Higher International Prostate Symptom Score Research Articles

The urinary and prostatic microbiome in non-neurogenic male LUTS/BPH: A systematic review.

Despite advancements in the treatment of benign prostatic hyperplasia (BPH), the mechanisms underlying BPH development and progression remain elusive and lacks a one-size-fits-all therapeutic solution. Prostatic inflammation contributes to BPH and lower urinary tract symptoms (LUTS), but the initial trigger remains unknown. Current research suggests dysbiosis of the urinary microbiome as a potential culprit. This systematic review explores the emerging field of the male urinary and prostatic microbiome and its relationship with BPH/LUTS. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A systematic search in the Pubmed and Scopus databases was performed using specific terms. Inclusion criteria considered male non-neurogenic patients with LUTS due to BPH with analyses of urinary microbiome, concerning evaluation of English-language publications with relevance. Among seven articles involving 542 patients, there was an association between male LUTS/BPH and the urinary microbiome. Findings indicate a correlation between urinary microbiome dysbiosis and LUTS severity, with specific bacterial genera such as Streptococcus and Haemophilus linked to higher International Prostate Symptom Score (IPSS) scores and PSA levels. The fecal microbiome may be associated with LUTS, although contradictory findings are reported. The review also highlights methodological inconsistencies, small sample sizes, few negative controls and a lack of comprehensive clinical data as major limitations. While there is an undeniable correlation between the microbiome and LUTS/BPH, future research should aim to standardize sampling techniques and expand the score to include functional microbiome characterization, potentially leading to novel, microbiome-targeted therapeutic strategies for BPH.

Benign prostatic hyperplasia and metabolic syndrome; prevalence and association: a cross-sectional study in Syria

BackgroundBenign Prostatic Hyperplasia (BPH) is considered the most common cause of lower urinary tract symptoms in men aged 40 years and older. BPH is related to sex steroids, but there are increasing studies investigating the relationship between the urinary symptoms and the metabolic syndrome. They still have inconsistent results; some reported a significant positive association, while others found no significant association. In this study, we aim to assess the prevalence rate of metabolic syndrome in BPH patients and whether there is an association between symptoms linked to BPH and metabolic syndrome in the Syrian community.MethodsThe participants of this observational cross-sectional study were benign prostatic hyperplasia patients aged 40-year-old and older from Homs, Syria. An interview questionnaire was performed to collect data from all patients who visited the urology clinic of Homs Military Hospital in the period of January 10 to March 10, 2023. We used the International Prostate Symptom Score (IPSS) to assess the urinary symptoms, and we used the US National Cholesterol Education Program Adult Treatment Panel (NCEP ATPIII) criteria to define the metabolic syndrome.ResultsThe final sample size was 426 patients. The overall prevalence of metabolic syndrome was 46.2%. Patients with metabolic syndrome had higher International Prostate Symptom Score compared to patients without metabolic syndrome (21 vs. 18, P < 0.001), and 59.3% of patients with metabolic syndrome suffered from severe symptoms compared to 36.2% of patients without metabolic syndrome who suffered from severe lower urinary tract symptoms (P < 0.001). There was a positive association between (waist circumference, diabetes, triglycerides) (P < 0.001), HDL (P = 0.014) and higher International Prostate Symptom Score. However, there was no statistically significant association between blood pressure and International Prostate Symptom Score (P = 0.879).ConclusionOur results showed that patients with metabolic syndrome had a higher International Prostate Symptom Score. This idea should be used to design a new benign prostatic hyperplasia/lower urinary tract symptoms treatment.

Is Holmium Laser Enucleation of the Prostate Truly Size-Independent? A Critical Evaluation at the Extreme Ends of the Spectrum

