American Urological Association Symptom Index Research Articles

Association between dietary fatty acids and urinary incontinence

BackgroundDietary nutrient intake contributes to urination; however, the association between dietary nutrient intake, especially that of fat, and urinary incontinence (UI) is not well understood. The most common types of UI include stress UI (SUI) and urgency UI (UUI). ObjectiveTo investigate the potential effect(s) of dietary fat intake on UI and explore its mechanism of action in relation to body mass index (BMI). MethodsA cross-sectional survey of data from 15,121 individuals (20–85 years of age) from the National Health and Nutrition Examination Survey (2001–2008), a random population-based sample, was performed. Data regarding dietary nutrient intake were collected through 24 h dietary recall interviews. UI and covariate data were collected through in-person interviews. UI was assessed according to the American Urological Association Symptom Index. The odds ratio (OR) for SUI and UUI were calculated using multivariate logistic regression analysis. The mediation effect was estimated using observational mediation analysis. ResultsHigher total fat intake was positively associated with increased odds for developing UI (OR 1.44 [95% confidence interval (CI) 1.08–1.93]). Females who consumed more saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) were more likely to develop SUI. BMI partially explained the association between total fat, SFA, MUFA, and PUFA and SUI; the proportions of the mediation effect of BMI were 14.7%, 13.0%, 18.7%, and 16.3%, respectively. ConclusionsResults of this study emphasize the key role of dietary fat intake in the prevalence of UI. Higher fat intake was positively associated with UI and BMI partially mediated the effect of fat intake on SUI.

Efficacy and safety of tibial nerve stimulation using a wearable device for overactive bladder.

To evaluate the efficacy and safety of a wearable, smartphone-controlled, rechargeable transcutaneous tibial nerve stimulation (TTNS) device in patients with overactive bladder (OAB). This multicentre, prospective, single-blind, randomised clinical trial included eligible patients with OAB symptoms who were randomly assigned to the stimulation group or sham group. The primary efficacy outcome was change from baseline in voiding frequency/24 h after 4 weeks of treatment. The secondary efficacy outcomes included changes in bladder diary outcomes (urgency score/void, nocturia episodes/day, micturition volume/void, and incontinence episodes/day), questionnaires on Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and American Urological Association Symptom Index Quality of Life Score (AUA-SI-QoL) at baseline and after 4 weeks of treatment. Device-related adverse events (AEs) were also evaluated. In the full analysis set (FAS), the mean (sd) change of voiding frequency/24 h in the stimulation group and sham group at 4 weeks were -3.5 (2.9) and -0.6 (2.4), respectively (P < 0.01). Similar results were obtained in the per-protocol set (PPS): -3.5 (2.9) vs -0.4 (2.3) (P < 0.01). In the FAS and PPS, micturition volume/void significantly improved at 4 weeks (P = 0.01 and P = 0.02). PPBC improvement almost reached significance in the FAS (P = 0.05), while it was significant in the PPS (P = 0.02). In the FAS and PPS, AUA-SI-QoL significantly improved at 4 weeks in the two groups (P < 0.01 and P < 0.01), whereas there were no significant differences in urgency score/void, nocturia episodes/day or OABSS between the groups. Also, no device-related serious AEs were reported. The non-invasive neuromodulation technique using the novel ambulatory TTNS device is effective and safe for treating OAB. Its convenience and easy maintenance make it a new potential home-based treatment modality. Future studies are warranted to confirm its longer-term efficacy.

Characterizing the spectrum of bladder health and lower urinary tract symptoms among men: Results from the CARDIA study.

To operationalize a new definition for bladder health, we examined the distribution and impact of lower urinary tract symptoms (LUTS), along with risk factors, among men in the Coronary Artery Risk Development in Young Adults (CARDIA) study. LUTS were defined by American Urologic Association Symptom Index (AUASI) scores and impact on quality of life (QoL). Separate questions assessed urinary incontinence (UI) and postvoid dribbling. We performed cluster analyses using AUASI scores, with and without urine incontinence and postvoid dribbling, and impact collected in 2010-11. We performed analyses to evaluate sociodemographic and cardiovascular risk factors between clusters. Among CARDIA men (mean age: 50.0, SD = 3.6; range: 42-56 years) with complete LUTS data (n = 929), we identified and compared four clusters: men who reported no or very mild symptoms and no impact on well-being (bladder health, n = 696, 75%), men with moderate symptoms and moderate impact on well-being (moderate symptoms/impact, n = 84, 9%), men with high symptoms and high impact on well-being (severe symptoms/impact, n = 117, 13%), and a separate group that reported moderate symptoms and UI with a high impact on well-being (UI + moderate symptoms/severe impact, n = 32, 3%). Exploration of the groupings showed a large percentage of postvoid dribbling across groups (overall 69%). Sociodemographic and cardiovascular risk factors were not associated with symptom/impact groups. Bladder health clustered into four categories. A majority of middle-aged men in the community showed no or mild bladder symptoms without impact on QoL. Postvoid dribbling is pervasive but did not cluster with a specific LUTS or impact category.

Preoperative Bladder Scanning Can Predict Postoperative Urinary Retention Following Total Joint Arthroplasty.

