Changes In Lower Urinary Tract Symptoms Research Articles

Extent and pattern of symptom relief following surgical castration in patients with advanced prostate cancer treated at a tertiary referral hospital in Tanzania: a prospective cohort study

BackgroundAdvanced prostate cancer leads to many symptoms, notably bone pain and lower urinary tract symptoms (LUTs); however, the degree and duration of pain relief, changes in LUTs severity and underlying factors associated with the extent of symptom relief remain inadequately understood. Surgical castration has proven effective in relieving both bone pain and urinary symptoms for metastatic prostate cancer patients.ObjectiveTo determine the extent and pattern of symptom relief in advanced prostate cancer patients following surgical castration at Muhimbili National Hospital (MNH).MethodsWe conducted a prospective cohort study for a period of 6 months involving men with advanced Prostate cancer (PCa) undergoing surgical castration at MNH and followed them for 30 days. The international prostate symptoms score tool was used to assess changes in LUTs, and the pain rating scale was used for assessing changes in bone pain symptoms before and after surgery. Logistic regression model was used to determine factors associated with complete bone pain relief.ResultsA total of 210 participants with a mean age of 72.3 years were recruited. The LUTS score showed a decrease of 7.1 points after surgical castration (95% CI: 6.4 to 7.7, p < 0.001). The bone pain score showed an absolute decrease of 39.8% (95% CI: 34.7 to 44.9, p < 0.001) after surgical castration, with more than half of the patients (111, 52.9%) reporting bone pain relief within the first two weeks. Among the factors associated with greater pain relief were being in a marital union (aOR 2.73, 95% CI: 1.26 to 5.89, p < 0.011). Normal BMI was also linked to pain relief in bivariate analysis (OR 1.92, 95% CI: 1.03 to 3.61, p < 0.035). Additionally, patients with severe bone pain before surgical castration were more likely to achieve complete pain relief compared to those with mild or moderate pain (odds ratio 8.32, 95% CI: 3.63 to 19.1, p < 0.001).ConclusionSurgical castration improves both bone pain and lower urinary tract symptoms in patients with advanced prostate cancer. Notably, patients experiencing severe bone pain reported resolution of bone pain symptoms within the first and second weeks, respectively, indicating the prompt effectiveness of the surgery on these symptoms.

The association of fecal incontinence, constipation, and pelvic pain with the course of lower urinary tract symptoms in community-dwelling men and women.

Fecal incontinence, constipation, and pelvic pain are common pelvic floor symptoms (PFS), and frequently coexist with lower urinary tract symptoms (LUTS). However, their association with the longitudinal trajectory of LUTS have not been well described. Our objective was to investigate the association between PFS and the course of LUTS in community-dwelling men and women. Men and women aged ≥16 years were invited to participate in a prospective observational cohort study. At baseline, and after 12 and 24 months, participants filled in the International Consultation on Incontinence Modular Questionnaire (ICIQ-MLUTS and ICIQ-FLUTS) for men and women respectively, the Wexner incontinence and constipation scale, and a questionnaire on pelvic pain. Generalized estimating equations were used to examine the association between change scores in defecation problems and pelvic pain, and LUTS change scores. A total of 694 men and 997 women gave informed consent, with 417 men and 566 women included in the analysis. The mean age was 63.2 ± 12.7 years for men and 58.6 ± 14.8 years for women. The study showed minor changes in LUTS scores over the 0-12 and 12-24-month periods. Generalized estimating equations revealed positive associations between changes in constipation and fecal incontinence and LUTS changes in both sexes. For instance, a one-point increase in Wexner constipation score was associated with 0.376 (0.165, 0.587) points higher LUTS change in men and 0.223 (0.109, 0.336) points in women during the 0-12-month follow-up. However, associations between changes in pain and LUTS scores varied across sexes and time periods. We observed minor changes in LUTS over time and weak associations between PFS and LUTS that sometimes differed between males and females, emphasizing the need for sex-specific considerations. These insights can provide valuable guidance for the development of targeted prevention trials, ultimately aiming to enhance overall pelvic health and patient well-being.

Prevalence of Lower Urinary Tract Symptoms in Women Planning to Undergo Hysterectomy for Uterine Leiomyoma and Abnormal Uterine Bleeding.

