Changes In Urinary Symptoms Research Articles

Mimickers and tumours in the lower urinary tract: Need for a more efficient vigilance?

Lower urinary tract symptoms are common in pediatric urology, but an atypical presentation may portend significant pathophysiology. We present 5 cases of young males with a sudden change in urinary symptoms, which resulted in the discovery of a variety of benign bladder tumours. We present the clinical, radiologic and histologic findings of these cases emphasizing on mimickers in clinics. Although rare tumours, these may be increasing in frequency and pediatric care may further be enhanced by the development of multinational registry.

A Pilot Clinical Trial of Radioprotective Effects of Curcumin Supplementation in Patients with Prostate Cancer

Background: Patients with prostate cancer who accede to radiation therapy usually experience several side effects and these toxicities are sometimes dose limiting. Some previous in vitro and in vivo studies have proposed a radioprotective role for curcumin, the yellow pigment of turmeric. Objectives: The purpose of this investigation was to assess the radioprotective effects of curcumin supplementation in patients with prostate cancer. Methods: Forty prostate cancer patients undergoing external beam radiotherapy (EBRT) were randomly assigned to curcumin group, taking 3 g/d curcumin (6 × 500 mg capsules of BCM95 n=20), or placebo group (n=20). Quality of life was assessed by the Persian version of the European Organization for Research and Treatment of Cancer prostate cancer-specific quality of life questionnaire (QLQ-PR25).Analysis of covariance was used to compare radiotherapy related symptoms between groups following the intervention, adjusted for baseline symptoms. Results: No differences in urinary symptoms, bowel symptoms, treatment related symptoms and sexual activity were observed between the curcumin and placebo groups before the intervention. The change in urinary symptoms across the 20-week period differed significantly between groups (p=0.011) and patients in the curcumin group experienced much milder urinary symptoms compared with the placebo group. No group differences were observed in any other domain of the QLQ-PR25. Conclusions: Curcumin can confer radioprotective effect in patients with prostate cancer who undergo radiation therapy through reducing the severity of radiotherapy related urinary symptoms. However supplementation with 3 g/ day curcumin could not reduce the severity of bowel symptoms or other treatment related symptoms.

Construct validation of patient global impression of severity (PGI-S) and improvement (PGI-I) questionnaires in the treatment of men with lower urinary tract symptoms secondary to benign prostatic hyperplasia.

BackgroundLower urinary tract symptoms (LUTS) in aging men are often associated with benign prostatic hyperplasia (BPH). While regulatory evaluations of treatment benefit require an assessment of specific symptoms, a simpler approach to measuring patients’ perceptions of severity and symptom change may be particularly useful for clinical practice. The aim of this study was to provide evidence of the validity of the 1-item Patient Global Impression of Severity (PGI-S) and Improvement (PGI-I) questionnaires for use as outcome measures in the treatment of BPH-LUTS.MethodsThis was a secondary analysis of data from 4 randomized placebo-controlled 12-week trials evaluating tadalafil for the treatment of BPH-LUTS (N=1694). Visit 2 (V2 [beginning of a 4-week placebo lead-in period]) and endpoint assessments included International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (IPSS-QoL), BPH Impact Index (BII), and peak urine flow (Qmax). PGI-S was only administered at V2 and PGI-I only at endpoint. Associations between the PGI-S or the PGI-I and the other assessments were analyzed by calculating Spearman rank correlation coefficients and performing analysis of variance (ANOVA).ResultsSpearman correlation coefficients were 0.43, 0.43, 0.53, and −0.09, between the PGI-S and IPSS, IPSS-QoL, BII, and Qmax baseline results (all P<0.001). Similar results were seen across race, ethnicity, and baseline severity (moderate LUTS versus severe LUTS). IPSS, IPSS-QoL, BII baseline scores (P <0.001) and Qmax values (P=0.003) were significantly different among the 4 PGI-S severity levels. Spearman correlation coefficients were 0.56, 0.53, 0.47 and −0.15 between the PGI-I and change in IPSS, IPSS-QoL, BII scores, and Qmax values from baseline to endpoint (all P<0.001). Similar results were seen across race, ethnicity, and baseline severity. Change in IPSS, IPSS-QoL, BII scores, and Qmax values (P<0.001) were significantly different among the PGI-I levels (i.e., patient perception of change in urinary symptoms).ConclusionsThis study demonstrated patients’ overall perceptions of their severity and change in BPH-LUTS can be captured in a way that is simple, valid, and easily administered in a research setting or clinical practice. Clinical parameters are weakly associated with patients’ perception of urinary symptoms, emphasizing the importance of a patient-reported assessment in the evaluation of BPH-LUTS treatment benefit.

