Evaluation Of Lower Urinary Tract Symptoms Research Articles

Can we increase the value of data from bladder diaries? International Consultation on Incontinence-Research Society 2023.

Bladder diaries represent a fundamental component in the assessment of patients presenting with lower urinary tract symptoms. Nevertheless, their importance often remains underappreciated and undervalued within clinical practice. This paper aims to conduct a comprehensive review of the existing literature concerning the utility of bladder diaries, underscore the criticality of their precision, elucidate the factors contributing to noncompliance with bladder diary completion, and investigate potential strategies for enhancing patient compliance. A review of the English-language scientific literature available in the domains of Medline, Embase, Emcare, Midirs, and Cinahl was conducted. This was supplemented by discussion at the International Consultation on Incontinence Research Society Proposal session to define knowledge and identify gaps in knowledge surrounding the utility of bladder diaries. The existing evidence and outcome of the relevant discussion held in the meeting are presented. Bladder diaries (BD) serve to characterize the nature and severity of storage lower urinary tract symptoms (LUTS) and provide an objective record of an individual's urination patterns. They aid in the refinement and customization of treatment strategies based on the clinical responses documented in the diary, optimizing treatment outcomes. Notably, both BD and urodynamic studies (UDS) play complementary yet distinct roles in LUTS evaluation. BD offers a more comprehensive and accessible approach to assessing specific storage LUTS, particularly due to their affordability and widespread availability, especially in resource-limited settings. Nevertheless, the absence of a standardized BD format across global healthcare systems presents a significant challenge. Despite being recognized as reliable, noninvasive, validated, and cost-effective tools for evaluating patients with LUTS, the implementation and completion of BD have proven to be complex. The introduction of automated bladder diaries heralds an era of precise, real-time data collection, potentially enhancing the patient-clinician relationship. Completion of bladder diaries depends on an array of individual, social, and healthcare-specific factors. Compliance with bladder diary completion could be enhanced with clear instructions, patient education, regular follow-ups and positive re-enforcement. This study has identified four critical areas for future research: Addressing healthcare disparities between affluent and developing nations, enhancing the current functionality and effectiveness of bladder diaries, exploring the feasibility of incorporating bladder diaries into the treatment and education process and improving the quality and functionality of existing bladder diaries. Bladder diaries play a pivotal role in the evaluation and management of patients with LUTS, providing a holistic perspective. When their complete potential is harnessed, they have the capacity to revolutionize the paradigm of LUTS management, ushering in a patient-centered era of care.

The association of lower urinary tract symptoms with schizophrenia and its treatments: A narrative review.

A higher incidence of lower urinary tract symptoms (LUTS) in people with schizophrenia compared to the general population is often suggested. However, it is not clear whether this is a genuine association, and whether it is a direct result of schizophrenia itself, or a side-effect of certain antipsychotics. We undertook a narrative review evaluating how the published literature reports the relationship between LUTS and schizophrenia and its treatments. We searched Embase, Ovid Emcare, and Ovid MEDLINE(R) ALL to August 2022, limited to the English language. We selected the following search terms: schizophrenia, schizophrenic, LUTS, overactive bladder, urinary urgency, urinary incontinence, overactive bladder, enuresis, nocturnal enuresis, and voiding dysregulation. We identified seven domains for assessment in advance of commencing the review. These were the categorization, description, and treatment status of schizophrenia; evaluation of LUTS; categorization of LUTS confounders; recapturing of the disease states of both schizophrenia and LUTS after therapies; assessment of the association between LUTS and schizophrenia and/or antipsychotics. The association between LUTS and schizophrenia was poorly described. The evidence was low quality and focused predominantly on urinary incontinence as an antipsychotic side effect, neglecting other LUTS. The status of schizophrenia was often incompletely characterized, and no papers made use of a bladder diary or LUTS-specific questionnaires to assess symptoms. No papers collected information about LUTS in patients not on antipsychotics, nor did any thoroughly evaluate the influence of confounding variables. Despite the tendency of symptoms and severity of both conditions to fluctuate over time, no studies fully assessed the status of both schizophrenia and LUTS at baseline, therapy initiation, and follow-up. It is not possible to state whether there is an association between LUTS and schizophrenia or its treatments. This review highlights the need to improve research and clinical management of the urinary tract in schizophrenia, with meticulously designed longitudinal studies.