Introduction: Leiomyomas are associated with lower urinary tract symptoms (LUTS), but more specific characterization of their impact on LUTS is needed. Methods: This is a retrospective cohort study of 202 participants (101 per group) who underwent hysterectomy for leiomyomas versus abnormal uterine bleeding nonclassified (AUB-N) from July 2015 to May 2019. Baseline demographics, leiomyoma characteristics, and presence of baseline LUTS were collected. The main objective was to compare the prevalence of LUTS between these two groups. Secondary objectives were to analyze the association between leiomyoma characteristics and the prevalence of LUTS. Results: There was no difference in baseline prevalence of LUTS between the hysterectomy for leiomyoma versus AUB-N groups (42.6% vs. 45.5%, p = 0.67). When examining the entire study cohort of participants, irrespective of hysterectomy indication, leiomyoma size >6 cm was associated with an increased prevalence of LUTS when compared with leiomyoma <6 cm (64.9% vs. 40.4%, p = 0.02), and specifically difficulty passing urine (p = 0.02), nocturia (p = 0.04), and urinary frequency (p = 0.04). When controlling for age, body mass index, parity, chronic pelvic pain, and diabetes, leiomyomas >6 cm remained significantly associated with the presence of LUTS (odds ratio 3.1, 95% confidence interval = 1.2-8.3) when compared with leiomyoma <6 cm. Presence of >1 leiomyoma was associated with urinary frequency (67.9% vs. 32.1%, p = 0.02) when compared with ≤1 leiomyoma. Anterior location and uterine volume were not associated with a difference in LUTS. Conclusion: LUTS are prevalent in those planning hysterectomy for leiomyoma and AUB-N. Leiomyomas >6 cm are associated with the presence of LUTS. Future studies should evaluate change in LUTS following hysterectomy for leiomyomas.

Effect of Diabetes Mellitus on Symptomatic Improvement After Surgery for Benign Prostatic Hyperplasia in Patients With Lower Urinary Tract Symptom and its Relations With Prostatic Urethral Angulation.

To compare improvement of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia in diabetic versus nondiabetic patients after transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP). The medical records of 437 patients who underwent TURP or HoLEP at a tertiary referral center from January 2006 to January 2022 were retrospectively analyzed. Among them, 71 patients had type 2 diabetes. Patients in the diabetic mellitus (DM) and non-DM groups were matched 1:1 according to age, baseline International Prostate Symptom Score (IPSS), and ultrasound measured prostate volume. Changes in LUTS were assessed at 3 months after surgery using IPSS and evaluated by categorizing patients according to prostatic urethral angulation (PUA; <50° vs. ≥50°). Medication-free survival after surgery was also investigated. No significant differences were noted between the DM and non-DM groups in baseline characteristics except for comorbidities (i.e., hypertension, cerebrovascular disease, and ischemic heart disease, P=0.021, P=0.002, and P=0.017, respectively) and postvoid residual urine volume (115±98 mL vs. 76±105 mL, P=0.028). Non-DM patients showed significant symptomatic improvement regardless of PUA, while DM patients demonstrated improvement in obstructive symptoms only in those with large PUA (≥51°). Among patients with small PUA, DM patients had worse medication-free survival after surgery compared to controls (P=0.044) and DM was an independent predictor of medication reuse (hazard ratio, 1.422; 95% confidence interval, 1.285-2.373; P=0.038). DM patients experienced symptomatic improvement after surgery only in those with large PUA. Among patients with small PUA, DM patients were more likely to reuse medication after surgery.

Changes in Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia Patients Affected by Covid-19

Introduction: Benign prostatic hyperplasia (BPH) is a histological diagnosis characterized by an increase in the number of epithelial and stromal cells in the transitional zone of the prostate gland. The clinical manifestation of BPH is associated with the appearance of so-called lower urinary tract symptoms (LUTS) which can also be a consequence of other conditions not related to the prostate. Covid-19, also known as severe acute respiratory syndrome coronavirus 2 was discovered as a disease in late 2019 in the city of Wuhan, China. Materials and Methods: A case-control study was conducted between September 2021 and May 2022. Information was initially collected on 60 patients followed up and treated conservatively for BPH in two outpatient practices and recovered from Covid-19. After processing the received information, 27 patients were excluded from the study and 33 patients remained for observation The assessment of patients is carried out through an internationally validated questionnaire – international prostate symptom score (IPPS), prostate specific antigen, digital rectal examination (DRЕ), and ultrasound diagnostics of the prostate gland with consideration of its volume and the amount of residual urine. Results: Our data show a strong correlation between the changes in LUTS in patients with BPH and Covid-19 infection. Conclusion: Although almost 3 years have passed since the beginning of this pandemic, there are still many unanswered questions surrounding this disease. We believe that with our experience we will enrich the information about the relationship between Covid-19 and LUTS, and the results obtained by us can serve as a basis for future large-scale and more in-depth studies on the subject.