Transvaginal posterior colporrhaphy combined with laparoscopic ventral mesh rectopexy for isolated Grade III rectocele: a prospective study of 27 patients

The aim of this study was to evaluate prospectively transvaginal posterior colporrhaphy (TPC) combined with laparoscopic ventral mesh rectopexy (LVR) in patients with a symptomatic isolated rectocele. Patients with these complaints underwent dynamic and static MRI. All consecutive patients with a Grade III (4 cm or more) rectocele and without internal/external rectal prolapse, enterocele and external sphincter damage were operated on. The patients completed the Obstructed Defecation Syndrome (ODS) score and the Cleveland Clinic Incontinence Score (CCIS). All tests were repeated after treatment. Dynamic disorders of the pelvic floor detected by MRI were recorded. In 27 patients [median age 67 (46-73) years], TPC combined with LVR was feasible. Complications were limited to port site infection in two patients. Sexual discomfort (n = 8) due to prolapse diminished in six (75%) patients and in one (4%) de novo dyspareunia developed after treatment. The median follow-up was 12 (10-18) months. The median CCIS was 12 (10-16) before treatment and 8 (7-10) after (P < 0.0001). The median ODS score was 19 (17-23) before and 6 (3-10) after treatment (P < 0.0001). There was no change in urinary symptoms. TPC combined with LVR for obstructed defaecation and faecal incontinence in patients with Grade III rectocele significantly relieves the symptoms of these disorders.

Urodynamic Outcomes After Hysterectomy for Benign Conditions

Hysterectomy, the most common gynecological surgery performed in the United Kingdom, has been highlighted as a possible etiological factor in urinary dysfunction in women who have undergone nonradical hysterectomy. Multiple studies in recent years have examined this question with both clinical and urodynamics metrics. The aim of this systematic review was to analyze urodynamic outcomes before and after total hysterectomy for benign conditions, and report if urinary function was changed after hysterectomy. English articles on MEDLINE and CINAHL from 1950 to February 2009 and on Web of Knowledge all years were searched. The search strategy used combinations of search terms related to urinary function and hysterectomy. The keywords used were "urodynamics," "stress incontinence," "urge incontinence," "bladder instability," "overactive bladder," "detrusor overactivity," and "hysterectomy." Observational studies and randomized controlled trials investigating urodynamic outcomes before and after hysterectomy were included. The data were analyzed in Review Manager 5 software. Overall, symptoms of urinary incontinence were significantly reduced after hysterectomy (relative risk [RR] = 1.37, 95% confidence interval [CI] [1.01, 1.84]). The urodynamic diagnosis of detrusor overactivity was significantly reduced after hysterectomy (RR = 1.58, 95% CI [1.16, 2.16]), but there was no significant reduction in the prevalence of urodynamic stress incontinence after hysterectomy (RR = 0.89, 95% CI [0.58, 1.38]). There was no significant change to urine flow rate after hysterectomy (RR = -0.36, 95% CI [-1.40, 0.68]). Hysterectomy for benign gynecological conditions does not adversely impact urodynamic outcomes nor does it increase the risk of adverse urinary symptoms and may even improve some urinary function. Obstetricians & Gynecologists and Family Physicians. After the completing the CME activity, physicians should be better able to categorize changes in urinary function following hysterectomy, assess changes in urinary symptoms following hysterectomy.

