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01.
arXiv (CS.CV) 2026-06-18

Beyond the Linear Separability Ceiling: Aligning Representations in VLMs

A challenge in advancing Visual-Language Models (VLMs) is determining whether their failures on abstract reasoning tasks, such as Bongard problems, stem from flawed perception or faulty top-down reasoning. To disentangle these factors, we introduce a diagnostic framework centered on the Linear Separability Ceiling (LSC), the performance achievable by a linear classifier on a VLM's raw visual embeddings. Applying this framework to state-of-the-art VLMs, we uncover a pervasive ''alignment gap'', where most models fail to generatively outperform the linear separability of their representations. We find that the few models surpassing this ceiling do so via two mechanisms: by further refining visual representations into a more linearly separable format or by executing non-linear decision logic. We demonstrate that this bottleneck is not a fundamental limitation but a solvable visual alignment issue. Our method augments standard next-token prediction with a contrastive objective to restructure the visual manifold into a more one-dimensionally linear geometry, improving image-to-image comparison and enabling models to significantly surpass the LSC on abstract compositional reasoning tasks.

02.
arXiv (CS.CL) 2026-06-11

Building Social World Models with Large Language Models

Understanding and predicting how social beliefs evolve in response to events – from policy changes to scientific breakthroughs – remains a fundamental challenge in social science. Given LLMs' commonsense knowledge and social intelligence, we ask: Can LLMs model the dynamics of social beliefs following social events? In this work, we introduce the concept of the Social World Model (SWM), a general framework designed to capture how social beliefs evolve in response to major events. SWM learns state-transition functions for social beliefs by mining temporal patterns in social data and optimizing the evidence lower bound, without the need for explicit human annotations linking events to belief shifts, or for expensive census data. To evaluate SWM, we introduce a benchmark, SWM-bench, derived from real-world prediction markets, specifically Kalshi and Polymarket. SWM-bench includes over 12k data points for social belief prediction tasks spanning diverse domains such as politics, finance, and cryptocurrency. Our experimental results show that SWM significantly outperforms time-series foundation models, achieving state-of-the-art results on Kalshi data and demonstrating competitive performance on Polymarket data, while offering interpretable insights into the underlying mechanisms of social belief dynamics.

03.
arXiv (CS.CV) 2026-06-11

How Seemingly Inconsequential Design Choices Dictate Performance of LLMs in Pathology

General-purpose large language models (LLMs) are routinely used as baselines when evaluating specialized pathology models on whole-slide images (WSIs). Because WSIs exceed contemporary model context limits, LLM baselines routinely use small, high-magnification patches processed independently via majority voting, without systematic evaluation of seemingly inconsequential design choices such as patch size, patch count, and magnification. Generalist LLMs have consistently underperformed specialized systems, reinforcing the perception that domain-specific training or architectural adaptation is necessary for pathology tasks involving WSIs. Here, we conduct a systematic factorial analysis of four input design factors: inference mode, patch size, magnification, and patch count. We demonstrate that prior studies have overstated the gap between specialized models and general-purpose LLMs by choosing non-optimized input configurations. On the MultiPathQA benchmark, switching to a single balanced configuration (large patches at lower magnification, processed jointly) raises GPT-5 from 15.1% to 39.5% on cancer-type classification (TCGA) and from 38.1% to 62.9% on organ classification (GTEx). Per-task optimization yields further gains up to 43.9% (TCGA) and 71.6% (GTEx). The same configuration generalizes to two other models and to a fully held-out CPTAC cohort, where it improves Gemini 3 Flash by 23.4 percentage points without any task-specific tuning.