To assess the outcomes of holmium laser enucleation of the prostate (HoLEP) at the extremes of the size spectrum, comparing whether the results are consistent for very large and small prostates. A retrospective review of 402 patient charts was conducted to compare the outcomes of HoLEP in patients with prostate size ≤40g (group 1), 41-200g (group 2), and >200g (group 3). Various preoperative, perioperative, and postoperative variables were collected. HoLEP showed comparable voiding outcomes among all 3 groups, although patients with small prostates had a higher International Prostate Symptom Score during follow-up (P=.022). We noted a higher rate of perioperative blood transfusion in patients with very large prostates (P=.019) and a higher rate of transient acute urinary retention (AUR) in group 1 when compared to group 3 (P=.048). Patients with smaller prostates had a higher rate of bladder neck stenosis and urethral strictures, but the differences were not found to be statistically significant. The incidence of other complications, length of hospital stay, and catheterization duration did not differ significantly among the groups. HoLEP has consistent and safe outcomes across a wide range of prostate sizes. Although, the risk of blood transfusion is higher in patients with very large prostates and the risk of transient AUR is greater in patients with small glands, the overall efficacy and safety of HoLEP are not significantly influenced by prostate size.

Tumor necrosis factor-alpha, transforming growth factor-beta, degree of lower urinary tract symptoms as predictors of erectile dysfunction in benign prostatic hyperplasia patients

ObjectiveErectile dysfunction (ED) is a condition of insufficient penile erection, consistently or recurrently, for sexual activity. Tumor necrosis factor-alpha (TNF-α) induces transforming growth factor-beta (TGF-β), which causes the transition of epithelial cells into mesenchymal cells that affect ED. This study aimed to evaluate the roles of TNF-α, TGF-β, degree of lower urinary tract symptoms, and prostatic volume for the presence of ED in benign prostatic hyperplasia (BPH) patients. MethodsOur study performed an analytic observational retrospective cohort study using secondary data from four hospitals in Bali, Indonesia, including medical records and other administrative data. The sample was BPH patients with several history qualifications. ResultsOur sample was 83 respondents, ranging from 50 years to 80 years, 61 respondents with ED and 22 with non-ED. International Prostate Symptom Score showed a significant result, which indicates that ED is more common in patients with higher International Prostate Symptom Score (p=0.002). Moreover, the TNF-α of ≥43.9 pg/mg and TGF-β of ≥175.8 pg/mL were significantly associated with the presence of ED in BPH patients (p<0.0001). Despite these results, prostate volume is not significant with ED (p=0.947). ConclusionTNF-α, TGF-β, and lower urinary tract symptoms severity can predict the occurrence of ED in BPH, while prostatic volume was not significant.

A Novel Insight into the Immune-Related Interaction of Inflammatory Cytokines in Benign Prostatic Hyperplasia.

Benign prostatic hyperplasia (BPH) is a common male condition that impacts many men's quality of life by generating lower urinary tract symptoms (LUTS). In recent years, inflammation has become very common in the prostate, and BPH with inflammation has a higher International Prostate Symptom Score (IPSS) score and an enlarged prostate. Chronic inflammation leads to tissue damage and the release of pro-inflammatory cytokines, which play an important role in the pathogenesis of BPH. We will focus on current advancements in pro-inflammatory cytokines in BPH, as well as the future of pro-inflammatory cytokine research.

Clinical significance of distally located periurethral calcification in patients with lower urinary tract symptoms of benign prostate hyperplasia.

This study evaluated the association of periurethral calcification (PUC) with uroflowmetric parameters and symptom severity in male patients with lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). The data were collected from a prospectively maintained database of 1321 men with LUTS of BPH who visited Chonnam National University Hospital (Gwang-ju, Korea) from January 2015 to December 2019. PUC severity and location were evaluated on the midsagittal plane during transrectal ultrasonography. Relationships among age, prostate-related parameters, International Prostate Symptom Score (IPSS), and uroflowmetric parameters were assessed. Among the 1321 patients in this study, 530 (40.1%) had PUC. Patients with PUC had significantly higher IPSS (mean ± standard deviation [s.d.]: 15.1 ± 8.7 vs 13.1 ± 7.9; P < 0.001) and lower peak flow rate (Qmax; mean ± s.d.: 12.4 ± 6.6 ml s-1 vs 14.7 ± 13.3 ml s-1; P < 0.001), compared with patients who did not have PUC. Analyses according to PUC severity revealed that patients with severe PUC had higher prostate-specific antigen (PSA) level (P = 0.009), higher total IPSS (P < 0.001), lower Qmax (P = 0.002), and smaller prostate volume (P < 0.001), compared with patients who had non-severe (mild or moderate) PUC. Multivariate analysis showed that distal PUC was independently associated with high total IPSS (P = 0.02), voiding symptom score (P = 0.04), and storage symptom score (P = 0.023), and low Qmax (P = 0.015). In conclusion, PUC was significantly associated with worse LUTS parameters in terms of IPSS and Qmax. Furthermore, distally located PUC was independently associated with worse LUTS of BPH in men.

