those forming recurrent stones (n[12) despite medical management.RESULTS: Bladder stones are more likely to be uric acid in composition in men who form recurrent stones (12/19, 63.2%) compared to those who do not (15/47, 31.9%) (p[0.0195). There were no differences in flow rate, prostatic size, or serum uric acid between groups. Patients forming recurrent uric acid bladder stones have a higher post void residual (PVR) (127 vs 29 cc, p[0.035). In the non-recurrent group, 79% (11/14) were compliant with urinary alkalization vs. 33% (4/12) in the recurrent group (p[0.0199). Recurrent uric acid stone formers generally had lower urinary volume and urinary pH (1.4 vs 1.7L and 5.3 vs 5.4, not statistically significant). Recurrent uric acid stone formers had higher uric acid supersaturation (SSUA) (2.67 vs. 1.46, p [ 0.005) and higher 24-hour urinary citrate (814.6 vs 415.7 mg, p[0.0146) compared to non-recurrent uric acid bladder stone formers (Table 1).CONCLUSIONS: Uric acid bladder stone formation is largely influenced by urinary metabolic abnormalities. Obstruction and urinary stasis may play a role in its pathogenesis. Recurrent uric acid bladder stone formers have increased urinary uric acid supersaturation and increased PVR, which may be driving forces for stone recurrence. Urinary citrate levels were higher in recurrent stone formers, but patients may be taking citrate supplements for their 24-hour urine tests. Long-term compliance to urinary alkalization is associated with successful prevention of recurrent uric acid urolithiasis.

therapy that is optimal for disease control in patients with HR-LPCa. In this study, we compared the long-term oncological outcomes of RP and intensity-modulated radiation therapy (IMRT) for HR-LPCa at our institution using a propensity score-matched analysis.METHODS: We retrospectively reviewed 62 patients with HR-LPCa who underwent RP and 107 patients who received IMRT between 1999 and 2011. After adjusting for age, prostate-specific antigen (PSA) level, biopsy Gleason score, and clinical tumor (T)stage using a propensity score-matched analysis, the rates of castration-resistant prostate cancer-free (CRPC-F), cancer-specific survival (CSS), and overall survival (OS) were compared between the RP and IMRT groups using Kaplan-Meier analysis.RESULTS: After propensity score matching, 52 patients were assigned to each of the study groups, and age, initial PSA level, biopsy Gleason score, and clinical T-stage were matched exactly. The median follow-up durations in the RP and IMRT groups were 105 and 97 months, respectively. ADT was administered as a combination therapy to 27% and 77% of patients in the RP and IMRT groups, respectively. The 10-year CSS and OS rates were not significantly different between the RP and IMRT groups (CSS rate, 92.6% and 97.9%, respectively; p [ 0.519 and OS rate, 88.6% and 91.6%, respectively; p [ 0.635). The 10-year CRPC-F rate was not different between the RP and IMRT groups (16.0% and 16.0%, respectively); however, the 13-year CRPC-F rate was significantly higher in the RP group than in the IMRT group (58.9% and 16.0%, respectively; p [ 0.038).CONCLUSIONS: Long-term survival outcomes are not different between RP and IMRT. However, in late stages, RP may be superior to IMRT with respect to CRPC-F survival.

p[0.012) and post-treatment TURP (RRR[41.63, p<0.001) increased risk of mixed incontinence. CONCLUSIONS: Overall rates of incontinence following PPB are low, whether measuring PRI or PRP. However, there is discordance between these metrics. Pre-and post-treatment TURP remain the strongest factors associated with post-procedural incontinence, though history of diabetes and EBRT are associated with increased urge incontinence, and higher NCCN risk is associated with increased stress incontinence.