Lower Urinary Tract Symptoms in Patients With Chronic Low Back Pain: A Cross-Sectional Study.

This study aimed to determine the extent of lower urinary tract symptoms (LUTS) in patients with chronic low back pain (CLBP) and the relationship between LUTS and patients' clinical and functional factors. Patients aged 40 to 80 who were admitted with CLBP were included. Demographic data and the duration of CLBP and LUTS were noted. Anteroposterior and lateral lumbar radiographs and lumbar MRI findings were recorded. Short Form 36 (SF-36) and the Oswestry Disability Index (ODI) were used for functional status assessment. For the LUTS evaluation, patients were asked to tick the symptoms from the list of LUTS prepared. We included 90 patients with CLBP. The frequency of urinary incontinence was 81.1%. The mean number of LUTS was 2.81±3.22. The LUTS rates were higher in patients with vertebral height loss (p = 0.03), with central (p = 0.02) and lateral spinal narrow canals (p = 0.03), and with facet hypertrophy (p = 0.04). The rates of LUTS were lower in patients with decreased lumbar lordosis (p = 0.02). The ODI and LUTS were found to be related (p = 0.01). The role limitations due to physical problems of the SF-36 subgroups and LUTS were significantly correlated (p = 0.01). The incidence of the coexistence of CLBP and LUTS is high. Patients cannot match and report LUTS among their complaints, so physicians should inquire about LUTS in patients with CLBP and carry out the appropriate diagnosis and treatment.

Advanced Sensoring Technologies for Evaluation and Management of Lower Urinary Tract Symptoms

AbstractNowadays, urination dysfunction caused by lower urinary tract symptoms (LUTS) has been a nonnegligible issue owing to its influences on patients’ physical and mental health, and in particular, the detection of the urination process and analysis of the urine samples of the patients have been the priority for diagnosis and treatment of LUTS. In this article, the existing perception of LUTS, such as the etiologies of LUTS and current approaches for LUTS evaluation in the clinic, is systematically summarized. Furthermore, several novels lower urinary tract (LUT) status‐sensing systems used for monitoring physiological indexes, including intravesical pressure, urine flow rate, residue urine volume, bladder volume, and biomarkers in urine, are introduced. It is believed that this presentation will make a contribution to deepening the comprehension of LUTS and promote the development of rapid, accurate, and convenient LUT testing techniques.

MRI of Benign Prostatic Hyperplasia: Important Pre- and Posttherapeutic Considerations

New minimally invasive techniques that reduce morbidity while improving lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) have become attractive alternatives for patients, in comparison to traditional techniques such as transurethral resection of the prostate (TURP) and simple prostatectomy. Pre- and postprocedural MRI is not routinely performed for LUTS due to BPH treatments. However, because of the combination of rapidly evolving treatments available for LUTS due to BPH and increasing demand for prebiopsy prostate MRI for detection of clinically significant prostate cancer (PCa), an understanding of procedural techniques and expected changes are important for accurate interpretation of prostate MRI performed after treatment of BPH. The authors discuss the imaging evaluation of LUTS due to BPH and emerging predictors of treatment success. The posttreatment appearance and underlying anatomic changes in the prostate after medical, surgical, and minimally invasive treatments including TURP, simple prostatectomy, laser enucleations and ablations, prostatic urethral lift, water vapor thermal therapy, and prostate artery embolization are detailed. Most procedures reduce prostate volume, notably in the periurethral prostatic tissue. Ablations create areas of necrosis and can distort the normal zonal anatomy between the transition zone and the peripheral zone, and prostate artery embolization creates infarcts in the transition zone. Mechanical prostatic urethral lift devices open the anterior channel at the bladder base but create susceptibility artifacts that can obscure and prevent detection of a lesion in the transition zone. Also discussed are the detection of clinically significant prostate cancer in the postprocedural prostate and imaging of BPH procedure complications such as urethral strictures, abscesses, and hematuria. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material. See the invited commentary by Purysko in this issue.

The spectrum and etiologies of lower urinary tract symptoms in postmenopausal women.

