American Urological Association Symptom Index Research Articles

Intakes of Vitamins and Minerals in Relation to Urinary Incontinence, Voiding, and Storage Symptoms in Women: A Cross-Sectional Analysis from the Boston Area Community Health Survey

BackgroundWhether lower urinary tract symptoms (LUTS), including voiding, storage, and urinary incontinence, are affected by dietary micronutrients is uncertain. ObjectiveTo test the hypothesis that carotenoid, vitamin C, zinc, and calcium intakes are associated with LUTS and urinary incontinence in women. Design, setting, and participantsDuring an observational, cross-sectional, population-based epidemiologic study of 2060 women (30–79 yr of age) in the Boston Area Community Health (BACH) survey (2002–2005), data were collected by validated food frequency questionnaire and in-person interviews and analyzed using multivariate regression. MeasurementsLUTS, storage, and voiding symptoms were assessed using the American Urological Association Symptom Index (AUASI) and a validated severity index for urinary incontinence. Results and limitationsWomen who consumed high-dose vitamin C from diet and supplements were more likely to report storage symptoms, especially combined frequency and urgency (≥500 vs<50mg/d; odds ratio [OR]: 3.42; 95% confidence interval [CI], 1.44–8.12). However, greater consumption of dietary vitamin C or β-cryptoxanthin was inversely associated with voiding symptoms (ptrend≤0.01). Both dietary and supplemental calcium were positively associated with storage symptoms (eg, supplement ≥1000mg/d vs none; OR: 2.04; 95% CI, 1.35–3.09; ptrend=0.0002). No consistent associations were observed for β-carotene, lycopene, or other carotenoids, although smokers using β-carotene supplements were more likely to report storage problems. Whether the observed associations represent direct causes of diet on LUTS is uncertain. ConclusionsHigh-dose intakes of vitamin C and calcium were positively associated with urinary storage or incontinence, whereas vitamin C and β-cryptoxanthin from foods and beverages were inversely associated with voiding symptoms. Results indicate that micronutrient intakes may contribute to LUTS in dose-dependent and symptom-specific ways. Further study is needed to confirm these findings and their relevance to clinical treatment decisions.

Are Statin Medications Associated with Lower Urinary Tract Symptoms in Men and Women? Results from the Boston Area Community Health (BACH) Survey

Statins may ameliorate lower urinary tract symptoms (LUTS) through anti-inflammatory or other pathways. We investigated the association between statin use and storage, voiding, and overall LUTS symptoms. The Boston Area Community Health Survey is an epidemiologic study of Boston, MA residents (2301 men; 3202 women) 30-79 years of age. LUTS, voiding, and storage symptoms were ascertained through an interviewer-administered questionnaire and defined as scores of greater than or equal to 8, greater than or equal to 5, and greater than or equal to 4, respectively, on relevant components of the American Urologic Association Symptom Index. Participants were included if they had a history of provider-diagnosed high cholesterol or recently used statin medications (n = 1346). Associations were estimated using odds ratios (ORs) and 95% confidence intervals (CI) from multivariate logistic regression. In multivariate models, statin use had no association with LUTS (OR= 1.03, 95% CI: 0.70, 1.51) among women. No associations were observed for any LUTS among younger (<60) men, but among older (60+) men, we observed significant inverse associations for voiding (OR= 0.23, 95% CI: 0.08, 0.66), storage (OR = 0.24, 95% CI: 0.11, 0.56), and overall LUTS (OR = 0.15, 95% CI: 0.05, 0.44). Our results suggest that use of statins is associated with a lower prevalence of urologic symptoms among older men but not among women or younger men.