Association between urine 6-sulfatoxy-melatonin level and intravesical Bacillus Calmette-Guerin treatment-induced sleep quality deterioration in patients with non-muscle invasive bladder cancer.

The level of 6-sulfatoxy-melatonin (SaMT), a metabolite of melatonin, in first-void morning urine reflects blood melatonin levels from the previous night. We investigated the association between urine SaMT and sleep quality deterioration in patients with non-muscle invasive bladder cancer (NMIBC) treated with intravesical Bacillus Calmette-Guerin induction therapy (iBCG). We enrolled 51 patients who received iBCG once weekly for 6 or 8weeks. Patient-reported outcomes were assessed with questionnaires including the International Prostate Symptom Score (IPSS) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQC30). Questionnaires were completed before (baseline), during, at completion, and 1 and 3months after iBCG. Melatonin and SaMT levels at baseline were measured in serum and first-void morningurine samples, respectively. Based on changes in the QLQC30 insomnia subscale, 28 (55%) patients experienced sleep quality deterioration (deterioration group). Urine SaMT values in the deterioration group were lower than those in the non-deterioration group (P = 0.0015; 7.5 vs 15.4ng/mg creatinine, respectively). Nocturia scores in the non-deterioration group decreased over time, while those of the deterioration group remained high after completion of iBCG. A binary logistic regression analysis revealed that low urine SaMT levels (≤ 9.6 ng/mg creatinine), high IPSS nocturia scores at baseline, and high IPSS storage subscores at baseline were associated with BCG-induced sleep quality deterioration. This study confirmed the association among urine SaMT levels, nocturia, and sleep disturbance in patients with NMIBC who receive iBCG. We should be aware of treatment-induced impairments to aid in appropriate decision-making.

IPSS "bother question" score predicts health-related quality of life better than total IPSS score.

The objective of thisstudy was to investigate the role of bothersomeness of urinary symptoms on the general health-related quality of life (HRQoL) of patients with benign prostatic hyperplasia. We hypothesised that a higher International Prostate Symptom Score (IPSS) would be associated with a higher score on the IPSS bother question (IPSS-BQ), and a higher IPSS-BQ score would be the dominant factor associated with poorer general HRQoL. A case-control, cross-sectional study design was used. Patients were selected according to strict inclusion and exclusion criteria and stratified by IPSS severity group (controls: IPSS < 8; moderately symptomatic: IPSS = 8-18; and severely symptomatic: IPSS > 18). The IPSS-BQ was used to analyse bothersomeness of urinary symptoms. A standardised, multidimensional measure of HRQoL (RAND-36) was used. Data were collected on prostate size, uroflowmetry parameters, prostate specific antigen and comorbidities that were quantified using the Charlson Index and the American Association of Anaesthesiologists (ASA) score. Multiple linear regression models were used to assess the impact of bothersomeness of urinary symptoms on physical and mental HRQoL. Cohen's d was used to determine the effect size. We included 83 patients in the statistical analysis. Linear regression analyses showed that the IPSS was not an independent predictor of HRQoL. Only the highest IPSS-BQ score was associated with both worse physical (P = 0.021) and mental (P = 0.011) HRQoL in the final model. The effect sizes were small to moderate. The IPSS-BQ score is an important predictor of HRQoL. The IPSS-BQ score as a proxy should be regarded as a standard outcome measure and reported in all LUTS-related research.

Clinical outcomes of iodine-125 low-dose-rate brachytherapy for localized prostate cancer: a single-institution review in Japan.

