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01.
arXiv (CS.CL) 2026-06-16

SciOrch: Learning to Orchestrate Expert LLMs for Solving Frontier Multimodal Scientific Reasoning Tasks

Frontier scientific reasoning remains a major challenge for large language models (LLMs), where even the strongest commercial systems fall short of expert-level performance. A closer look at model behavior reveals substantial complementarity that single-model evaluation hides: different frontier models excel on different question types, and no single model captures the full picture. We present SciOrch, a framework that trains a lightweight 8B model to orchestrate frontier LLMs for scientific reasoning. The orchestrator decomposes each question, delegates sub-problems to selected commercial models through API calls, and synthesizes a final answer. Training such an orchestrator is fundamentally harder than conventional agentic RL: each action triggers an API call that is expensive in both dollar cost and latency, making standard online rollouts infeasible. We address this with MCTS-based approach, producing diverse orchestration trajectories, extracting per-node single-turn samples, and optimizing the orchestrator with GRPO-style training. On a 240-question test set spanning SGI-Reasoning and Scientists' First Exam, SciOrch reaches 56.66% average accuracy, outperforming the strongest single commercial model by 3.74% and the strongest multi-agent baseline by 3.33%. It also attains the best accuracy on both SGI and SFE with less than half the API cost of typical multi-agent methods.

02.
arXiv (CS.CV) 2026-06-15

GarmentSketch: Large-scale Sketch-to-Fashion Benchmark

Fashion sketching is a cornerstone of design workflows, allowing rapid visualization of creative concepts prior to physical prototyping. Yet, progress in sketch-based fashion image synthesis has been hindered by the absence of large-scale, high-quality paired resources. To bridge this gap, we present GarmentSketch, a novel dataset comprising 26,249 fashion sketches across 21 garment categories, each paired with detailed textual descriptions. Captions were produced through a multi-stage pipeline that integrates multiple multimodal large language models (MLLMs) with human-in-the-loop refinement, ensuring both semantic accuracy and descriptive richness. We benchmark GarmentSketch on state-of-the-art generative models, providing baseline performance for sketch-guided text-to-image generation. Our experiments reveal both the promise and the current limitations of existing methods. By offering a comprehensive and richly annotated resource, GarmentSketch establishes a foundation for advancing sketch understanding, fine-grained fashion image generation, and creative human-AI collaboration in design. The dataset will be available at: https://khangbdd.github.io/garmentsketch.

03.
arXiv (CS.CL) 2026-06-16

Hidden Ghost Hand: Unveiling Backdoor Vulnerabilities in MLLM-Powered Mobile GUI Agents

Graphical user interface (GUI) agents powered by multimodal large language models (MLLMs) have shown greater promise for human-interaction. However, due to the high fine-tuning cost, users often rely on open-source GUI agents or APIs offered by AI providers, which introduces a critical but underexplored supply chain threat: backdoor attacks. In this work, we first unveil that MLLM-powered GUI agents naturally expose multiple interaction-level triggers, such as historical steps, environment states, and task progress. Based on this observation, we introduce AgentGhost, an effective and stealthy framework for red-teaming backdoor attacks. Specifically, we first construct composite triggers by combining goal and interaction levels, allowing GUI agents to unintentionally activate backdoors while ensuring task utility. Then, we formulate backdoor injection as a Min-Max optimization problem that uses supervised contrastive learning to maximize the feature difference across sample classes at the representation space, improving flexibility of the backdoor. Meanwhile, it adopts supervised fine-tuning to minimize the discrepancy between backdoor and clean behavior generation, enhancing effectiveness and utility. Extensive evaluations of various agent models in two established mobile benchmarks show that AgentGhost is effective and generic, with attack accuracy that reaches 99.7\% on three attack objectives, and shows stealthiness with only 1\% utility degradation. Furthermore, we tailor a defense method against AgentGhost that reduces the attack accuracy to 22.1\%. Our code is available at \texttt{anonymous}.

