Chronic Lower Urinary Tract Symptoms Research Articles

Holmium Laser Incision of Ejaculatory Duct (HoLIED): Surgical Procedure

Introduction: Ejaculatory duct obstruction is a well-known cause of infertility and many other symptoms, such as hematospermia and lower urinary tract symptoms. Diagnosis is made based on the medical history and a series of imaging tests identifying the obstructed ducts. Transurethral resection of the ejaculatory ducts is the mainstay treatment to release the obstruction. In this step-by-step surgical video, we will describe a novel technique using the holmium laser to incise the ejaculatory ducts in a patient with chronic lower urinary tract symptoms, hematospermia, and persistent urethral discharge. Materials and Methods: A pelvic MRI was obtained in workup of the above issues and identified a complex ejaculatory duct cyst. The patient consented for Holmium Laser Incision of Ejaculatory Duct. A holmium laser fiber was used through a 24F rigid cystoscope to unroof the ejaculatory duct cyst, resulting in the drainage of a dark brown fluid. Following unroofing of the cyst, the ejaculatory ducts were identified using a 17F rigid cystoscope and a 16F Foley catheter was inserted. Results: The Foley catheter was removed on POD1, and the patient was able to void. His symptoms improved progressively with time and antibiotics. A repeat MRI was obtained several months postoperatively and showed the resolution of the cystic lesion. Conclusion: Holmium Laser Incision of Ejaculatory Duct is safe and feasible procedure allowing to treat ejaculatory duct obstruction without increased risk of complications.

Diagnostic accuracy of urine biomarkers for urinary tract infection in older women: a case-control study

ObjectivesUrinary tract infection (UTI) is common among older women. However, diagnosis is challenging because of frequent chronic lower urinary tract symptoms, cognitive impairment, and a high prevalence of asymptomatic bacteriuria (ASB). Current urine diagnostics lack specificity, leading to unnecessary treatment and antimicrobial resistance. This study aimed to evaluate the diagnostic accuracy of 12 urine biomarkers for diagnosing UTI in older women. MethodsIn this case-control study, cases were women ≥65 years with ≥2 new-onset lower urinary tract symptoms, pyuria, and one uropathogen ≥104 CFU/mL. Controls were asymptomatic and classified as ASB (one uropathogen ≥105 CFU/mL), negative culture, or mixed flora. Urine biomarker concentrations were measured through liquid chromatography-mass spectrometry and ELISA. Diagnostic accuracy parameters of individual biomarkers and a biomarker model were derived from receiver operating characteristic curves. ResultsWe included 162 community-dwelling and institutionalized older women. Five urine inflammatory biomarkers demonstrated high discriminative ability (area under the curve ≥0.80): interleukin 6, azurocidin, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinases 2, and C-X-C motif chemokine 9. Azurocidin exhibited the highest diagnostic accuracy (sensitivity 86% [95% CI 75%–93%] and specificity 89% [95% CI 82%–94%] at 16.7 ng/mmol creatinine). A combined biomarker and pyuria model showed improved diagnostic accuracy in patients with UTI and ASB, compared with pyuria alone. DiscussionWe identified several urine biomarkers that accurately differentiated older women with UTI from asymptomatic women, including ASB. These findings represent a potential advancement towards improved diagnostics for UTI in older women and warrant validation in a diverse population.

Proposing the “continuum of UTI” for a nuanced approach to antimicrobial stewardship

