Objective• To present the first age-stratified assessment of outcomes after holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms resulting from prostate enlargement. Patients and Methods• We retrospectively analysed and compared the morbidity, and the peri-operative and functional outcomes of patients aged 50-59, 60-69, 70-79 and Ն80 years. Complications at 30 days were stratified using the Clavien system. • Functional outcomes were assessed using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR) and urinary continence. Results• A total of 311 patients underwent HoLEP for obstructive voiding symptoms from August 2007 to June 2011, of whom 22 patients were aged 50-59 years, 91 were aged 60-69 years, 153 were aged 70-79 years, and 45 were aged Ն80 years.• The overall morbidity rates were similar among the age groups (20, 24.4, 21.6 and 22.1% for groups 1, 2, 3 and 4, respectively), as were the incidence of significant complications (Clavien grade Ն III), change in serum haemoglobin level, and length of hospital stay.• Patients Ն80 years did have a longer catheterization time (3.4 days) than patients aged 50-59 years (1.68 days).• By 1 year there were no significant differences in urinary continence, IPSS, Qmax, or PVR among the age groups. Conclusions• Overall morbidity, hospital stay, and 1-year functional outcomes of HoLEP were similar among all age groups. • This study shows that HoLEP is a safe and effective treatment for benign prostatic hyperplasia regardless of age.

Cancer cells require both migratory and tumorigenic property to establish metastatic tumors outside the primary microenvironment. Identifying the characteristic features of migratory cancer stem cells with tumorigenic property is important to predict patient prognosis and combat metastasis. Here we established one epithelial and two mesenchymal cell lines from ascites of a bladder cancer patient (i.e. cells already migrated outside primary tumor). Analyses of these cell lines demonstrated that the epithelial cells with surface expression of PD-L1, E-cadherin, CD24, and VEGFR2 rapidly formed tumors outside the primary tumor microenvironment in nude mice, exhibited signatures of immune evasion, increased stemness, increased calcium signaling, transformation, and novel E-cadherin–RalBP1 interaction. The mesenchymal cells on the other hand, exhibited constitutive TGF-β signaling and were less tumorigenic. Hence, targeting epithelial cancer stem cells with rapid tumorigenesis signatures in future might help to combat metastasis.

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