05.
arXiv (CS.CV) 2026-06-16

Simulation-Based Multi-Fillet Evaluation of Woody Breast Poultry Fillets

Woody breast (WB) is a myopathy in modern broiler chickens that causes the breast muscle to become unusually stiff and fibrous, leading to decreased meat quality and significant economic losses. State-of-the-art automated WB detection relies on a side-view imaging system to analyze the bending behavior of a single fillet as it falls off a conveyor belt. While highly accurate, this approach is constrained by its single-fillet field of view, creating throughput bottlenecks on commercial processing lines. In this paper, we address this limitation via a novel multi-fillet detection architecture utilizing a top-down camera configuration. To validate our approach, we first develop a high-fidelity digital twin of an industrial conveyor system. Next, we synthesize a diverse dataset of 3D fillet meshes and model their viscoelastic bending dynamics using a physics-based simulation engine. Lastly, a continuous 2D shape deformation score is extracted from the top-down perspective as the simulated fillets traverse the roller precipice. Experimental results demonstrate that the top-down shape score effectively captures the contour changes of the fillets as it bends, providing a robust and scalable alternative to a side-view imaging system for simultaneous multi-fillet WB evaluation.

06.
arXiv (CS.AI) 2026-06-24

LemonHarness Technical Report

arXiv:2606.24311v1 Announce Type: new Abstract: As large language model (LLM) agents are applied to longer tasks, they increasingly modify workspace state across multiple rounds of iteration. However, agents typically observe only tool outputs and log fragments, while the actual state changes occur in the file system. Without explicit workspace boundaries, state-changing operations such as file writes and temporary artifact generation may scatter changes across paths. Over time, these weakly constrained changes accumulate, making states such as modified files difficult to track. This paper presents LemonHarness, an integrated execution framework for long-horizon agents. LemonHarness establishes an explicit execution boundary by constraining state-changing operations within a clearly defined workspace and bringing model invocation, tool execution, and rule knowledge within a single controlled boundary. State-changing operations, including file writes, dependency installation, and temporary artifact creation, are executed through structured tool interfaces, with execution feedback recorded as observations available to subsequent model decisions. The system also introduces a reusable rule knowledge base, which turns recurring execution rules and acceptance criteria into runtime knowledge. LemonHarness further adds a time-aware execution mechanism that exposes elapsed and remaining budget to the model, so it can rebalance exploration, implementation, and validation effort as time pressure shifts and avoid timeouts from long waits or excessive verification. On Terminal-Bench 2.0, LemonHarness_GPT-5.3-CodeX reached 84.49% accuracy over 445 trials; pairing the same framework with the stronger GPT-5.5 backbone raised the average accuracy to 86.52% across five jobs. The results suggest that a unified runtime boundary, callable rule knowledge, and time-aware execution can improve the stability of long-horizon agent execution.

07.
arXiv (CS.AI) 2026-06-16

OmniMouse: Scaling properties of multi-modal, multi-task Brain Models on 150B Neural Tokens

arXiv:2604.18827v2 Announce Type: replace-cross Abstract: Scaling data and artificial neural networks has transformed AI, driving breakthroughs in language and vision. Whether similar principles apply to modeling brain activity remains unclear. Here we leveraged a dataset of 3.1 million neurons from the visual cortex of 73 mice across 323 sessions, totaling more than 150 billion neural tokens recorded during natural movies, images and parametric stimuli, and behavior. We train multi-modal, multi-task models that support three regimes flexibly at test time: neural prediction, behavioral decoding, neural forecasting, or any combination of the three. OmniMouse achieves state-of-the-art performance, outperforming specialized baselines across nearly all evaluation regimes. We find that performance scales reliably with more data, but gains from increasing model size saturate. This inverts the standard AI scaling story: in language and computer vision, massive datasets make parameter scaling the primary driver of progress, whereas in brain modeling – even in the mouse visual cortex, a relatively simple system – models remain data-limited despite vast recordings. The observation of systematic scaling raises the possibility of phase transitions in neural modeling, where larger and richer datasets might unlock qualitatively new capabilities, paralleling the emergent properties seen in large language models. Code available at https://github.com/enigma-brain/omnimouse.