Background: Historically, diagnosis of urinary tract infections (UTIs) has been divided into 3 categories based on symptoms and urine culture results: not UTI, asymptomatic bacteriuria (ASB), or UTI. However, some populations (eg, older adults, catheterized patients) may not present with signs or symptoms referrable to the urinary tract or have chronic lower urinary tract symptoms (LUTS), making the diagnosis of UTI challenging. We sought to understand the clinical presentation of patients who receive urine tests in a cohort of diverse hospitals. Methods: This retrospective descriptive cohort study included all adult noncatheterized inpatient and ED encounters with paired urinalysis and urine cultures (24 hours apart) from 5 community and academic hospitals in 3 states (NC, VA, GA) between January 1, 2017, and December 31, 2019. Trained abstractors collected clinical and demographic data using a 60-question REDCap survey. The study group met with multidisciplinary experts (ID, geriatrics, urology) to define the “continuum of UTI” (Table 1), which includes 2 new categories: (1) LUTS to capture patients with chronic lower urinary tract symptoms and (2) bacteriuria of unclear significance (BUS) to capture patients who do not clinically meet criteria for ASB or UTI (eg, older adults who present with delirium and bacteriuria). The newly defined categories were compared to current guideline-based categories. We further compared ASB, BUS, and UTI categories using a lower bacterial threshold of 1,000 colony-forming units. Results: In total, 220,531 encounters met study criteria. After using a random number generator and removing duplicates, 3,392 encounters were included. Based on current IDSA guidelines, the prevalence of ASB was 32.1% (n = 975), and prevalence of patients with “not UTI” was 1,614 (53%). Applying the expert panel’s new “continuum of UTI” definitions, the prevalence of “not UTI” patients decreased to 1,147 (37.7%), due to reassignment of 467 patients (15.3%)to LUTS. The prevalence of ASB decreased by 24% due to reassignment to BUS. Lowering the bacterial threshold had a slight impact on the number of definitive UTIs (14.9 vs 15.9%) (Table 1). Conclusions: Our rigorous review of laboratory and symptom data from a diverse population dataset revealed that diagnostic uncertainty exists when assessing patients with suspicion for UTI. We propose moving away from dichotomous approach of ASB versus UTI and using the “continuum of UTI” for stewardship conversations. This approach will allow us to develop nuanced deprescribing interventions for patients with LUTS or BUS (eg, watchful waiting, shorter course therapy) that account for the unique characteristics of these populations.Disclosures: None

Intriguing case of fistula-in-ano presenting as corpora spongiosum abscess

A 77-year-old male, with a known history of diabetes mellitus for 10 years on alternative medication, known case of chronic constipation with hemorrhoids, and chronic lower urinary tract symptoms for many years, presented to the emergency with fever and chills for 2 days followed by acute urinary retention, which was relieved by insertion of Foley’s catheter. Eventually, he developed pain in the perianal region along with perianal discharge. On clinical examination, fistula-in-ano was evident. Magnetic resonance imaging was done for further evaluation which revealed fistula-in-ano communicating into a large abscess of corpus spongiosum of penis.

Characterization of the Interstitial Cystitis/Bladder Pain Syndrome Microbiome in Clinically Diagnosed Patients

Aim: Ongoing research in the urinary disease field suggests that a subset of patients with bladder pain and incontinence may have an infection as the cause of those clinical features, which may be difficult to diagnose by standard testing. Shotgun metagenomics sequencing (smNGS) provides a comprehensive way to identify infectious agents, namely, viruses, fungi, or bacteria, one possible cause that may be responsible for Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). Methods: DNA was extracted from these samples and sequenced by combining KAPA HyperPlus library construction with next generation sequencing (Nextseq500, Illumina). Reads were analyzed using Xplore-Patho®, an analytical system that permits the detection of 37,000+ microorganisms, including over 12,000 known pathogens. Results: Urine samples were collected from 49 clinically diagnosed IC/BPS. Additionally, controls urine samples were collected from 13 individuals without chronic lower urinary tract symptoms. Comparisons in diversity between the IC/ BPS and control groups were performed. Of the 41 female patients who were diagnosed with IC/BPS, 35 had signs of infection with a microbial signature for IC/BPS, including the presence of Proteobacterium, BK and JC viruses (Betapolyomavirus), and higher fungal loads. The alpha diversity differences between the female IC/BPS and female control groups were not statistically significant (p = 0.18). In contrast, the beta diversity was found to be different between female IC/BPS and control groups using Kruskal-Wallis ANOVA (p = 2.33e-14). Conclusion: Culture, PCR, antigen, or antibody-based standard urine tests cannot comprehensively screen for the infectious causes of IC/BPS. We present an all-inclusive, unbiased smNGS approach that helped unravel the infectious causes of IC/BPS. This new tool can help clinicians treat their patients in a more timely and effective manner.