04.
arXiv (CS.LG) 2026-06-16

Coercivity and Local Convergence of Physical Learning in Linear Circuits

arXiv:2606.15443v1 Announce Type: cross Abstract: Physical learning methods train physical networks to perform computational tasks using only local update rules, exploiting the physics of the system to handle the global transfer of information. We provide the first local convergence analysis of three such methods – Equilibrium Propagation (EP), Coupled Learning (CL), and a new method we call Adjoint Coupled Learning (AL) – for linear circuits, in the limit of small-nudging for both discrete and continuous time. EP and AL perform gradient descent on a natural loss function, while CL follows modified dynamics with an additional cubic correction. Assuming the existence of a solution, we identify a coercivity condition, expressed as a rank condition on a matrix built from the network's incidence structure, under which the training loss decays exponentially and the parameters converge to the solution manifold. We show that coercivity can fail by exhibiting a kite circuit in which a symmetry causes the coercivity constant to degenerate on the solution manifold, but prove using Sard's theorem that such degeneracies are non-generic: coercivity holds at every point of the solution manifold for almost every choice of desired output.

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

Dynamic Black-hole Emission Tomography with Physics-informed Neural Fields

With the success of static black-hole imaging, the next frontier is the dynamic and 3D imaging of black holes. Recovering the dynamic 3D gas near a black hole would reveal previously-unseen parts of the universe and inform new physics models. However, only sparse radio measurements from a single viewpoint are possible, making the dynamic 3D reconstruction problem significantly ill-posed. Previously, BH-NeRF addressed the ill-posed problem by assuming Keplerian dynamics of the gas, but this assumption breaks down near the black hole, where the strong gravitational pull of the black hole and increased electromagnetic activity complicate fluid dynamics. To overcome the restrictive assumptions of BH-NeRF, we propose PI-DEF, a physics-informed approach that uses differentiable neural rendering to fit a 4D (time + 3D) emissivity field given EHT measurements. Our approach jointly reconstructs the 3D velocity field with the 4D emissivity field and enforces the velocity as a soft constraint on the dynamics of the emissivity. In experiments on simulated data, we find significantly improved reconstruction accuracy over both BH-NeRF and a physics-agnostic approach. We demonstrate how our method may be used to estimate other physics parameters of the black hole, such as its spin.

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

FasterPy: An LLM-based Code Execution Efficiency Optimization Framework

arXiv:2512.22827v2 Announce Type: replace-cross Abstract: Code often suffers from performance bugs. These bugs necessitate the research and practice of code optimization. Traditional rule-based methods rely on manually designing and maintaining rules for specific performance bugs (e.g., redundant loops, repeated computations), making them labor-intensive and limited in applicability. In recent years, machine learning and deep learning-based methods have emerged as promising alternatives by learning optimization heuristics from annotated code corpora and performance measurements. However, these approaches usually depend on specific program representations and meticulously crafted training datasets, making them costly to develop and difficult to scale. With the booming of Large Language Models (LLMs), their remarkable capabilities in code generation have opened new avenues for automated code optimization. In this work, we proposed FasterPy, a low-cost and efficient framework that adapts LLMs to optimize the execution efficiency of Python code. FasterPy combines Retrieval-Augmented Generation (RAG), supported by a knowledge base constructed from existing performance-improving code pairs and corresponding performance measurements, with Low-Rank Adaptation (LoRA) to enhance code optimization performance. Our experimental results on the Performance Improving Code Edits (PIE) benchmark demonstrate that our method outperforms existing models on multiple metrics. The FasterPy tool and the experimental results are available at https://github.com/WuYue22/fasterpy.

07.
arXiv (CS.CV) 2026-06-17

MoonSplat: Monocular Online Gaussian Splatting with Sim(3) Global Optimization

Online 3D reconstruction from monocular image sequences is a challenging and ongoing research topic. 3D Gaussian Splatting (3DGS), leveraging its high-quality real-time rendering capability, empowers online 3D reconstruction to represent dense scenes with enhanced expressiveness, and thus holds great promise for a wide range of applications such as robotics and AR/VR. However, existing online 3DGS methods still suffer from some key challenges: fragile camera pose estimation due to the lack of global optimization, and low optimization efficiency in large-scale or long-sequence scenarios. To address these issues, we propose a robust and efficient online voxelized 3DGS reconstruction framework integrated with global $Sim(3)$ optimization, which enables reliable camera tracking and efficient global loop closure for both camera poses and voxelized 3DGS. To accelerate the convergence of the voxelized 3DGS, we further introduce a color residual learning strategy, which not only boosts optimization speed but also enhances rendering quality. Extensive experiments on diverse indoor and outdoor datasets demonstrate that our method achieves state-of-the-art performance in both camera pose estimation accuracy and rendering quality, while retaining real-time efficiency. Additionally, we develop and deploy a real-world UAV-based active reconstruction system grounded on our proposed method, validating its robustness and generalizability for practical online 3D reconstruction tasks. Our code and data are available at https://github.com/TrickyGo/MoonSplat.