Dose-Escalated Hypofractionated Intensity-Modulated Radiotherapy in High-Risk Carcinoma of the Prostate: Outcome and Late Toxicity

Background. The benefit of dose-escalated hypofractionated radiotherapy using intensity-modulated radiotherapy (IMRT) in prostate cancer is not established. We report 5-year outcome and long-term toxicity data within a phase II clinical trial. Materials and Methods. 60 men with predominantly high-risk prostate cancer were treated. All patients received neoadjuvant hormone therapy, completing up to 6 months in total. Thirty patients were treated with 57 Gy in 19 fractions and 30 patients with 60 Gy in 20 fractions. Acute and 2-year toxicities were reported and patients followed longitudinally to assess 5 year outcomes and long-term toxicity. Toxicity was measured using RTOG criteria and LENT/SOMA questionnaire. Results. Median followup was 84 months. Five-year overall survival (OS) was 83% and biochemical progression-free survival (bPFS) was 50% for 57 Gy. Five-year OS was 75% and bPFS 58% for 60 Gy. At 7 years, toxicity by RTOG criteria was acceptable with no grade 3 or above toxicity. Compared with baseline, there was no significant change in urinary symptoms at 2 or 7 years. Bowel symptoms were stable between 2 and 7 years. All patients continued to have significant sexual dysfunction. Conclusion. In high-risk prostate cancer, dose-escalated hypofractionated radiotherapy using IMRT results in encouraging outcomes and acceptable late toxicity.

Effects of pelvic organ prolapse repair on urinary symptoms: A comparative study between the laparoscopic and vaginal approach

To compare changes in urinary symptoms before and after pelvic organ prolapse (POP) surgery, using either laparoscopic sacrocolpopexy (LSC) or transvaginal porcine dermis hammock placement with sacrospinous ligament suspension (VS). Data were prospectively collected from all women undergoing POP surgery between May 2001 and October 2009. Pre- and postoperative urinary symptoms, Urinary Distress Inventory (UDI), and Urinary Impact Questionnaires (UIQ) scores were compared within and between groups. A generalized linear model was used for multivariate analysis. Out of the 151 patients included, 87 patients underwent LSC, and 64 VS. Overall, after a median follow-up of 32.4 months, POP surgery improved urinary frequency (P = 0.006), voiding difficulty (P = 0.001), stress urinary incontinence (SUI) (P = 0.001), but not urgency (P = 0.29). VS was more effective in treating SUI (P < 0.001 vs. 0.52) while LSC more effective on voiding difficulty (P = 0.01 vs. 0.08). Postoperative de novo symptoms were observed in 35.8% of patients with no difference between the groups (P = 0.06). UDI (P = 0.04) and UIQ (P = 0.01) scores were significantly lower after surgery. However, LSC significantly improved UDI (P = 0.03) with no effect on UIQ (P = 0.29) scores while VS significantly improved both scores (P = 0.02 and 0.001, respectively). Upon multivariate analysis, only the improvement in the impact of urinary symptoms on daily living was independently associated to VS (OR = 5.45 [95% confidence interval 2.20-13.44], P = 0.01). Most preoperative urinary symptoms decreased after POP surgery with equivalent proportion of de novo symptoms after vaginal and laparoscopic approaches.

Efficacy and Safety of Tadalafil Once Daily in the Treatment of Men With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Results of an International Randomized, Double-Blind, Placebo-Controlled Trial