Quality of Life of Saudi Women With Chronic Lower Urinary Tract Symptoms.

Background Chronic lower urinary symptoms (LUTS) are reported to affect more than half of women of all ages and have a significant impact on their quality of life (QoL). We aimed in this study to assess the QoL of adult Saudi women with chronic LUTS. Methods A cross-sectional study was done on 390 female patients diagnosed with LUTS at three tertiary care hospitals in Riyadh, Saudi Arabia, from October to December 2021. LUTS are classified into three categories: symptoms related to bladder storage (increased daytime frequency, nocturia, and urinary incontinence [UI]), symptoms of bladder voiding (hesitancy, extended micturition time, and insufficient emptying), and symptoms involved in the post-urination phase such as post-micturition dribbling. The data was collected using a self-administered questionnaire which comprised demographic characteristics, International Prostate Symptom Score (IPSS) for assessment of LUTS severity, and King's Health Questionnaire (KHQ) for assessment of QoL. Results After analyzing the study results, we found that symptoms were mild, moderate, and severe in 11%, 51%, and 39% of participants, respectively. Increased age and parity were found to have a significant association with increased symptom severity (p-value <0.05). The current study reported a moderate effect of LUTS on QoL. There was a significant correlation between increased symptom severity and negative impact on QoL, excluding the personal relationships domain. The highest scores in KHQ, which indicate worse QoL, were found in the domains of incontinence impact and emotions, while the lowest scores, which indicate better QoL, were found in the domains of social limitations and severity measures. Employed females were found to have worse QoL in the severity measures domain, which refers to the degree of urinary symptoms affecting day-to-day functioning. In addition, younger age, below 45 years, was found associated significantly with better QoL, especially in the domains of general health, personal relationships, and severity measures. Conclusion In the current study, the majority of patients reported moderate symptoms severity. Chronic LUTS have a significant impact on the QoL of Saudi women in many aspects, including physical, social, and emotional health, especially for those who have moderate to severe symptoms. Healthcare providers should assess high-risk women for the presence of LUTS. Furthermore, we recommend evaluating the QoL of patients with LUTS as a part of routine management.

Prevalence and Predictors of Bladder Outlet Obstruction in Women With Chronic Urinary Symptoms and a History of Urethral Sling Surgery.

The objective of this study is to review patients with chronic urinary symptoms and remote urethral sling surgery to determine the prevalence and predictors of obstruction. A single-center retrospective review was performed on patients referred with chronic lower urinary tract symptoms (>6 months) and a history of urethral sling surgery. Obstruction was identified by urodynamics using the Blaivas criteria or fluoroscopy. Clinical findings for patients with and without obstruction were compared. Logistic regression was applied to identify predictors of urodynamic obstruction. The need for sling revision and post-revision outcomes were evaluated. In total 105 patients were included, median age 61 years (IQR 19), median time since sling surgery 5.0 years (IQR 8). Sixty percent (63/105) met the definition for obstruction. Patients with obstruction had higher mean detrusor pressure at maximum urinary flow rate (35 vs 19 cm H2O) and lower maximum urinary flow rate (6.0 vs 14 mL/s; P < .05). A tight suburethral band and increased post-void residuals were significantly associated with urodynamic obstruction (P < .05). Fifty-nine (59/105; 56%) patients underwent suburethral sling excision. The incidence of improvement in storage and voiding symptoms at 6 months was 43% and 87%, respectively. At 30 months post-excision, the probability of being incontinence-free was 56% (95% CI 41, 69) and the probability of being free from redo sling surgery was 75% (95% CI 55, 87). Obstruction is common in patients with chronic urinary symptoms and history of urethral sling surgery. Patients undergoing sling revision should be observed for persistent storage symptoms and recurrent incontinence.