08.
arXiv (CS.LG) 2026-06-11

Enhancing Spectral Embedding through Robust and Flexible Knowledge Transfer in Electronic Health Records

arXiv:2606.11570v1 Announce Type: cross Abstract: We propose a spectral-based, unsupervised representation learning framework to derive low-dimensional embeddings for clinical concepts and patients in rare disease cohorts from electronic health records, where data are high-dimensional but sample sizes are limited. To overcome this challenge, we incorporate a knowledge matrix extracted from a broader population that shares a partially overlapping subspace with the rare-disease cohort. Our method departs from existing approaches by relaxing restrictive one-to-one signal-alignment assumptions between the latent data matrix and knowledge matrix, allowing more flexible and realistic forms of structured sharing. We introduce a novel two-step spectral embedding procedure: first, we identify and remove irrelevant components from the knowledge matrix; then, we apply a projection-based method to separately recover shared and heterogeneous components. Simulations and an analysis of a real-world multiple sclerosis cohort show that the proposed method outperforms competing approaches, particularly in challenging scenarios where shared signals are weak and only partially aligned, as is common in rare-disease data.

09.
arXiv (CS.AI) 2026-06-15

A Fixed-Point Neural Operator for Size- and Functional-Transferable Hamiltonian Prediction

arXiv:2606.14498v1 Announce Type: cross Abstract: Predicting the Kohn-Sham Hamiltonian with machine learning can accelerate density functional theory while retaining access to molecular orbitals, energy levels, and electronic-structure observables that energy-only surrogates cannot resolve. Yet element-wise agreement with the converged Hamiltonian, an implicit fixed point of the self-consistent field iteration, does not determine the occupied subspace that governs orbital energies and densities. Here we present HamEvo, a neural operator that learns the single-step self-consistent update and returns the converged Hamiltonian as its fixed point. HamEvo is pre-trained on intermediate self-consistent trajectories and calibrated at equilibrium with density-matrix supervision. Across benchmarks from MD17 to drug-like QMugs, HamEvo lowers Hamiltonian errors by 35-49% over direct-regression and deep-equilibrium baselines, and predicts QMugs HOMO and LUMO energies with mean absolute errors of 0.036 and 0.053 eV, near the 1 kcal/mol chemical-accuracy scale. Few-shot fine-tuning with only 20 reference conformations extends HamEvo to molecules of up to 122 atoms, well beyond the size range covered by pre-training. With thermal molecular-dynamics sampling, HamEvo captures temperature-dependent HOMO-LUMO gap renormalization beyond the harmonic approximation. Inference is up to 242 times faster than conventional DFT.

10.
arXiv (quant-ph) 2026-06-19

Steady-state entanglement of spin qubits mediated by nonreciprocal and chiral magnons

arXiv:2509.13094v3 Announce Type: replace Abstract: We propose a hybrid quantum system in which a magnet supporting non-reciprocal magnons, chiral magnons, or both mediates the dissipative and unidirectional coupling of spin qubits. By driving the qubits, the steady state of this qubit-qubit coupling scheme becomes the maximally entangled Bell state. We devise a protocol where the system converges to this entangled state and benchmark it including qubit decay and dephasing. The protocol is numerically tested on a hybrid system consisting of nitrogen-vacancy (NV) centers coupled to magnon surface modes of an yttrium iron garnet (YIG) film. We show that the dephasing time of the NV centers forms the bottleneck for achieving the entanglement of NV centers separated by a distance within the magnon coherence length. Our findings identify the key technological requirements and demonstrate a viable route toward steady-state entanglement of solid-state spins over distances of several microns using magnonic quantum networks, expanding the toolbox of magnonics for quantum information purposes.