BackgroundTadalafil is being investigated for the treatment of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH-LUTS). ObjectiveTo assess efficacy, including onset, and safety of tadalafil on BPH-LUTS and the subject's and clinician's perception of changes in urinary symptoms. Design, setting, and participantsThis randomized, double-blind, placebo-controlled, 12-week trial enrolled men ≥45 yr of age with BPH-LUTS for >6 mo, International Prostate Symptom Score (IPSS) ≥13, and maximum urine flow rate (Qmax) ≥4 to ≤15ml/s. InterventionTadalafil 5mg (n=161) or placebo (n=164), once daily. MeasurementsAnalysis of covariance (ANCOVA) modeling evaluated change from baseline in continuous efficacy variables. Categoric efficacy variables were analyzed with the Cochran-Mantel-Haenszel test, and between-group differences in treatment-emergent adverse events (TEAEs) were assessed using the Fisher exact test. Results and limitationTadalafil significantly improved IPSS results, from baseline to endpoint, compared to placebo (−5.6 vs −3.6; p=0.004). Reduction in IPSS results was apparent after 1 wk and significant after 4 wk (tadalafil −5.3 vs placebo −3.5; p=0.003). The BPH Impact Index (BII) was not assessed at week 1; however, BII improvement was apparent at 4 wk (tadalafil −1.8 vs placebo −1.2; p=0.029) and continued at 12 wk (tadalafil −1.8 vs placebo −1.3; p=0.057). Tadalafil significantly improved the International Index of Erectile Function–Erectile Function score in sexually active men with erectile dysfunction (ED; 6.7 vs 2.0; p<0.001) at 12 wk (not assessed at week 1). Few subjects reported one TEAE or more (p=0.44). For tadalafil, the most common TEAEs were headache (3.7%) and back pain (3.1%). Tadalafil did not significantly improve Qmax or reduce postvoid residual volume. ConclusionsTadalafil 5mg once daily for 12 wk resulted in a clinically meaningful reduction in total IPSS results as early as 1 wk and achieved statistical significance at 4 wk in men with BPH-LUTS. The adverse event profile was consistent with that previously reported in men with ED. Trial registrationThis clinical trial is registered on the clinicaltrials.gov website (http://www.clinicaltrials.gov). The registration number is NCT00827242.

629 PERCEPTION OF CLINICAL CHANGE IN THE EXPANDED PROSTATE INDEX COMPOSITE (EPIC) URINARY DOMAIN

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2011629 PERCEPTION OF CLINICAL CHANGE IN THE EXPANDED PROSTATE INDEX COMPOSITE (EPIC) URINARY DOMAIN Robert Turner, Jeffrey Tomaszewski, Ryan Smith, Sunil Beriwal, and Ronald Benoit Robert TurnerRobert Turner Pittsburgh, PA More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski Pittsburgh, PA More articles by this author , Ryan SmithRyan Smith Pittsburgh, PA More articles by this author , Sunil BeriwalSunil Beriwal Pittsburgh, PA More articles by this author , and Ronald BenoitRonald Benoit Pittsburgh, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1505AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Health-related quality of life (HRQOL) is an important endpoint in assessing treatments for clinically localized prostate cancer, and the Expanded Prostate Index Composite (EPIC) is increasingly used as an instrument to measure HRQOL. An important question regarding the use of this survey is the change in score that is perceptible to patients. To date, these thresholds have not been defined. In order to best use the EPIC survey in outcomes research, changes in scores that are reliably perceptible and clinically significant must be established. The present study correlates changes in the EPIC urinary scores with the patient's subjective assessment of their change in urinary symptoms. METHODS All men undergoing prostate brachytherapy at a single institution completed an EPIC survey pre-operatively and at all follow up visits. At each follow-up visit, patients were also asked to describe their urinary symptoms as much better, slightly better, about the same, slightly worse, or much worse when compared to their last visit. The numerical change in the EPIC score was correlated with the patient's reported subjective degree of change in their urinary symptoms. At each post-operative visit, patients were also asked to report via a yes or no answer whether their urinary symptoms had returned to their pre-operative baseline. RESULTS The study included 252 men who completed 587 surveys. The mean pre-operative EPIC urinary summary score was 86.9 (scale 0–100). Mean change in the EPIC urinary summary score was a decrease of 25.8 for men who described their urinary symptoms as “much worse”, a decrease of 13.2 for men “slightly worse,” an increase of 0.32 for men “about the same,” an increase of 4.3 for men “slightly better,” and an increase 11.0 for men “much better.” Urinary subscales followed the same pattern with the greatest magnitude of change in the bother and irritative/obstructive subscales and the smallest magnitude of change in the incontinence subscale. Patients who answered “yes” to the question of whether their symptoms were back to pre-operative baseline had a mean change of 0.03 in their EPIC urinary summary score when compared to their pre-operative baseline. CONCLUSIONS This study correlates numerical changes in the EPIC urinary summary and subscale scores with the patient's perception of clinical change. The results will provide guidelines for investigators using the EPIC survey as an outcome measure and help in reconciling statistically significant changes in EPIC scores with their clinical significance. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e254 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Turner Pittsburgh, PA More articles by this author Jeffrey Tomaszewski Pittsburgh, PA More articles by this author Ryan Smith Pittsburgh, PA More articles by this author Sunil Beriwal Pittsburgh, PA More articles by this author Ronald Benoit Pittsburgh, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Changes in Urinary Symptoms and Tolerance due to Long-term Ureteral Double-J Stenting