Most Bothersome Symptom and Symptom Specific Goal Achievement in Patients With Benign Prostatic Obstruction: A Prospective Open Label Study

We evaluated symptom specific goal achievement, and the correlations between goal achievement and traditional outcome measures after pharmacological therapy in patients with benign prostatic obstruction. Men 50 years old or older with lower urinary tract symptoms secondary to benign prostatic obstruction and International Prostate Symptom Score 8 or greater were enrolled and treated with 10 mg alfuzosin XL for 12 months. Before treatment, face-to-face interviews were conducted to identify the single most bothersome symptoms and to set treatment goals for the symptoms in individual patients. After treatment, patients described perceptions of goal achievement using a 5-point Likert scale. Changes in International Prostate Symptom Score/quality of life score, International Continence Society male short form questionnaire, 3-day voiding diary and uroflowmetry parameters were analyzed to evaluate the correlations between goal achievement and traditional outcome measures. Of 108 most bothersome symptoms slow stream (26.9%) was the most frequently reported followed by increased daytime frequency (21.3%) and nocturia (19.4%). After treatment the median score of goal achievement was 3 points with no significant difference among most bothersome symptoms. Changes in quality of life score (correlation coefficient -0.247, p=0.020) and maximal flow rate (correlation coefficient 0.254, p=0.021) were correlated with goal achievement. For men with most bothersome symptoms of storage, changes in the number of micturition and urgency episodes per 24 hours were correlated with goal achievement. For men with most bothersome symptoms of voiding the International Prostate Symptom Score voiding score was correlated with goal achievement. Assessing goal achievement for most bothersome symptoms can be a useful outcome measure in patients with benign prostatic obstruction with heterogeneous symptoms or goals reflecting change in quality of life.

TRANS VESICAL PROSTATECTOMY

To determine the effectiveness of prostectomy in reducing symptom severity and quality of life. Design: A prospective study. Setting: Urology department civil hospital Dadu. Period: 2005 to 2007. Patients &amp; methods: 100 men under going prostectomy were assessed using the American urological Association (AUA) symptom index score and quality of life. The adverse events like urinary incontinence, erectile dysfunction and retrograde ejaculation also detected. The outcome was assessed after 3 month of prostectomy. Results:Prostectomy was effective in reducing symptoms. Initial mean IPSS was 25 and reduced to 7 with p value &lt; 0.001. Quality of life also assessed which showed majority of cases were mostly satisfied. Adverse events like transient incontinence 10%, retrograde ejaculation in 65% and erectile dysfunction in 25% respectively. Conclusion: Prostectomy is effective in reducing symptom severity and improve quality of life whichwas detected by IPSS and quality of life questionnaire.

Major Depression Drives Severity of American Urological Association Symptom Index

To evaluate the unclear relationship between depression and benign prostatic hyperplasia (BPH) by assessing depression's effect on the American Urological Association Symptom Index (AUA-SI) scores. Depression is a common illness associated with chronic inflammatory disease states. Data have suggested a significant role of inflammation in the progression of BPH. The present prospective study involved 547 male patients who completed the Geriatric Depression Scale and the AUA-SI. We evaluated whether the mean AUA-SI score and the severity categories differed by the state of depression. We then conducted binary logistic regression analysis with forward stepwise regression to assess the relationship between depression and the severity symptoms as determined by the AUA-SI score. Of the cohort, 22% screened positive for depressive symptoms. The depressed patients (Geriatric Depression Scale score >5) reported significantly more severe symptoms (mean AUA-SI score 16.61 ± 9.89) compared with the nondepressed patients (Geriatric Depression Scale score of ≤5 and mean AUA-SI score 10.65 ± 7.29; F = 40.19, P <.001). After controlling for socioeconomic and demographic variables, depressed patients were 3 times more likely to present with severe symptoms (odds ratio 3.079, 95% confidence interval 1.129-8.402, P = .028). A significant association was found between depression and BPH. However, it remains unclear whether this relationship represents unidirectional or bidirectional causality. Additional research is imperative to assess the nature of this correlation, either to address comorbid depression in patients with BPH or to ensure that depressed patients do not report falsely elevated symptoms.