As total joint arthroplasty (TJA) moves to the outpatient setting, it is becoming clear that postoperative urinary retention (POUR) is a potential impediment to same-day discharge. Although risk factors for POUR have been widely studied, the lack of their clinical utility warrants investigation of specific preoperative factors that can assist in surgical planning and patient optimization. The purpose of the current study was to determine whether preoperative symptom surveys and bladder scanning are useful tools in identifying POUR risk. We performed a prospective analysis of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a high-volume orthopaedic hospital between December 1, 2020, and September 30, 2021. A total of 507 patients (324 female and 183 male) undergoing TJA completed the American Urological Association (AUA) symptom index preoperatively and then again at 14 and 64 days postoperatively. Post-void bladder scans were obtained in the immediate preoperative setting. POUR was defined as a bladder volume of >500 mL that required catheterization. Chi-square and quintile analysis were used to compare bladder scanning volumes, and Student t tests were used to compare AUA scores. The rate of POUR was 37% (66 female and 34 male) and 23% (37 female and 19 male) in the TKA and THA groups, respectively. Increasing post-void residual volume (PVRV) measured on preoperative bladder scanning was found to be predictive of POUR. Among the TKA cohort, younger age and lower body mass index were also associated with increased catheterization, although age was not statistically significant. The AUA symptom survey was not found to correlate with POUR in either population. There was a predictable and exponential increase in the rate of catheterization as preoperative PVRV increased from 50 to 200 mL. The AUA symptom score showed no utility in predicting POUR in our study population. We propose that preoperative bladder ultrasonography become standard practice in TJA, especially among patients scheduled for same-day discharge. Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Associations of Lower Extremity Muscle Strength, Area, and Specific Force With Lower Urinary Tract Symptoms in Older Men: The Baltimore Longitudinal Study of Aging.

Lower urinary tract symptoms (LUTS) in older men are associated with an increased risk of mobility limitations. Lower extremity muscle quality may represent a novel shared mechanism of both LUTS and mobility limitations. We evaluated associations of thigh skeletal muscle measures (strength, area, and specific force) with total LUTS severity (American Urologic Association Symptom Index; AUASI) and voiding and storage subscores among 352 men aged ≥60 years enrolled in the Baltimore Longitudinal Study of Aging. Thigh muscle strength (Nm) was defined as maximum concentric 30°/s knee extensor torque, area (cm2), and specific force (Nm/cm2) defined as strength/area. Associations with AUASI score were estimated using multivariable linear regression and linear mixed models. Mean thigh muscle strength at baseline was 139.7Nm. In cross-sectional multivariable models, each 39Nm increment in thigh muscle strength and 0.28Nm/cm2 increment in specific force was associated with -1.17 point (95% CI: -1.93 to -.41) and -0.95 point (95% CI: -1.63 to -0.27) lower AUASI score, respectively. Similar associations were observed for voiding and storage subscores, although somewhat attenuated. In longitudinal analyses, baseline muscle measures were not associated with annual change in AUASI, and current changes in muscle measures and AUASI were unrelated. Cross-sectionally, higher thigh muscle strength and specific force were associated with decreased LUTS severity in older men. However, we did not observe concurrent worsening LUTS severity with declining thigh muscle strength, area, or specific force in longitudinal analyses.

Long term follow-up on young adults that underwent hypospadias repair through urethral advancement in childhood.

Assess the long-term outcome on cosmetic appearance, voiding, sexual function, and psychological impact of young adults operated by urethral advance (UA) technique in childhood. Patients over 14 years old, who underwent UA hypospadias repair in our centre (2000-2010) were evaluated. All patients presented mid-distal hypospadias with subcoronal or penile meatus and curvature lower than 20°. The cosmetic appearance, urinary and sexual function, body perception and overall satisfaction were assessed through 5 questionnaires. From 2000 to 2010, 143 children underwent UA hypospadias repair. 36 patients between 14 and 27 years were evaluated. The Hypospadias Objective Penile Evaluation (HOPE) showed an average of 8.75 (+/- 0.97), which indicates a good aesthetic result. Voiding dysfunction symptoms were assessed through the American Urological Association Symptom Index (AUASI) where 80.6% had none or mild symptoms and 19.4% had moderate symptoms. Only 11/36 patients were sexually active, according to the International Index of Erectile Function (IIEF-15) scale, none had erectile dysfunction, and their relationships were satisfactory. Assessment of the body perception through the Genital Perception Scale (GPS) was positive or very positive in 88.9% of the patients. However, the perception of their genitals was positive or very positive in 77.8%, there is a negative correlation between the perception of their body and genitals in 13.9% of the patients. Our results indicate that UA technique for hypospadias repair might be a valid option for the correction of mid-distal hypospadias when indicated.

Intravesical Electrical Stimulation Improves Abnormal Prefrontal Brain Activity in Patients With Underactive Bladder: A Possible Central Mechanism.