PurposeTo evaluate the oncological outcomes and genitourinary and gastrointestinal adverse events in acute and late-phases of iodine-125 low-dose-rate brachytherapy for localized prostate cancer.Material and methodsWe retrospectively evaluated 334 patients treated for localized prostate cancer with low-dose-rate brachytherapy. Bio-chemical relapse-free survival, cause-specific survival, and overall survival were evaluated using Kaplan-Meier method and log-rank test. Incidence of adverse events was calculated using National Cancer Institute common terminology criteria for adverse events, version 5. Logistic regression was used to identify independent predictors of acute and late-phase genitourinary and gastrointestinal adverse events.ResultsNational Comprehensive Cancer Network’s low-, intermediate-, and high-risk groups included 133 (39.8%), 163 (48.8%), and 38 (11.3%) patients, respectively. The 5-year cause-specific survival rate was 100%. The 5-year bio-chemical relapse-free survival rates for the low-, intermediate-, and high-risk groups were 98.3%, 95.8%, and 100%, respectively. One patient had a ≥ grade 3 acute adverse event. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 genitourinary adverse event rates were 27.9%, 14.4%, and 0.5%, respectively. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 gastrointestinal adverse event rates were 3.1%, 1.5%, and 0.5%, respectively. A high pre-treatment international prostate symptom score and non-use of α1-blockers were associated with an increased risk of acute genitourinary adverse events.ConclusionsLow-dose-rate brachytherapy had good oncological outcomes, with acceptable adverse event rates. Pre-treatment urinary function and use of α1-blockers may be useful in predicting and preventing acute genitourinary adverse events.

MP46-18 PATIENTS REPORT SATISFACTION/REGRET FOLLOWING FOCAL THERAPY FOR LOCALIZED PROSTATE CANCER: A PROSPECTIVE MULTICENTER EVALUATION

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy (MP46)1 Sep 2021MP46-18 PATIENTS REPORT SATISFACTION/REGRET FOLLOWING FOCAL THERAPY FOR LOCALIZED PROSTATE CANCER: A PROSPECTIVE MULTICENTER EVALUATION Alireza Ghoreifi, Masatomo Kaneko, Samuel Peretsman, Atsuko Iwata, Aliasger Shakir, Dordaneh Sugano, Jie Cai, Giovanni Cacciamani, Daniel Park, Osamu Ukimura, Duke Bahn, Inderbir Gill, and Andre Luis Abreu Alireza GhoreifiAlireza Ghoreifi More articles by this author , Masatomo KanekoMasatomo Kaneko More articles by this author , Samuel PeretsmanSamuel Peretsman More articles by this author , Atsuko IwataAtsuko Iwata More articles by this author , Aliasger ShakirAliasger Shakir More articles by this author , Dordaneh SuganoDordaneh Sugano More articles by this author , Jie CaiJie Cai More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Daniel ParkDaniel Park More articles by this author , Osamu UkimuraOsamu Ukimura More articles by this author , Duke BahnDuke Bahn More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Andre Luis AbreuAndre Luis Abreu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002067.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The objective is to evaluate the treatment decision satisfaction and regret among patients who underwent Focal Therapy (FT) for localized prostate cancer (PCa) with high-intensity focused ultrasound (HIFU) or cryoablation (CRYO). METHODS: We identified consecutive patients who underwent hemi-gland HIFU or CRYO FT as primary treatment for localized PCa at three US institutions (IRB# HS-17-00749). A survey with validated questionnaires was mailed between February and December of 2020, including: 5-question Decision Regret Scale (DRS); International Prostate Symptom Score (IPSS); and International Index of Erectile Function (IIEF-5). Potency was defined as IIEF-5 ≥ 18. The regret score was calculated based on the 5 items of DRS (Figure). Agreement with each item is measured on a 5-point scale and the final score is converted to a 0-100 scale. Regret was defined as DRS ≥ 26. Multivariable logistic regression models were applied to assess baseline and post-FT predictors for treatment decision regret. Statistically significant if p<0.05. RESULTS: Out of 236 patients, 143 (61%) responded the survey (71/116 HIFU and 72/120 CRYO). Baseline characteristics were similar between responders and no-responders. For the responders, the median (IQR) follow-up was 43 (26-68) months. The treatment decision regret rate was 19.6%, being CRYO 23.6% vs. HIFU 15.5% (OR 1.7, p=0.22). The Figure shows the details of patients’ responses to each DRS question. Higher PSA at nadir (OR 1.48, 95%CI 1.1-2, p=0.009) post FT, presence of PCa on the follow-up biopsy (OR 3.98, 95%CI 1.5-10.6, p=0.006), higher IPSS after FT (OR 1.18, 95%CI 1.01-1.04, p=0.03), and de-novo impotence (OR 6.67, 95%CI 1.57-27, p=0.03) were independent predictors of treatment decision regret. CONCLUSIONS: Focal therapy for localized PCa is well-accepted by the patients. Higher PSA at nadir, presence of cancer on the follow-up biopsy, higher post-operative IPSS, and de-novo impotence are independent predictors of treatment decision regret. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e820-e821 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author Masatomo Kaneko More articles by this author Samuel Peretsman More articles by this author Atsuko Iwata More articles by this author Aliasger Shakir More articles by this author Dordaneh Sugano More articles by this author Jie Cai More articles by this author Giovanni Cacciamani More articles by this author Daniel Park More articles by this author Osamu Ukimura More articles by this author Duke Bahn More articles by this author Inderbir Gill More articles by this author Andre Luis Abreu More articles by this author Expand All Advertisement Loading ...