A Multidisciplinary Approach to Improving Incidence Rates of UTI at a Post Acute and Long Term Care Setting

Among patients aged 65 and older, urinary tract infection (UTI) is the most common diagnosis for antibiotic use in nursing homes. Asymptomatic bacteriuria (ASB) comprises a large portion of suspected UTI. Older adults are at increased risk of adverse events from unnecessary antibiotic use. However, clinicians find it difficult to distinguish UTI from ASB, especially in older adults who are likely to have chronic lower urinary tract symptoms, neurocognitive impairments, atypical and nonspecific symptoms.

Hypothyroidism is prevalent among adult women with chronic lower urinary tract symptoms.

To define the prevalence of hypothyroidism in women with chronic lower urinary tract symptoms (LUTS) and to compare the severity of each symptom between patients with hypothyroidism and controls. In this prospective observational study, we screened all adult women who came to the urology clinic between March 2017 and September 2020, and enrolled patients with chronic LUTS in the study. We assessed thyroid function. We evaluated the severity of voiding and storage urinary symptoms by the International Prostate Symptom Score. We also assessed the severity of urge urinary incontinence (UUI) and stress urinary incontinence (SUI). For between-group analysis, we selected age-matched cases and controls and compared them regarding the distribution and severity of urinary symptoms. Seven hundred and twenty-five women with a mean age of 51.7 ± 14.0 years were included in the final analysis. Two hundred fifty-eight patients (35.6%) had hypothyroidism. Age-matched case and control groups consisting of 210 patients each were selected. There was no significant difference in the severity and distribution of voiding LUTS and UUI between the study groups (P values >0.05). The severity of storage symptoms was lower in patients with hypothyroidism (P = 0.04). Sixty-seven patients with hypothyroidism (31.9%) had SUI, which was significantly higher than controls (23.3%) (P = 0.03). More than one-third of women with chronic LUTS have hypothyroidism which is much more frequent than in the general population. We also suggest a possible relationship between hypothyroidism and the severity of SUI and an inverse relationship between hypothyroidism and storage symptoms.

Association between lower urinary tract symptoms (LUTS) and obsessive-compulsive disorders (OCD) in women: A study based on urodynamic findings and micturition problem.

This study focused on women with chronic lower urinary tract symptoms (LUTS) who simultaneously suffered from obsessive-compulsive disorder (OCD) to evaluate the association between micturition abnormality and OCD. A cohort case study was conducted on 128 women with chronic LUTS who visited the academic clinic from 2012 to 2018. The participants with a history of OCD were grouped together, whereas the other group consisted of those with no psychiatric issues. Data were analyzed using the Kolmogorov-Smirnov test and also the nonparametric Kruskal-Wallis and χ2 tests. The participants with OCD had a lower mean age (41.7 vs. 48.8 years) and longer symptom duration than the control group. Moreover, voiding phase problems were more prevalent among OCD patients (mean voiding score: 9.3 vs. 6.9). Urge urinary incontinence (UUI) was the most common type of urinary incontinence in OCD patients, and the most important urodynamic study finding was bladder outlet obstruction (45% and 17% in the OCD and control groups, respectively). Voiding disorders resulted in chronic renal failure in two patients (3.12%). It was shown that bladder outlet obstruction (odds ratio (OR) 4.43, 95% confidence interval [CI] 1.53-12.78, p = 0.006] was the strongest predictor of OCD and stress urinary incontinence (OR 0.20, 95% CI 0.07-0.53, p < 0.001) was the best protector against OCD. The findings revealed that chronic LUTS was related to voiding dysfunction and urodynamic abnormality in OCD patients. These disorders may be categorized as somatoform disorder that requires appropriate treatments.

This Month in Adult Urology

This Month in Adult Urology

Mycoplasma and Ureaplasma Molecular Testing Does Not Correlate with Irritative or Painful Lower Urinary Tract Symptoms.