Chronological changes of lower urinary tract symptoms after low-dose-rate brachytherapy for prostate cancer using SpaceOAR® system.

The aim of this study is to investigate chronological changes of lower urinary tract symptoms (LUTS) in patients with prostate cancer who underwent low-dose-rate brachytherapy (LDR-BT) followed by the insertion of SpaceOAR® system (SpaceOAR). In this retrospective study, 483 patients with localized prostate cancer underwent LDR-BT at the Gifu University Hospital between August 2004 and December 2020. SpaceOAR was inserted in 30 patients after LDR-BT (SpaceOAR group), and 453 patients received LDR-BT alone (non-SpaceOAR group). The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), quality of life due to urinary symptoms (IPSS-QOL), and uroflowmetry (UFM), including maximum flow rate (Qmax), voided volume, and post-voided residual urine (PVR), were evaluated before LDR-BT, and at 1, 3, 6, 9, and 12months after LDR-BT. The outcomes were chronological changes in IPSS, OABSS, and IPSS-QOL compared to pretreatment values and those of covariates in relation to UFM. The IPSS, OABSS, IPSS-QOL, Qmax, and voided volume were not significantly associated with either group. According to the PVR interaction effect, the insertion of SpaceOAR was significantly affected by chronological changes in PVR (P=0.001). Three months after LDR-BT, PVR in the SpaceOAR group was significantly higher than that in the non-SpaceOAR group (49.8mL vs. 30.5mL; P=0.002). SpaceOAR use may temporally increase PVR; however, IPSS, OABSS, IPSS-QOL, Qmax, and voided volume were not significantly associated with LUTS before and after LDR-BT. The combination of LDR-BT and SpaceOAR may be acceptable for treating patients with prostate cancer regarding the chronological changes in LUTS after brachytherapy.

Seasonal changes in occurrence and severity of lower urinary tract symptoms-Tampere Aging Male Urologic Study (TAMUS).

To determine if lower urinary tract symptoms (LUTS) involve seasonal variation and how this affects the severity of LUTS. A total of 3163 men aged 50 to 70 years were mailed a questionnaire on urinary symptoms. The overall response rate was 65.3% (2064 out of 3163 men). The men were asked whether their urinary symptoms showed variation in degree of difficulty according to time of year and if yes, when LUTS were the worst and the mildest. Ten different LUTS were evaluated with four response options for the severity of symptoms. Mean symptom scores and the proportions of symptomatic men were evaluated according to the presence of seasonal changes in different symptoms. Overall, 17.1% of men reported seasonal variation in severity of LUTS, older men more frequently than younger men. Worse LUTS during winter were reported by 81% of the men reporting seasonal variation, and 93% reported that LUTS were relieved in summer. More seasonal variation was reported by men with comorbidities (stroke, neurological disease) and those with medical treatment for LUTS or operative treatment for benign prostatic hyperplasia. Men with more severe LUTS were more likely to report seasonal changes. One out of six men reported seasonal changes in LUTS, with winter worsening and summer relieving the symptoms. Men with seasonal variation in LUTS had more severe LUTS in all 10 symptom groups that were investigated.

Correlation between prostatic urethral angulation and symptomatic improvement after surgery in patients with lower urinary tract symptoms according to prostate size.