The aim of this study was to explore the mechanisms of central brain action in patients with neurogenic underactive bladder (UAB) treated with intravesical electrical stimulation (IVES). We prospectively recruited patients with neurogenic UAB who chose to receive IVES treatment and healthy subjects (HS). At baseline, the following data were obtained: a 72-hour voiding diary; measurements of postvoid residual urine (PVR), voiding efficiency (VE) and first sensation of bladder filling (FS); American Urological Association Symptom Index Quality of Life (AUA-SI-QOL) scores, and functional near-infrared spectroscopy scans of the prefrontal cortex in the voiding stage. All UAB patients were re-evaluated for these indices after completing 4 weeks of IVES. A >50% improvement in PVR was defined as successful IVES treatment. Prefrontal activity was analyzed using the NIRS_KIT software, corrected with the false discovery rate (P<0.05). Statistical analysis was performed using IBM SPSS Statistics ver. 22.0, and P<0.05 was considered statistically significant. Eighteen UAB patients and 16 HS were included. IVES treatment was successful in 11 UAB patients and failed in 7. The PVR, VE, 24-hour clean intermittent catheterization, FS volume, and AUA-SI-QOL scores of the UAB group significantly improved after successful IVES treatment. BA9 (right dorsolateral prefrontal cortex [DLPFC]) and BA10 (right frontal pole) were significantly activated after successful IVES, and no significant difference was found between the successful group and HS group after IVES. Before IVES, BA10 (right frontal pole) was significantly deactivated in the failed group compared with the successful group. The possible central mechanism of IVES treatment for neurogenic UAB is that IVES reactivates the right DLPFC and right frontal pole.

MP24-03 BLADDER DETRUSOR MUSCULAR RING SIZE ON MAGNETIC RESONANCE IMAGING IS ASSOCIATED WITH MODERATE AND SEVERE AMERICAN UROLOGICAL ASSOCIATION SYMPTOM INDEX SCORES IN UNTREATED MEN WITH BENIGN PROSTATIC HYPERPLASIA- A POTENTIAL NOVEL PREDICTOR OF LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyCME1 Apr 2023MP24-03 BLADDER DETRUSOR MUSCULAR RING SIZE ON MAGNETIC RESONANCE IMAGING IS ASSOCIATED WITH MODERATE AND SEVERE AMERICAN UROLOGICAL ASSOCIATION SYMPTOM INDEX SCORES IN UNTREATED MEN WITH BENIGN PROSTATIC HYPERPLASIA- A POTENTIAL NOVEL PREDICTOR OF LOWER URINARY TRACT SYMPTOMS Kiran Nandalur, David Walker, Hong Ye, Sayf Al-Katib, Brian Seifman, David Gangwish, Abhay Dhaliwal, Ervin Connor, Kayla Dobies, Channing Sesoko, Wesley Dejoie, Bernadette Zwaans, Sirisha Nandalur, Jennifer Nyguyen, and Jason Hafron Kiran NandalurKiran Nandalur More articles by this author , David WalkerDavid Walker More articles by this author , Hong YeHong Ye More articles by this author , Sayf Al-KatibSayf Al-Katib More articles by this author , Brian SeifmanBrian Seifman More articles by this author , David GangwishDavid Gangwish More articles by this author , Abhay DhaliwalAbhay Dhaliwal More articles by this author , Ervin ConnorErvin Connor More articles by this author , Kayla DobiesKayla Dobies More articles by this author , Channing SesokoChanning Sesoko More articles by this author , Wesley DejoieWesley Dejoie More articles by this author , Bernadette ZwaansBernadette Zwaans More articles by this author , Sirisha NandalurSirisha Nandalur More articles by this author , Jennifer NyguyenJennifer Nyguyen More articles by this author , and Jason HafronJason Hafron More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The etiology of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) remains uncertain. The purpose of our study was to quantitatively analyze anatomic characteristics on magnetic resonance imaging (MRI) to assess novel independent factors for LUTS. METHODS: This retrospective single-institution study evaluated treatment-naïve men who underwent prostate MRI within 3 months of American Urological Association Symptom Index (AUASI) scoring from June 2021 to September 2022. Factors measured on MRI included: size of the detrusor muscular ring (DMR) surrounding the bladder outlet, prostate volume, intravesicular prostate protrusion (IPP) volume, and prostate urethra angle (PUA). Multivariable logistic regression and ROC analysis were used to analyze factors for moderate/severe (AUASI≥8) and severe LUTS (AUASI≥20). RESULTS: 318 total men (mean age: 66.2 (SD:8.0)) were included: 31 with severe symptoms, 131 with moderate symptoms, and 156 with mild symptoms. Increasing age (p=0.02;OR:1.05(1.01-1.08)), PUA (p=0.02;OR:1.05(1.01-1.09), and DMR size measured as diameter (p<0.001;OR:5.6(3.37-9.16)) were significantly independently associated with AUASI≥8. For every one cm increase in DMR diameter, patients had approximately five times the odds for AUASI≥8. Increasing DMR size (diameter p<0.001;OR: 2.74 (1.76-4.27) was independently associated with severe symptoms. CONCLUSIONS: Expansion of the detrusor muscular ring surrounding the bladder outlet is a novel anatomic factor independently associated with moderate/severe LUTS. Prostate volume and IPP volume were unrelated to AUASI scoring. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e317 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kiran Nandalur More articles by this author David Walker More articles by this author Hong Ye More articles by this author Sayf Al-Katib More articles by this author Brian Seifman More articles by this author David Gangwish More articles by this author Abhay Dhaliwal More articles by this author Ervin Connor More articles by this author Kayla Dobies More articles by this author Channing Sesoko More articles by this author Wesley Dejoie More articles by this author Bernadette Zwaans More articles by this author Sirisha Nandalur More articles by this author Jennifer Nyguyen More articles by this author Jason Hafron More articles by this author Expand All Advertisement PDF downloadLoading ...