Statin use and decreased risk of benign prostatic enlargement and lower urinary tract symptoms

To determine whether statin use is associated with a decreased risk of developing benign prostatic enlargement (BPE) and lower urinary tract symptoms (LUTS). We conducted a retrospective, population-based cohort study of 2447 men, 40-79 years of age, residing in Olmsted County, MN, USA, in 1990, and followed these men biennially through 2007. Cox proportional hazard models were used to assess associations between statin use and new onset of moderate/severe LUTS (American Urological Association Symptom Index score >7), a decreased maximum urinary flow rate (<12 mL/s) or BPE (prostate volume >30 mL). Statin use was inversely associated with new onset of LUTS (Hazard ratio (HR) 0.39; 95% confidence interval (CI) 0.31-0.49), a decreased maximum flow rate (HR 0.53; 95% CI 0.34-0.82) and BPE (HR 0.40; 95% CI 0.23-0.69) after adjustment for baseline age and body mass index, diabetes, hypertension, coronary heart disease, smoking, alcohol use, activity level and non-steroidal anti-inflammatory use. The longest duration of statin use was associated with the lowest risk of developing each outcome (all tests for trend: P < 0.001). In this study, statin use was associated with a 6.5- to 7-year delay in the new onset of moderate/severe LUTS or BPE. While men typically take statin medications to prevent coronary heart disease events and related outcomes, these data suggest that men who use statins may also receive urologic benefits.

Correlates of Bother Following Treatment for Clinically Localized Prostate Cancer

We determined factors associated with bother, the distress patients experience as a result of functional detriments after treatment for localized prostate cancer. A prospective cohort of men treated for clinically localized prostate cancer completed a questionnaire comprising the UCLA-PCI, Medical Outcomes Study Short Form-36, American Urological Association Symptom Index and Memorial Anxiety Scale for Prostate Cancer fear of recurrence subscale. We used nonlinear mixed models to identify factors associated with severe urinary, sexual and bowel bother. Worse function scores were associated with severe urinary, sexual and bowel bother following treatment (OR 0.88-0.94, p <0.001). Worse American Urological Association Symptom Index score was associated with severe urinary bother (OR 1.22, 95% CI 1.16-1.28). Time since treatment was inversely associated with urinary (OR 0.68, 95% CI 0.54-0.83) and bowel bother (OR 0.63, 95% CI 0.47-0.80) early after treatment but not for the entire 48-month study period. Receipt of concomitant androgen deprivation therapy was not associated with bother 48 months after radiation. Addressing functional detriment may confer improvement in urinary, sexual and bowel bother. Patient distress related to dysfunction improves with time. Measuring health related quality of life after prostate cancer treatment should incorporate functional and bother assessments.

A randomised controlled trial: outcomes of bladder rehabilitation in persons with multiple sclerosis

ObjectiveA stratified, randomised, waitlist controlled study over 12 months assessed the effectiveness of a 6 week bladder rehabilitation programme in persons with multiple sclerosis (pwMS) in an Australian community cohort.MethodsPatients...

Serum sex hormones and the 20‐year risk of lower urinary tract symptoms in community‐dwelling older men

To evaluate serum sex steroid hormone concentrations and long-term risk of subsequent lower urinary tract symptoms (LUTS) in a cohort of community-dwelling older men. Between 1984 and 1987, serum sex hormone concentrations were measured in participants in the Rancho Bernardo Study, a prospective, community-based study. In 2006, the American Urological Association Symptom Index (AUA-SI) was mailed to surviving male participants. Logistic regression was used to examine associations of baseline hormone concentrations with AUA-SI. Among 158 surviving men with complete data and no history of prostate cancer, the mean (sd) age at serum sex steroid assessment was 58 (6.6) years with a mean (sd) follow-up of 20.3 (0.6) years. In age-adjusted logistic regression, there was a significant inverse association of testosterone : dihydrotestosterone (DHT) with LUTS (P = 0.05). Also, men with higher concentrations of bioavailable testosterone had a 56% decreased risk of LUTS compared with those with hypogonadal concentrations, although the association was not statistically significant (odds ratios 0.44, 95% confidence interval 0.14-1.40) or distributed evenly among quartiles. There were no significant associations of total testosterone, oestradiol (E(2)), testosterone : E(2), DHT, or dehydroepiandrosterone with LUTS or with any measured hormones and urinary bother. In this cohort, men with higher mid-life levels of testosterone : DHT and bioavailable testosterone had a decreased 20-year risk of LUTS. These data support other studies reporting inverse associations of serum testosterone with LUTS. Clinical trials of testosterone therapy should include LUTS and clinical benign prostatic hyperplasia as outcomes.

