This study confirmed that PKEP is a safe, easy to learn, and durable technique suitable for any prostate sizes.

Background: Erectile dysfunction (ED) is a socioeconomic problem.There are several options for its management including intra-cavernosal injection (ICI).Objective: To compare the safety, efficacy, and durability of ICI of onabotulinum toxin-A (BTX) in different doses (50 and 100 U) against placebo (saline) in the management of vasculogenic ED non-responding to pharmacological therapy (phosphodiesterase type 5 inhibitors or/and ICI of trimix). Materials and Methods:A prospective randomized double-blind placebo-controlled trial was conducted between July 2016 and February 2019. A total of 176 patients were randomly assigned (1:1:1) to one of the treatment sequences: Botox 100 U group (BTX-100; 62 patients), Botox 50 U group (BTX-50; 59 patients), or placebo group (55 patients). All patients were followed up for 6 months.Results: Significant improvement in all parameters, that is, SHIM score & Erection Hardness Score (EHS), Sexual Encounter Profile (SEP), Global Assessment Score (GAS), and Doppler parameters (p < 0.001) was observed in patients of BTX-100 and BTX-50 groups with maximum improvement at 3rd month of treatment. Around 40% of patients were responders and were able to engage in sexual intercourse. Patients in placebo group did not experience significant improvement (p = 0.264). It was noted that at the 2nd week and 3rd months after treatment, there was no statistically significant difference in the improvement of these parameters in BTX-100 and BTX-50 groups (p > 0.05). In the 6th month, there was a statistically significant difference between the aforementioned groups in favor of BTX-100 (p < 0.01). Conclusions:Only one-time ICI of BTX (50 U and 100 U) is effective and safe for the treatment of refractory ED. This agent has a considerable long duration of action, particularly BTX-100U seems to be more durable.

Androgen receptor (AR) activation plays an important role in the promotion and progression of urothelial tumorigenesis. Also, dysregulation of the Wnt/β-catenin signaling pathway has also been linked to bladder cancer growth. However, cross talk between the two pathways in remains unclear in bladder cancer. This study investigated the prognostic significance of AR and β-catenin expression and their relationship to different clinic-pathological parameters, recurrence free and progression free survival. 106 urothelial carcinoma cases were used to study the immunohistochemical expression of AR and β-catenin. Log-Rank test to compare survival between groups. Androgen receptor positivity was in 37 (34.9%) cases. Both aberrant β-catenin and AR positivity were associated with higher tumor grade (p = 0.033 and p = 0.037 respectively) and muscle invasion (p = 0.007 and p = 0.039 respectively). Aberrant β-catenin only showed statistically significant association with tumor diameter (p = 0.036), tumor stage (p = 0.038), LN metastasis (p = 0.001), tumor recurrence (p = 0.026) and tumor progression (p = 0.01). Cases with aberrant β-catenin showed higher AR positivity (p = 0.018). Our study highlighted important information about the link between Wnt/β-catenin and AR pathway during the progression of transitional urothelial carcinoma with aberrant β-catenin could be used as a prognostic marker Key words: androgen receptors, β-catenin, non-detrusor muscle invasive urothelial carcinoma, detrusor muscle invasive urothelial carcinoma.

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ObjectivesTo assess the safety and efficacy of bipolar plasmakinetic enucleation and resection of the prostate (PKERP) for the management of benign prostatic hyperplasia (BPH) in patients on oral anticoagulant (OAC) therapy and/or platelet aggregation inhibitors (PAIs).Patients and methodsIn all, 91 patients were recruited and underwent PKERP whilst they were receiving PAIs (aspirin, 56 patients; clopidogrel, three; aspirin and clopidogrel, 11). In all, 15 patients were receiving an OAC drug perioperatively, whilst another six patients were on dual PAIs and OACs. The primary outcomes were the perioperative morbidity and mortality rates. The secondary outcomes were functional outcomes including maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS), and post-void residual urine volume (PVR).ResultsThe mean (SD) age of the patients was 65 (5.9) years, preoperative adenoma volume was 80.9 (30.4) mL, and the operative time was 67 (23) min. No patient developed serious perioperative cardiovascular complications. The mean (SD) duration of hospital stay was 1.79 (1) days and the postoperative catheterisation time was 1.14 (0.76) days. The mean (SD) haemoglobin drop was 0.74 (0.61) g/dL, blood transfusion rate was 2.2%, and the clot retention rate was 2.2%. The mean (SD) postoperative Qmax was 18.6 (4.37) mL/s as compared to 7.2 (3.2) mL/s preoperatively (P < 0.001), and the preoperative IPSS was reduced from 24.3 (6.1) to 5.7 (2.3) postoperatively (P < 0.05). Prostate volume measured by transrectal ultrasonography was significantly reduced from a mean (SD) of 80.9 (30.4) mL preoperatively to 29.5 (10.6) mL postoperatively (P < 0.001).ConclusionMinimally invasive PKERP may be considered as a safe and effective treatment option for managing patients with BPH receiving OAC/PAI drugs.