Outcomes of iTind Treatment for Benign Prostatic Hyperplasia at a Single UK Institution

Outcomes of iTind Treatment for Benign Prostatic Hyperplasia at a Single UK Institution | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outcomes of iTind Treatment for Benign Prostatic Hyperplasia at a Single UK Institution Erkin Karaca, Mehmet Caglar Cakici, Ahmed Nafie, Keng Lim Ng, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8752740/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Benign prostatic hyperplasia (BPH) is a prevalent cause of lower urinary tract symptoms (LUTS) in aging men. While transurethral resection of the prostate (TURP) remains the gold standard, its associated morbidity—particularly ejaculatory dysfunction—has driven interest in minimally invasive surgical therapies (MISTs). The temporary implantable nitinol device (iTind) is designed to relieve obstruction while preserving sexual function. Methods We retrospectively analysed 41 patients who underwent iTind implantation between January 2022 and September 2025 at a UK tertiary BPH centre. Pre- and post-operative outcomes included International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual (PVR), complications, and ejaculatory function. Statistical analysis was performed using non-parametric tests where appropriate. Results Mean patient age was 52.2 ± 13.8 years, with a mean prostate volume of 33.8 ± 12.0 cc. Significant improvements were observed in IPSS, QoL, Qmax, and PVR at 0–6 and 6–12 months (all p < 0.001). Median follow-up was 15 months. Complications were predominantly Grade 1, with one case of acute urinary retention (2.4%). Ejaculatory function was preserved in 75.6% of patients. Conclusion iTind is a safe and effective minimally invasive option for BPH-related LUTS, providing durable symptom relief with minimal morbidity and high rates of ejaculatory function preservation in a real-world UK setting. Figures Figure 1 Introduction Benign prostatic hyperplasia (BPH) is a common and progressive condition in aging men, causing lower urinary tract symptoms that significantly reduce quality of life [ 1 ], [ 2 ]. Its prevalence rises with age, affecting 44% of men aged 40–59 years and up to 70% of those over 80 years [ 3 ]. BPH contributes more to overall male morbidity than prostate and bladder cancer or urolithiasis and is associated with marked psychosocial burden and substantial healthcare costs [ 3 ]. TURP remains the traditional gold standard [ 2 ], [ 4 ], but it carries risks such as bleeding, urinary retention, and particularly retrograde ejaculation, with meta-analytic evidence highlighting notably high postoperative ejaculatory dysfunction [ 5 ]. This has accelerated interest in minimally invasive surgical techniques that provide effective symptom relief with improved safety and preservation of sexual function [ 1 ], [ 2 ], [ 6 ]. The temporary implantable nitinol device (iTind) is one such MIST, designed to improve LUTS while maintaining erectile and ejaculatory function [ 2 ], [ 6 ]. The device temporarily expands in the prostatic urethra for 5–7 days, applying localized pressure to create channels through ischemic necrosis, producing a “Turner Warwick–like incision” without tissue resection or permanent implantation [ 7 ], [ 8 ]. Clinical studies demonstrate rapid and durable improvements in IPSS, QoL, and Qmax with minimal perioperative morbidity [ 1 ], [ 7 ]. A key advantage is the consistent preservation of sexual and ejaculatory function [ 2 ], [ 7 ]. However, as a relatively recent therapy, continued real-world evaluation is necessary to confirm long-term durability and refine patient selection [ 2 ]. This study reports outcomes of iTind treatment at a single UK institution to contribute further evidence on its effectiveness and safety across a diverse patient population. Methodology This study retrospectively analysed data from 41 patients who underwent the temporary implantable nitinol device (iTind) procedure between January 2022 and September 2025 at our tertiary BPH centre. Patients with missing data were excluded from the analysis. All included patients adhered to a standardized iTind surgical protocol and underwent the procedure under sedation. Preoperative flexible cystoscopy and transrectal ultrasound of the prostate were performed for all patients. Device removal was performed on day 7 via open ended catheter using lubricating lidocaine gel. All procedures were conducted as day cases. This study was conducted as a registered clinical audit and approved by the Frimley Health NHS Foundation Trust Quality and Audit Committee (Audit Reference Number: FH1358-3a). Formal Research Ethics Committee or Institutional Review Board approval was not required in accordance with NHS governance guidance for clinical audits. Written informed consent was obtained from all individual participants included in the study, in accordance with institutional requirements and the principles of the Declaration of Helsinki. Statistical analyses were conducted using SPSS software version 26.0 (SPSS Inc., Chicago, IL, USA). The one-sample Kolmogorov–Smirnov test was applied to verify the normality of the data distribution. For variables with a normal distribution—namely, IPSS, quality of life, and peak urinary flow rate—comparisons between pre- and post-iTind implantation values were performed using the Wilcoxon signed-rank test. Differences in post-void residual (PVR) volumes, which did not follow a normal distribution, were analysed using the Friedman test. A two-sided alpha level of 0.05 was considered statistically significant. Data are reported as the mean ± standard deviation or as the median with minimum and maximum values, as appropriate. Results Table 1 Baseline characteristics of the study population (n = 41) Age, mean ± SD, years 52.2 ± 13.8 Prostate volume, cc 33.8 ± 12.0 High BN, n (%) 30 (73.2) PSA, median (min-max), ng/ml 1.4 (0.2–11.0) Qmax, ml/sec 12.3 ± 4.5 PVR, ml 107 (10–507) IPSS 20.8 ± 5.5 QoL points 4.5 ± 1.0 Follow-up, median (min-max), mo 15 (1–34) SD: standard deviation, BN: Bladder neck, PSA: prostate-specific antigen, Qmax: maximum flow rate, PVR: post-void residual, IPSS: international prostate