To investigate the effect of prostate anatomical factors on the changes in lower urinary tract symptoms (LUTS) and uroflowmetric values after surgery. The medical records of 448 patients who underwent transurethral resection of the prostate (TURP) from January 2006 to December 2018 were analyzed retrospectively. Changes in the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual urine volume (PVR) at 3months after TURP were evaluated. Prostate volume, intravesical prostatic protrusion (IPP), and prostatic urethral angulation (PUA) were measured using transrectal ultrasonography, and their effect on the changes in LUTS after TURP was analyzed using multivariable linear regression. Among patients with prostate volume < 50mL, preoperative IPSS total score (IPSS-t), voiding symptom score (IPSS-vs), and storage symptom score (IPSS-ss) were significantly better in patients with a smaller PUA (< 51°) than in those with a larger PUA (≥ 51°) (p = 0.001, < 0.001, and 0.020, respectively). Changes in IPSS-t, IPSS-vs, IPSS-ss, and PVR at 3months after TURP were significantly correlated with PUA (p ≤ 0.001, < 0.001, 0.048, and 0.012, respectively). Multivariable linear regression revealed PUA to be independently associated with changes in IPPS-t and IPSS-vs (p = 0.025 and < 0.001, respectively) only in patients with prostate volume < 50mL. Prostatic urethral angulation was significantly associated with postoperative changes in LUTS only in patients with small prostate, and had no clinical significance in patients with large prostate. In patients with small prostate and large PUA, surgery should actively be considered.

Changes in lower urinary tract symptoms after iodine-125 brachytherapy for prostate cancer

PurposeTo investigate chronological changes in lower urinary tract symptoms (LUTS) in patients who received iodine-125 brachytherapy (BT) for prostate cancer. MethodsWe enrolled 706 patients who received BT. Of these, 265 (38%) received BT combined with external beam radiation therapy (EBRT). An International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL) score, and overactive bladder symptom score (OABSS) were recorded before BT (baseline, BL), and 1, 3, 6, 12, 24, 36, 48, and 60 months after BT. The sum of frequency (2), urgency (4) and nocturia (7) of the IPSS questionnaire was defined as the storage symptoms score, whereas the sum of emptying (1), intermittency (3), weak stream (5), and hesitancy (6) was defined as the voiding symptom score. ResultsTotal IPSS significantly increased at 3 months following BT compared with BL (mean score: 17.1 vs. 7.99, P < 0.001) and returned to BL by 36 months. The storage symptom score did not return to BL 36 months after BT. Total OABSS significantly increased 3 months after BT compared with BL (mean score: 6.52 vs. 3.45, P < 0.001), and returned to BL 48 months after BT. The IPSS-QOL score was the highest score (mean score: 2.46 vs. 3.9, P < 0.001) 3 months after BT and returned to BL 48 months after BT, however the IPSS-QOL score was lower than BL (mean score: 2.01 vs 2.46, P < 0.001) at 60 months. The risk factors for LUTS within 1 year after BT were BL IPSS (P < 0.001) and PV (P < 0.001). Patients who received combined EBRT experienced transient storage symptoms 24 and 36 months after BT, whereas those who received BT alone did not. However, the storage symptom score of the patients who received combined EBRT was improving 48 months after BT and eventually showed no significant difference compared with those treated with BT alone. ConclusionThree months after BT, LUTS, including storage symptoms, deteriorated the most but improved with time. The urinary symptom in patients who received combined EBRT can potentially flare again in 24 and 36 months after BT. Knowledge of changes in LUTS associated with BT may influence treatment recommendations and enable patients to make better-informed decisions.

High dose vitamin D may improve lower urinary tract symptoms in postmenopausal women

Lower urinary tract symptoms (LUTS) are common in postmenopausal women, and have been reported inversely associated with vitamin D intake and serum 25-hydroxyvitamin D (25(OH)D) levels. The aim of this study was to investigate if high dose vitamin D supplementation would affect LUTS in comparison to standard dose. In a randomized controlled study including 297 postmenopausal women with low bone mineral density, the participants were allocated to receive capsules of 20 000IU of vitamin D3 twice a week (high dose group) or similar looking placebo (standard dose group). In addition, all the participants received 1g of calcium and 800IU of vitamin D daily. A validated questionnaire regarding LUTS was filled in at baseline and after 12 months. At baseline, 76 women in the high dose group and 82 in the standard dose group reported any LUTS. Levels of serum 25(OH)D increased significantly more in the high dose group (from 64.7 to 164.1nmol/l compared to from 64.1 to 81.8nmol/l, p<0.01). No differences between the groups were seen regarding change in LUTS except for a statistically significant reduction in the reported severity of urine incontinence in the high dose group as compared to the standard dose group after one year (p<0.05). The results need confirmation in a study specifically designed for this purpose.