Most studies have reported the effects of short-term double-J ureteral stenting on patient symptoms. We reviewed the changes in symptoms and the factors associated with tolerance due to long-term stenting. We investigated 20 patients (mean age±SD, 58.3±11.8 years). The patients consisted of those with cervical cancer (n=12), retroperitoneal fibrosis (n=5), colon cancer (n=1), rectal cancer (n=1), and endometrial cancer (n=1). A questionnaire that included domains for urinary symptoms and quality of life (QoL) scores for evaluation of urinary symptoms (International Prostate Symptom Score, or IPSS), a 10-cm linear visual analogue scale (VAS) score rated from 0 (no pain) to 10 (unendurable pain) for tolerance, and uroflowmetry were performed at every replacement. Frequency and urgency on the storage symptom score, residual urine sensations, and intermittency on the voiding symptom score were significantly aggravated at the initial stenting (p<0.05), but the sum of the storage symptom score and urgency improved with time (p<0.05). The quality of life score and total IPSS score also changed significantly (p<0.05). However, although the QoL score and the total IPSS score after stenting were not decreased to less than before stenting, the QoL score was significantly decreased at 9 months (p<0.05), and the total IPSS score was significantly decreased at 12 months (p<0.05). The symptoms were acutely aggravated at first, but the results showed increased tolerance with time. Adaptation of the bladder and desensitization of the patients may be important factors in the increased tolerance.

Do high radiation doses in locally advanced prostate cancer patients treated with 103Pd implant plus external beam irradiation cause increased urinary, rectal, and sexual morbidity?

Purpose To investigate the morbidity of higher radiation doses in prostate cancer patients. Methods and Materials Five hundred eighty-five men treated with seed implantation and external beam irradiation were followed a median of 5 years (range, 2–11). Hormonal therapy (HT) of 9 months duration was used in 504 (86.2%) patients. The biologic effective dose (BED) was calculated using an α/ β of 2. Urinary incontinence (UI) and symptoms (IPSS) were prospectively collected. Rectal morbidity was scored according to the Radiation Therapy Oncology Group (RTOG) scale. Two BED dose groups of ≤220 Gy ( n = 449) and >220 Gy ( n = 136) were used. Comparisons of means were made by Student's t test, and the associations were tested by chi-square analysis (Pearson). Results Urinary retention developed in 36 (6.2%) and was not associated with BED or IPSS. Retention occurred more often with prostate volume >50 cc (17%, p = 0.001). The median change in urinary symptoms (IPSS) was 1. Sixty-one percent with high BED were more likely to have increased postimplant symptoms compared with 39% with lower BED ( p = 0.025; odds ratio [OR], 1.107; 95% confidence interval [CI], 1.10–1.21). UI occurred in 25 patients (4.3%) and was only associated with a postimplant transurethral resection of the prostate (TURP) ( n = 25), 16% vs. 2.3% for no TURP ( p = 0.001; OR, 8; 95% CI, 2.4–27). Of the 373 patients initially potent, 204 (54.7%) maintained potency. Impotence was only associated with age at implant ( p = 0.001) and HT ( p = 0.004). Sixty-two (10.6%) patients had Grade 1–2 and 4 patients had Grade 3–4 (0.7%, 2 ulcers and 2 fistulas) rectal complications. Three of the Grade 3/4 complications occurred with a dose ≤220 Gy. Conclusion A BED >220 Gy does not seem to increase morbidity.

UP-1.118: Complications and Change in Urinary Symptoms Following Prostate Biopsy

We conducted a prospective study to find if there is any difference in urinary symptoms (by using IPSS score changes) before and after transrectal ultrasound (TRUS) guided prostate biopsies and its associated complications.