symptom score, QoL: quality of life. Table 2 Summary of functional results up to 12 months of follow-up Parameter Baseline 0–6 months (n = 30) 6–12 months (n = 28) IPSS (mean ± SD) 20.8 ± 5.5 12.0 ± 6.2 (p < 0.001) 13.5 ± 6.3 (p < 0.001) QoL (mean ± SD) 4.5 ± 1.0 2.1 ± 1.4 (p < 0.001) 2.7 ± 1.6 (p < 0.001) Qmax (mean ± SD) 12.3 ± 4.5 16.0 ± 4.9 (p < 0.001) 15.6 ± 5.1 (p < 0.001) PVR (median, min–max) 107 (10–507) 47.5 (18–150) (p = 0.001) 62.5 (25–270) (p = 0.001) IPSS : International prostate symptom score; QoL : quality of life; Qmax : maximum flow rate; PVR : post-void residual. Wilcoxon signed-rank test for IPSS, IPSS-QoL, Qmax; Friedman test for PVR. Table 3 Post iTind ejaculatory function Ejaculatory Function Number of Patients (n = 32) Worse 5 (12.2%) No Change 31 (75.6%) Better 5 (12.2%) The study population consisted of 41 patients with a mean age of 52.2 ± 13.8 years. The mean prostate volume was 33.8 ± 12.0 cc, and the median PSA was 1.4 ng/ml. At baseline, patients presented with significant lower urinary tract symptoms, indicated by a mean IPSS of 20.8 ± 5.5 and a QoL score of 4.5 ± 1.0. The baseline maximum flow rate was 12.3 ± 4.5 ml/sec, and the median post-void residual was 107 ml. A notable proportion (30 patients) had a high bladder neck. The median follow-up duration was 15 months (Table 1 ). The safety profile of the iTind procedure in this cohort was favourable, with reported complications primarily classified as Grade 1 according to the modified Clavien–Dindo classification. The most frequent complications were pain requiring re-presentation to hospital (12%), non of the patient needed admission, they were all discharged with pain management. one individual needed catheterisation due to acute urinary retention (2.4%). Frequency were observed in 2.4% of patients. The iTind procedure resulted in marked improvements in lower urinary tract symptoms over the 12-month follow-up. Mean IPSS reduced from 20.8 ± 5.5 at baseline to 12.0 ± 6.2 at 0–6 months (p < 0.001) and remained improved at 13.5 ± 6.3 at 6–12 months (p < 0.001) (Fig. 1 ). Quality-of-life scores improved from 4.5 ± 1.0 to 2.1 ± 1.4 at 0–6 months (p < 0.001) and to 2.7 ± 1.6 at 6–12 months (p < 0.001). Maximum flow rate increased from 12.3 ± 4.5 ml/s at baseline to 16.0 ± 4.9 ml/s at 0–6 months (p < 0.001) and to 15.6 ± 5.1 ml/s at 6–12 months (p < 0.001). Post-void residual volume decreased from a median of 107 ml (10–507) to 47.5 ml (18–150) at 0–6 months (p = 0.001) and 62.5 ml (25–270) at 6–12 months (p = 0.001)(Table 2 ). Regarding ejaculatory function post-iTind (total n = 41), 31 patients (75.6) reported no change, 5 patients (12.2%) reported worsening, and 5 patients (12.2%) reported improvement (Table 3 ). Discussion The findings from our study, conducted at a UK tertiary referral center, largely resonate with and augment the existing body of literature regarding the efficacy and safety of the iTind for treating LUTS secondary to BPH. The observed significant improvements in IPSS, QoL, Qmax, and PVR in our cohort are consistent with outcomes reported in numerous clinical studies and real-world assessments globally [ 1 ], [ 2 ], [ 11 ], [ 12 ]. For instance, a multi-center real-world study showed median IPSS changes from 23 to 11 and QoL from 4 to 2, comparable to our results [ 2 ]. Furthermore, previously published data demonstrate significant and sustained improvements, with Qmax values rising by as much as 100% and IPSS dropping by 60% at 12 months in some cohorts [ 1 ]. This consistency across diverse patient populations reinforces iTind’s position as an effective treatment modality. The favorable safety profile observed in our study, with complications predominantly classified as Grade 1 according to the modified Clavien-Dindo classification, aligns well with established literature on iTind [ 1 ], [ 8 ]. The low incidence of acute urinary retention (2.4%) and minimal re-presentations for pain are consistent with previous reports indicating that most complications associated with iTind are mild, transient, and often occur within the first week post-procedure, such as dysuria and haematuria [ 1 ]. The ease of performing the iTind procedure, often under light sedation with same-day discharge and minimal perioperative morbidity, as evidenced in our study and supported by other sources, marks a considerable advantage for patient convenience and healthcare efficiency [ 2 ], [ 7 ], [ 11 ]. A paramount consideration in BPH treatment, especially for younger or sexually active patients, is the preservation of sexual function. Our finding shared that the majority of patients (31 out of 41) reported no change in ejaculatory function post-iTind is strongly supported by existing literature [ 2 ]. Several studies, including the MT-06 study, have explicitly demonstrated the preservation of sexual function and antegrade ejaculation rates following iTind implantation, often utilizing validated questionnaires like SHIM and MSHQ-EjD [ 2 ], [ 7 ]. This aspect is particularly critical when contrasted with traditional surgical interventions like TURP, which frequently lead to retrograde ejaculation, or medical therapies like 5-ARIs that can cause erectile dysfunction and decreased libido [ 4 ], [ 5 ]. The ability of iTind to provide significant symptomatic relief without compromising sexual health makes it a highly attractive option for a significant patient demographic [ 2 ], [ 6 ]. The durability of iTind outcomes remains a key area of investigation. Our median follow-up of 15 months provides robust data on sustained improvements, building upon existing evidence. Previous studies have documented the durability of functional benefits for up to 24 months [ 7 ], and a 3-year follow-up study further confirmed the sustained efficacy of iTind, showing stable IPSS, QoL, Qmax, and PVR values [ 11 ]. While the pivotal studies indicate a cumulative retreatment rate of approximately 11.1% over 48 months [ 2 ], this rate is considered acceptable within the context of BPH interventions. It is important to note that a Cochrane review highlighted very low certainty regarding iTind's retreatment rates due to concerns about risk of bias and imprecision in