Experience in the Treatment of Patients with Sexual Disorders and Lower Urinary Tract Symptoms After Surgical Treatment of Benign Prostatic Hyperplasia

The aim of the research: the choice of treatment for patients with sexual disorders (SD) and lower urinary tract symptoms (LUTS) after surgical treatment of benign prostatic hyperplasia (BPH).&#x0D; Materials and methods. There were examined 270 patients, who were divided into two groups: 75 patients with BPH stage I1II who received medical therapy and 160 after surgical treatment (85 and 75 patients undergoing TUPR and the different types of prostatectomy, respectively). The period between surgery and inclusion in the study was 1-2 months. In addition, the study included 35 healthy men who made up the reference group. All patients received basic therapy according to the standards of the European Association of urology, guidelines regarding healthy lifestyle, avoiding harmful habits, diet and physical therapy methods. In addition, patients received therapy with inhibitors of phosphodiesterase of 5-th type, tailor-made preparations and metabolic stimulation therapy, drugs to improve blood flow of blood to the cavernous bodies, or tools that reduce the outflow of venous blood from them.&#x0D; Results. Treatment results were assessed by the dynamics of changes in LUTS, objective information about the functional status after 3, 6 and 12 months. Dynamics of indicators of SD, psycho1emotional status was assessed at 1, 3, 6 and 12 months.&#x0D; Conclusion. Established the identity of the nature of the assessment of men from both groups’ satisfaction with the treatment was a linear relationship between time and criteria such as overall satisfaction with desire to continue it, with confidence and pleasure, sexual opportunities, quality of erections.

The Influence of Androgen Deprivation Therapy on Prostate Size and Voiding Symptoms in Prostate Cancer Patients in Korea.

PurposeThe goal of this study is to investigate the effects of androgen deprivation therapy (ADT) on total prostate volume and lower urinary tract symptoms (LUTS).MethodsBetween January 2007 and June 2014, 110 patients who received androgen deprivation treatment were enrolled in this retrospective study. Clinical parameters and urodynamic parameters along with changes at follow-up were analyzed. Factors such as reduction in prostate volume, changes in LUTS, and prostate volume tertiles were compared 1 year after ADT.ResultsAfter ADT, the total International Prostate Symptom Score (IPSS) score decreased from 17.45 to 12.21 and the IPSS voiding subscore decreased from 9.16 to 6.24. Maximal uroflow rate increased from 8.62 to 11.50 mL/sec and residual urine also reduced significantly by 29.34 mL. Change in prostate size was more prominent (–51.14%) in the patients with less than 1 year of ADT (n=21) than those who had more than 1 year of treatment (n=89, –44.12%). The decrease in the IPSS voiding subscore was greater within 1 year of ADT than after 1 year of treatment (–4.10 vs. –2.65). The differences were more significant in the 30–50 g group (n=59) and >50 g group (n=11) than the <30 g group (n=40) of the IPSS voiding subscore improvement (–3.76 , –4.91 vs. –2.10), and maximal uroflow rate improvement (2.78, 2.90 vs 1.49).ConclusionADT resulted in statistically significant clinical improvement in terms of prostate volume, urodynamic parameters, and LUTS for patients with prostate cancer when analyzed by ADT duration and prostate volume.

Changes in lower urinary tract symptoms and quality of life after salvage radiotherapy for biochemical recurrence of prostate cancer

Background and purposeThe aim of this study was to evaluate chronologic changes in lower urinary tract symptoms (LUTS), health-related (HR) quality of life (QOL), and disease-specific QOL during the first 12months after salvage radiotherapy (SRT) for biochemical recurrence of prostate cancer in patients who underwent radical prostatectomy. Materials and methodsIn 81 patients who received SRT (70Gy/35fr/7weeks), International Prostate Symptom Score (IPSS), 36-Item Short Form scores, and UCLA-Prostate Cancer Index (UCLA-PCI) were recorded before, during, and immediately after SRT, and 1–12months after the completion of SRT. ResultsThe total IPSS and storage symptom-related sum were significantly increased following initiation of SRT, and returned to the baseline 6months after SRT. For three of eight domains of HRQOL, and the physical component summary score showed transient deterioration in the period between completion of SRT and 1month following SRT. The UCLA-PCI for urinary function/bother and bowel function/bother was affected until 1–6months after SRT. ConclusionsThis is the first report to concurrently evaluate detailed chronologic changes in LUTS and QOL in patients who received SRT. Knowledge of changes in LUTS and QOL outcomes associated with SRT may influence treatment recommendations and enable patients to make better-informed decisions.