Although the prevalence of lower urinary tract symptoms (LUTS) is high in the female population, it is even higher in postmenopausal females. The frequency, severity, and etiology of LUTS vary among populations and individuals. This study aimed to define the characteristics of LUTS in postmenopausal women and their underlying etiologies. Overall, 74 postmenopausal patients presenting with LUTS in the urological outpatient department were included in the study. A detailed evaluation of LUTS and their underlying etiologies was performed. Patients were divided into 2 groups based on age (<65 and ≥65 years), and the variation in different factors was compared across the groups. Variables were compared using the t test and 1-way analysis of variance. Nocturia was the most common symptom (89.2%) followed by frequency (83.8%). Among voiding LUTS, the most common was a weak stream (63.5%). Frequency, nocturia, urgency, urge urinary incontinence (UI), stress UI, and nocturnal enuresis were more common in patients older than 65 years. Urgency and urge UI were recognized to be the most bothersome symptoms by 37% of the study population followed by straining (32%). The mean storage scores, incontinence scores, and quality of life (QoL) scores for patients younger than 65 years and 65 years or older were 6.9 and 8.5 (p < 0.01), 1.8 and 4.1 (p ≤ 0.01), 4.9 and 6.1, respectively. The most common diagnosis was bladder outlet obstruction due to urethral/meatal stenosis (40.5%) followed by an overactive bladder (32.4%), urinary tract infection (10.8%), cystocele (8.1%), urethral prolapse (4.1%), and urethral caruncle (4.1%). Storage LUTS were the most common and increased in both frequency and severity with age. The QoL was also more severely affected in older postmenopausal women. Bladder outlet obstruction due to meatal with or without distal urethral stenosis was the most common underlying cause of LUTS followed by an overactive bladder. Overactive bladder had the most severe impact on patients' QoL among all the etiologies.

Prostatic zonal parameters and lower urinary tract symptoms as quantified via magnetic resonance imaging.

Benign prostatic hyperplasia (BPH) is a common diagnosis among aging males; however, the relationship between prostate volume and lower urinary tract symptoms (LUTS) severity is imperfect. The goal of this study was to comprehensively investigate the relationship between various prostate zone-based parameters measured using magnetic resonance imaging (MRI) and LUTS. Data were retrospectively collected for 144 patients who underwent MRI between 2015 and 2017 at a single institution. Prostate volumes were measured on sagittal and axial T2 weighted using the prostate ellipsoid formula. Only transition zone thickness (TZT) correlated with International Prostate Symptom Score (IPSS) (Pearson's=0.33; p=0.007). The intraprostatic protrusion (IPP) component (rho 0.261; p=0.036), transitional zone volume (TZV) (rho 0.264; p=0.034), and TZT (Pearson's correlation 0.422; p<0.001) all correlated with worsening QoL scores. In total, 97.9% of men had the presence of an IPP (>0 mm) and larger IPPs were found in older men with higher postvoid residual volumes. Larger peripheral zone volume (PZV) (odds ratio [OR] 3.62, 95% confidence interval [CI] 1.07-12.30, p<0.05), TZV (OR 6.00, 95% CI 1.69-21.35, p<0.05), and TZT (OR 4.00, 95% CI 1.17-13.69, p<0.05) were predictive of developing severe LUTS; however, IPP (p=0.122) was not. TZV, TZT, and IPP all demonstrated a role in the evaluation of LUTS with predictive capabilities. IPP is very common but not always clinically significant. Clarifying more precise zonal parameters and their relationship with LUTS may ultimately help clinicians guide the need for surgical intervention more precisely.

Evaluation of LUTS of the filling phase after Aquablation: A prospective single center experience