11.
arXiv (CS.LG) 2026-06-12

Limits of spectral learning under noise

arXiv:2606.13067v1 Announce Type: new Abstract: Learning functional relationships from noisy data is a central problem in scientific inference. Spectral methods approximate unknown functions by expanding them in a basis and estimating the corresponding coefficients from data, but the stability of these coefficients under noise remains poorly understood. Here we study supervised regression with additive label noise using sparse spectral representations across multiple bases and dimensions. We show that noise induces a predictable drift in the learned coefficient vector whose magnitude depends on the effective number of active spectral modes. After whitening the empirical feature geometry, we derive a closed-form expression for the overlap between noisy and noiseless coefficient vectors, revealing a universal degradation curve governed by a single intrinsic noise scale. Numerical experiments across Fourier, Legendre, Bessel, and Haar bases confirm the theoretical prediction. The results demonstrate that spectral learning exhibits a fundamental noise threshold beyond which coefficient estimates become unstable, placing intrinsic limits on recovering functional structure from noisy data.

13.
arXiv (CS.AI) 2026-06-19

Triangular Consistency as a Universal Constraint for Learning Optical Flow

arXiv:2606.19938v1 Announce Type: cross Abstract: We propose triangular consistency as a first-principled constraint for optical flow, which is agnostic to network architecture, supervision type, and dataset, and applies to both image-pair and multi-frame settings. This simple but powerful constraint is to compose two flows to induce a third flow and enforce consistency among the three. The composed flows may arise from (i) image pairs, yielding cycle consistency; (ii) multiple video frames, producing longer-range motion through temporal chaining; or (iii) image pairs combined with controlled synthetic transformations, which becomes data augmentation. This triangular consistency introduces negligible computational overhead and requires no additional annotations. Since it is derived directly from the geometry of optical flow, it does not rely on model-specific assumptions and serves as a ``universal'' plug-and-play component for optical flow training. Experiments show consistent improvement across supervised, unsupervised, and transfer learning settings.

14.
arXiv (CS.CV) 2026-06-19

The FID Lottery: Quantifying Hidden Randomness in Generative-Model Evaluation

The Frechet Inception Distance (FID) is the de facto arbiter of image generation, yet most papers report just a single number from a single trained model using a single sampling seed. How reproducible is that number if we retrain the model, or merely resample from it? In this paper, we treat FID as a random variable on a two-axis panel of training and generation seeds, and measure its variance directly on several hundred SiT networks trained on class-conditional ImageNet 256x256. We report surprising findings: (a) Retraining the model using the same recipe with a different seed moves FID 3.2x more (in Inception feature space) than redrawing samples from a fixed network. (b) That gap is driven by three factors: random initialisation, data ordering, and the per-step Gaussian noise of the flow-matching loss. (c) Increasing compute or model size barely tightens the spread, holding the FID coefficient of variation (CoV) inside a 1-2% band. (d) Per-cell classifier-free-guidance tuning halves the spread but reshuffles which seeds work best, and a lucky training seed reaches the same FID with up to 2x less compute than an unlucky one. Based on these findings, we recommend a new FID evaluation protocol: evaluate under per-cell optimal guidance, treat any FID gap below the empirically measured ~1.3% CoV as inconclusive, and report an error bar over several training seeds rather than a single FID number.

15.
arXiv (CS.CV) 2026-06-11

SG2Loc: Sequential Visual Localization on 3D Scene Graphs

Visual localization in complex indoor environments remains a critical challenge for robotics and AR applications. Sequential localization, where pose estimates are refined over time, is important for autonomous agents. However, traditional methods often require storing extensive image databases or point clouds, leading to significant overhead. This paper introduces a novel, lightweight approach to sequential visual localization using 3D scene graphs. Our method represents the environment with a compact scene graph, where nodes represent objects (with coarse meshes) and edges encode spatial relationships. For each image in the localization phase, we extract per-patch semantic features, predicting object identities. Localization is performed within a particle filter framework. Each particle, representing a camera pose, projects the coarse object meshes from the scene graph into the image, assigning object identities to patches based on visibility. The similarity of the per-patch features, in the input image, and object features from the scene graph determines the weight of a particle. Subsequent images are incorporated sequentially, refining the pose estimate. By leveraging a compact scene graph and efficient semantic matching, our method significantly reduces storage while maintaining performance on real-world datasets. The code will be available at https://github.com/DmblnNicole/sg2loc.