available data [ 13 ]. Our study's observation that only 4 patients (9.8%) underwent reoperation, further contributes to the understanding of retreatment rates. This contrasts with other MISTs like prostatic urethral lift, where 5-year retreatment rates were reported at 11.6% in a large claims study, and TURP at 7.0% [ 14 ]. iTind offers significant procedural advantages; as a rapid intervention performed under sedation in a day-case setting, it facilitates greater surgical efficiency and alleviates pressure on limited NHS inpatient bed capacity, aligning with the Get It Right First Time (GIRFT) guidelines. Such comparisons emphasize the ongoing need for long-term, high-quality data specific to iTind. Careful patient selection is paramount for optimizing iTind outcomes. Our cohort, with a mean prostate volume of 33.8 ± 12.0 cc, falls within the commonly recommended range (e.g., < 60 mL) for iTind treatment [ 2 ], [ 11 ]. It has been previously noted that patients with an obstructive median lobe may be at a higher risk of treatment failure [ 7 ], and such conditions are typically exclusion criteria in iTind studies [ 1 ], [ 2 ]. While our study observed a high bladder neck in 30 patients, which warrants further exploration, our general exclusion criteria were aligned with established guidelines. Overall, while a network meta-analysis suggested that iTind's short-term symptomatic efficacy might be less than TURP, this conclusion was drawn with low certainty of evidence and noted that iTind provides similar IPSS improvement without sexual function impairment [ 12 ]. Our real-world data provide additional clinical context, reinforcing iTind's role as a valuable and effective option within the BPH treatment algorithm. Conclusion This study provides compelling real-world evidence from a UK tertiary referral centre, reinforcing the effectiveness and favourable safety profile of the temporary implantable nitinol device (iTind) for the treatment of benign prostatic hyperplasia-related lower urinary tract symptoms. We observed significant and sustained improvements across key functional parameters including IPSS, quality of life, maximum urinary flow rate, and post-void residual volumes over a median follow-up period of 15 months. These findings are consistent with, and strengthen, the growing body of literature supporting iTind as a valuable intervention [ 1 ], [ 2 ], [ 11 ], [ 12 ]. The iTind procedure demonstrated minimal perioperative morbidity, with complications predominantly classified as low-grade according to the modified Clavien–Dindo classification. This aligns with previous studies highlighting the transient and mild nature of adverse events, contributing to its excellent safety profile [ 1 ], [ 7 ], [ 8 ]. Crucially, the majority of patients in our cohort reported no adverse impact on ejaculatory function, a finding that is consistently reported in dedicated studies and is a significant advantage over more invasive procedures [ 2 ], [ 6 ], [ 7 ]. This preservation of sexual function makes iTind a highly attractive option for patients prioritizing this aspect of their health. As a minimally invasive, temporary, and non-ablative intervention, iTind offers a safe, effective, and patient-friendly alternative to more traditional BPH treatments, particularly for those seeking to avoid the higher complication rates and sexual side effects associated with conventional surgery [ 1 ], [ 2 ], [ 6 ]. However, continued research is essential to fully understand the long-term durability of iTind outcomes beyond current follow-up periods. Future prospective studies with larger patient cohorts, direct comparative arms against other MISTs and established surgical treatments, and extended follow-up durations are needed to solidify its role in routine clinical practice and to further refine patient selection criteria. Additionally, further investigation into specific anatomical factors, such as bladder neck characteristics, could help optimize patient stratification for iTind treatment. This study contributes significantly to the real-world evidence, advocating for iTind as an efficacious and safe option within the evolving landscape of BPH management. Declarations Funding This research received no external funding from public, commercial, or not-for-profit sectors. Author Contribution E.K. contributed to study conception and design, data collection, data analysis and interpretation, and manuscript drafting. M.C.C. contributed to data acquisition and critical revision of the manuscript. A.N. contributed to data collection and manuscript review. K.L.N. contributed to study design, supervision, and critical revision of the manuscript. N.B. contributed to study conception, supervision, and critical revision of the manuscript. All authors reviewed and approved the final manuscript. References Cillis SD et al (2022), Functional Results after First- and Second-Generation Temporary Implantable Nitinol Device (TIND) for BPH: A Narrative Review of the Literature, Current Bladder Dysfunction Reports , vol. 17, no. 2. Springer Science+Business Media, p. 104, Jan. 27. 10.1007/s11884-022-00644-9 Castellucci R et al (Aug. 2025) First Multi-Center, Real-World Study on the Temporary Implantable Nitinol Device (iTind) for the Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Obstruction. Société Int d’Urologie J 6(4):54. 10.3390/siuj6040054 Launer B, McVary KT, Ricke WA, Lloyd GL (2020) The rising worldwide impact of benign prostatic hyperplasia, British Journal of Urology , vol. 127, no. 6, p. 722, Nov. 10.1111/bju.15286 Devlin CM, Simms M, Maitland NJ (2020) Benign prostatic hyperplasia – what do we know? British Journal of Urology , vol. 127, no. 4. Wiley, p. 389, Sep. 14. 10.1111/bju.15229 Manfredi C et al (2022) Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 8(06):1711. 6. Elsevier BV10.1016/j.euf.2022.06.007 Sibona M, Destefanis P, Vercelli E, Secco S, Gontero P, Cindolo L (2023) Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs, Prostate Cancer and Prostatic Diseases , vol. 26, no. 3. Springer Nature, p. 475, Jul. 27. 10.1038/s41391-023-00686-y Kadner G et al (Mar. 2020) Second generation of temporary implantable nitinol device (iTind) in men with LUTS: 2 year results of the MT-02-study. World J Urol 38(12):3235. 