MP61-10 URINARY FUNCTIONAL OUTCOMES OF RADICAL PROSTATECTOMY VS. RADIATION THERAPY FOR PROSTATE CANCER FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)

You have accessJournal of UrologyCME1 Apr 2023MP61-10 URINARY FUNCTIONAL OUTCOMES OF RADICAL PROSTATECTOMY VS. RADIATION THERAPY FOR PROSTATE CANCER FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Alex Piroozi, Austen Slade, RJ Caras, T. Max Shelton, Udit Vyas, Katrina Collins, Omar Ishaq, Mohamed Elsaqa, Corey Able, Ronald Boris, Marawan M. El tayeb, Marcelino Rivera, and James Lingeman Alex PirooziAlex Piroozi More articles by this author , Austen SladeAusten Slade More articles by this author , RJ CarasRJ Caras More articles by this author , T. Max SheltonT. Max Shelton More articles by this author , Udit VyasUdit Vyas More articles by this author , Katrina CollinsKatrina Collins More articles by this author , Omar IshaqOmar Ishaq More articles by this author , Mohamed ElsaqaMohamed Elsaqa More articles by this author , Corey AbleCorey Able More articles by this author , Ronald BorisRonald Boris More articles by this author , Marawan M. El tayebMarawan M. El tayeb More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , and James LingemanJames Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is a well-documented finding in Holmium Laser Enucleation of the Prostate (HoLEP); however, there is little data on the outcomes of patients who underwent HoLEP followed by definitive therapy for subsequent prostate cancer diagnosis. We sought to compare the urinary functional outcomes after undergoing radical prostatectomy or external beam radiation for prostate cancer following HoLEP. METHODS: All patients from 2010 to 2021 at Indiana University and Baylor Scott and White Hospitals who underwent radiation or prostatectomy for treatment of prostate cancer after HoLEP were included. We performed a retrospective analysis of their urinary function with greater than 1-year post-treatment American Urological Association Symptom Index (AUA), Quality of Life (QOL), and incontinence follow up. Incontinence was defined as patient reported leakage of any urine. RESULTS: There were 33 radical prostatectomy and 36 radiation patients who met the inclusion criteria. There was no statistical significance between the mean AUA scores of greater than 1-year post-prostatectomy patients (7.69) and post-radiation patients (8.08) (p=0.8175). Similarly, there was no statistical significance between the QOL scores of greater than 1-year post-prostatectomy patients (1.96) and post-radiation patients (2.00) (p=0.9175). There is a statistically significant decrease in complaints of incontinence in greater than 1-year post-radiation patients (28%) compared to post-prostatectomy patients (73.3%) (p=0.0017). There was also a significant difference between mean age of the prostatectomy group (66.4 years) and the radiation group (75.3 years) (p<0.001). There was no significant difference in BMI, pre-HoLEP prostate size, pre-HoLEP AUA score, or pre-HoLEP QOL score between the groups. CONCLUSIONS: Radical prostatectomy and radiation provide similar AUA and QOL symptom scores for prostate cancer patients who previously underwent HoLEP, with radiation associated with decreased incidence of incontinence. Patients specifically concerned with the risk of incontinence following prostate cancer treatment may consider the increased risk from a prostatectomy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e856 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Piroozi More articles by this author Austen Slade More articles by this author RJ Caras More articles by this author T. Max Shelton More articles by this author Udit Vyas More articles by this author Katrina Collins More articles by this author Omar Ishaq More articles by this author Mohamed Elsaqa More articles by this author Corey Able More articles by this author Ronald Boris More articles by this author Marawan M. El tayeb More articles by this author Marcelino Rivera More articles by this author James Lingeman More articles by this author Expand All Advertisement PDF downloadLoading ...

Age, Benign Prostatic Hyperplasia, Geography of Residence, and Occupation are Predictors of Bladder Calculi in Men: A Three-Year Data Analysis.

The formation of bladder calculi is a complex multifactorial process. Our objective was to identify predictors of bladder calculi in men. This cross-sectional study was conducted at a regional public hospital. We used medical records from 2017 to 2019 for men diagnosed with urinary calculi or benign prostatic hyperplasia (BPH). The diagnosis of urinary calculi was based on urinalysis, plain x-ray, and ultrasonography (USG). The diagnosis of BPH was based on digital rectal examination (DRE), USG, and American Urological Association (AUA) Symptom Index to assess the severity of BPH. The data were analyzed using Kruskal-Wallis, Mann-Whitney U, Chi-square tests, and binary logistic regression. Of 2010 study participants, 66.0% were men with urinary calculi, 39.7% had BPH, 21.0% were aged 70 years or more, 12.5% lived in limestone mountain areas, and 24.6% had occupations that were mainly outdoors. Urinary calculi in men with BPH were found in the urethra (3.0%), bladder (27.6%), ureter (2.2%), and kidney (1.1%). Of all men with urinary calculi, the odds of having bladder calculi in men aged 70 years or more was 13.484, 95% confidence interval (95% CI): 8.336-21.811; In men with BPH was 11.182, 95% CI: 6.440-19.416; In men who lived in limestone mountain area was 1.894, 95% CI: 1.242-2.887; In men whose occupation is mainly outdoor was 3.240, 95% CI: 1.954-5.375, compared to reference groups. Age, BPH, geography of residence, and occupation were predictors of bladder calculi in men.