For patients with persistent irritative lower urinary tract symptoms, such as dysuria and urinary frequency, evaluation for the atypical organisms Ureaplasma and Mycoplasma has been a common part of care. However, these species are genitourinary colonizers and have not been established as causative pathogens in chronic lower urinary tract symptoms. We therefore sought to evaluate diagnostic testing patterns for Ureaplasma and Mycoplasma and characterize the associations of these bacteria with irritative lower urinary tract symptoms using molecular detection techniques. Ureaplasma/Mycoplasma testing patterns for 2019 were assessed using an anonymized data repository. Clean catch urine specimens (179) were collected prospectively from female and male patients with and without irritative lower urinary tract symptoms. Quantitative polymerase chain reaction evaluated urinary Ureaplasma and Mycoplasma DNA concentrations, while next-generation sequencing assessed the relative abundance of Ureaplasma and Mycoplasma within the urinary bacterial population. Ureaplasma/Mycoplasma testing was common, with 575 tests performed in 2019 in our community hospital system. In our cohort, Ureaplasma and Mycoplasma were identified in similar proportions in symptomatic and asymptomatic subjects: 25% of female controls and 27% of females with lower urinary tract symptoms and 9.5% of asymptomatic males and 3.3% of men with symptoms (p=0.87 and p=0.91 for females and males, respectively). Regression analysis revealed that both abundance and concentrations of Mycoplasmataceae correlated negatively with a range of irritative lower urinary tract symptoms, including dysuria and urethral pain. A statistically significant negative correlation of Ureaplasma/Mycoplasma levels with a variety of lower urinary tract symptoms suggests that polymerase chain reaction-based Mycoplasmataceae detection has little diagnostic benefit in assessment of chronic irritative urinary symptoms.

Foreign Bodies in the Urinary Bladder and its Management: a Single Centre Experience from North India

This study was done to assess the nature, clinical presentation, mode of insertion and management of intravesical foreign bodies treated at our hospital. Between January 2008 and December 2014, 49 patients had been treated for intravesical foreign bodies at King George Medical University, Lucknow. All records of these patients were retrospectively analysed for the nature of foreign body, clinical presentation, mode of insertion and its management. A total of 49 foreign bodies were retrieved from the urinary bladders during study period. The age of patients ranged from 11 to 68 years. Thirty-three presented with complaints of haematuria (67.3%), 29 complained of frequency of urination and dysuria (59.1%) and 5 patients had pelvic pain (10.2%) The circumstances of insertion were as follows: iatrogenic in 20 (40.8%) cases, self-insertion in 17 (34.6%), sexual abuse in 4 (8.1%), migration form other organ in 4 (8.1%) and assault in four (8.1%). Thirty-three (67.3%) foreign bodies were retrieved by cystoscopy, and transurethral cystolitholapaxy was required in 10 (20.4%) patients, percutaneous suprapubic cystolitholapaxy in 4 (8.1%) and holmium laser lithotripsy in 2 patients (4.08%). Foreign bodies should always be kept in the differential when accessing a patient presenting with chronic lower urinary tract symptoms. A large percentage of foreign bodies can be retrieved using endoscopic techniques. Open surgical removal is done in cases where endoscopic techniques are unsuitable or have failed.

Utility of DNA Next-Generation Sequencing and Expanded Quantitative Urine Culture in Diagnosis and Management of Chronic or Persistent Lower Urinary Tract Symptoms.

Many patients suffer from chronic, irritative lower urinary tract symptoms (LUTS). The evaluation and management of these patients have proven difficult with the use of standard diagnostic tools, including urinalysis and urine culture. The growing body of literature on the urinary microbiome has looked at the possible implications of the bladder microbiome and dysbiosis, or perturbations in the microbiome, in conditions associated with chronic LUTS. Disorders such as recurrent urinary tract infections (UTIs) and interstitial cystitis have been studied utilizing 16S rRNA rapid next-generation gene sequencing (NGS) and expanded quantitative urine culture (EQUC). In this article, we first present a brief review of the literature describing the current understanding of the urinary microbiome and the features and applications of NGS and EQUC. Next, we discuss the conditions most commonly associated with chronic, persistent LUTS and present the limitations of current diagnostic practices utilized in this patient population. We then review the limited data available surrounding treatment efficacy and clinical outcomes in patients who have been managed based on results provided by these two recently established diagnostic tools (DNA NGS and/or EQUC). Finally, we propose a variety of clinical scenarios in which the use of these two techniques may affect patients' clinical outcomes.