MP15-17 VARIATION IN PATIENT REPORTED AMERICAN UROLOGIC ASSOCIATION SYMPTOM INDEX SCORES: WHAT REPRESENTS A CLINICALLY SIGNIFICANT CHANGE?

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2014MP15-17 VARIATION IN PATIENT REPORTED AMERICAN UROLOGIC ASSOCIATION SYMPTOM INDEX SCORES: WHAT REPRESENTS A CLINICALLY SIGNIFICANT CHANGE? Thomas Fuller, Benjamin Ristau, and Ronald Benoit Thomas FullerThomas Fuller More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , and Ronald BenoitRonald Benoit More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.570AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The American Urologic Association Symptom Index (AUA-SI) is a commonly used clinical tool for the assessment of lower urinary tract symptoms (LUTS). Few studies have precisely characterized the magnitude of change in AUA-SI score required for a patient to perceive a clinical difference in the severity of their LUTS. We sought to define the association between a patient’s AUA-SI and their subjective sense of change in LUTS. METHODS Men who had undergone prostate brachytherapy at our institution completed an AUA-SI preoperatively and at postoperative intervals of 2 weeks, 4 weeks, 3 months, 6 months, and 12 months. At the same postoperative intervals, patients were asked whether their lower urinary tract symptoms were much better, slightly better, the same, slightly worse, or much worse when compared to their previous visit. Differences in the patient’s AUA-SI scores were compared to their subjective sense of the change in their LUTS. The median change from baseline and interquartile range (IQR) were calculated. RESULTS A total of 1,438 surveys were completed and included in the analysis. For men who described their symptoms as much worse, the median change in the AUA-SI was +16 and the IQR was +9 to +23. For those who ranked their symptoms as much better, the AUA-SI was -2 and the IQR was -6 to 0. The median change and IQR for patients who ranked their symptoms as slightly worse, the same, and slightly better were calculated. Table 1. CONCLUSIONS Using a large cohort of prostate brachytherapy patients as a model for change in lower urinary tract symptoms over time, a 2-point difference in AUA-SI scores correlated with a clinically apparent change in LUTS. Further, a smaller difference in AUA-SI scores is required to sense an improvement in LUTS relative to that needed to sense worsening LUTS. Finally, by comparing a subjective questionnaire to the more objective AUA-SI, the present study provides additional external validation of the AUA-SI as an appropriate clinical tool for the assessment of lower urinary tract symptoms in urologic patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e151-e152 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Thomas Fuller More articles by this author Benjamin Ristau More articles by this author Ronald Benoit More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A prospective randomized double‐blind trial of grape juice antioxidants in men with lower urinary tract symptoms

Many patients take alternative medications for their lower urinary tract symptoms (LUTS) either in addition or as a substitute for traditional therapies, despite a lack of clinical data. Grapes products are hypothesized to improve bladder function due to their antioxidant and membrane-protective actions. There is increasing evidence that progression of obstructed bladder dysfunction is related to bladder ischemia, reperfusion injury and free radical damage. We prospectively studied a standardized grape product on urinary symptoms. Men >45 years with significant LUTS were randomized to 240 ml daily of either 100% Concord grape juice or placebo. Participants were followed with validated questionnaires for LUTS, erectile dysfunction, and quality of life in addition to PSA, uroflow, and serum and urinary antioxidant levels. The primary endpoint was change in LUTS in Male International Continence Symptom score. The secondary endpoint was correlation between the level of antioxidants and changes in symptom scores. One hundred thirteen participations were randomized with 96 completing the 3-month follow-up. There was no difference in the primary endpoint between the groups. (ISCmale score improved by a mean of 1.6 points in both groups.) There was no statistical difference between groups by PSA or secondary questionnaires. A statistical significance was found between uroflow rates. Linear regression analysis gave no correlation between antioxidants (serum or urine) and changes in symptom scores or grape juice consumption. Our study did not demonstrate any difference in LUTS in men taking a daily 240 ml 100% grape juice versus placebo after 3 months.