08.
arXiv (CS.CL) 2026-06-17

EmoFSM: A Finite State Machine for Emotional Support Conversation

Emotional support conversation (ESC) aims to alleviate people's emotional distress through effective conversations. Although large language models (LLMs) have made remarkable progress in ESC, most of these studies may not define the diagram from a state-model perspective, thereby providing a suboptimal solution for long-term satisfaction. To address such an issue, we leverage the Finite State Machine (FSM) on LLMs, and propose a framework called EmoFSM. Our framework allows a single LLM to bootstrap the planning during ESC, and self-reason the seeker's emotion, support strategy, and the final response upon each conversation turn. Substantial experiments in ESC datasets suggest that EmoFSM outperforms many baselines, including direct inference, self-fine, chain of thought, finetuning, and externally supported methods, even those with many more parameters.

09.
arXiv (CS.CL) 2026-06-16

Interactor: Agentic RL oriented Iterative Creation for Ad Description Generation in Sponsored Search

This paper focuses on automatically generating informative ad descriptions in sponsored search. Unlike ad titles which are usually optimized to attract user click feedbacks, ad descriptions have a longer text span and possess the potential of incorporating world knowledge to address user search intents while presenting the fine-grained selling points of the ads. We propose Interactor, a multi-turn iterative creation framework optimized with agentic RL for ad description generation. The generation model acts as a policy that interacts with a customized environment consisting of multiple generative reward models. Given initial generations by the policy, the customized GenRMs evaluate multi-dimensional qualities including knowledge capacity and landing page consistency, providing both binary signals and reasoning feedbacks. The policy then iteratively refines the descriptions based on such feedbacks to ensure continuous improvement. Experiments on industrial datasets show that the Interactor framework significantly outperforms state-of-the-art approaches in generating knowledge-rich and faithful ad descriptions. Since May 2026, it has been deployed online in a leading search ads system, contributing to both ad revenue and user experience.

10.
arXiv (CS.CV) 2026-06-17

Enhancing Pathological VLMs with Cross-scale Reasoning

Pathological images are inherently multi-scale, requiring pathologists to integrate evidence from global tissue architecture at low magnification to cellular morphology at higher magnification for accurate diagnosis. While existing pathological datasets for vision-language model (VLM) include various scales, they often lack an explicit cross-scale reasoning objective. This limitation prevents VLMs from capturing essential cross-scale representations and learning evidence-based reasoning. To bridge this gap, we introduce the first cross-scale training and evaluation paradigm that formulates pathology interpretation as multi-magnification reasoning. However, creating such a task reveals a critical challenge: multi-image visual question answering (VQA) is prone to text-only shortcuts, which allow models to guess answers using magnification-dependent artifacts rather than visual evidence. To address this, we propose a leakage-aware curation pipeline that combines adversarial text-only screening with constraint-guided question design. Using this pipeline, we construct Scale-VQA, a high-quality benchmark with 4,685 multiple-choice questions grounded in 2,537 pathology images across multiple magnification levels. Finally, we present ScaleReasoner-R1, a model trained via reinforcement learning to optimize performance on the cross-scale VQA task. ScaleReasoner-R1 achieves state-of-the-art performance on our cross-scale reasoning benchmark and generalizes to SOTA performance on established single-scale benchmarks. Findings suggest that even the limited cross-scale supervision can significantly improve pathological understanding. The code and demos will be open-sourced.