10.1007/s00345-020-03140-z Cornu JN et al (2025) EAU Guidelines on MANAGEMENT OF NON-NEUROGENIC MALE LOWER URINARY TRACT SYMPTOMS (LUTS) - UPDATE APRIL 2024 Garcia-Argibay M, Hiyoshi A, Fall K, Montgomery S (Dec. 2022) Association of 5α-Reductase Inhibitors With Dementia, Depression, and Suicide. JAMA Netw Open 5(12). 10.1001/jamanetworkopen.2022.48135 Fotovat A et al (Nov. 2022) The effect of Melatonin on Improving the benign Prostatic Hyperplasia Urinary Symptoms, a Randomized Clinical Trial. 19(5):406. 10.22037/uj.v18i.6761 . PubMed Porpiglia F et al (Jan. 2018) 3-Year follow‐up of temporary implantable nitinol device implantation for the treatment of benign prostatic obstruction. Br J Urol 122(1):106. 10.1111/bju.14141 Cornu J et al (2023) Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol 83 6. Elsevier BV. 10.1016/j.eururo.2023.02.028 Franco JVA et al (2021), Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis, British Journal of Urology , vol. 130, no. 2. Wiley, p. 142, Nov. 25. 10.1111/bju.15653 Kaplan S et al (Oct. 2023) Retreatment rates and postprocedural complications are higher than expected after BPH surgeries: a US healthcare claims and utilization study. Prostate Cancer Prostatic Dis 27(3):485. 10.1038/s41391-023-00741-8 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8752740","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588990040,"identity":"359ba692-6482-4cef-8f2d-05c7ad6a6649","order_by":0,"name":"Erkin Karaca","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYFACNoYDQAgBH0B8dlK0MM4A8ZmJ0MIA08LMAyYJaOCXPpZ4uOCMXT5/++GHn21+bZPnY2Zg/PAxB7cWyb60A4dn3Ei2nHEmzVg6t++2YRszA7PkzG24tRicYW84zPOB2YDhBoOBdG7PbUagFjZmXjxa7CFa6g3kb7B//m3Zc9ueoBYDHrYDh3luHDYwuMFjJs3w43YiQS0SZ9gSDvOcOW5geCanzLK34XZyGzNjM16/8PewGX/mOVZtIHf8+OYbP/7ctp3f3nzww0c8WlABYxuYbCBWPQj8IUXxKBgFo2AUjBQAAOOPUXMMkyDdAAAAAElFTkSuQmCC","orcid":"","institution":"Ashford and St Peter's Hospitals NHS Foundation Trust","correspondingAuthor":true,"prefix":"","firstName":"Erkin","middleName":"","lastName":"Karaca","suffix":""},{"id":588990041,"identity":"0d160419-6a04-4484-8461-5c2996c88fa5","order_by":1,"name":"Mehmet Caglar Cakici","email":"","orcid":"","institution":"Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Caglar","lastName":"Cakici","suffix":""},{"id":588990042,"identity":"3ebfea54-c2cb-4f28-bd3b-bfb00203b478","order_by":2,"name":"Ahmed Nafie","email":"","orcid":"","institution":"Frimley Park Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Nafie","suffix":""},{"id":588990043,"identity":"114c592d-bf49-4f7e-92d2-246917c43b78","order_by":3,"name":"Keng Lim Ng","email":"","orcid":"","institution":"Frimley Park Hospital","correspondingAuthor":false,"prefix":"","firstName":"Keng","middleName":"Lim","lastName":"Ng","suffix":""},{"id":588990044,"identity":"bdaecfe1-6ff6-434a-99fb-afa7e6281c27","order_by":4,"name":"Neil Barber","email":"","orcid":"","institution":"Frimley Park Hospital","correspondingAuthor":false,"prefix":"","firstName":"Neil","middleName":"","lastName":"Barber","suffix":""}],"badges":[],"createdAt":"2026-01-31 22:38:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8752740/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8752740/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102621742,"identity":"7e0c2bea-d078-4d66-83b8-3af2e21d04b7","added_by":"auto","created_at":"2026-02-13 16:52:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88130,"visible":true,"origin":"","legend":"\u003cp\u003eIPSS over Time\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8752740/v1/1e85a1c9de4967eb4679c309.png"},{"id":103818867,"identity":"c0bfe691-ce5d-48c0-9984-f0b1165532d0","added_by":"auto","created_at":"2026-03-03 09:43:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":518292,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8752740/v1/35454797-87fe-4991-ab3e-0b0911e25e13.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Outcomes of iTind Treatment for Benign Prostatic Hyperplasia at a Single UK Institution","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBenign prostatic hyperplasia (BPH) is a common and progressive condition in aging men, causing lower urinary tract symptoms that significantly reduce quality of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Its prevalence rises with age, affecting 44% of men aged 40\u0026ndash;59 years and up to 70% of those over 80 years [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. BPH contributes more to overall male morbidity than prostate and bladder cancer or urolithiasis and is associated with marked psychosocial burden and substantial healthcare costs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTURP remains the traditional gold standard [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], but it carries risks such as bleeding, urinary retention, and particularly retrograde ejaculation, with meta-analytic evidence highlighting notably high postoperative ejaculatory dysfunction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This has accelerated interest in minimally invasive surgical techniques that provide effective symptom relief with improved safety and preservation of sexual function [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe temporary implantable nitinol device (iTind) is one such MIST, designed to improve LUTS while maintaining erectile and ejaculatory function [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The device temporarily expands in the prostatic urethra for 5\u0026ndash;7 days, applying localized pressure to create channels through ischemic necrosis, producing a \u0026ldquo;Turner Warwick\u0026ndash;like incision\u0026rdquo; without tissue resection or permanent implantation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinical studies demonstrate rapid and durable improvements in IPSS, QoL, and Qmax with minimal perioperative morbidity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A key advantage is the consistent preservation of sexual and ejaculatory function [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, as a relatively recent therapy, continued real-world evaluation is necessary to confirm long-term durability and refine patient selection [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study reports outcomes of iTind treatment at a single UK institution to contribute further evidence on its effectiveness and safety across a diverse patient population.