650 LOWER URINARY TRACT SYMPTOM (LUTS) TRAJECTORIES: A NOVEL METHOD OF CHARACTERIZING DYNAMIC CHANGE IN URINARY SYMPTOMS IN ELDERLY MEN

INTRODUCTION AND OBJECTIVES: Little is known about the natural history of lower urinary tract symptoms (LUTS) among elderly community-dwelling men. Our objective was to use a novel trajectory method to characterize dynamic changes in LUTS. METHODS: We performed this analysis in the Osteoporotic Fractures in Men Study (MrOS), a prospective cohort of 5994 communitydwelling men age 65 years. Data collected at 4 study visits ( 2 year intervals) included the American Urological Association Symptom Index (AUA-SI), urinary bother, treatment for benign prostatic hyperplasia (BPH), and current prescription medications. The analytic cohort included 1897 men with complete data, who were not treated for LUTS or diagnosed with prostate cancer during follow-up. Trajectories of the AUA-SI scores were modeled using the SAS 9.1 procedure PROC TRAJ. RESULTS: Nine trajectories of AUA-SI scores were identified (Figure). We characterized the shape of each trajectory using average scores at each visit. We designated stable groups as ‘Very Few Symptoms’ (Traj 1, N 857, 45%) and ‘Low Stable’ (Traj 2, N 494, 26%); progressing groups as ‘Low Stable Increase’ (Traj 3, N 52, 3%), ‘Moderate Increase’ (Traj 6, N 227, 12%), ‘Moderate-High Increase’ (Traj 7, N 91, 5%), and ‘High Increase’ (Traj 9, N 25, 1%); and remitting groups as ‘Low Increase then Decrease’ (Traj 5, N 20, 1%), ‘Moderate-Low Decrease’ (Traj 4, N 85, 5%), and ‘High-Moderate Decrease’ (Traj 8, N 46, 2%). Most men (71%) had stable trajectory patterns, whereas 21% had progression and 8% had remission of symptoms. Voiding and storage symptoms followed each trajectory pattern, with storage being the most prominent symptom type in all but the 3 highest trajectories (Traj 7-9). On average, urinary bother scores increased in progressing trajectories and declined in remitting trajectories. Surprisingly, the frequency of self-reported BPH increased over time in all trajectories. CONCLUSIONS: In this cohort of older men not treated for LUTS, we observed nine distinct trajectories, including symptom progression and remission. Trajectory modeling of AUA-SI scores is a novel tool that could inform future clinical research and decision making.

Associations Between Modest Weight Changes and Onset and Progression of Lower Urinary Tract Symptoms in Two Population-based Cohorts

To conduct a study to determine whether weight changes were associated with the risk of developing lower urinary tract symptoms (LUTS). Obesity has been associated with LUTS in aging men. The study population consisted of men participating in the Olmsted County Study of Urinary Symptoms and Health Status among Men and the Flint Men's Health Study. Weight loss and weight gain were defined as a change of ≥5% of the baseline weight. LUTS progression was measured by calculating the American Urological Association Symptom Index (AUASI) score slopes for 4 years of follow-up in both cohorts. Additional Cox proportional hazard models were constructed to determine whether the weight changes were associated with the later development of moderate-to-severe symptoms or with a ≥4-point increase in the AUASI score (Olmsted County Study of Urinary Symptoms and Health Status among Men cohort only). Weight changes were not associated with LUTS progression (all P > .05). Additionally, the rate at which the AUASI scores changed did not vary by the weight change. Finally, in the Olmsted County Study of Urinary Symptoms and Health Status among Men cohort, the weight changes were not associated with risk of having a moderate-to-severe AUASI score or a ≥4-point increase in the AUASI score. Modest weight loss might not prevent the onset or progression of LUTS. However, modest weight gain also might not contribute to changes in LUTS.

Associations Between Longitudinal Changes in Serum Estrogen, Testosterone, and Bioavailable Testosterone and Changes in Benign Urologic Outcomes

Some men have rapid increases in benign prostatic enlargement and lower urinary tract symptoms (LUTS), and it is not clear how sex steroid hormones contribute to the rates of change in these urologic outcomes. Therefore, the authors conducted a population-based cohort study of 648 men residing in Olmsted County, Minnesota, from 1990 to 2007, to examine associations between baseline sex steroid hormones, the rate of change in these hormones, and the rates of change in LUTS, maximum urinary flow rate, and prostate volume. Annual changes in hormone levels and urologic outcomes were calculated using mixed-effects regression models. Associations between hormone variables and rates of change in urologic outcomes were assessed with linear regression models. Higher baseline estradiol levels and rapid declines in estradiol over time were associated with rapid increases in LUTS and rapid decreases in maximum flow rate. Lower baseline bioavailable testosterone levels and more rapid declines in bioavailable testosterone were associated with more rapid increases in prostate volume. These results suggest that both absolute sex steroid hormone levels and the rates at which the levels change may be important in the development of urologic conditions in aging men.

