The use and applicability of machine learning algorithms in predicting the surgical outcome for patients with benign prostatic enlargement. Which model to use?

Objectives: Artificial intelligence (AI) is increasingly used in medicine, but data on benign prostatic enlargement (BPE) management are lacking. This study aims to test the performance of several machine learning algorithms, in predicting clinical outcomes during BPE surgical management. Methods: Clinical data were extracted from a prospectively collected database for 153 men with BPE, treated with transurethral resection (monopolar or bipolar) or vaporization of the prostate. Due to small sample size, we applied a method for increasing our dataset, Synthetic Minority Oversampling Technique (SMOTE). The new dataset created with SMOTE has been expanded by 453 synthetic instances, in addition to the original 153. The WEKA Data Mining Software was used for constructing predictive models, while several appropriate statistical measures, like Correlation coefficient (R), Mean Absolute Error (MAE), Root Mean-Squared Error (RMSE), were calculated with several supervised regression algorithms - techniques (Linear Regression, Multilayer Perceptron, SMOreg, k-Nearest Neighbors, Bagging, M5Rules, M5P - Pruned Model Tree, and Random forest). Results: The baseline characteristics of patients were extracted, with age, prostate volume, method of operation, baseline Qmax and baseline IPSS being used as independent variables. Using the Random Forest algorithm resulted in values of R, MAE, RMSE that indicate the ability of these models to better predict % Qmax increase. The Random Forest model also demonstrated the best results in R, MAE, RMSE for predicting % IPSS reduction.Conclusions: Machine Learning techniques can be used for making predictions regarding clinical outcomes of surgical BPRE management. Wider-scale validation studies are necessary to strengthen our results in choosing the best model.

Urology

This chapter explores urology, starting with the symptoms and signs. Symptoms in urology include pain, haematuria, urinary incontinence, male sexual dysfunction, haemotospermia, and lower urinary tract symptoms. Lower urinary tract symptoms refer to a group of symptoms that typically affect the ageing male. It is often caused by bladder outflow obstruction (BOO) related to prostatic enlargement and includes symptoms related to both voiding and storage. The chapter then looks at the investigations of urinary tract disease, detailing laboratory investigations, radiology investigations, and endoscopy. It deals with urinary tract stones; obstruction of the ureter; benign prostatic hyperplasia; stricture of the urethra; scrotal swellings; disorders of the foreskin; common conditions of the penis; and erectile dysfunction. The chapter also considers adenocarcinoma of the kidney; transitional cell tumours; adenocarcinoma of the prostate; carcinoma of the penis; testicular tumours; haematuria; acute urinary retention (AUR); and acute testicular pain.

714 An Evaluation of The Discontinuation of Tamsulosin and Finasteride Post Transurethral Resection of The Prostate (TURP) At UHL

Aim A significant proportion of men suffer from lower urinary tract symptoms (LUTS) secondary to prostatic enlargement. If medical management of BPH fails surgical transurethral resection of the prostate maybe required. The continuation of pharmacological therapy post operatively is redundant, however it was noted that several patients remained on these medications post TURP. The aim of this project was to identify if patients following surgical intervention were discontinued from preexisting medications that became redundant post operatively. Method A retrospective analysis was performed of patients who underwent TURPs between July- December 2019 within the University Hospitals of Leicester NHS trust to assess if patients preexisting medications used for the treatment of LUTS were discontinued post operatively. Results In the above time frame, 104 TURPs were performed in the trust. Out of these, 89 men were already on 5-alpha reductase inhibitors and/or alpha blocker, predominantly tamsulosin and finasteride. Of the 89 men, only 46 were given a clear instruction to stop these drugs on discharge. Conclusions Continuation of the above medication is unnecessary post TURPs with potentially avoidable side effects for patients and an unnecessary expense. A series of changes were implemented to improve practice. These will be reevaluated on the recommencement of TURPs following the covid-19 pandemic.

Phloretin Ameliorates Testosterone-Induced Benign Prostatic Hyperplasia in Rats by Regulating the Inflammatory Response, Oxidative Stress and Apoptosis

The inflammatory process is proposed to be one of the factors to benign prostatic enlargement (BPH), and this is the first study examining the anti-inflammatory ability of phloretin in treating rats with testosterone-induced BPH. BPH would be induced by testosterone (10 mg/kg/day testosterone subcutaneously for 28 days), and the other groups of rats were treated with phloretin 50 mg/kg/day or 100 mg/kg/day orally (phr50 or phr100 group) after induction. Prostate weight and prostate weight to body weight ratio were significantly reduced in the Phr100 group. Reduced dihydrotestosterone without interfering with 5α-reductase was observed in the phr100 group. In inflammatory proteins, reduced IL-6, IL-8, IL-17, NF-κB, and COX-2 were seen in the phr100 group. In reactive oxygen species, malondialdehyde was reduced, and superoxide dismutase and glutathione peroxidase were elevated in the phr100 group. In apoptotic assessment, elevated cleaved caspase-3 was observed in rats of the phr100 group. Enhanced pro-apoptotic Bax and reduced anti-apoptotic Bc1-2 could be seen in the phr100 group. In histological stains, markedly decreased glandular hyperplasia and proliferative cell nuclear antigen were observed with reduced expression in the phr100 group. Meanwhile, positive cells of terminal deoxynucleotidyl transferase dUTP nick end labeling were increased in the phr100 group. In conclusion, the treatment of phloretin 100 mg/kg/day could ameliorate testosterone-induced BPH.

Incidence of Prostatic Carcinoma in Transurethral Resection Specimen

Objective: This study done to identify the rates of incidentally detected prostate cancer in patients undergoing surgical management of Benign Prostatic Hyperplasia (BPH). Methods: This cross section study was done on all transurethral resections of the prostate (TURP) cases. One hundred and eighty one men, aged 45 to 94 year, underwent TURP and their specimens were sent for the histopathological analysis. Those with a known diagnosis of prostate cancer prior to TURP were excluded (𝑛 = 5) from the analysis. Results: Hundred eighty-one patients had prostatic enlargement; fifteen patients (8.29%) patients were found to have prostate adenocarcinoma. Grade of disease ranged from Gleason score 7 to 10. Majority of them (fourteen patients) aged 65 year or above. Conclusion: Prostate carcinoma is showing high grade at the diagnosis and widely frequent (8.29%) in TURP, especially in-patient above 65 years (11.0%) and therefore a screening program advised.

The role of plant extract drugs in treatment of LUTS due to benign prostate enlargement. Clinical cases review

In this article covered in detail the problem of lower urinary tract symptoms (LUTS), due to benign prostatic enlargement. The mechanisms of etiology and pathogenesis of prostate hyperplasia are analyzed. The review is done of modern methods of treatment, such as surgical methods and conservative. Special attention is paid to plant extract drugs in therapy of LUTS. Have done the analysis of several clinical trials, they prove effectiveness and low percentage of side effects. Some clinical cases are considered, demonstrating the way of outpatient examination of patients with LUTS and how to choose the tactic of treatment witch based on anamnesis, laboratory and instrumental examination. What confirms the necessity of individual treatment for every patient.