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis study retrospectively analysed data from 41 patients who underwent the temporary implantable nitinol device (iTind) procedure between January 2022 and September 2025 at our tertiary BPH centre. Patients with missing data were excluded from the analysis. All included patients adhered to a standardized iTind surgical protocol and underwent the procedure under sedation. Preoperative flexible cystoscopy and transrectal ultrasound of the prostate were performed for all patients. Device removal was performed on day 7 via open ended catheter using lubricating lidocaine gel. All procedures were conducted as day cases.\u003c/p\u003e \u003cp\u003eThis study was conducted as a registered clinical audit and approved by the Frimley Health NHS Foundation Trust Quality and Audit Committee (Audit Reference Number: FH1358-3a). Formal Research Ethics Committee or Institutional Review Board approval was not required in accordance with NHS governance guidance for clinical audits. Written informed consent was obtained from all individual participants included in the study, in accordance with institutional requirements and the principles of the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eStatistical analyses were conducted using SPSS software version 26.0 (SPSS Inc., Chicago, IL, USA). The one-sample Kolmogorov\u0026ndash;Smirnov test was applied to verify the normality of the data distribution. For variables with a normal distribution\u0026mdash;namely, IPSS, quality of life, and peak urinary flow rate\u0026mdash;comparisons between pre- and post-iTind implantation values were performed using the Wilcoxon signed-rank test. Differences in post-void residual (PVR) volumes, which did not follow a normal distribution, were analysed using the Friedman test. A two-sided alpha level of 0.05 was considered statistically significant. Data are reported as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or as the median with minimum and maximum values, as appropriate.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the study population (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstate volume, cc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh BN, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (73.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSA, median (min-max), ng/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4 (0.2\u0026ndash;11.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQmax, ml/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePVR, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (10\u0026ndash;507)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQoL points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up, median (min-max), mo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (1\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSD: standard deviation, BN: Bladder neck, PSA: prostate-specific antigen, Qmax: maximum flow rate, PVR: post-void residual, IPSS: international prostate symptom score, QoL: quality of life.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of functional results up to 12 months of follow-up\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;6 months (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026ndash;12 months (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIPSS (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQoL (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQmax (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePVR (median, min\u0026ndash;max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (10\u0026ndash;507)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.5 (18\u0026ndash;150) (p\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.5 (25\u0026ndash;270) (p\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eIPSS\u003c/b\u003e: International prostate symptom score; \u003cb\u003eQoL\u003c/b\u003e: quality of life; \u003cb\u003eQmax\u003c/b\u003e: maximum flow rate; \u003cb\u003ePVR\u003c/b\u003e: post-void residual.\u003c/p\u003e \u003cp\u003eWilcoxon signed-rank test for IPSS, IPSS-QoL, Qmax; Friedman test for PVR.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost iTind ejaculatory function\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEjaculatory Function\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Patients (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo Change\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (75.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBetter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe study population consisted of 41 patients with a mean age of 52.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8 years. The mean prostate volume was 33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0 cc, and the median PSA was 1.4 ng/ml. At baseline, patients presented with significant lower urinary tract symptoms, indicated by a mean IPSS of 20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 and a QoL score of 4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0. The baseline maximum flow rate was 12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 ml/sec, and the median post-void residual was 107 ml. A notable proportion (30 patients) had a high bladder neck. The median follow-up duration was 15 months (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe safety profile of the iTind procedure in this cohort was favourable, with reported complications primarily classified as Grade 1 according to the modified Clavien\u0026ndash;Dindo classification. The most frequent complications were pain requiring re-presentation to hospital (12%), non of the patient needed admission, they were all discharged with pain management. one individual needed catheterisation due to acute urinary retention (2.4%). Frequency were observed in 2.4% of patients.