Novel Concentrated Cranberry Liquid Blend, UTI-STAT With Proantinox, Might Help Prevent Recurrent Urinary Tract Infections in Women

To determine the safety, tolerability, maximal tolerated dose, and efficacy of a concentrated cranberry liquid blend, UTI-STAT with Proantinox, in female patients with a history of recurrent urinary tract infections (rUTIs). The study agent was administered orally at 15, 30, 45, 60, and 75 mL daily for 12 weeks to women with a history of 2.78 ± 0.73 rUTIs <6 months. Blood and urine samples were collected at baseline and weeks 4 and 12. The women took daily doses of the agent. The primary endpoints were the safety, tolerability, and maximal tolerated dose. The secondary endpoints were the efficacy with regard to rUTI and quality-of-life (QOL) symptoms. A total of 28 subjects were included in the study. Of these 28 women, the data from 23 were analyzable. The average age was 46.5 ± 12.8 years. The maximal tolerated dose of UTI-STAT was 75 mL/d, and the recommended dose was set at 60 mL/d. The secondary endpoints demonstrated that only 2 (9.1%) of 23 reported a rUTI, a markedly better rate than the historical data. At 12 weeks, the reduction in worry about rUTIs and increased QOL with regard to the physical functioning domain and role limitations from physical health domain, as measured by the Medical Outcomes Study short-form 36-item questionnaire, were significant (P = .0097). A lower American Urological Association Symptom Index indicating greater QOL was also significant (P = .045). The novel concentrated cranberry liquid blend showed a good safety profile and tolerability in both pre- and postmenopausal women with history of rUTIs. The secondary endpoints demonstrated its effectiveness in reducing the incidence of rUTI and increasing QOL. Given this evidence, supplementation might be beneficial in the prevention of rUTIs in this population.

1228 PREOPERATIVE AND POSTOPERATIVE ERECTILE FUNCTION IN PATIENTS UNDERGOING PEYRONIES PLAQUE INCISION AND GRAFTING

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery IV1 Apr 20101228 PREOPERATIVE AND POSTOPERATIVE ERECTILE FUNCTION IN PATIENTS UNDERGOING PEYRONIES PLAQUE INCISION AND GRAFTING Benjamin Whittam, Todd Doran, Melissa Kaufman, and Douglas Milam Benjamin WhittamBenjamin Whittam More articles by this author , Todd DoranTodd Doran More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , and Douglas MilamDouglas Milam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.751AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical treatment of Peyronies disease is aimed at correction of penile deformity while preserving erectile function. Review of the current literature indicates this series is the first reported data to use the widely accepted Sexual Inventory in Men (SHIM) to evaluate preoperative and postoperative function in Peyronies patients undergoing plaque incision and small intestine submucosa (SIS) grafting. METHODS A retrospective chart review was undertaken to identify patients who underwent incision and grafting for Peyronies disease from January 2004 to February 2009. These patients were stratified to include patients who had filled out preoperative and postoperative SHIM and underwent grafting with SIS graft. Patient records were reviewed to obtain demographics, voiding symptoms, preoperative and postoperative SHIM score, American Urological Association Symptom Index, perioperative degree and direction of curvature, perioperative use of phosophodiesterase-5 inhibitors, operative time, length of stay, and complications. RESULTS 25 patients were identified that underwent incision and grafting with SIS graft who had completed both a preoperative and postoperative SHIM questionnaire. Mean patients age at time of surgery was 58.1 years (range 39-78 years). Average length of follow-up after surgery was 6.3 months (range 1-17 months). All patients presented with sign and symptoms of Peyronies disease, with an average duration of symptoms of 38 months (range 9-240 months). Symptoms were stable for an average of 16.5 months (range 6-120 months). Mean degree of curvature was reported at 84.2 degrees (range 70-130 degrees). Preoperative average SHIM score was 11.96 and postoperatively the average SHIM score increased significantly to 16.04 (p = 0.001). 52% of patients preoperatively utilized PDE-5 inhibitors which increased to 73% postoperatively. Postoperative residual curvature was on average 19.8 degrees (range 5-45 degrees), 3 had no curve and another 13 were within physiologically normal limits (≤20 degrees). Preoperatively, 24% were able to have intercourse, while postoperatively 80% reported satisfactory intercourse. Complications included urinary retention (1), urinary tract infection (1), and a residual curve requiring dorsal corpoplasty (1). CONCLUSIONS This data suggests that in patients with adequate preoperative erectile function, SIS grafting is a feasible and effective method for treatment of Peyronies disease associated with improved SHIM scores, satisfactory capacity for intercourse, and minimal morbidity. Nashville, TN© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e475 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Whittam More articles by this author Todd Doran More articles by this author Melissa Kaufman More articles by this author Douglas Milam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