A CLINICAL STUDY TO CORRELATE LOWER URINARY TRACT SYMPTOMS DUE TO BENIGN PROSTATIC HYPERPLASIA WITH THE PROSTATE VOLUME AND THE INTRAVESICAL PROSTATIC PROTRUSION

Introduction: International Prostate Symptom score (IPSS) which is identical to AUA symptom index, is recommended as a symptom scoring instrument to be used for baseline assessment of symptoms severity in men presenting with Lower Urinary Tract Symptoms.The correlation of prostate volume PV, IPP and IPSS has been extensively investigated. It was generally accepted that there was weak correlation of PV with IPSS and strong correlation of IPP with IPSS.We conducted this study to nd out whether this generally accepted correlation holds true for our patients from north east region of india Materials and Methods:This was a prospectively designed study conducted in the department of Urology, Regional institute of medical sciences imphal to To correlate lower urinary tract symptoms due to benign prostatic hyperplasia with prostate volume and intravesical prostatic protrusion. A total of 154 patients of BPH were included in the study. Statistical analysis was done by using IBM SPSS Version 21 for windows.Chi square test/scher exact test was used as a test of signicance of the study for comparing the outcome variables. P-value &lt;0.05 was taken as signicant. Spearman correlation coefcient for categorical data and Pearson's correlation coefcient analysis for continuous variables was carried out Results and Observations:In our study maximum number of patients were in the moderate IPSS grade category 89 patients(58.00%) were having moderate symptoms,55 patients(36.0%) were having severe symptoms and 10 patients(6.0%) were having mild symptoms.There was statistically signicant and strong correlation between intraprostatic protrusion and International Prostate Symptoms Score with ('p' value &lt;0.0001 and r =0.78). There was statistically signicant and strong correlation between Prostate volume (PV) and International Prostate Symptoms Score with ('p' value &lt;0.001 and r =0.56). Conclusion:This study concludes that both IPP and PV have strong correlation with symptoms of BOO measured by IPSS. IPP is easy to acquire and non invasive. IPP can also helps in predicting some times the high IPSS score despite of a small prostate volume

PP188 Prevalence And Severity Of Erectile Dysfunction In Patients With Benign Prostatic Hyperplasia In China: A Cross-Sectional Survey

IntroductionErectile dysfunction (ED) and benign prostatic hyperplasia (BPH) are highly prevalent among aging men. However, the rate of coexistence of these two conditions in China is still unclear, especially among men aged 45 to 60 years. Instruments such as the abbreviated five-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) can be used to determine the presence of ED and the symptoms and severity of BPH, respectively. This study aimed to estimate the prevalence of ED in men with BPH and to assess its impact on the quality of life (QoL) of these patients.MethodsBetween October 2018 and March 2019 we enrolled 650 patients aged 45 to 65 years who were diagnosed with BPH by a urologist in nine first- and second-tier cities in China. Information on patients’ demographics, lifestyle, comorbidities, and medication use was collected through an electronic clinical outcome assessment tool. Patients with an IIEF-5 score of less than twenty-two were considered to have ED. The IPSS and the five-level EuroQol questionnaire (EQ-5D-5L) were used to assess BPH severity and overall health-related QoL.ResultsWe enrolled 650 patients with BPH. Of these, only the 607 men who reported sexual intercourse attempts (mean age of 56.6 years, standard deviation 5.5) were included in the analysis because it was assumed that the other patients did not have ED. Signs of ED were present in ninety-seven percent of patients (IIEF-5 score &lt; 22), and eighty-four percent had at least mild to moderate impairment (IIEF score &lt; 17). Up to nineteen percent reported having physician-diagnosed ED previously, and twenty-eight percent had used medication for ED in the past six months. Compared to men without ED, those with ED and BPH had higher IPSS scores (13.2 versus 6.7, p &lt; 0.05) and lower EQ-5D-5L scores (0.90 versus 0.97, p &lt; 0.05).ConclusionsAlthough the prevalence of ED in men with BPH in China is high, it is still underdiagnosed and undertreated. Co-existing ED in patients with BPH is associated with more severe BPH symptoms and lower quality of life.