ASSOCIATION OF LOWER URINARY TRACT SYMPTOMS WITH INCIDENT FRAILTY AND MORTALITY AMONG OLDER COMMUNITY-DWELLING MEN

Abstract Lower urinary tract symptoms (LUTS) are associated with increased risk of new mobility and functional limitations among older men. Our objective was to evaluate the longitudinal relationship between baseline LUTS severity and incident frailty or all-cause mortality among 3667 community-dwelling non-frail men age &amp;gt;70 years from the Osteoporotic Fractures in Men (MrOS) study. LUTS severity at analytic baseline was defined using the American Urologic Association Symptom Index (AUASI). Phenotypic frailty was defined at baseline and 2-year follow-up visits using modified Fried criteria and classified as robust (0), intermediate stage (1-2), or frail (3-5); men classified as frail at analytic baseline were excluded. Vital status was assessed every 4 months. Since the proportional odds assumption was not met, we used multivariable multinomial logistic regression to estimate odds ratios (OR) for the association between baseline LUTS severity and incident frailty or death at follow-up compared to robust. OR were adjusted for demographics, health-behaviors, comorbidities, and cognition. After a mean follow-up of 2.3 years, 37% of men were categorized as robust, 46% were intermediate stage, 9.2% developed incident frailty, and 7.9% had died. Per 4 point higher AUASI, the adjusted odds incident frailty versus robust was 1.23 (95% CI 1.12, 1.34). Odds of death versus robust was not statistically significant (OR=1.05, 95% CI 0.94, 1.18). In conclusion, non-frail men with greater LUTS severity at baseline have slightly greater odds of incident frailty within 2 years. Clinicians should be aware that LUTS severity is a prognostic marker for developing frailty in older men.

Lower urinary tract symptom severity, urinary bother, and incident life-space mobility restriction among older men.

Life-space mobility represents the distance, frequency, and independence of mobility, ranging from one's bedroom to beyond their town. Older men with lower urinary tract symptoms (LUTS) may limit their life-space to stay close to a bathroom. However, it's unknown whether LUTS severity or urinary bother are associated with risk of life-space mobility restriction. We analyzed data from 3025 community-dwelling men age ≥71 years without life-space mobility restriction at analytic baseline (Year 7) of the Osteoporotic Fractures in Men (MrOS) study. The American Urologic Association Symptom Index (AUASI) was assessed at baseline and includes one question assessing urinary bother ("If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?"; score 0-1,2,3,4-6) and seven items to classify LUTS severity as none/mild (score 0-7), moderate (8-19), or severe (20-35). The University of Alabama Life-space Assessment was used to define life-space mobility restriction (≤60) at baseline and follow-up (Year 9). We used log-binomial regression with robust variance estimators to model adjusted risk ratios (ARR) for LUTS severity and urinary bother with incident life-space mobility restriction, controlling for age, site, health-related factors, and comorbidities. We then mutually adjusted for urinary bother and LUTS severity. Overall, the 2-year risk of life-space mobility restrictions was 9.9%. Compared to men without urinary bother (scores 0-1), the risk of life-space mobility restriction was significantly higher among men with bother scores of 4-6 (ARR=2.20, 95% CI: 1.52, 3.19), independent of LUTS severity and confounders. Conversely, LUTS severity was not independently associated with the risk of life-space mobility restriction. Urinary bother, but not LUTS severity, is independently associated with incident life-space mobility restriction among older men. To maintain life-space mobility in older men with LUTS, future studies should identify shared mechanisms and interventions that minimize urinary bother.

Initial Quality of Life and Toxicity Analysis of a Randomized Phase 3 Study of Moderately Hypofractionated Radiation Therapy With or Without Androgen Suppression for Intermediate-Risk Adenocarcinoma of the Prostate: PCG GU003