11.
arXiv (CS.CL) 2026-06-11

RLCSD: Reinforcement Learning with Contrastive On-Policy Self-Distillation

On-policy self-distillation (OPSD) provides dense, token-level supervision for reasoning models by aligning a model's own distribution with the distribution it produces under privileged context, typically a verified solution. However, we show that the learning signal drawn from this distributional gap concentrates on style tokens rather than task-bearing ones, as the hinted model tends to produce more direct, shorter outputs. We term this pathology privilege-induced style drift, which destabilizes training or causes response length to shrink. To address this, we propose RLCSD (Reinforcement Learning with Contrastive on-policy Self-Distillation), which mitigates this drift by contrasting the teacher-student gap under a correct hint against that under a wrong hint, suppressing the style shift that conditioning on a hint tends to induce regardless of correctness, and yielding a signal that is more concentrated on task-bearing tokens. Experiments on Qwen3 (1.7B/4B/8B) and Olmo-3-7B-Think across mathematical and logical reasoning show that RLCSD consistently outperforms GRPO and prior OPSD methods. We further show that the contrastive principle is general: it plugs into existing OPSD methods to improve them, and its underlying insight extends to the broader cross-model on-policy distillation setting.

12.
arXiv (math.PR) 2026-06-16

Balanced affine Motzkin paths: Pearson geometry and global endpoint asymptotics

arXiv:2601.17634v2 Announce Type: replace Abstract: We study endpoint distributions of balanced affine weighted Motzkin paths. In the balanced case, the generating-function equation has Pearson-type characteristic geometry. We show that this geometry controls the terminal-height law globally: the characteristic escape time determines the limiting cumulant generating function, the large-deviation rate function, and the ray-scale asymptotics. Thus the usual Gaussian window is only the local quadratic approximation to a global Pearson-driven profile. For finite sizes, we prove a uniform Daniels saddlepoint approximation in the one-dominant-singularity regimes and identify the exceptional antipodal case requiring a lattice/interference correction.

13.
arXiv (quant-ph) 2026-06-17

Optimality Condition for the Petz Map

arXiv:2410.23622v5 Announce Type: replace Abstract: In quantum error correction, the Petz map serves as a perfect recovery map when the Knill-Laflamme conditions are satisfied. Notably, while perfect recovery is generally infeasible for most quantum channels of finite dimension, the Petz map remains a versatile tool with near-optimal performance in recovering quantum states. This work introduces and proves, for the first time, the necessary and sufficient conditions for the optimality of the Petz map in terms of entanglement fidelity. In some special cases, the violation of this condition can be easily characterized by a simple commutator that can be efficiently computed. We provide multiple examples that substantiate our new findings.

14.
arXiv (math.PR) 2026-06-16

Scaling Limits of Bivariate Nearly-Unstable Hawkes Processes and Applications to Rough Volatility

arXiv:2605.03703v3 Announce Type: replace Abstract: We study a pair of nearly-unstable Hawkes processes coupled through a one-directional, or triangular, cross-excitation: the first component evolves autonomously and excites the second, but not conversely. Each component is self-exciting through a heavy-tailed memory kernel, and the two kernels are allowed to have different tail indices, so that the limiting components exhibit genuinely different degrees of roughness. As the system approaches criticality, we prove that the suitably rescaled intensity vector converges weakly to the unique solution of a coupled system of stochastic Volterra equations of rough-volatility type. The first limiting component is autonomous, while the second is driven both by its own noise and by an inherited noise transmitted from the first component through an effective cross-kernel. This cross-kernel is the convolution of the two limiting Mittag-Leffler kernels and therefore combines the two memory structures. As a consequence, we obtain a short-time cross-decorrelation law: although the two components are coupled, their functional correlation vanishes at small time scales at an explicit polynomial rate. This time-dependent correlation distinguishes the limit from independent rough processes and from classical bivariate rough models with constant Brownian correlation.

15.
arXiv (CS.AI) 2026-06-24

Sensing Intelligence as a Trainable Metamaterial Property

arXiv:2605.23967v2 Announce Type: replace-cross Abstract: In biological systems, sensing is not performed by the brain alone: the body deforms, vibrates, and filters external stimuli before they are transduced into neural signals. In engineered systems, this processing burden is placed largely on electronics and computation, while the mechanical body is usually designed only for strength and stability. Here, we present sensing intelligence as a trainable property of the body. We show that the geometry of a metamaterial can be optimized to reshape external stimuli into internal signals that are easier for a neural network to interpret. Rather than hand-designing this physical preprocessing, we let the neural network train its own body for sensing by backpropagating the sensing loss to the body's design parameters through differentiable simulation. Across numerical and experimental sensing scenarios, the optimized body improves sensing accuracy by up to fivefold or reduces the number of required electronic sensors by nearly an order of magnitude.