IntroductionThis study aims to assess our first clinical experience with Aquablation in terms of perioperative and 1-year micturition outcomes, with a focus on postoperative lower urinary tract symptoms (LUTS).Materials and methodsFrom 10/2018 to 07/2021, patients referred to our center with BPH-related LUTS, International Prostate Symptom Score (IPSS) ≥10, maximum urinary flow rate (Qmax) ≤12 ml/s, and prostate volume &amp;lt;80 ml were enrolled in this prospective study to undergo Aquablation. Demographics, perioperative data, and complications (according to the Clavien–Dindo system) were collected. Functional outcomes were assessed at 1, 3, 6, and 12 months with IPSS, IPSS quality of life (IPSS QoL), uroflowmetry, and evaluation of post void residue (PVR). The types of LUTS were classified on the basis of IPSS single question answers in filling phase LUTS and voiding phase LUTS.ResultsSixty patients were enrolled in the study. The mean patient age was 64.9 ± 7.3 years, prostate volume was 63.5 ± 16.8) ml, Qmax was 8.4 ± 2.6 ml/s, the median (IQR) IPSS was 23 (19–26), and the IPSS QoL score was 5 (4–5). The mean Qmax at 1, 3, 6, and 12 months was 21.1 ± 11, 18.1 ± 5.4, 17.1 ± 6, and 17.8 ± 6.6 ml/s, respectively. The median IPSS urinary symptom score was 2 (2–5) one year after surgery. In parallel, the median IPSS QoL score and mean PVR reached 1 (0–1) and 23.6 ml (25.5) in the 12th month. At 1- and 3-month follow-up, filling phase symptoms were predominant in almost two-thirds of the study population. Within the patients who reported a prevalence of filling phase symptoms at 3 months, 27 of 38 (71%) reported a de novo onset of these symptoms after surgery.ConclusionAquablation is a safe procedure for treating BPH-related LUTS, and it has been demonstrated to be effective up to 12 months after the procedure. LUTS of the filling phase were more prevalent than voiding phase ones in the first 3 months following surgery, but showed a self-limited fashion.

Anatomical and symptomatic outcomes in patients with Le Fort colpocleisis with or without hysterectomy

BackgroundWe aimed to evaluate the short-term anatomical and clinical outcomes of elderly patients who underwent the Le Fort colpocleisis operation due to pelvic organ prolapse (POP) in our clinic.MethodsThe medical records of fifty-nine sexually inactive females, with stage 2 or higher vaginal or uterine prolapse who underwent Le Fort colpocleisis operations were prospectively analysed. Preoperative and 12th month postoperative data were recorded. Lower urinary tract symptoms (LUTS) was also evaluated preoperatively and 12 months postoperatively in all patients. Anatomical success was determined as no prolapse of any POP-Q point at or below 1 cm above vaginal introitus.ResultsA total of 59 patients were included in this study. The average age of the patients was 71.67 ± 7.01 (years). The mean BMI was 27.1 ± 9.52 kg/m2. POP-Q point, C (6.70 ± 2.44 vs. − 2.66 ± 1.21) measurements were significantly deeper, as well as Gh (4.83 ± 0.94 vs. 4.26 ± 0.94) and TVL (3.51 ± 1.24 vs. 8.93 ± 1.73) measurements were significantly higher after surgery than during the preoperative period (p < 0.01, p < 0.01, p < 0.01, respectively). There were no cases of recurrence. The evaluation of LUTS at the 12-months postoperative follow-up revealed significant differences for SUI, urinary frequency, nocturia, and pelvic pain symptoms (p = 0.007, p < 0.001, p = 0.01, p < 0.001, respectively).ConclusionsLe Fort colpocleisis is a simple and effective procedure that provides successful anatomical and clinical outcomes in sexually inactive and elderly women with POP. However, the long-term results of this procedure need further investigation.

Evaluating the Lower Urinary Tract Syndrome with a Telemedicine Application: An Exploration of the Electronic Audiovisual Prostate Symptom Score.

BackgroundThe Visual Prostate Symptom Score (VPSS) is used for the assessment of lower urinary tract symptoms (LUTS). It is usually administered by general practitioners (GPs), but in these cases, outcomes do not seem to be reflecting the real conditions of a patient well, with consequent risks of misestimations and misinterpretations. We developed an electronic audiovisual version of VPSS (EPSS), a new symptom scale based on a telemedicine mobile light-based app. The aim of this study is to test and evaluate its reliability.MethodsWe enrolled male patients aged between 50 and 80 years across 24 community-based healthcare facilities in Guangzhou, China. Patients were asked to complete the Chinese version of VPSS and EPSS before consultation with the urology specialists. Patients were divided into two groups based on age. First, we analyzed the rate of full understanding of EPSS using a chi-square test. Then, we analyzed the difference between each score of EPSS, VPSS, and outcomes measured by specialists, used as the reference score (RS). Finally, the outcomes were analyzed with the Spearman test and Bartlett test separately.ResultsSeventy-nine male patients were included (mean age 70.42 years). Patients were divided into two groups: group 1 (>70 years, n = 40) and group 2 (<70 years, n = 39). The full-understanding rates in groups 1 and 2 were 50% and 64.1%, respectively. No significant differences were noted between groups (p = 0.206). A t-test was presented between each question of VPSS, EPSS, and RS. All questions did not display significant differences (p > 0.05); total scores from the three scales had no significant differences in the evaluation of LUTS. We further explored the variations of choices made by patients in different scales. Spearman’s test among VPSS, EPSS, and RS showed positive correlations, and coefficients of the total score were 0.92, 0.91, and 0.93 (p < 0.05).ConclusionEPSS can be easily used in a significant number of patients and showed correlation with the VPSS and RS. Moreover, certain items resulted in better performance than VPSS. The results showed that EPSS could be a valuable option for both patients and GPs monitoring LUTS and particularly helpful when teleconsultations are considered, especially during the COVID-19 pandemic.