18.
arXiv (CS.LG) 2026-06-12

Towards Provably Fair Machine Learning: Bayesian Approaches For Consistent and Transparent Predictions

arXiv:2606.12615v1 Announce Type: new Abstract: ML classifiers deployed in high-stakes domains produce predictions whose quality varies systematically across subgroups. For granular subgroups defined by intersections of multiple features, predictions are often inconsistent with the observed data: the model's outputs contradict the evidence available for that subgroup. This problem is exacerbated by regularisation, which improves aggregate performance by collapsing small subgroups into larger groups, disproportionately affecting demographic minorities. We define two requirements for consistent prediction: determinism (identical individuals receive identical predictions) and statistical consistency (we cannot reject, at significance level alpha, the hypothesis that the predictions for a subgroup were drawn from the Bayesian optimal target distribution inferred for that subgroup). From these requirements we derive the Fair Bayesian classifier, which enforces both across every group and subgroup simultaneously and abstains whenever no consistent deterministic prediction is possible. On three benchmark datasets (Adult, COMPAS, and Bank Marketing), standard classifiers produce statistically inconsistent predictions for a substantial proportion of subgroups. Our classifier achieves zero consistency error by construction while exceeding baseline accuracy and multicalibration on every dataset tested. Statistical consistency provides a principled foundation for prediction quality with direct implications for algorithmic fairness. Minority demographics are disproportionately concentrated in small subgroups, precisely where frequentist inference is least reliable; addressing this inference problem is therefore a necessary step toward fair ML. By enforcing Bayesian consistency at the finest resolution the data supports, the our classifier demonstrates that exhaustive subgroup fairness with principled abstention is achievable in practice.

19.
arXiv (CS.AI) 2026-06-19

Too long; didn't solve

arXiv:2604.07593v2 Announce Type: replace Abstract: Mathematical benchmarks consisting of a range of mathematics problems are widely used to evaluate the reasoning abilities of large language models, yet little is known about how their structural properties influence model behaviour. In this work, we investigate two structural length variables, prompt length and solution length, and analyse how they relate to model performance on a newly constructed adversarial dataset of expert-authored mathematics problems. We find that both prompt and solution lengths correlate positively with increased model failure across models. We also include a secondary, exploratory analysis of cross-model disagreement. Under a difficulty-adjusted normalised analysis, both variables retain weak negative associations with realised model separation, slightly stronger for prompt length. Overall, our main robust finding is that structural length is linked to empirical difficulty in this dataset.

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

CoVEBench: Can Video Editing Models Handle Complex Instructions?

While recent text-guided video editing models excel at elementary tasks (e.g., style transfer, object insertion), real-world user requests are highly compositional. A single prompt often demands multiple coupled edits, such as modifying subjects, actions, and camera views, while strictly preserving unrelated spatiotemporal content. Existing benchmarks, heavily constrained by isolated edits and coarse global metrics, fail to diagnose how models handle such complex workflows. To address this gap, we introduce CoVEBench, a compositional video editing benchmark comprising 416 curated source videos, 626 multi-point editing instructions, and 9,990 fine-grained checklist items. Covering diverse editing dimensions, CoVEBench evaluates models via MLLM-judged instruction compliance and video fidelity, alongside automated metrics for video quality. Extensive experiments reveal that compositional editing remains a profound challenge: current models frequently omit edits, violate preservation constraints, or introduce artifacts when handling multiple operations simultaneously. CoVEBench provides a challenging, diagnostic testbed to advance video editing toward realistic user workflows.

21.
arXiv (CS.AI) 2026-06-16

Do Large Language Models Have Emotions?

arXiv:2606.14742v1 Announce Type: cross Abstract: Do LLMs have emotions? A recent paper from Anthropic reports finding internal representations of emotion concepts in Claude Sonnet 4.5, concluding that the LLM has 'functional emotions.' We evaluate this claim against what is known about how emotions actually function in biological systems. We argue that emotions serve two core functions: the context-sensitive interpretation of situations, and the reorganization of processing across multiple systems in response to those interpretations. The Anthropic findings offer partial support for the first function, though the consistent, discrete emotional representations identified in Claude sit uneasily with affective neuroscience findings that human emotion is characterized by variable rather than uniform neural signatures. On the second function, the evidence is mixed: Claude's representations modulate output without producing the dynamic reorganization of attention, decision speed, and motivational state that defines emotion in biological systems. We close by proposing what it would take for an LLM to have emotions.