46 COMPARISON OF MEDICAL AND SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE COMMUNITY SETTING

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 201046 COMPARISON OF MEDICAL AND SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE COMMUNITY SETTING Amy Krambeck, Debra Jacobson, Michaela McGree, Deborah Lightner, Michael Lieber, Steven Jacobsen, and Jennifer St. Sauver Amy KrambeckAmy Krambeck Rochester, MN More articles by this author , Debra JacobsonDebra Jacobson Rochester, MN More articles by this author , Michaela McGreeMichaela McGree Rochester, MN More articles by this author , Deborah LightnerDeborah Lightner Rochester, MN More articles by this author , Michael LieberMichael Lieber Rochester, MN More articles by this author , Steven JacobsenSteven Jacobsen Pasadena, CA More articles by this author , and Jennifer St. SauverJennifer St. Sauver Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.092AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many treatments exist for BPH and lower urinary tract symptoms (LUTS); however, data comparing the efficacy of these treatments in the general population are lacking. METHODS A randomly selected cohort of white men, aged 40-79 years in 1990, from Olmsted County, MN was enrolled in the study. Participants completed the American Urological Association Symptom Index and reported symptoms of incontinence and use of medications (including 5- α reductase inhibitors [5-ARIs] and α-adrenergic receptor inhibitors [α-ARs]). Surgical treatment for BPH was obtained from community medical records. Men were followed biennially through 2007, and categorized by the most aggressive therapy received. Symptom score slopes were calculated from baseline to last assessment prior to treatment, and from first assessment following treatment to last follow-up, using mixed models. Incontinence rates were calculated at the last assessment prior to treatment and at the first assessment following treatment. RESULTS Of 2184 men, 1574 (72%) had no treatment, 195 (9%) used 5-ARIs, 307 (14%) used α-ARs, 23 (1%) received laser vaporization, and 85 (4%) received a transurethral resection of the prostate (TURP). Median follow-up ranged from 5.4 to 6.1 years after treatment. Men undergoing vaporization or TURP had higher baseline symptom scores (p<0.001) and more rapid increases in scores over time prior to treatment (p=0.002) than those treated with medications (Figure). Incontinence prior to treatment ranged from 31.0% of the α-AR group to 64.5% of the TURP group. After intervention, the TURP group had the greatest improvement in symptoms, followed by vaporization, 5-ARIs, and α-ARs (Figure). Only the TURP group reported a decrease in incontinence (pre-TURP: 64.5%, post-TURP: 41.9%). Post intervention, symptom score increases over time did not differ between the four treatment groups (p=0.65). CONCLUSIONS In the community setting, patients with the highest symptom scores were most likely to receive surgical intervention. Further, urinary incontinence was common, coexisting with BPH/LUTS. Although symptoms stabilized after intervention for all groups, patients receiving surgical intervention had the greatest decrease in both symptoms and incontinence. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e19-e20 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amy Krambeck Rochester, MN More articles by this author Debra Jacobson Rochester, MN More articles by this author Michaela McGree Rochester, MN More articles by this author Deborah Lightner Rochester, MN More articles by this author Michael Lieber Rochester, MN More articles by this author Steven Jacobsen Pasadena, CA More articles by this author Jennifer St. Sauver Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Progression of Lower Urinary Tract Symptoms in Older Men: A Community Based Study