Association between Urodynamic and Cystoscopic findings in Women with Bothersome Lower Urinary Tract Symptoms: A Prospective Observational Study

Introduction: Lower Urinary Tract Symptoms (LUTS) are responsible for negative impact on quality of life of women. Urodynamic Study (UDS) is gold standard objective investigation in evaluating bothersome LUTS. Cystoscopy is important where UDS is difficult or unavailable. Despite vital role and unique properties of UDS and cystoscopy, the role of UDS and cystoscopy in the assessment of bothersome LUTS in young females continues to be heavily debatable subject as there is limited study in this age group. Aim: To evaluate causes of LUTS in young female patients and associate them with urodynamic and cystoscopic findings. Materials and Methods: This was a prospective observational study conducted in IPGMER and SSKM Hospital, Kolkata, West Bengal, India, from July 2019 to December 2020. A total of 100 female patients from adulthood to menopause were evaluated having decreased quality of life due to LUTS called bothersome LUTS in the form of history taking, clinical examination, basic biochemical tests, ultrasonography followed by urodynamic and cystoscopic examination. Patients were classified according to their LUTS into three groups: storage dysfunction, urinary incontinence and bladder emptying dysfunction. Association of UDS parameters like Idiopathic Detrusor Overactivity (IDO), IDO with detrusor underactivity, Compensated Bladder Outlet Obstruction (CBOO) was made with cystoscopic findings like dilated veins with cystitis,lax urethra, bladder trabeculations,diverticula, urethral stricture. Results were analyzed using Microsoft Excel spreadsheet and International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 27.0. Results: In storage dysfunction group, frequency with nocturia (53.3%) and in urinary incontinence group, stress urinary incontinence (58.3%) was predominant bothersome symptom. In storage dysfunction group 73.3% patients had IDO and 26.7% patients had normal UDS findings. In these patients on cystoscopic examination, 83.3% patients had dilated veins with cystitis changes. In urinary incontinence group 70.8% patients had IDO and 29.2% patients had IDO with detrusor underactivity on UDS examination. In these patients cystoscopic examination 54.2% had lax urethra with cystitis changes. In bladder emptying dysfunction group on UDS examination, all patients had CBOO and 75% had urethral stricture on cystoscopy. Conclusion: Significant association exists between UDS and cystoscopic findings on evaluation of LUTS in young females patients. Storage dysfunction symptoms were the most common in young age group followed by urinary incontinence symptoms. Bladder emptying dysfunction symptoms were least common.

Visual Analogue Score for Urinary Symptoms-VASUS, validation of a visual scale for lower urinary tract symptoms (LUTS) in an African country.

Validate a visual scale to assess LUTS, especially in developing countries, as an alternative to IPSS. VASUS consist of five questions, where Q1 and Q2 assess urinary stream quality, Q3 nocturia, Q4 incomplete emptying and Q5 QoL. Between 2014 and 2017, we carried out a study in the male population over 30 years from São Tomé and Príncipe, a Portuguese speaking African Country. A stratified sample (age and district) of subjects completed IPSS, VASUS and a free flowmetry. We obtained 812 valid responses (average age: 50.72, range: 30-95years old). In the comparison between IPSS and VASUS, we found positive correlations, with p value < 0.0001, for all variables analyzed and negative correlation for all urodynamic variables. Upon verifying the association of VASUS with IPSS, namely when comparing questions with similar objectives such as nocturia (VASUS-Q3 and IPSS-Q7), the stream quality (VASUS-Q1 and Q2 and IPSS-Q5) or the quality of life (VASUS-Q5 and IPSS-Q8), strong positive correlations were found. VASUS is a visual alternative to IPSS allowing evaluation of LUTS and having correlation with IPSS and flowmetry. Its use in developing countries with low levels of literacy will be an asset. The authors believe that widespread use of a scale such as VASUS in urology consultations is warranted, to increase daily practice objectification of LUTS.

