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      It is not the best option to perform transurethral enucleation of the prostate immediately after biopsy in patients with histological inflammation

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          Abstract

          Objective

          This study seeks to investigate the impact of histopathological evidence of histological prostatic inflammation (PI) on the surgical outcomes of patients with benign prostatic hyperplasia (BPH) undergoing transurethral bipolar enucleation of the prostate (BiLEP) after biopsy.

          Methods

          We conducted a prospective study in which data were collected from 112 patients with BPH who underwent BiLEP immediately after prostate biopsy at the Department of Urology in our hospital between October 2020 and October 2023. This cohort included 52 patients with histopathological prostatic inflammation (BPH + PI group) and 60 patients with simple BPH (BPH group). Baseline characteristics, surgical details, International Prostate Symptom Score (IPSS), quality of life (QoL), post-void residual volume (PVR), maximum flow rate (Qmax), International Index of Erectile Function-5 (IIEF-5), postoperative pathology results, and surgical complications were compared between the two groups.

          Results

          The study findings indicate that in patients with BPH who underwent BiLEP, various parameters in the BPH + PI group including operation time, intraoperative flushing volume, hemoglobin drop value, postoperative white blood cells, postoperative C-reactive protein, and average pain score at 3 days postoperatively were significantly higher compared to those in the BPH group ( p < 0.01). In addition, the IPSS and IIEF-5 scores of the BPH + PI group were significantly worse before surgery and at 2 weeks postoperatively compared to the BPH group ( p < 0.01); however, no significant differences were observed between the two groups at 1 and 3 months postoperatively ( p > 0.05). At 2 weeks postoperatively, the BPH + PI group exhibited significantly worse outcomes in terms of QoL, PVR, and Qmax compared to the BPH group ( p < 0.01). However, there were no statistically significant differences between the two groups at 1 and 3 months postoperatively ( p > 0.05). The incidence rates of postoperative complications, such as fever, prostatic capsule perforation, urinary tract irritation, bladder spasm, acute epididymitis, urinary tract infection, and urethral stricture, were higher in the BPH + PI group compared to the BPH group ( p < 0.05). Nevertheless, there was no significant difference in the overall complication rates between the two groups ( p > 0.05). There were no statistically significant differences observed between the two groups in postoperative irrigation volume, extubation time, hospitalization time, proportion of secondary operations, proportion of bladder injury, and proportion of urinary incontinence ( p > 0.05). However, the proportion of reported prostate cancer after surgery in the BPH + PI group was significantly higher than that in the BPH group ( p < 0.05).

          Conclusion

          Histopathological prostatic inflammation does not have a significant impact on the long-term efficacy of BiLEP surgery immediately after biopsy. However, it does prolong surgery time, increase surgery-related complications, and influence short-term surgical outcomes and patient treatment experience. Therefore, it may be advisable to administer a course of anti-inflammatory treatment before performing BiLEP in such patients. Nevertheless, further high-quality studies are necessary to validate this approach.

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          Most cited references22

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          Inflammation in the pathophysiology of neuropathic pain.

          Peripheral nerve injuries and diseases often lead to pain persisting beyond the resolution of damage, indicating an active disease-promoting process, which may result in chronic pain. This is regarded as a maladaptive mechanism resulting from neuroinflammation that originally serves to promote regeneration and healing. Knowledge on these physiological and pathophysiological processes has accumulated over the last few decades and has started to yield potential therapeutic targets. Key players are macrophages, T-lymphocytes, cytokines, and chemokines. In the spinal cord and brain, microglia and astrocytes are involved. Recently, data have been emerging on the regulation of these players. MicroRNAs and other noncoding RNAs have been discussed as potential master switches that may link nerve injury, pain, and inflammation. Clinical disorders most intensely studied in the context of neuroinflammation and pain are the complex regional pain syndrome, polyneuropathies, postherpetic neuralgia, and the fibromyalgia syndrome, in which recently a neuropathic component has been described. Research from several groups has shown an important role of both proinflammatory and anti-inflammatory cytokines in neuropathic and other chronic pain states in humans. There is ample evidence of an analgesic action of anti-inflammatory cytokines in animal models. The interplay of anti-inflammatory cytokines and the nociceptive system provides possibilities and challenges concerning treatment strategies based on this concept.
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            The rising worldwide impact of benign prostatic hyperplasia

            To describe the trend in the impact of lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH) on a global scale using the Global Burden of Disease (GBD) database.
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              Recent Advances and Current Role of Transperineal Prostate Biopsy.

              "Approximately 1 million prostate biopsies are performed each year in the United States. This procedure has traditionally been performed using a transrectal approach, which is associated with a significant risk of infectious complications including sepsis. In recent years, transperineal prostate biopsy has been increasingly adopted due to its lower associated infectious risk. In this review, we explore the benefits of the transperineal approach for performing prostate biopsy and detail technical advancements that have allowed for this procedure to now be routinely performed in the outpatient settings under local anesthesia."
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/2664922/overviewRole: Role: Role:
                Role: Role: Role: Role:
                Role: Role: Role:
                Role: Role: Role:
                Role: Role: Role: Role:
                Journal
                Front Surg
                Front Surg
                Front. Surg.
                Frontiers in Surgery
                Frontiers Media S.A.
                2296-875X
                01 July 2024
                2024
                : 11
                : 1390656
                Affiliations
                [ 1 ]Department of Urology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University , Lishui, China
                [ 2 ]Department of Nursing, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University , Lishui, China
                Author notes

                Edited by: Theodoros Tokas, University Hospital of Heraklion, Greece

                Reviewed by: Francesco Sessa, Careggi University Hospital, Italy

                Afonso Morgado, Centro Hospitalar Universitário de São João (CHUSJ), Portugal

                [* ] Correspondence: Jing Sha sj13735951326@ 123456163.com
                Article
                10.3389/fsurg.2024.1390656
                11246918
                39011051
                2b612e44-8523-4763-810f-a62c8279cc2e
                © 2024 Gu, Li, Chen, Pan and Sha.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 23 February 2024
                : 10 May 2024
                Page count
                Figures: 1, Tables: 4, Equations: 3, References: 22, Pages: 8, Words: 0
                Funding
                The authors declare financial support was received for the research, authorship, and/or publication of this article.
                This work was supported by Lishui Science and Technology Plan Project number: 2023GYX69.
                Categories
                Surgery
                Original Research
                Custom metadata
                Genitourinary Surgery

                prostatic hyperplasia,prostatic histological inflammation,bipolar enucleation of the prostate,clinical efficacy,prostate biopsy,prospective research

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