Urinary Outcomes for Men With High Baseline International Prostate Symptom Scores Treated With Prostate SBRT

PurposeThere are limited data regarding high-dose stereotactic body radiation therapy (SBRT) for prostate cancer in patients with poor baseline urinary function. The purpose of this study was to evaluate genitourinary (GU) toxicity and changes in patient-reported symptom severity scores after prostate SBRT in men with a high pretreatment International Prostate Symptom Score (IPSS). Methods and MaterialsSeven hundred fifty-three patients treated with prostate SBRT at our institution from 2012 to 2019 were identified, of whom 72 consecutive patients with baseline IPSS ≥15 were selected for this study. GU toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) v3.0 and IPSS were prospectively documented at each follow-up visit. Univariable logistic regression was used to evaluate for potential predictors of GU toxicity. ResultsMedian follow-up in survivors was 26.8 months. The rates of acute grade 2 and 3 GU toxicity were 20.8% and 1.4%, respectively. The rates of late grade 2 and 3 GU toxicity were 37.5% and 5.6%, respectively. The majority of grade 2+ toxicities resolved by last follow-up, and when toxicities were regraded per CTCAE v5.0, there were no longer any grade 3 adverse events. Total IPSS and individual symptom subscores improved over time. Compared with baseline, median total IPSS at 24 ± 6 months was significantly lower (18 vs 12; P < .001) and the proportion of patients with severe scores (IPSS ≥20) decreased from 29.2% to 13.9%. Pretreatment urinary urgency was associated with late grade 2+ GU toxicity (odds ratio, 2.10; 95% confidence interval, 1.33-3.31; P = .001). ConclusionsIn men with baseline IPSS ≥15 managed with prostate SBRT, the rate of severe GU toxicity was low and patient-reported symptoms generally improved over time. Thus, high pretreatment IPSS should not deter clinicians from offering prostate SBRT.

Does radical prostatectomy result in lower urinary tract symptom improvement in high-risk and locally advanced prostate cancer? A Single-center experience.

Radical prostatectomy represents the most popular method of prostate cancer treatment, including cases with high-risk and locally advanced cancer. Besides, men with this disease often experience lower urinary tract symptoms (LUTS) and report high International Prostate Symptom Scores (IPSS), pathological post-void residual (PVR) urine volumes and low levels of maximum urinary flow rates (Qmax). In this study we assessed the effect of radical prostatectomy on the above parameters in patients with high-risk and locally advanced disease. A number of 240 individuals were enrolled in the study. Patients that required any post-operative manipulation up to the completion of 12 months after surgery were excluded. All patients were assessed pre- and post-operatively at 3, 6 and 12 months. Evaluation included IPSS, Qmax and PVR. Mean age was 66.8 years. Mean PSA value was 12.7 ng/ml and mean Gleason score was 7.9. At baseline 41.3% of the patients had Qmax ⩽10 and 42.5% had IPSS >8. There was a significant increase in Qmax during the follow-up (median value was 12 at baseline and increased to 21 at 12 months). Also, IPSS and PVR decreased significantly during the follow-up. IPSS median value decreased from 9 at baseline to 5 at 12 months. Improvement was observed in all grades of symptoms.