The Relationship between Chronic Lower Urinary Tract Symptoms and Psychological Disorders in Women Referring to Baqyiatallah Hospital Clinic in Tehran City

Introduction: Lower urinary tract symptoms (LUTS) refer to a group of medical symptoms with the prevalence of 62.5% in men and 66.6% in women. LUTS (Lower Urinary Tract Symptoms) was associated with increased risk of having clinically relevant depressive symptoms or depression and vice versa. We assumed that patients with chronic lower urinary tract symptoms who referred to urology clinic and have negative urologic evaluations, may suffer from psychological symptoms such as anxiety, depression or obsession. &#x0D; Methods and Materials: This was a cross-sectional, single group survey of women living in Tehran province. Patients who were suffering from lower urinary tract symptoms for over than 6 months, were included in the study. We evaluate the presence of LUTS by asking the patients about their problems of urinary tract in two major categories: Filling or irritative symptoms - e.g. frequency, urgency, dysuria, nocturia, stress incontinence, urge incontinence. Chi square and independent T tests were used to evaluate the correlation between study variables. All statistical analysis was performed using SPSS software version 16.&#x0D; Results: There was a positive correlation between irritative symptoms and depression symptoms (p‹0.001) and a negative correlation between obstructive symptoms and depression (p‹0.001). There was no association between LUTS and symptoms of OCD (Obsessive- Compulsive disorder). The mean age of participants with positive BDI (Beck depression inventory) was higher than those with negative BDI. (p= 0.007).&#x0D; Discussion: The results of this study emphasized the important association of LUTS and depression. In conclusion, depressive disorder can increase the risk of developing LUTS or accelerate this process. So when a patient with either urinary or depression symptoms referred to a psychiatry center, he should be screened for the other disease. This requires an adequate interaction between urology and psychiatry departments to achieve.

Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection.

Midstream urine (MSU) culture remains the gold standard diagnostic test for confirming urinary tract infection (UTI). We previously showed that patients with chronic lower urinary tract symptoms (LUTS) below the diagnostic cutoff on MSU culture may still harbor bacterial infection and that their antibiotic treatment was associated with symptom resolution. Here, we evaluated the results of the United Kingdom's MSU culture in symptomatic patients and controls. Next, we compared the bacterial enrichment capabilities of the MSU culture with those of a 50-µl uncentrifuged culture, a 30-ml centrifuged sediment culture, and 16S rRNA gene sequencing. This study was conducted on urine specimens from 33 LUTS patients attending their first clinical appointment (mean age, 48.7 years; standard deviation [SD], 16.5 years), 30 LUTS patients on treatment (mean age, 47.8 years; SD, 16.5 years) whose symptoms had relapsed, and 29 asymptomatic controls (mean age, 40.7 years, SD, 15.7 years). We showed that the routine MSU culture, adopting the UK interpretation criteria tailored to acute UTI, failed to detect a variety of bacterial species, including recognized uropathogens. Moreover, the diagnostic MSU culture was unable to discriminate between patients and controls. In contrast, genomic analysis of urine enriched by centrifugation discriminated between the groups, generating a more accurate understanding of species richness. In conclusion, the United Kingdom's MSU protocol misses a significant proportion of bacteria, which include recognized uropathogens, and may be unsuitable for excluding UTI in patients with LUTS.

Internal Urethrotomy in Treatment of Female with Anatomical Bladder Outlet Obstruction.