Lower urinary tract symptom progression in community dwelling older men is not well described. We evaluated 5,697 participants in Osteoporotic Fractures in Men, a prospective cohort study of community dwelling men 65 years old or older. We characterized lower urinary tract symptoms using the American Urological Association symptom index at 2 time points, including at study entry and at 2-year followup. Progression was examined in the overall cohort and within baseline symptom strata (symptom index 7 or less and 8 or greater) using descriptive statistics. At baseline mean +/- SD age was 73.5 +/- 5.8 years and mean symptom index score was 8.3 +/- 6.3 points. Mean and median total symptom index increased during followup by 1.1 +/- 5.0 and 1.0 points, respectively. Of the 3,092 men with a symptom index of 7 points or less at baseline 883 (29%) reported lower urinary tract symptoms progression (8 points or greater) at followup. The incidence of lower urinary tract symptom progression increased with advancing baseline age. Of the 2,605 men with a symptom index of 8 points or greater at baseline 622 (24%) reported progression of at least 4 points at followup. Of the 2,200 men with a baseline symptom index of 7 points or less and no history of benign prostatic hyperplasia or lower urinary tract symptom treatment 94% remained untreated, 2% reported benign prostatic hyperplasia surgery and 4% reported medication use at followup. Up to 29% of community dwelling older men with no or mild lower urinary tract symptoms will have clinically significant lower urinary tract symptoms within 2 years. These data help elucidate the natural history of lower urinary tract symptoms in the community and provide useful data to design clinical trials of lower urinary tract symptom prevention.

Determining the Utility of Recalled Lower Urinary Tract Symptoms

To assess the utility of recalled American Urological Association Symptom Index (AUA-SI) scores 6 months after an initial outpatient clinic visit. The AUA-SI is a validated questionnaire used to assess a patient's lower urinary tract symptoms (LUTS) over a 4-week period. However, patient recall of their LUTS at greater time points is currently unknown. Between May 2007 and August 2008, 98 patients completed the AUA-SI questionnaire at their initial visit ("Past"). At 6-month follow-up, patients recalled their AUA-SI and quality of life (QoL) scores ("Recall"). As a reference, patients also reported their current symptom scores ("Present"). Descriptive statistics, correlations, regression models, and kappa statistics were performed to assess the associations between the "Past" and "Recall" symptom scores as either categorical (mild, moderate, severe) or continuous (0-35 points) variables. Similar analyses were performed for QoL scores. Analyses indicated significant correlations between the "Recall" and "Past" AUA-SI and QoL scores. Although 70% of patients remained in the same categorical groupings, 62% of patients had clinically significant differences (>or= 3 points) between "Recall" and "Past" scores. Approximately, 80% of patients recalled their QoL score accurately (<or= 1 point). In an outpatient setting, only approximately one-third of patients can accurately recall AUA-SI scores as a continuous variable from 6 months prior. However, when used as a categorical variable, "Recall" scores may provide some insight into a patient's "Past" urinary symptoms. Future validation in other populations is required.

The Role of Uroflowmetry Biofeedback and Biofeedback Training of the Pelvic Floor Muscles in the Treatment of Recurrent Urinary Tract Infections in Women With Dysfunctional Voiding: A Randomized Controlled Prospective Study

To evaluate the efficacy of a training program with uroflowmetry biofeedback and pelvic floor relaxation biofeedback on urodynamic and voiding parameters in women with dysfunctional voiding. Eighty-six women with recurrent urinary tract infections (UTIs) and dysfunctional voiding were randomly assigned to receive a treatment schedule as follows: uroflowmetry biofeedback (group 1), biofeedback training of the pelvic floor muscles (group 2), uroflowmetry biofeedback combined to biofeedback training of the pelvic floor muscles (group 3), no treatment (group 4). Patients were regularly evaluated by American Urological Association Symptom Index and urodynamics during the study period. All the patients were followed up for 1 year with monthly urine cultures. A further evaluation was done at month 24 by American Urological Association Symptom Index and free uroflowmetry with measurement of residual urine. The prevalence of storage and emptying symptoms decreased significantly at 3, 6, and 12 months in the groups 1, 2, and 3, and remained stable during the study period. Mean flow rate, flow time, voiding volume increased significantly, whereas postvoid residual urine decreased. The prevalence of UTI decreased significantly in groups 1, 2, and 3. At month 24, storage and emptying symptoms and voiding patterns were similar to the baseline values in all the patients. The incidence of UTIs was similar to baseline values in groups 1, 2, and 3. Training the voluntary control of the pelvic floor seems essential in obtaining control over the bladder function. These results reinforce the importance of pelvic floor therapy in the resolution of UTIs.