Our objective was to report the quality of life (QoL) analysis and toxicity in patients with intermediate-risk prostate cancer treated with or without androgen deprivation therapy (ADT) in Proton Collaborative Group (PCG) GU003. Between 2012 and 2019, patients with intermediate-risk prostate cancer were enrolled. Patients were randomized to receive moderately hypofractionated proton beam therapy (PBT) to 70 Gy relative biologic effectiveness in 28 fractions to the prostate with or without 6 months of ADT. Expanded Prostate Cancer Index Composite, Short-Form 12, and the American Urological Association Symptom Index instruments were given at baseline and 3, 6, 12, 18, and 24 months after PBT. Toxicities were assessed according to Common Terminology Criteria for Adverse Events (version 4). One hundred ten patients were randomized to PBT either with 6 months of ADT (n=55) or without ADT (n=55). The median follow-up was 32.4 months (range, 5.5-84.6). On average, 101 out of 110 (92%) patients filled out baseline QoL and patient-reported outcome surveys. The compliance was 84%, 82%, 64%, and 42% at 3, 6, 12, and 24 months, respectively. Baseline median American Urological Association Symptom Index was comparable between arms (6 [11%] ADT vs 5 [9%] no ADT, P=.359). Acute and late grade 2+ genitourinary and gastrointestinal toxicity were similar between arms. The ADT arm experienced a QoL decline of mean scores in the sexual (-16.1, P < .001) and hormonal (-6.3, P < .001) domains, with the largest time-specific hormonal differences at 3 (-13.8, P < .001) and 6 (-11.2, P < .001) months. The hormonal QoL domain returned to baseline 6 months after therapy. There was a trend to baseline in sexual function 6 months after completion of ADT. After 6 months of ADT, sexual and hormonal domains returned to baseline 6 months after completion of treatment for men with intermediate-risk prostate cancer.

Clinical hypnosis can reduce lower urinary tract symptoms in individuals with chronic pain.

Lower urinary tract symptoms (LUTS) can occur in chronic pain populations at high rates and drastically affect quality of life. Hypnosis is a nonpharmacological treatment used in chronic pain known to have beneficial implications to health outside of pain reduction. This study evaluated the potential for hypnosis to reduce LUTS in a sample of individuals with chronic pain, if baseline LUTS severity affected outcomes, and specific LUTS that may respond to hypnosis. Sixty-four adults with chronic pain and LUTS at a level of detectable symptom change (American Urological Association Symptom Index, AUASI 3) participated in an 8-week group hypnosis protocol. Participants completed validated assessments of LUTS, pain, and overall functioning before, after, 3- and 6-months posttreatment. Linear mixed effects models assessed improvement in LUTS over time while accounting for known factors associated with outcome (e.g., age, gender). The interaction of baseline symptom severity and treatment assessed the potential effect of baseline symptoms on change scores. Participants experienced significant and meaningful improvements in LUTS following group hypnosis (p = 0.006). There was a significant interaction between baseline symptom severity and treatment (p < 0.001), such that those with severe symptoms experienced the most pronounced gains over time (e.g., an 8.8 point reduction). Gains increased over time for those with moderate and severe symptoms. Changes in LUT symptoms occurred independently of pain relief. This pilot study suggests hypnosis has the potential to drastically improve LUTS in individuals with chronic pain, even when pain reduction does not occur. Results provide initial evidence for the treatment potential of hypnosis in urologic pain (and possibly non-pain/benign) populations, with randomized trials needed for definitive outcomes.

Randomized controlled trial of intravesical electrical stimulation for underactive bladder.

To evaluate the efficacy and safety of intravesical electrical stimulation (IVES) performed with a novel device in patients with underactive bladder (UAB). This was a multicentre, prospective, single-blind, randomized controlled clinical trial of patients with UAB in China. Eligible patients were randomly assigned in a 1:1 ratio to receive conventional IVES (n = 38) or IVES with an open circuit (n = 38). The primary efficacy measure was change from baseline in post-void residual urine volume (PVR) after 4 weeks of treatment. Secondary efficacy measures included changes in maximum urinary flow rate (Qmax ), bladder voiding efficiency (BVE), number of 24-h clean intermittent catheterization (CIC) procedures, and Patient Perception of Bladder Condition-Scale (PPBC-S) and American Urological Association Symptom Index Quality of Life (AUA-SI-QoL) scores from baseline after 4 weeks of treatment. Adverse events (AEs) were monitored throughout the trial. In the full analysis set (FAS), the mean (sd) PVR changes in the trial and control groups at 4 weeks were -97.1 (107.5) mL and -10.5 (86.7) mL, respectively (P < 0.01). Similar results were obtained in the per-protocol set (PPS): -102.9 (100.0) mL vs 0.7 (82.5) mL (P < 0.01). In the FAS and PPS, Qmax improved significantly at 4 weeks (P = 0.04 and P = 0.03). In the FAS and PPS, BVE was significantly improved at 4 weeks in the two groups (P < 0.01 and P < 0.01), whereas no significant differences in the number of 24-h CIC procedures, PPBC-S score or AUA-SI-QoL score were observed between the groups. Six possible therapy-related AEs occurred in six patients (four in the trial group and two in the control group; P = 0.67), all of which were urinary tract infections. No severe AEs were reported. The results of this clinical study strongly demonstrate that UAB patients benefit from this novel IVES device. More research is needed to validate the clinical utility of this device.