Impact of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Treatment with Tamsulosin and Solifenacin Combination Therapy on Erectile Function

PurposeTo examine the effects on erectile function of concomitant treatment with an alpha-blocker (tamsulosin) and an antimuscarinic agent (solifenacin) in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH).Materials and MethodsFifty-seven male patients with LUTS/BPH were assessed for the degree of LUTS and erectile function. In group 1 (tamsulosin) and group 2 (tamsulosin and solifenacin), changes in the International Prostate Symptom Score [IPSS: total scores, storage symptoms (ST), voiding symptoms (VD), and quality of life (QoL)], prostate-specific antigen, trans-rectal ultrasonography, urine flowmetry, residual urine, and a 5-item version of the International Index of Erectile Function (IIEF-5) were assessed after a 3-month treatment period. In both groups, it was determined whether treatment was associated with changes in LUTS and erectile function and whether improvement in the IPSS was correlated with the IIEF-5. Comparative analysis was also done to examine the linear relationship between improved IPSS scores and IIEF-5 scores.ResultsA comparison of the degree of improvement in all the parameters indicated that both groups showed significant improvement in total IPSS, IPSS-ST, IPSS-VD, and IPSS-QoL (p<0.05). A comparison of the degree of improved sexual function associated with improved LUTS in each patient showed significant improvement in the IIEF-5 score associated with the degree of improvement in the IPSS-ST domain in group 1, but no significant associations were found in group 2. In cases in which tamsulosin was administered, the IIEF-5 score significantly improved as the IPSS-ST domain score improved. In the group in which tamsulosin and solifenacin were concomitantly administered, improvement of the IPSS-ST domain score had no significant effect on the IIEF-5 score.ConclusionsIn patients with LUTS/BPH, tamsulosin and solifenacin combination therapy was effective for LUTS, but erectile function was not significantly improved. Therefore, although effective for improving LUTS, combination therapy with an alpha-blocker and an antimuscarinic agent was not effective for improving erectile function.

Correlation between Lower Urinary Tract Symptoms (LUTS) and Sexual Function in Benign Prostatic Hyperplasia: Impact of Treatment of LUTS on Sexual Function

Although many reports have shown a relationship between lower urinary tract symptoms (LUTS) and sexual function (SF), it is not known which symptom(s) among LUTS should be treated to improve SF. Thus, the aim of this study was to investigate correlations between LUTS and SF and to determine which symptom(s) should be improved to increase SF. The correlation between the severity of LUTS and erectile dysfunction (ED) was investigated, and changes in LUTS were compared and analyzed to determine which symptom(s) should be eliminated to improve SF. The correlation between LUTS and SF was investigated in 365 men (62.04 +/- 8.26) with benign prostatic hyperplasia. To measure the severity of the LUTS and ED, the International Prostate Symptom Score (IPSS), frequency of nocturia, uroflowmetry, residual urine, transrectal ultrasonography, and the International Index of Erectile Function (IIEF)-5 were performed at the first visit. After 3 months of treatment with alpha-blockers (n = 304), they were assessed again to evaluate the effectiveness of the treatment. All parameters of LUTS (IPSS, age, residual urine, uroflow rate, and nocturia) except prostate volume correlated significantly with the total and each domain of IIEF-5 (P < 0.01). After 3 months, the changed scores in the IPSS-VD domain and IPSS-quality of life (QoL) correlated significantly with the improvement in total IIEF-5 and the domains of IIEF-5 (P < 0.05). The changed rates of the mean uroflow correlated significantly with the improvement in total IIEF-5 and the EF domain (P < 0.05). Among the LUTS parameters, improvement in the IPSS-VD domain, IPSS-QoL, and mean uroflow significantly correlated with an increased score in the IIEF-5 EF domain. Thus, it is expected that the improvement of voiding symptoms and uroflow will be associated with the improvement in erectile function.