22.
arXiv (math.PR) 2026-06-17

Time and Killed Resolvents in Reflected Optimal Stopping with a Max Payoff

arXiv:2606.18214v1 Announce Type: cross Abstract: We study infinite-horizon optimal stopping for normally reflected two-dimensional diffusions in the positive quadrant with max payoff \(G(x_1,x_2)=x_1\vee\alpha x_2\). The non-smooth payoff produces a singular stopping-gain measure on the kink set \(\Delta=\{x_1=\alpha x_2\}\). We prove $\displaystyle \Gamma^\Delta(dx) = -\frac{n^\top a(x)n}{2\sqrt{1+\alpha^2}}\,\sigma_\Delta(dx)$, with $n=(1,-\alpha)$, so the diagonal component is non-positive and strictly negative under local ellipticity. This implies that every interior kink point lies in the continuation region. We further show that the correct value representation uses the resolvent killed at first entry into the stopping set, $\displaystyle V=G-R_r^{\mathcal C}\Gamma$, and give a closed-form reflected Brownian counter-example showing that the unrestricted reflected resolvent is generally wrong. A reflected Brownian benchmark and numerical experiments illustrate the local-time, resolvent-gap, and diagonal-avoidance mechanisms.

23.
bioRxiv (Bioinfo) 2026-06-12

Systematic functional annotation of thousands of BAHD acyltransferases in plant genomes using Protein Language Model and phylogenomic tools

The functional annotation of plant genes lags significantly behind their genomic annotation. Closing this gap requires thorough cataloging of reported protein activities alongside predictive methods that scale beyond sequence-similarity inference. Focusing on the BAHD acyltransferase enzyme family as a model, we assembled FuncZymeDB-BAHD, a large database of 2,705 LLM-retrieved and curated enzyme-acceptor-donor activities covering 336 BAHDs from 156 plant species, a 2-to-6-fold expansion over Swiss-Prot and prior compilations. We further developed FuncPred-OG, which maps queries to orthologous groups and previously characterized enzymes in FuncZymeDB-BAHD, returning hits with high evidence provenance. FuncPred-OG enabled functional prediction of over half of BAHDs across 85 plant proteomes, of which five novel predictions were validated via in vitro assays and recent studies. For the remaining BAHDs without FuncPred-OG annotation, we developed FuncPred-AI, where logistic-regression classifiers trained on protein language model embeddings achieved high Area-Under-the-Precision-Recall-curve (AUPR) scores and correct-hit rates up to 93%. FuncPred-AI yielded >1 probable donor/acceptor annotation for 99.9% (8894/8897) of BAHDs in our pan-plant dataset. Finally, the FuncPred workflow and datasets were deployed on a web portal for broader utilization, potentially reducing experimentalist efforts for selecting candidates from days to minutes. Overall, this framework provides a generalizable template for functional annotation of entire enzyme families.

24.
arXiv (CS.LG) 2026-06-16

An RRAM-based Hardware Implementation of a Radial Basis Function Neuron for Edge Classifiers

arXiv:2606.14739v1 Announce Type: cross Abstract: The deployment of modern machine learning (ML) solutions on resource-constrained edge devices highlights implementation challenges. This is especially true for extreme edge applications that include safety-critical components, such as autonomous navigation tasks. This paper demonstrates an artificial neural network (ANN) design leveraging Metal-Oxide Resistive RAM (RRAM) -based Analogue Content Addressable Memory (ACAM) as an efficient hardware substrate for performing metric-based classification and online adaptation on the edge. The proposed design is based on a custom Template piXeL (TXL) cell used for building the ACAM module, where each TXL cell acts as a configurable receptive field neuron. These cells employ a Radial Basis activation function to calculate the distance of an input from the programmed receptive field. The TXL can be organised into dense arrays for calculating the distance of a high-dimensional input against all stored prototypes, effectively performing fast and energy efficient similarity search. This hardware engine enables on-the-fly learning, where the receptive field parameters can be tuned to track domain shift. Through simulation of the proposed TXL-RBF classifier we can achieve 89.1\% accuracy on the MNIST dataset while consuming 185fJ per cell per operation when operating at 100MHz.

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.