Polish versions of the ICIQ-FLUTS and the ICIQ-FLUTS LF: translation, adaptation, and validation of female-specific instruments for evaluation of lower urinary tract symptoms.

Previously, there was no specific questionnaire in the Polish language for overall assessment of lower urinary tract symptoms (LUTS) in women. The aim of this study was to translate, culturally adapt, and validate Polish versions of the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS and ICIQ-FLUTS LF, short and long forms) for use in clinical practice and research in Poland. The original English ICIQ-FLUTS and ICIQ-FLUTS LF were adapted to Polish according to international standards and recommended procedures. Adult women with LUTS who were seen at the Department of Urology at the Jagiellonian University, Krakow, Poland, completed the ICIQ-FLUTS and ICIQ-FLUTS LF at baseline and 2weeks later. Control participants completed the questionnaires once. Validity and reliability were determined. One hundred and eighty Polish-speaking women who had LUTS completed the questionnaires. Content validity was high. Significant differences between women with LUTS and controls for both ICIQ-FLUTS and ICIQ-FLUTS LF confirmed optimal construct validity. An intercorrelation analysis revealed that internal consistency was good for ICIQ-FLUTS and ICIQ-FLUTS LF (Cronbach's alpha >0.7). Test-retest reliability (reproducibility) demonstrated strong stability (intraclass correlation coefficient > 0.7). Floor and ceiling effects were absent from women with LUTS, whereas a floor effect was detected in the control group. The Polish ICIQ-FLUTS and ICIQ-FLUTS LF are valid, reliable, and consistent measures of overall evaluation of LUTS in women. They are equivalent to the original English versions, and they retained the psychometric properties of the original questionnaires.

Postoperatif Radyoterapi Sonrası Alt Üriner Sistem Semptomlarının Değerlendirilmesinde Ürodinaminin Rolü: Retrospektif Kesitsel Çalışma

Objective: The aim of this study was to evaluate lower urinary tract symptoms (LUTS) and urodynamic parameters in patients with prostate cancer who received adjuvant radiotherapy (ART) or salvage radiotherapy (SRT) following open radical prostatectomy (RP) or robot-assisted radical prostatectomy (RARP) by using urodynamic parameters. Material and Meth ods: Patients who were treated with ART or SRT following RP or RARP due to prostate cancer were included. International Consultation on Incon tinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and Inter national Prostate Symptom Score (IPSS) questionnaires were filled in for the evaluation of LUTS for each irradiated patient. Urodynamic parameters such as bladder pressure, maxi mum cystometric capacity, maximum urethral pressure, maximum urethral clo sure pressure used for diagnosis of intrinsic sphincteric deficiency (ISD), and urethral length were recorded. Results: Fifty patients had un dergone open RP, while 48 had undergone RARP. ART and SRT was applied with 55 and 43 patients, respectively.There was no significant difference between the groups in terms of IPSS and ICIQ-SF scores, urgency-related measurements and maximum cystometric capacity values. Findings in filling cystometry were not significant in comparison of both RP and radiotherapy technique (p>0.05). Maximum urethral closure pressure values were significantly higher in RARP recipients, the frequency of ISD was significantly higher in the open RP group, and ure thral length was longer in the RARP group. Conclusion: No significant differ ence was found in terms of LUTS in patients who underwent ART or SRT after RP. RARP had positive effects on functional urethral length, urethral clo sure pressures and ISD frequency, regardless of timing of radiotherapy.