Readability of Health Related Quality of Life Instruments in Urology

The average American adult reads at a fifth to eighth-grade level, with wide variability, presenting challenges for the assessment of self-reported health related quality of life. We identified the health related quality of life instruments used in patients with urological diseases and evaluated their readability. We focused on the most burdensome urological diseases, based on total expenditures in the United States. We then identified disease specific instruments by systematically searching PubMed, the Cochrane Database of Systematic Reviews, Google, Google Scholar, the Patient Reported Outcome and Quality of Life Instruments Database (Mapi Research Institute, Lyon, France) and Yahoo! for health related quality of life studies in patients with these urological conditions. Where disease specific instruments were lacking, we noted the general health related quality of life measures most commonly used. For each instrument, we calculated the median Flesch-Kincaid grade level, the proportion of questionnaire items below an eighth-grade reading level, the mean Flesch Reading Ease, and the mean number of words per sentence and characters per word, all of which are validated measures of readability. The average +/- SD of the median Flesh-Kincaid reading levels was 6.5 +/- 2.1 (range 1.0 to 12.0). Of the 76 instruments 61 (80%) were at or below an eighth-grade reading level. The mean reading ease was greater than 30 for each of the 76 questionnaires and greater than 60 for 66 (87%). Urinary tract infection, the costliest urological disease, has only 1 disease specific health related quality of life measure. Urolithiasis, the second costliest, has none. The reading level of health related quality of life questionnaires in urology is appropriate for the reading ability of most adults in the United States. However, the most burdensome urological diseases lack disease specific health related quality of life instruments.

Urinary flow and urinary symptoms in elderly males exposed to either escitalopram or duloxetine

Objective:To profile the effects of escitalopram with duloxetine on urinary flow rate and symptoms in elderly males aged 55–75 years.Research design and methods:This was an open, randomised pilot study. A total of 34 male volunteers with no existing urinary symptoms were randomised: 17 to escitalopram 10 mg once daily and 17 to duloxetine 60 mg once daily for 16 days. Doses were then tapered to 5 mg and 30 mg, respectively for 14 days. Subjects measured their urinary flow at home using a Urospec device for 48 hours pre-dose, immediately after the first dose, at 2 weeks and 5 days after stopping treatment.Main outcome measures:The primary variable was the maximum urinary flow rate (Qmax). Secondary variables were time to maximum flow rate (TQmax) and mean flow rate (Qm). The percentage of voided volume voided when the maximum flow was reached (VQmax), average voided volume (Vv) and urinary symptoms assessed using the American Urological Association symptom index were also measured.Results:Mean Qmax values increased from baseline in escitalopram-treated subjects and decreased in duloxetine-treated subjects. The maximum difference in treatment effect was observed after 2 days of treatment and was statistically significant (4.27 mL/sec, 95% CI 1.14–7.39, p = 0.009). Similar results were obtained with TQmax. There were no significant differences between treatments in other urinary flow measures or urinary symptoms. Urinary flow measures reverted towards baseline values after stopping treatment. There were no treatment-related adverse events.Conclusions:The results of this small, pilot study suggest that duloxetine may cause a decline in urinary flow in elderly men. A larger study in patients with urinary flow symptoms would be required to determine the clinical relevance of these findings.