Background:Bladder outlet obstruction (BOO) is a relatively infrequent urologic condition in women, but can cause bothersome symptoms. In this article, transurethral incisions of the bladder neck (TUIBN) and urethra in the treatment of anatomical BOO were assessed.Materials and Methods:A total of 23 women who referred with chronic lower urinary tract symptoms, urinary retention, and difficulty in micturition were assessed. Diagnose was made on the basis of urethrocystoscopy, voiding cystourethrography, and urodynamic studies. All patients underwent transurethral incisions of bladder neck contracture or site of observed urethral stenosis at 3- and 9-o'clock positions. Clinical improvements and complications were assessed by follow-up examination and International Prostate Symptom Score (IPSS) and quality of life (QOL) scoring before and after intervention.Results:All patients were followed for at least 6 months after intervention. Follow-up data were available for 19 (90.5%), 13 (61.9%), and 7 (33.3%) of patients at 12, 24, and 48 months' follow-up, respectively. During the follow-up period, the mean IPSS and QOL significantly changed from 26.84 to 10.74 and 4.76 to 2.32, respectively (P < 0.001). Approximately 66.7% had satisfactory outcomes, 47.7% patients after first, and 19.1% after second TUI. About9.5% patients developed new onset of stress urinary incontinence, one of them had indications of surgical intervention, and thus, symptoms were relieved by mid-urethral sling.Conclusion:Transurethral incision of bladder neck and urethra seems to be effective in relieving urinary symptoms of anatomical BOO in women. Complications may rarely occur and can be fully managed.

Lower urinary tract symptoms that predict microscopic pyuria

Introduction and hypothesisUrinary dipsticks and culture analyses of a mid-stream urine specimen (MSU) at 105 cfu ml−1 of a known urinary pathogen are considered the gold standard investigations for diagnosing urinary tract infection (UTI). However, the reliability of these tests has been much criticised and they may mislead. It is now widely accepted that pyuria (≥1 WBC μl−1) detected by microscopy of a fresh unspun, unstained specimen of urine is the best biological indicator of UTI available. We aimed to scrutinise the greater potential of symptoms analysis in detecting pyuria and UTI.MethodsLower urinary tract symptom (LUTS) descriptions were collected from patients with chronic lower urinary tract symptoms referred to a tertiary referral unit. The symptoms informed a 39-question inventory, grouped into storage, voiding, stress incontinence and pain symptoms. All questions sought a binary yes or no response. A bespoke software package was developed to collect the data. The study was powered to a sample of at least 1,990 patients, with sufficient power to analyse 39 symptoms in a linear model with an effect size of Cohen’s f2 = 0.02, type 1 error probability = 0.05; and power (1-β); 95% where β is the probability of type 2 error). The inventory was administered to 2,050 female patients between August 2004 and November 2011. The data were collated and the following properties assessed: internal consistency, test–retest reliability, inter-observer reliability, internal responsiveness, external responsiveness, construct validity analysis and a comparison with the International Consultation on Incontinence Modular Questionnaire for female lower urinary tract symptoms (ICIQ-FLUTS). The dependent variable used as a surrogate marker of UTI was microscopic pyuria. An MSU sample was sent for routine culture.ResultsThe symptoms proved reliable predictors of microscopic pyuria. In particular, voiding symptoms correlated well with microscopic pyuria (χ2 = 88, df = 1, p < 0.001). The symptom inventory has significant psychometric characteristics as below: test–retest reliability: Cronbach’s alpha was 0.981; inter-observer reliability, Cronbach’s alpha was 0.995, internal responsiveness F = 221, p < 0.001, external responsiveness F = 359, df = 5, p < 0.001. The correlation coefficients for the domains of the ICIQ-FLUTS were around R = 0.5, p < 0.001.ConclusionThis symptoms score performed well on the standard, psychometric validation. The score changed in response to treatment and in a direction appropriate to the changes in microscopic pyuria. It correlated with measures of quality of life. It would seem to make a good candidate for monitoring treatment progress in ordinary clinical practice.

Pelvic gossypiboma with spontaneous intravesical erosion

A 23-year-old man presented with chronic lower urinary tract symptoms and right flank pain. He had undergone ureterolithotomy a few years ago. Ultrasonography and CT of the abdomen and pelvis...

Factors related to receipt of non-cancer-related transurethral prostatectomy: findings from a large prospective study of 106 769 middle-aged and older Australian men

BackgroundTransurethral prostatectomy (TURP) is a common surgical intervention for chronic lower urinary tract symptoms (LUTS). Little large-scale evidence exists on factors related to receipt of non-cancer-related TURP.MethodsA prospective study of...