Can We Link Vitamin D Deficiency to Benign Prostatic Enlargement? An Observational Case Control Study

Purpose: To study the association of prostatic volume, prostatomegaly grade and IPSS (International Prostate Symptom Score) with vitamin D deficiency if any. Materials and Methods: The study was conducted on 150 patients, 50 to 70 years of age. Patients presenting with LUTS (Lower Urinary Tract Symptoms) were randomly selected for the study. A diagnostic evaluation for LUTS was done in all the patients based on IPSS & clinical examination. Prostate volume was calculated using Ultrasonography (USG) and serum Prostate Specific Antigen (PSA) cut off of <4 ng/ml was considered for inclusion. Successively all the patients were tested for serum 25-hydroxyvitamin D 25(OH) D level. Patients diagnosed with vitamin D deficiency were classified as “study population” and those with normal vitamin D level were classified as controls”. Results: The median serum level of 25(OH) D in the participants was 18.95ng/ml. Vitamin D deficiency was detected in 70% of the participants. The study population had a significantly greater mean prostate volume of 41.32 ± 23.29 ml than 23.42 ± 8.62 in controls (P <0.001). The study population also had significantly greater prostatomegaly grade on DRE and IPSS than controls (P=0.001). Conclusion: Vitamin D deficiency is associated with higher prostate volume and IPSS score in patients with BPE. If further studies confirm this association, treatment of vitamin D deficiency may help to prevent or delay symptoms of BPE.

Lower urinary tract symptoms in men: challenges to early hospital presentation in a resource-poor health system

BackgroundThe point at which men seek medical care for lower urinary tract symptoms (LUTS) varies between individuals. Presentation to hospital with complications beyond LUTS appears prevalent in our setting. The aim of this survey is to assess from the community perspective in southeast Nigeria, the challenges to early presentation for medical evaluation for LUTS by men.MethodsA questionnaire-based cross-sectional survey of randomly-selected men ≥40 years. The questionnaire captured respondent’s age; presence, duration and severity of LUTS; access to health information; wealth-index; and when (and why) medical care for LUTS was sought. Analysis was with SPSS® version 20.ResultsIn all, responses from 1319 men (mean age 54.2 ± 10.2 years) are analysed. Of these, 267 report LUTS: 58.4% (156) report moderate to severe LUTS and 51.7% (138) are yet to seek medical care. As regards seeking medical care, all the men reporting LUTS of 3 months, 35.7% of 126 men reporting moderate LUTS, and 20.0% of 30 men reporting severe LUTS are yet to seek medical care. LUTS being non-bothersome (not financial constraint) is the most prevalent reason for not seeking medical care early. Delay is encouraged by limited access to health information (OR 3.10; p < 0.001), but discouraged by literacy (OR 0.86; p < 0.001) and aging (OR 0.93; p = 0.002).ConclusionFrom the community perspective, the prevalent challenge to seeking medical care for LUTS early is absence of bother. Empowering men through formal education and researched health information will influence positively the time that LUTS in men is appreciated as bothersome.

Transcultural adaptation and validation of the questionnaire "Urgency, Weak stream, Incomplete emptying and Nocturia (UWIN)" for the Brazilian Portuguese.

Lower urinary tract symptoms (LUTS) are common complaints in the adult male population and have a negative affect in the quality of life and represent an economic burden for the healthcare system worldwide. The International Prostatism Symptom Score (IPSS) is a validated tool for assessing these symptoms, but patients with low literacy may have difficulties comprehending and completing it accurately. The Urgency, Weak Stream, Incomplete Emptying, and Nocturia (UWIN) questionnaire was developed as a shorter tool in the assessment of LUTS to improve accuracy and minimize error. This study aimed at performing cross-cultural adaptation to Brazilian Portuguese and validation of UWIN questionnaire for patients with LUTS. The cross-cultural adaptation followed the steps of conceptual, item, semantic, operational, and pre-test equivalence to obtain the UWIN-Br version. The IPSS (gold standard) and UWIN-Br were coadministered, and information regarding the uroflowmetry examination was also recorded. We evaluated 306 men, median age 59 [52-66] years. There was a positive correlation r = 0.804 (p < 0.001) between the total IPSS score and the total UWIN-Br score, as well as the quality of life question (r = 0.761) (p < 0.001). The Bland-Altman plot showed good agreement between. Also, we observed that the maximum flow values decreased with the severity of the LUTS. UWIN-Br demonstrated excellent diagnostic accuracy in detecting the most severe cases. The area under the ROC curve was 89% [81–97%] 95% CI. 280 (91.5%) subjects completed the questionnaires without help, while 26 (8.5%) did so through an interview. The response time was 1.2 [1.0–1.5] min for UWIN-Br and 2.8 [2.2–3.4] min for IPSS (p < 0.001). UWIN-Br presents satisfactory and similar psychometric properties to the IPSS in the evaluation of LUTS and quality of life and is suitable for use in both clinical practice and research in our country.