Holmium Laser Enucleation of the Prostate for Prostates Larger Than 175 Grams

Open simple prostatectomy has been considered the treatment of choice for symptomatic benign prostatic hyperplasia (BPH) of large prostates because traditional endoscopic techniques have not proven either effective or feasible. We present our experience with holmium laser enucleation of the prostate (HoLEP) for glands >175 cc. An Institutional Review Board approved prospective database has been maintained since January 1999 for all HoLEP procedures. The database was reviewed retrospectively for patients who underwent HoLEP for BPH with a preoperative transrectal ultrasonography (TRUS) volume of >175 cc. From January 1999 to November 2008, we identified 57 patients with a mean pretreatment TRUS volume of 217.8 cc (range 175-391 cc). Preoperative retention was present in 30 patients. Preoperative mean prostate-specific antigen level was 14.6 ng/mL, mean American Urological Association (AUA) symptom index was 19.0, and mean peak flow (Qmax) was 8.2 mL/sec. Mean hospital stay was 26 hours, and postoperative catheterization was 18.5 hours (range 6-96 hrs). All patients were able to void after catheter removal. Mean enucleated tissue weight was 176.4 g (range 48-532.2 g). At 6-month follow-up, AUA symptom index was 6.5, mean PSA level was 0.78 ng/mL, and Qmax was 18.5. During the follow-up period, no patient needed catheterization or had persistent incontinence. Even in the large prostate gland, HoLEP provides a satisfactory outcome with low morbidity. HoLEP is the only endoscopic technique that allows for tissue removal comparable to that of open prostatectomy for such patients.

Bladder dysfunction in spinal tuberculosis: clinical, urodynamic and MRI study

An observational study. We report clinical, MRI and urodynamic findings in spinal tuberculosis. Tertiary care teaching hospital. Patients with spinal tuberculosis having micturition disturbances or high postvoidal residual (PVR) urine were subjected to clinical evaluation, urodynamic and spinal MRI. Urinary symptoms were scored as per the American Urological Association Symptom (AUAS) Index. The outcome was defined at 12 months into complete, partial and poor. Of 30 spinal tuberculosis patients, 15 had micturition disturbance and included urinary retention in 4, stress incontinence in 2, hesitancy in 6, urgency in 11 and urge incontinence in 9 patients. Thirteen patients had paraparesis and one had quadriparesis. Spinal MRI revealed granuloma in 2, dorsal vertebral involvement in 12 and cervical and lumbar vertebral involvement in 1 patient each. On urodynamic study, detrusor hyperreflexia (DH) with high-pressure voiding was present in six, detrusor areflexia (DA) in four, normal study in one and increased PVR urine in the remaining patients. AUAS score improved on follow-up. DA changed to DH with high-pressure voiding in one patient. The 15 patients without micturition disturbance had no horizontal sensory level, milder or no weakness and only 2 had spinal cord signal changes. Patients with micturition disturbances had poorer functional recovery at 1 year compared to those without micturition disturbances. Bladder symptoms were present in 50% of the admitted patients with spinal tuberculosis and related to severity of paraplegia, horizontal sensory level, cord signal abnormality and poorer outcome compared to those without spinal tuberculosis. Urodynamic study helped in categorization and management.

Lower urinary tract symptoms in women with irritable bowel syndrome

To investigate lower urinary tract symptoms (LUTS) in women with irritable bowel syndrome (IBS) and to evaluate risk factors associated with the psychiatric morbidity of these patients. The study group included 52 female patients with a diagnosis of IBS. Fifty-five women without gastrointestinal symptoms were used as controls. LUTS were evaluated using the American Urological Association Symptom Index questionnaire. Psychiatric morbidity was evaluated using a 12-item version of the Chinese Health Questionnaire. Multiple logistic regression analysis was performed to identify the risk factors associated with psychiatric morbidity in IBS patients. There were no significant differences between the two groups in any of the demographic variables. The most common LUTS in patients with IBS were storage symptoms. These patients had significantly higher scores of frequency, nocturia, urge incontinence, lower maximal flow rate and lower voiding volume (P < 0.05). In addition, significantly higher storage and total American Urological Association Symptom Index questionnaire scores were also noted in IBS patients (P < 0.05). The prevalence of psychiatric morbidity in IBS patients was 28.8%, which was significantly higher than in the control group (20%). The urinary storage symptom score (odds ratio: 1.518; 95% confidence interval: 1.17-1.96; P = 0.002) was significantly correlated with psychiatric morbidity. LUTS are common in IBS patients and have a negative impact on their psychiatric status. Healthcare providers should be aware of the psychological consequences of LUTS in these patients.