\u003c/p\u003e \u003cp\u003eThe iTind procedure resulted in marked improvements in lower urinary tract symptoms over the 12-month follow-up. Mean IPSS reduced from 20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 at baseline to 12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 at 0\u0026ndash;6 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and remained improved at 13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3 at 6\u0026ndash;12 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Quality-of-life scores improved from 4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 to 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 at 0\u0026ndash;6 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and to 2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 at 6\u0026ndash;12 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Maximum flow rate increased from 12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 ml/s at baseline to 16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9 ml/s at 0\u0026ndash;6 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and to 15.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 ml/s at 6\u0026ndash;12 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Post-void residual volume decreased from a median of 107 ml (10\u0026ndash;507) to 47.5 ml (18\u0026ndash;150) at 0\u0026ndash;6 months (p\u0026thinsp;=\u0026thinsp;0.001) and 62.5 ml (25\u0026ndash;270) at 6\u0026ndash;12 months (p\u0026thinsp;=\u0026thinsp;0.001)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding ejaculatory function post-iTind (total n\u0026thinsp;=\u0026thinsp;41), 31 patients (75.6) reported no change, 5 patients (12.2%) reported worsening, and 5 patients (12.2%) reported improvement (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings from our study, conducted at a UK tertiary referral center, largely resonate with and augment the existing body of literature regarding the efficacy and safety of the iTind for treating LUTS secondary to BPH. The observed significant improvements in IPSS, QoL, Qmax, and PVR in our cohort are consistent with outcomes reported in numerous clinical studies and real-world assessments globally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. For instance, a multi-center real-world study showed median IPSS changes from 23 to 11 and QoL from 4 to 2, comparable to our results [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Furthermore, previously published data demonstrate significant and sustained improvements, with Qmax values rising by as much as 100% and IPSS dropping by 60% at 12 months in some cohorts [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This consistency across diverse patient populations reinforces iTind\u0026rsquo;s position as an effective treatment modality.\u003c/p\u003e \u003cp\u003eThe favorable safety profile observed in our study, with complications predominantly classified as Grade 1 according to the modified Clavien-Dindo classification, aligns well with established literature on iTind [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The low incidence of acute urinary retention (2.4%) and minimal re-presentations for pain are consistent with previous reports indicating that most complications associated with iTind are mild, transient, and often occur within the first week post-procedure, such as dysuria and haematuria [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The ease of performing the iTind procedure, often under light sedation with same-day discharge and minimal perioperative morbidity, as evidenced in our study and supported by other sources, marks a considerable advantage for patient convenience and healthcare efficiency [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA paramount consideration in BPH treatment, especially for younger or sexually active patients, is the preservation of sexual function. Our finding shared that the majority of patients (31 out of 41) reported no change in ejaculatory function post-iTind is strongly supported by existing literature [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Several studies, including the MT-06 study, have explicitly demonstrated the preservation of sexual function and antegrade ejaculation rates following iTind implantation, often utilizing validated questionnaires like SHIM and MSHQ-EjD [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This aspect is particularly critical when contrasted with traditional surgical interventions like TURP, which frequently lead to retrograde ejaculation, or medical therapies like 5-ARIs that can cause erectile dysfunction and decreased libido [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The ability of iTind to provide significant symptomatic relief without compromising sexual health makes it a highly attractive option for a significant patient demographic [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe durability of iTind outcomes remains a key area of investigation. Our median follow-up of 15 months provides robust data on sustained improvements, building upon existing evidence. Previous studies have documented the durability of functional benefits for up to 24 months [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and a 3-year follow-up study further confirmed the sustained efficacy of iTind, showing stable IPSS, QoL, Qmax, and PVR values [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. While the pivotal studies indicate a cumulative retreatment rate of approximately 11.1% over 48 months [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], this rate is considered acceptable within the context of BPH interventions. It is important to note that a Cochrane review highlighted very low certainty regarding iTind's retreatment rates due to concerns about risk of bias and imprecision in available data [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Our study's observation that only 4 patients (9.8%) underwent reoperation, further contributes to the understanding of retreatment rates. This contrasts with other MISTs like prostatic urethral lift, where 5-year retreatment rates were reported at 11.6% in a large claims study, and TURP at 7.0% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. iTind offers significant procedural advantages; as a rapid intervention performed under sedation in a day-case setting, it facilitates greater surgical efficiency and alleviates pressure on limited NHS inpatient bed capacity, aligning with the Get It Right First Time (GIRFT) guidelines. Such comparisons emphasize the ongoing need for long-term, high-quality data specific to iTind.