16.
arXiv (CS.LG) 2026-06-17

Dropout Neural Network Training Viewed from a Percolation Perspective

arXiv:2512.13853v2 Announce Type: replace Abstract: In this work, we investigate the existence and effect of percolation in training deep Neural Networks (NNs) with dropout. Dropout methods are regularisation techniques for training NNs, first introduced by G. Hinton et al. (2012). These methods temporarily remove connections in the NN, randomly at each stage of training, and update the remaining subnetwork with Stochastic Gradient Descent (SGD). The process of removing connections from a network at random is similar to percolation, a paradigm model of statistical physics. If dropout were to remove enough connections such that there is no path between the input and output of the NN, then the NN could not make predictions informed by the data. We study new percolation models that mimic dropout in NNs and characterise the relationship between network topology and this path problem. The theory shows the existence of a percolative effect in dropout. We also show that this percolative effect can cause a breakdown when training NNs without biases with dropout; and we argue heuristically that this breakdown extends to NNs with biases.

17.
bioRxiv (Bioinfo) 2026-06-11

Integrating Spatially Adjusted Protein Summaries for Survival Prediction in Spatial Proteomics

Recent advances in spatial proteomics, particularly imaging mass cytometry, enable the measurement of protein expression at the single-cell level while preserving a spatial context. Conventional survival analyses, however, typically rely on patient-level averages of protein intensities and therefore overlook spatial heterogeneity and tissue architecture. To address this limitation, we introduce a framework that incorporates spatial information into survival modeling by generating spatially adjusted protein summaries (SAPS). In this approach, cell-level protein intensities within each patient are modeled using spatial spline regression to capture spatial trends. From these models, we extract two complementary features: a spatially adjusted mean expression and a residual variance that reflects cell-to-cell variability unexplained by spatial effects. These summaries are then incorporated into Cox proportional hazards models in combination with clinical covariates. In simulation studies, our proposed framework achieved improved predictive performance compared to other alternative methods. The application of the method to breast cancer imaging mass cytometry data indicate that spatially adjusted summaries may enhance survival prediction and reveal biologically interpretable spatial protein patterns, suggesting high translational potential. This methodology offers an efficient means of translating complex spatial proteomics data into patient-level features, providing both improved survival prediction and new insights into the role of spatial heterogeneity in cancer outcomes.

18.
arXiv (quant-ph) 2026-06-12

Efficient certification of intractable quantum states with few Pauli measurements

arXiv:2511.07300v2 Announce Type: replace Abstract: Efficient verification of quantum computational resources is crucial as experiments advance toward fault-tolerance. Universal quantum computation can be achieved by consuming resource states through simple Pauli measurements, yet a significant gap remains between states that are easy to certify and those required for universality. We focus on Clifford-enhanced Product States, a class of resource states obtained by applying Clifford circuits to a product of single-qubit, potentially magic, states. While essential for universal computation, the certification of such states has previously relied on query oracles that are \#P-hard to implement, leaving their efficient, oracle-free verification an open challenge. In this work, we demonstrate that such classically intractable resource states can be efficiently verified using only Pauli measurements. Our protocol achieves sample- and time-efficiency in both i.i.d.\ and adversarial settings. This work fills a gap in Pauli-based certification, providing a new practical pathway to verify resource states that drive universal Pauli-based quantum computation.