National trends in the use of PSA, urinalysis, and digital rectal exam for evaluation of lower urinary tract symptoms in men.

The purpose of this study was to describe the practices of primary care physicians (PCPs) and urologists in their implementation of the 2010 American Urological Association (AUA) recommendations for the management of benign prostatic hyperplasia (BPH) in a nationally representative sample. Data collected from 2008 to 2015 in the National Ambulatory Medical Care Survey (NAMCS) were used. Men aged 45 and older who presented with either a new complaint or exacerbation of lower urinary tract symptoms (LUTS) were included. Primary outcomes were the prevalence and determinants of prostate-specific antigen (PSA) testing, urinalysis (UA), and digital rectal exam (DRE), as all three were included in the AUA guidelines during the time period studied. In logistic regression analyses weighted to reflect national estimates, potential determinants of adherence for each testing modality were examined. Between 2008 and 2015, 878 visits met inclusion criteria, corresponding to 14,399,121 ambulatory visits for new or exacerbated LUTS. Weighted prevalence estimates were 24% for PSA testing (95% CI: 19-29%), 61% forurinalysis (95% CI: 56-66%), and 18% for DRE (95% CI: 15-23%). Age ≥ 75years was associated with lower prevalence of testing for all three tests, and region was associated with different testing estimates for PSA and UA. Patients referred to urologists were more likely to receive a DRE, although overall rates of DRE decreased per additional year of data. Adherence to AUA guidelines for evaluation of LUTS in ambulatory visits was low in a nationally representative sample of Americans, particularly for PSA testing and DRE, suggesting substantial discordance between guidelines at the time and practice patterns. Practice patterns also differed by age and region. These discrepancies encourage increased education of providers in the implementation of the guidelines, particularly since they have been updated recently.

Correlation between Symptom Severity and Objective Parameters in Elderly Men with Lower Urinary Tract Symptoms

Lower urinary tract symptoms (LUTS) are mostly due to benign prostate hyperplasia (BPH) in the elderly men. The severity of LUTS associated with BPH is measured with the international prostate symptom score (IPSS). Objective indicators of the disease severity in BPH are prostate volume, post void residual urine volume (PVRU), uroflowmetry values etc. However the correlation between the severity of subjective symptoms and objective parameters remains unclear. We designed this study to see if there actually is a correlation between the subjective symptoms and the objective parameters in evaluation of LUTS. Elderly male patients presenting with LUTS in the Urology OPD over a period of 10 months are enrolled in this study. These patients are asked to fill the IPSS with assistance if necessary from medical person. Prostate volume and PVRU are measured with trans-abdominal ultrasonography. Uroflowmetry evaluations are done to record maximum flow rate (Qmax) and average flow rate (Qave). Correlation of IPSS with age, prostate volume, PVRU and uroflowmetry parameters is evaluated using correlation regression analysis. Our results revealed significant positive correlation of IPSS with prostate volume and PVRU. Similarly there is significant negative correlation of IPSS with Qmax and Qave. Hence this study concluded that there is significant correlation between symptom severity and objective parameters in elderly patients with LUTS.

New Diagnostics for Male Lower Urinary Tract Symptoms.

Lower urinary tract symptoms (LUTS) is a common constellation of symptoms that affect the aging male population with an astonishing prevalence. New technology and new uses of established technology are being used to help further evaluate LUTS in the male population and help guide treatment options. This review focuses on the developments and future directions in diagnostic modalities for evaluation of male LUTS, focusing on evaluation of both the filling and voiding phases of micturition. New techniques in evaluating the voiding phase include penile cuff test, external pressure sensing condom catheter, ultrasound measurement of detrusor wall thickness, ultrasound measurement of intravesical prostatic protrusion, doppler ultrasound and NIRS technology. Evaluation of the filling phase is still undergoing much development and requires additional validation studies. The techniques undergoing evaluation include sensation meters during UDS, assessing bladder micromotion and wall rhythm, assessing detrusor wall biomechanics, ultrasound measurement of detrusor wall thickness, pelvic doppler ultrasound, as well as functional brain imaging including fNIRS and fMRI. The development of novel, non-invasive, diagnostic tools have the potential for better evaluation of LUTS with earlier and enhanced treatments. This will likely improve the quality of life for men with LUTS.