Postoperative membranous urethral length is the single most important surgical factor predicting recovery of postoperative urinary continence

PurposeTo analyze the potential surgical factors affecting postoperative urinary continence, including postoperative membranous urethral length (MUL), in an era where open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) coexist. MethodsConsecutive patients undergoing either ORP or RARP between April 2009 and June 2017 were included in this study. Pericatheter urethrography (PCU) was performed the day of catheter removal to confirm healing of the vesicourethral anastomosis and to measure PCU-MUL. Daily usage of incontinence pad was self-reported by the patient at each post-operative visit through a questionnaire. Univariate and multivariate analyses were performed to identify factors that influenced recovery of continence. ResultsOf the 196 patients included, 121 and 75 patients received ORP and RARP, respectively. The cumulative full continence rates (0 pad/day) at 1 year in the ORP and RARP groups were 87% and 95%, respectively. In the univariate analysis, older age, high preoperative International Prostate Symptom Score (IPSS) irritative symptom domain, ORP, poorer NVB preservation, and shorter PCU-MUL were associated with delayed recovery of full continence. In the multivariate analysis, only older age, high preoperative IPSS irritative symptom domain, and shorter PCU-MUL remained as independent factors significantly associated with delayed recovery of full continence. ConclusionsOur study highlights the importance of saving the MUL as long as possible in terms of continence recovery. This holds true for ORP even in the era of RARP and surgeons should not simply give up the prospect of early urinary continence in exchange for the patient's choice of ORP instead of RARP.

Periprostatic fat thickness measured on MRI correlates with lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia progression.

This study investigated the correlation between periprostatic fat thickness (PPFT) measured on magnetic resonance imaging and lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia (BPH) progression. A total of 286 treatment-naive men diagnosed with BPH in our department between March 2017 and February 2019 were included. Patients were divided into two groups according to the median value of PPFT: high (PPFT >4.35 mm) PPFT group and low (PPFT <4.35 mm) PPFT group. After the initial evaluation, all patients received a combination drug treatment of tamsulosin and finasteride for 12 months. Of the 286 enrolled patients, 244 completed the drug treatment course. Patients with high PPFT had larger prostate volume (PV; P = 0.013), higher International Prostate Symptom Score (IPSS; P = 0.008), and lower five-item version of the International Index of Erectile Function (IIEF-5) score (P = 0.002) than those with low PPFT. Both high and low PPFT groups showed significant improvements in PV, maximum flow rate, IPSS, and quality of life score and a decrease of IIEF-5 score after the combination drug treatment. The decrease of IIEF-5 score was more obvious in the high PPFT group than that in the low PPFT group. In addition, more patients in the high PPFT group underwent prostate surgery than those in the low PPFT group. Moreover, Pearson's correlation coefficient analysis indicated that PPFT was positively correlated with age, PV, and IPSS and negatively correlated with IIEF-5 score; however, body mass index was only negatively correlated with IIEF-5 score.

Useful parameters to predict the presence of detrusor overactivity in male patients with lower urinary tract symptoms.

This study aimed to identify the easily obtainable parameters that predict the presence of detrusor overactivity (DO) in male patients with lower urinary tract symptoms (LUTS), because urodynamic studies cannot be performed in all cases. A total of 605 treatment-naïve men with non-neurogenic LUTS who underwent subjective and objective evaluations were retrospectively reviewed. We divided patients into two groups (the DO and the non-DO group) according to the presence or absence of DO as determined by urodynamic data and compared the clinical parameters between the two groups to identify clinical signs associated with DO. Of the 605 patients with a mean age of 69.8 years and a mean prostate volume of 45.4 mL, 319 (52.7%) had DO, while DO was not detected in 286 (47.3%). Men with DO were significantly older and had greater prostate volume, longer intravesical prostatic protrusion (IPP), higher international prostate symptom score, higher overactive bladder symptom score (OABSS), smaller bladder capacity, and higher bladder outlet obstruction than those without DO. In a multivariate logistic regression analysis, higher OABSS-urgency subscore and OABSS-urgency urinary incontinence (UUI) subscore and longer IPP were significant predictive signs of DO. Receiver operating characteristic curve analysis identified 3 points, 1 point, and 8.0 mm as the optimal cut-off values for OABSS-urgency subscore, OABSS-UUI subscore, and IPP, respectively, for the diagnosis of DO. Higher OABSS-urgency subscore, higher OABSS-UUI subscore, and longer IPP were found to be useful parameters to predict the presence of DO in male patients with LUTS.