19.
arXiv (CS.CV) 2026-06-17

Looped World Models

Current world models face a fundamental tension: faithful long-horizon simulation demands deep computation, but deeper models are expensive to deploy and prone to compounding errors. We resolve this by introducing Looped World Models (LoopWM), which are the first looped architectures for world modelling. Our method iteratively refines latent environment states through a parameter-shared transformer block. This yield up to 100x parameter efficiency over conventional approaches with adaptive computation that automatically scales depth to match the complexity of each prediction step. Orthogonal to scaling model size and training data, LoopWM establishes iterative latent depth as a new scaling axis for world simulation, which might significantly push the community forward.

20.
arXiv (CS.CL) 2026-06-11

Which Speech Representation Better Matches Text-Native Reasoning? A Study of Speech-Text Alignment on Frame Rate and Representation

Spoken dialogue models typically start from text LLM backbones, yet reasoning often degrades when conditioning on speech instead of text. We attribute part of this modality gap to a temporal-granularity mismatch: speech tokens are temporally redundant and far longer than text under matched semantics, diluting per-token semantic density and weakening text-native reasoning dynamics. We study speech token design as a representation selection problem and sweep frame rates under a frozen LLM backbone with a fixed information rate. To make low frame rates feasible, we introduce factorized FSQ and a lightweight non-autoregressive audio LM head, scaling capacity to nearly 300\,bits/frame without sacrificing efficient prediction. With the bottleneck removed, we sweep frame rates (50$\rightarrow$2.08\,Hz) and alignment depth, and observe a consistent best regime for speech QA at 4.17\,Hz with intermediate-layer representation alignment.

21.
arXiv (CS.CL) 2026-06-19

Granularity-Regulated Adaptive Computational Efficiency for Optimal Verification in Test-Time Scaling

Test-time scaling (TTS) has emerged as a powerful paradigm for improving the reasoning performance of large language models (LLMs) by investing additional compute at inference time. A central component of TTS is the verifier, which selects or scores candidate solutions to guide the search process. While prior work has explored the benefit of verification, a fundamental question remains underexplored: what is the optimal granularity of verification under a given compute budget? Coarse-grained outcome reward models (ORMs) and fine-grained process reward models (PRMs) represent two extremes, yet neither alone achieves compute-optimality across all regimes. In this paper, we establish a unified theoretical framework, called GRACE (\underline{G}ranularity-\underline{R}egulated \underline{A}daptive \underline{C}omputational \underline{E}fficiency), that characterizes the optimal verification granularity as an explicit function of problem difficulty, verifier accuracy, and compute budget. We prove that there exists a phase transition: fine-grained verification dominates when either the compute budget is large or the problem is hard, whereas coarse-grained verification is preferred in the low-budget, easy-problem regime. Our theory unifies Best-of-$N$, beam search, and step-level MCTS within a single Pareto-optimality framework, and motivates an adaptive granularity strategy that provably achieves the compute-performance Pareto frontier. Empirical results on MATH-500, GSM8K, and AIME benchmarks corroborate all four theoretical claims, with our adaptive strategy outperforming fixed-granularity baselines by up to 3.1\% accuracy at matched compute.

22.
arXiv (math.PR) 2026-06-11

Patterned matrices with random walk entries

arXiv:2512.04612v3 Announce Type: replace Abstract: It is well known that the weak limit of a suitably scaled continuous-time random walk (CTRW) is the Brownian motion. We investigate the convergence of certain patterned random matrices whose entries are independent CTRWs and their time-changed versions, in a non-commutative probability framework. For the Wigner link function, the limits are free Brownian motion and its time-changed version driven by an inverse stable subordinator. For the symmetric circulant and the circulant with CTRW entries, we use their explicit eigenvalue expressions to define some empirical processes that converge weakly to a Brownian motion and a complex Brownian motion, respectively. For matrices with iid entries, and for elliptic matrices, the algebraic limits are equal in $*$-distribution to processes whose marginals are circular and elliptic variables, respectively. A random time-changed variant of these results is also established.