HOW TO MANAGE OVERACTIVE BLADDER IN ELDERLY INDIVIDUALS WITH DEMENTIA? A COMBINED USE OF DONEPEZIL, A CENTRAL ACETYLCHOLINESTERASE INHIBITOR, AND PROPIVERINE, A PERIPHERAL MUSCARINE RECEPTOR ANTAGONIST

HOW TO MANAGE OVERACTIVE BLADDER IN ELDERLY INDIVIDUALS WITH DEMENTIA? A COMBINED USE OF DONEPEZIL, A CENTRAL ACETYLCHOLINESTERASE INHIBITOR, AND PROPIVERINE, A PERIPHERAL MUSCARINE RECEPTOR ANTAGONIST

SCHU-44: Changes in Urinary Symptoms Following I-125 Prostate Brachytherapy

SCHU-44: Changes in Urinary Symptoms Following I-125 Prostate Brachytherapy

A Comparative Survey of Bladder Symptoms Prior to and after Conservative Surgical Treatment of Endometriosis

Study Objective: Growing evidence exists for the benefits of surgical treatment for endometriosis including symptom relief and improvement in quality of life. Evidence on the possible risks of surgery related to urinary and bowel function is however limited. We set out to evaluate a change in urinary symptoms following conservative surgery to treat pelvic endometriosis using CO2 laser (n=24), monopolar excision (n=34) and a combination of both modalities (n=5) according to anatomical site of disease in 63 patients.

A randomized controlled trial of the effectiveness of pelvic floor therapies for urodynamic stress and mixed incontinence

To assess the efficacy and cost-effectiveness of pelvic floor muscle therapies (PFMT) in women aged > or = 40 years with urodynamic stress incontinence (USI) and mixed UI. In a three-arm randomized controlled trial in Leicestershire and Rutland UK, 238 community-dwelling women aged > or = 40 years with USI in whom previous primary behavioural intervention had failed were randomized to receive either intensive PFMT (79), vaginal cone therapy (80) or to continue with primary behavioural intervention (79) for 3 months. The main outcome measure was the frequency of primary UI episodes, and secondary measures were pad-test urine loss, patient perception of problem, assessment of PF function, voiding frequency, and pad usage. Validated scales for urinary dysfunction, and impact on quality of life and satisfaction were collected at an independent interview. All three groups had a moderate reduction in UI episodes after intervention but there was no statistically significant difference among the groups. There were marginal improvements in voiding frequency for all groups, with no statistically significant difference among them. In women who have already had simple behavioural therapies (including advice on PFM exercises) for urinary dysfunction, the continuation of these behavioural therapies can lead to further improvement. The addition of vaginal cone therapy or intensive PFMT does not seem to contribute to further improvement. The improvement in pelvic floor function was significantly greater in the PFMT arm than in the control arm although this did not translate into changes in urinary symptoms.

Quality of life of patients after permanent prostate brachytherapy in relation to dosimetry: Van Gellekom MPR, Moerland MA, Van Vulpen M, Wijrdeman HK, Battermann JJ, Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands

To investigate changes in quality of life (QoL) after permanent prostate brachytherapy and to correlate these changes with postimplant dosimetry based on magnetic resonance (MR) images. For this study, 127 patients with low-stage prostate cancer and treated with brachytherapy received a QoL questionnaire at five time points: before treatment and at 4 weeks, 6 months, 1 year, and 2 years after treatment. The questionnaire included the RAND-36 generic health survey, the cancer-specific European Organization for Research and Treatment of Cancer (EORTC) core questionnaire, the tumor-specific EORTC prostate cancer module, and the American Urological Association symptom index. Postimplant dosimetry was based on registered T1 spin echo transversal, T2 turbo spin echo transversal, and T2 turbo spin echo sagittal MR images and CT images taken 4 weeks after implantation of the iodine-125 seeds. Calculated parameters were prostate volume, prostate volume receiving 100% (V100) and 150% (V150) dose, dose to 90% of the prostate volume (D90), maximum dose in 1-, 2-, and 5-cm3 rectum volume, distance between prostate and anterior rectum wall, and the maximum dose in 1%, 2%, and 5% urethra volume. Analysis of variance for repeated measures was used for comparison of the means of all variables in the different questionnaires. Linear regression analysis (stepwise) was used to investigate the correlations between QoL parameters and dosimetry parameters. On average, only the QoL at 4 weeks after implant was significantly different from (worse than) the QoL at the other time points. Regression analysis showed a significant correlation between changes in bowel problems and the maximum dose in 2-cm3 rectum volume, between changes in urinary symptoms and prostate volume, and between changes in urinary problems and the D90 value of the prostate. The QoL for patients with permanent prostate implants was worse in the first months after treatment but returned to baseline values 1 year after implant. Significant correlations were found between dose distribution and QoL.