V02-12 LARGE VOLUME STONE EXTRACTION FOR THE TREATMENT OF CHRONIC PROSTATITIS

You have accessJournal of UrologyCME1 May 2022V02-12 LARGE VOLUME STONE EXTRACTION FOR THE TREATMENT OF CHRONIC PROSTATITIS George Koch, and Sarah Flury George KochGeorge Koch More articles by this author , and Sarah FlurySarah Flury More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic bacterial prostatitis can be a difficult condition to treat due both the variable tissue penetrance of antibiotics in the prostate, as well as the sometimes uncertain interaction between bacteria and prostatic stones. We present this video as both a demonstration of the atypical nature of this patient’s stone burden, as well as the multiple strategies employed to treat the stones. This patient presented with seven years of irritative voiding symptoms refractory to alpha-adrenergic blockers, long-term courses of antibiotics and serial prostatic message. His preoperative American Urological Association Symptom Index (AUASI) was 22 and his Quality of Life Score (QoL) was 4. MRI demonstrated a very large prostatic stone burden. METHODS: The procedure was performed using a 26 French Storz Resectoscope with both a Collins Knife electrocautery device and a 365 micron Holmium laser fiber via a laser bridge. The patient underwent unroofing of a large cavity within the prostate using the Collins Knife, and then stone fragmentation, further cavity resection, and hemostasis using the Holmium laser. Given the difficulty of removing stones with the resectoscope directly from the prostatic cavity, an Ellik evacuator was used to blow the stones into the bladder from which they were then easily drained through the sheath. RESULTS: The patient was discharged with a short course of antibiotics and a urethral catheter from the ambulatory surgery center and recovered well postoperatively. His catheter was removed on postoperative day seven and he passed a voiding trial. At his six-week follow-up appointment, he was voiding well and symptom free. His follow-up AAUSI was 14 and his QoL was 0. CONCLUSIONS: We found the use of both the Collins Knife electrocautery device and Holmium laser to be effective tools in the armamentarium to treat prostatic stones associated with chronic prostatitis. Our results demonstrate the importance of imaging and the role of nidus removal in the treatment of refractory chronic bacterial prostatitis. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e114 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Koch More articles by this author Sarah Flury More articles by this author Expand All Advertisement PDF DownloadLoading ...

Longitudinal Associations between Concurrent Changes in Phenotypic Frailty and Lower Urinary Tract Symptoms among Older Men

BackgroundLower urinary tract symptoms (LUTS) are associated with prevalent frailty and functional impairment, but longitudinal associations remain unexplored.ObjectivesTo assess the association of change in phenotypic frailty with concurrent worsening LUTS severity among older men without clinically significant LUTS at baseline.DesignMulticenter, prospective cohort study.SettingPopulation-based.ParticipantsParticipants included community-dwelling men age ≥65 years at enrollment in the Osteoporotic Fractures in Men study.MeasurementsData were collected at 4 visits over 7 years. Phenotypic frailty score (range: 0–5) was defined at each visit using adapted Fried criterion and men were categorized at baseline as robust (0), pre-frail (1–2), or frail (3–5). Within-person change in frailty was calculated at each visit as the absolute difference in number of criteria met compared to baseline. LUTS severity was defined using the American Urologic Association Symptom Index (AUASI; range: 0–35) and men with AUASI ≥8 at baseline were excluded. Linear mixed effects models were adjusted for demographics, health-behaviors, and comorbidities to quantify the association between within-person change in frailty and AUASI.ResultsAmong 3235 men included in analysis, 48% were robust, 45% were pre-frail, and 7% were frail. Whereas baseline frailty status was not associated with change in LUTS severity, within-person increases in frailty were associated with greater LUTS severity (quadratic P<0.001). Among robust men at baseline, mean predicted AUASI during follow-up was 4.2 (95% CI 3.9, 4.5) among those meeting 0 frailty criteria, 4.6 (95% CI 4.3, 4.9) among those meeting 1 criterion increasing nonlinearly to 11.2 (95% CI 9.8, 12.6) among those meeting 5 criteria.ConclusionsGreater phenotypic frailty was associated with nonlinear increases in LUTS severity in older men over time, independent of age and comorbidities. Results suggest LUTS and frailty share an underlying mechanism that is not targeted by existing LUTS interventions.

Feasibility of a Transcutaneous Tibial Nerve Stimulation Device Use in Overactive Bladder Patients: A Pilot Study From a Single Tertiary Care Center.

PurposeTo evaluate the preliminary efficacy, safety, and acceptability of a transcutaneous tibial nerve stimulation (TTNS) device in overactive bladder (OAB) patients.MethodsTwenty OAB patients who failed with conservative treatments were recruited consecutively. All patients received 60 min of daily unilateral stimulation for 4 weeks using a smart wearable transcutaneous tibial nerve stimulation device and the stimulations were at 20 Hz frequency, 200 μs pulse width. OAB symptoms were observed at baseline and week 4, using a 3-days voiding diary, the overactive bladder symptom score (OABSS), the perception of bladder condition (PPBC), and the American Urological Association Symptom Index Quality of Life Score (AUA-SI-QoL). Urodynamic characteristics were measured to determine the pilot efficacy of the device during the treatment comparing the baseline parameters to the post-treatment parameters.ResultsAmong the patients, 15 cases were OAB-dry and five cases were OAB-wet. All patients were evaluated at the end of the study and no significant side effects were found during the treatment. The daily micturition frequency and the number of incontinence episodes per day were reduced from 15.10 ± 1.61 to 12.00 ± 4.56, and 3.20 ± 0.80 to 0.47 ± 0.38, respectively. The mean voiding volume was increased from 130.10 ± 53.07 to 157.30 ± 66.95 mL. The OABSS, AUA-SI-QoL, and PPBC were reduced from 9.35 ± 1.39 to 5.9 ± 2.36, 5.70 ± 0.47 to 3.85 ± 1.04, and 5.70 ± 0.47 to 4.35 ± 0.86, respectively. The first sensation of bladder filling (1st SBF), maximal bladder capacity (MBC), and mean compliance were increased from 87.50 (60.00–167.50) to 150.00 (104.00–211.30) mL, 175.00 (120.30–354.00) to 255.00 (151.50–491.50) mL, and 36.67 (12.44–39.69) to 40.00 (20.00–52.50) mL/cmH2O, respectively. The maximum detrusor pressure (Pdet. max) was reduced from 14.50 (5.00–35.25) to 11.00 (6.00–20.00) cmH2O.ConclusionThe preliminary results demonstrated that the TTNS device was safe, effective, and acceptable to use in OAB patients, but the results need to be substantiated by conducting more randomized controlled studies further.