23.
arXiv (CS.LG) 2026-06-19

Tracking Representation Dynamics in Large Language Models with Persistent Homology

arXiv:2606.19542v1 Announce Type: new Abstract: Large language models are commonly aligned through supervised fine-tuning, yet little is known about how their internal representations evolve during this process. We study alignment dynamics using persistent homology by tracking the topology of activation spaces throughout fine-tuning. Across four transformer language models ranging from 1B to 7B parameters and three alignment objectives corresponding to helpful, harmless, and mixed training data, we find that the majority of topological reorganization occurs during the earliest stages of training. A dense checkpoint analysis reveals a transient peak in topological activity followed by rapid stabilization. We further show that different alignment objectives induce distinguishable topological trajectories, while instruction-tuned and pretrained models exhibit qualitatively different patterns of evolution. Our results suggest that persistent homology provides a complementary perspective on alignment, revealing representation-level changes that are not apparent from behavioral metrics alone.

24.
arXiv (CS.AI) 2026-06-24

T2D-Bench: Evidence-Gated Evaluation of LLM Outputs for Type 2 Diabetes Using a Multi-Layer Clinical-Lifestyle Knowledge Graph

arXiv:2606.24145v1 Announce Type: new Abstract: Large language models (LLMs) can produce clinically fluent recommendations for type 2 diabetes while failing to satisfy guideline constraints or explicitly justify lifestyle-related glycemic claims. We present T2D-Bench, a reproducible benchmark and evidence-gated evaluation framework for testing whether LLM outputs satisfy explicit, graph-checkable evidence requirements. T2D-Bench is built on a multi-layer clinical-lifestyle knowledge graph that combines a biomedical spine (UMLS, DrugBank, SIDER), computable ADA Standards of Care rules, and lifestyle knowledge connected through a mechanistic bridge to glycemic laboratory effects. Across 100 structured vignettes spanning diagnosis, medication safety, and adversarial lifestyle conflicts, baseline outputs failed benchmark-defined evidence-path checks in 35% of cases for GPT-4o-mini and 33% for GPT-4o. The evidence gate detects unsupported omissions and uses constrained revision to bring outputs into verifier-level compliance with benchmark-defined evidence requirements. These results show that computable evidence constraints can make unsupported clinical omissions explicit, measurable, and correctable in diabetes-focused LLM outputs.

25.
medRxiv (Medicine) 2026-06-10

Impact of Early Treatment on Symptom Improvement and Procedural Events among Men with BPH and Bothersome Lower Urinary Tract Symptoms: A Contemporary Analysis of the American Urological Association Quality (AQUA) Registry

PURPOSE: As the armamentarium of BPH therapies continues to expand, it remains imperative to maximize patient satisfaction and minimize decisional regret. We sought to determine the impact of time from BPH diagnosis to index treatment on symptom improvement and subsequent procedural events. MATERIALS AND METHODS: We queried the American Urological Association Quality Registry for men [&ge;] 40 years old with BPH, available IPSS data, and no receipt of prior BPH treatment. Index treatment included medication, surgery, or minimally invasive surgical therapy (MIST). Outcomes included IPSS over 3 years of follow-up, change in percentage of mild lower urinary tract symptoms (LUTS) by 3 months, and time to procedural event. Patients were stratified by time from index diagnosis to treatment by 3 years. Outcomes were compared across time-to-treatment cohorts with appropriate statistical tests with p < 0.05 as significant. RESULTS: 43,919 patients met criteria with 19,642 pursuing treatments. Patients pursued treatment at comparably lower baseline IPSS compared to prior prospective series. Patients undergoing surgery and MIST had significantly higher baseline IPSS, while medical comorbidities were significantly more common among men initiating pharmacotherapy. Early surgery and MIST were associated with significant improvement in IPSS within 6-12 months and an increase in mild LUTS by 3 months. All forms of early treatment were associated with delayed time to procedural events, including catheterization and fulguration. CONCLUSIONS: Early procedural intervention for BPH is associated with early symptom improvement and delayed time to procedural events among real-world, contemporary practice.