Correlations between Longitudinal Changes in Transitional Zone Volume and Measures of Benign Prostatic Hyperplasia in a Population-Based Cohort

ObjectiveTo determine whether measures of transitional zone volume (TZV) are more strongly associated than total prostate volume with longitudinal urologic outcomes. MethodsIn 1990, 2,115 randomly selected Caucasian men from Olmsted County, Minnesota (USA) completed validated questionnaires during a home visit. A 25% subsample underwent clinical evaluation that included transrectal ultrasonography, assessment of serum prostate-specific antigen levels, and maximum urinary flow rates. Examinations and questionnaires were repeated biennially through 2004. TZV measures were taken at the fifth through eighth visits. Men with at least one TZV measurement were included in this study (n=336). ResultsChanges in TZV correlated weakly with changes in peak urinary flow rate and urinary symptoms. After accounting for age and change in total prostate volume, change in TZV added no information to models that predict changes in urinary symptoms and peak urinary flow rates. Men who experienced the most rapid annual changes in TZV were not more likely to experience more rapid changes in urinary symptoms or maximum flow rate. ConclusionTracking changes in TZV over time may be unlikely to provide a good surrogate measure for the development of benign prostatic hyperplasia.

Controlled-release doxazosin in the treatment of benign prostatic hyperplasia

To evaluate the effectiveness and safety of controlled-release doxazosin for benign prostatic hyperplasia (BPH). In this open-label, noncontrolled, observational surveillance study, 3684 men with BPH received 4-8 mg of controlled-release doxazosin gastrointestinal therapeutic system (GITS) for 6 months; 3283 (89.1%) patients completed the trial. Changes in urinary symptoms and quality of life were assessed using the International Prostate Symptom Score (IPSS). Blood pressure and adverse events were assessed. After 6 months' treatment with doxazosin GITS resulted in significant improvements in IPSS. BP was reduced only in hypertensive patients. Doxazosin, GITS was well tolerated.

Quality of life of patients after permanent prostate brachytherapy in relation to dosimetry

To investigate changes in quality of life (QoL) after permanent prostate brachytherapy and to correlate these changes with postimplant dosimetry based on magnetic resonance (MR) images. For this study, 127 patients with low-stage prostate cancer and treated with brachytherapy received a QoL questionnaire at five time points: before treatment and at 4 weeks, 6 months, 1 year, and 2 years after treatment. The questionnaire included the RAND-36 generic health survey, the cancer-specific European Organization for Research and Treatment of Cancer (EORTC) core questionnaire, the tumor-specific EORTC prostate cancer module, and the American Urological Association symptom index. Postimplant dosimetry was based on registered T1 spin echo transversal, T2 turbo spin echo transversal, and T2 turbo spin echo sagittal MR images and CT images taken 4 weeks after implantation of the iodine-125 seeds. Calculated parameters were prostate volume, prostate volume receiving 100% (V100) and 150% (V150) dose, dose to 90% of the prostate volume (D90), maximum dose in 1-, 2-, and 5-cm3 rectum volume, distance between prostate and anterior rectum wall, and the maximum dose in 1%, 2%, and 5% urethra volume. Analysis of variance for repeated measures was used for comparison of the means of all variables in the different questionnaires. Linear regression analysis (stepwise) was used to investigate the correlations between QoL parameters and dosimetry parameters. On average, only the QoL at 4 weeks after implant was significantly different from (worse than) the QoL at the other time points. Regression analysis showed a significant correlation between changes in bowel problems and the maximum dose in 2-cm3 rectum volume, between changes in urinary symptoms and prostate volume, and between changes in urinary problems and the D90 value of the prostate. The QoL for patients with permanent prostate implants was worse in the first months after treatment but returned to baseline values 1 year after implant. Significant correlations were found between dose distribution and QoL.