The Efficacy of Written Symptom Questionnaires for the Management of Erectile Dysfunction

ABSTRACT Introduction The use of written screening tools and symptom questionnaires within the field of urology is widespread. Urologists regularly utilize such tools to help navigate preoperative counseling, understand the severity of a patient's symptoms, and guide clinical management. Self-administered screening questionnaires however require a baseline level of health literacy and comprehension in order for the results to be considered reliable. Prior work has shown that patient education and health literacy levels significantly impact the results of self-administered American Urological Association (AUA) symptom index questionnaire, which results in misclassification of voiding symptoms and potentially limits access to appropriate care. The International Index for Erectile Function (IIEF-5) is a previously validated self-administered questionnaire that is used to assess a patient's current erectile function. We hypothesize that men with lower health literacy and lower education levels are more likely to demonstrate a decreased understanding of the IIEF-5 and increased rates of symptom misclassification. Objective The aim of our project is to assess the frequency of poor understanding of the IIEF-5 and to determine if patient education and health literacy impact self-administered versus verbally administered IIEF-5 questionnaires. Methods In this pilot study, we prospectively enrolled consecutive, literate, English-speaking patients seen in an academic urology clinic for various complaints. Patients completed a self-administered, written IIEF-5 questionnaire per standard clinic protocol, and were subsequently re-administered the same IIEF-5 questionnaire verbally by a single trained researcher. The researcher answered patient questions and clarified questionnaire items as needed, as well as obtained basic demographic information related to education, health literacy, and race. Responses were compared by calculating the change in overall IIEF-5 scores between written and verbally administered instruments. Health literacy was determined utilizing the Brief Health Literacy Screen (BHLS), a validated health literacy tool. Results A total of one hundred consecutive men were enrolled into this pilot study. The population was primarily Caucasian (83%) with 76% of men having some form of college education or higher level education. The median written IIEF-5 was 14 (IQR: 5, 23) while the median verbal IIEF-5 was 14 (IQR: 5, 23), p=1.00. The median delta IIEF-5 was 0 (IQR: -2, 0). The median BHLS was 14 (IQR: 12, 15). On multivariable model evaluating for the impact of BHLS and education level on delta IIEF-5 while adjusting for age, education level, and race, BHLS (p=0.09) and education level (p=0.23) were not significant. Conclusions In this pilot study, there was no significant variance in overall scores when comparing the written to verbally administered IIEF-5 questionnaire. In contrast to prior studies evaluating the efficacy of other urologic symptom questionnaires, BHLS and education level were not significantly associated with changes in overall IIEF-5 scores. Disclosure No

Impact of Sleep Disturbance, Physical Function, Depression and Anxiety on Male Lower Urinary Tract Symptoms: Results from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN).

The impact of nonurological factors on male lower urinary tract symptoms (LUTS) remains unclear. We investigated cross-sectional and longitudinal associations among anxiety, depression, physical function, sleep quality and urinary symptom subdomains. Data from 518 men in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) study were analyzed to identify associations between Patient-Reported Outcomes Measurement Information System® (PROMIS®) depression, anxiety, sleep disturbance and physical function measures and LUTS subdomains, as derived from the American Urological Association Symptom Index and LUTS Tool. Multivariable linear regression was used to assess the relationships between PROMIS measures and LUTS subdomains at baseline and at 3- and 12-month followup. Baseline depression and anxiety were associated with urinary incontinence (p <0.001), voiding symptoms (p <0.001) and quality of life (p=0.002), whereas baseline sleep disturbance was associated with voiding and storage symptoms and quality of life (p <0.001 for all). Urinary symptom severity improved in all subdomains at 3 and 12 months. Similar associations between PROMIS measures and LUTS subdomains were observed at all time points, but baseline depression, anxiety, sleep disturbance and physical function measures were not associated with longitudinal trajectories of LUTS. Urinary symptom subdomains are independently associated with modifiable clinical variables including sleep quality and depression at all time points, but these variables do not predict the degree of improvement in LUTS following urological evaluation and treatment over the medium term. Bidirectional assessment and randomized experiments may improve our understanding of these relationships.