Revisiting the external urethral sphincter: new anatomical insights from a human cadaver study.

PURPOSE: The external urethral sphincter (EUS) is critical for urinary continence, but its complex anatomy is not fully understood, complicating its preservation during prostate surgeries. This study aims to elucidate the anatomy and development of the EUS to enhance surgical techniques for continence preservation. METHODS: The study consisted of a postmortem examination of three male cadavers, aged 52, 64, and 60, with intact urogenital systems. Specimens including the prostate and EUS were dissected, fixed in formalin, and stained with Hematoxylin-Eosin for microscopic analysis. Histological assessments focused on the muscle composition and structure of the EUS and prostate. RESULTS: Macroscopic examination revealed symmetrical prostates without pathologies. Histologically, the anterior prostate lacked tubuloalveolar glands, showing striated muscle fibers from the external urethral sphincter extending into the prostate and prostatic urethra. Reduced glandular structure and prevalent smooth muscle were noted. This intricate integration of striated muscle fibers at the EUS-prostate interface underscores the anatomical complexity vital for surgical preservation of urinary continence. CONCLUSION: Our study reveals a complex EUS-prostate relationship, challenging the view of the EUS as merely a circular muscle. The findings demonstrate the importance of the EUS's extension into the prostate for urethral stabilization and continence. Recognizing this anatomy is crucial for maintaining urinary continence in prostate surgeries and enhancing postoperative outcomes.

Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis.

PURPOSE: To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). METHODS: We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. RESULTS: We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. CONCLUSION: HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.

An independent indicator of erectile dysfunction is C-reactive protein/albumin ratio.

Research has found that, instead of passive lipid-accumulated vascular damage, atherosclerosis which is the primary cause of erectile dysfunction (ED) can be seen as an active inflammatory cycle and that inflammation has a central role in the entire atherosclerotic process. As an inflammatory marker, serum C-reactive protein (CRP)/albumin ratio (CAR) may link to ED and ED severity. The CAR, demographic features and other criteria of 198 patients with ED who visited our outpatient clinic during March 2019-April 2020 were prospectively evaluated. The research also included healthy control subjects without systemic or infectious diseases. The mean difference of CAR between ED and no ED was statistically significant (0.55 ± 0.27 and 0.79 ± 0.49, p = .002 respectively). On the basis of the ROC analysis, CAR has a good ED diagnostic value with an area under the curve (AUC) of 0.63 (95% CI:0.541-0.714) and better diagnostic performance to distinguish ED severity (AUC:0.73, 95% CI:0.620-0.842). Additionally, mean CAR gradually increased with increasing severity of ED (for all p < .001). The CAR has been described as an independent ED indicator in the multivariate analysis (p = .001OR = 8.934; 95% CI:2.449-32.583). Increased CAR is associated with ED severity and increased ED risk. For CAR predicting ED and ED severity, a considerable cut-off point was identified.