\u003c/p\u003e \u003cp\u003eCareful patient selection is paramount for optimizing iTind outcomes. Our cohort, with a mean prostate volume of 33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0 cc, falls within the commonly recommended range (e.g., \u0026lt;\u0026thinsp;60 mL) for iTind treatment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It has been previously noted that patients with an obstructive median lobe may be at a higher risk of treatment failure [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and such conditions are typically exclusion criteria in iTind studies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While our study observed a high bladder neck in 30 patients, which warrants further exploration, our general exclusion criteria were aligned with established guidelines.\u003c/p\u003e \u003cp\u003eOverall, while a network meta-analysis suggested that iTind's short-term symptomatic efficacy might be less than TURP, this conclusion was drawn with low certainty of evidence and noted that iTind provides similar IPSS improvement without sexual function impairment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Our real-world data provide additional clinical context, reinforcing iTind's role as a valuable and effective option within the BPH treatment algorithm.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides compelling real-world evidence from a UK tertiary referral centre, reinforcing the effectiveness and favourable safety profile of the temporary implantable nitinol device (iTind) for the treatment of benign prostatic hyperplasia-related lower urinary tract symptoms. We observed significant and sustained improvements across key functional parameters including IPSS, quality of life, maximum urinary flow rate, and post-void residual volumes over a median follow-up period of 15 months. These findings are consistent with, and strengthen, the growing body of literature supporting iTind as a valuable intervention [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe iTind procedure demonstrated minimal perioperative morbidity, with complications predominantly classified as low-grade according to the modified Clavien\u0026ndash;Dindo classification. This aligns with previous studies highlighting the transient and mild nature of adverse events, contributing to its excellent safety profile [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Crucially, the majority of patients in our cohort reported no adverse impact on ejaculatory function, a finding that is consistently reported in dedicated studies and is a significant advantage over more invasive procedures [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This preservation of sexual function makes iTind a highly attractive option for patients prioritizing this aspect of their health.\u003c/p\u003e \u003cp\u003eAs a minimally invasive, temporary, and non-ablative intervention, iTind offers a safe, effective, and patient-friendly alternative to more traditional BPH treatments, particularly for those seeking to avoid the higher complication rates and sexual side effects associated with conventional surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, continued research is essential to fully understand the long-term durability of iTind outcomes beyond current follow-up periods. Future prospective studies with larger patient cohorts, direct comparative arms against other MISTs and established surgical treatments, and extended follow-up durations are needed to solidify its role in routine clinical practice and to further refine patient selection criteria. Additionally, further investigation into specific anatomical factors, such as bladder neck characteristics, could help optimize patient stratification for iTind treatment. This study contributes significantly to the real-world evidence, advocating for iTind as an efficacious and safe option within the evolving landscape of BPH management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no external funding from public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.K. contributed to study conception and design, data collection, data analysis and interpretation, and manuscript drafting. M.C.C. contributed to data acquisition and critical revision of the manuscript. A.N. contributed to data collection and manuscript review. K.L.N. contributed to study design, supervision, and critical revision of the manuscript. N.B. contributed to study conception, supervision, and critical revision of the manuscript. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCillis SD et al (2022), Functional Results after First- and Second-Generation Temporary Implantable Nitinol Device (TIND) for BPH: A Narrative Review of the Literature, \u003cem\u003eCurrent Bladder Dysfunction Reports\u003c/em\u003e, vol. 17, no. 2. Springer Science+Business Media, p. 104, Jan. 27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11884-022-00644-9\u003c/span\u003e\u003cspan address=\"10.1007/s11884-022-00644-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastellucci R et al (Aug. 2025) First Multi-Center, Real-World Study on the Temporary Implantable Nitinol Device (iTind) for the Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Obstruction. Soci\u0026eacute;t\u0026eacute; Int d\u0026rsquo;Urologie J 6(4):54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/siuj6040054\u003c/span\u003e\u003cspan address=\"10.3390/siuj6040054\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLauner B, McVary KT, Ricke WA, Lloyd GL (2020) The rising worldwide impact of benign prostatic hyperplasia, \u003cem\u003eBritish Journal of Urology\u003c/em\u003e, vol. 127, no. 6, p. 722, Nov. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/bju.15286\u003c/span\u003e\u003cspan address=\"10.1111/bju.15286\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDevlin CM, Simms M, Maitland NJ (2020) Benign prostatic hyperplasia \u0026ndash; what do we know? \u003cem\u003eBritish Journal of Urology\u003c/em\u003e, vol. 127, no. 4. Wiley, p. 389, Sep. 14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/bju.15229\u003c/span\u003e\u003cspan address=\"10.1111/bju.15229\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManfredi C et al (2022) Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 8(06):1711. 6. Elsevier BV10.1016/j.euf.2022.06.007\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSibona M, Destefanis P, Vercelli E, Secco S, Gontero P, Cindolo L (2023) Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs, \u003cem\u003eProstate Cancer and Prostatic Diseases\u003c/em\u003e, vol. 26, no. 3. Springer Nature, p. 475, Jul. 27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41391-023-00686-y\u003c/span\u003e\u003cspan address=\"10.1038/s41391-023-00686-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKadner G et al (Mar. 2020) Second generation of temporary implantable nitinol device (iTind) in men with LUTS: 2 year results of the MT-02-study. World J Urol 38(12):3235. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00345-020-03140-z\u003c/span\u003e\u003cspan address=\"10.1007/s00345-020-03140-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCornu JN et al (2025) EAU Guidelines on MANAGEMENT OF NON-NEUROGENIC MALE LOWER URINARY TRACT SYMPTOMS (LUTS) - UPDATE APRIL 2024\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcia-Argibay M, Hiyoshi A, Fall K, Montgomery S (Dec. 2022) Association of 5α-Reductase Inhibitors With Dementia, Depression, and Suicide. JAMA Netw Open 5(12). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamanetworkopen.2022.48135\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2022.48135\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFotovat A et al (Nov. 2022) The effect of Melatonin on Improving the benign Prostatic Hyperplasia Urinary Symptoms, a Randomized Clinical Trial. 19(5):406. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22037/uj.v18i.6761\u003c/span\u003e\u003cspan address=\"10.22037/uj.v18i.6761\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cem\u003ePubMed\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePorpiglia F et al (Jan. 2018) 3-Year follow‐up of temporary implantable nitinol device implantation for the treatment of benign prostatic obstruction. Br J Urol 122(1):106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/bju.14141\u003c/span\u003e\u003cspan address=\"10.1111/bju.14141\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCornu J et al (2023) Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol 83 6. Elsevier BV. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.eururo.2023.02.028\u003c/span\u003e\u003cspan address=\"10.1016/j.eururo.2023.02.028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranco JVA et al (2021), Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis, \u003cem\u003eBritish Journal of Urology\u003c/em\u003e, vol. 130, no. 2. Wiley, p. 142, Nov. 25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/bju.15653\u003c/span\u003e\u003cspan address=\"10.1111/bju.15653\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaplan S et al (Oct. 2023) Retreatment rates and postprocedural complications are higher than expected after BPH surgeries: a US healthcare claims and utilization study. Prostate Cancer Prostatic Dis 27(3):485. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41391-023-00741-8\u003c/span\u003e\u003cspan address=\"10.1038/s41391-023-00741-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8752740/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8752740/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eBenign prostatic hyperplasia (BPH) is a prevalent cause of lower urinary tract symptoms (LUTS) in aging men. While transurethral resection of the prostate (TURP) remains the gold standard, its associated morbidity\u0026mdash;particularly ejaculatory dysfunction\u0026mdash;has driven interest in minimally invasive surgical therapies (MISTs). The temporary implantable nitinol device (iTind) is designed to relieve obstruction while preserving sexual function.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively analysed 41 patients who underwent iTind implantation between January 2022 and September 2025 at a UK tertiary BPH centre. Pre- and post-operative outcomes included International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual (PVR), complications, and ejaculatory function. Statistical analysis was performed using non-parametric tests where appropriate.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMean patient age was 52.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8 years, with a mean prostate volume of 33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0 cc. Significant improvements were observed in IPSS, QoL, Qmax, and PVR at 0\u0026ndash;6 and 6\u0026ndash;12 months (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Median follow-up was 15 months. Complications were predominantly Grade 1, with one case of acute urinary retention (2.4%). Ejaculatory function was preserved in 75.6% of patients.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eiTind is a safe and effective minimally invasive option for BPH-related LUTS, providing durable symptom relief with minimal morbidity and high rates of ejaculatory function preservation in a real-world UK setting.\u003c/p\u003e","manuscriptTitle":"Outcomes of iTind Treatment for Benign Prostatic Hyperplasia at a Single UK Institution","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 16:52:48","doi":"10.21203/rs.3.rs-8752740/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"04c776b1-54fe-4ee3-a8f2-af8c522cf647","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-03T09:42:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 16:52:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8752740","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8752740","identity":"rs-8752740","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}