Clinical efficacy of submucosal injection of triamcinolone acetonide in the treatment of type II/III interstitial cystitis/bladder pain syndrome

BackgroundTo evaluate the efficacy of submucosal injection of triamcinolone acetonide for the treatment of type II/III interstitial cystitis/bladder pain syndrome.MethodsA retrospective analysis of the clinical data of type II/III interstitial cystitis/bladder pain syndrome patients treated in our department from April 2016 to August 2018 was conducted, and changes in International Prostate Symptom Scores and the Pelvic Pain and Urgency/Frequency symptom scale after surgery were evaluated to explore factors that may affect patient outcomes.ResultsA total of 27 female patients and 8 male patients were enrolled, with type II patients accounting for 62.9% of the sample, and the median follow-up duration was 31 months (range: 12–40 months). Twenty-two patients (74.3%) had significantly improved questionnaire scores at 4 weeks postoperatively. Treatment efficacy was sustained for at least 1 year in 15 patients, and persistent effectiveness was noted in 10 (28.6%) patients. Patients with an advanced age (p = 0.015), high pain scores (p = 0.040), and higher International Prostate Symptom Scores (p = 0.037) and Pelvic Pain and Urgency/Frequency symptom scale scores (p = 0.020) were more likely to benefit from submucosal injection of triamcinolone acetonide. Gender, disease duration, and the presence of Hunner’s lesions had no predictive value for treatment outcomes.ConclusionSubmucosal injection of triamcinolone acetonide can improve the clinical symptoms and quality of life in both men and women with type II/III interstitial cystitis/bladder pain syndrome. Patients with an advanced age and more severe interstitial cystitis/bladder pain syndrome related symptoms may benefit more from triamcinolone acetonide injection.

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Epidemiological characteristics and associated risk factors of lower urinary tract symptoms in young obese males

Objective To investigate the epidemiological characteristics and its associated risk factors of lower urinary tract symptoms in young Chinese obese males. Methods A total of 126 young males aged 20-40 years admitted to Beijing Friendship Hospital, Capital Medical University were enrolled into two different groups in this study, including 74 obese patients visited metabolic weight loss clinic were included in the experimental group, and 52 conditionally healthy persons were included in the control group. Blood pressure (systolic blood pressure, diastolic blood pressure), insulin resistance (fasting blood glucose, insulin, C-peptide), blood lipid metabolism (triglycerides, high-density lipoprotein cholesterol), and sex hormones (estrogen) of the two groups of subjects. Hormones, serum testosterone), C-reactive protein (CRP), International prostate symptom score (IPSS) and quality of life score (QOL). were compared between the two groups of subjects. Comparisons of measurement data between groups were statistically analyze by t test, expressed by mean ± standard deviation (Mean±SD); the correlation between body mass index and LUTS was analyzed by Spearman rank correlation, and the risk factors of LUTS and clinical variables were analyzed by univariate logistic regression. The significant variables were analyzed by multivariate logistic regression. Results There were significant statistical differences between experimental group and control group in terms of systolic blood pressure [(144.30±15.78) mmHg vs (125.9±66.11) mmHg, P<0.001], diastolic blood pressure [(89.46±12.76) mmHg vs (81.35±4.58) mmHg, P=0.001], and fasting blood glucose [(6.73±3.15) mmol/L vs (5.26±1.47) mmol/L, P=0.016], insulin [(26.60±19.09) mg/dL vs (13.43±7.68) mg/dL, P<0.001], C-peptide [(4.20±1.73) ng/mL vs (1.59±0.52) ng/mL, P=0.001], triglycerides [(2.42±1.88) mg/dL vs (1.45±0.79) mg/dL, P=0.007), estrogen [(52.32±21.77) ng/L vs (42.11±12.19) ng/L, P=0.023] and CRP [(6.49±4.96) mg/L vs (1.62±1.53) mg/L, P=0.037], but no statistical difference regarding high-density lipoprotein [(1.10±0.55) mg/dL vs (1.06±0.26) mg/dL, P=0.669] and serum testosterone [(275.00±100.68) ng/dL vs (280.28±85.52) ng/dL, P=0.823]. In addition, the experimental group had higher IPSS[(3.81±1.88) scores vs (0.69±0.30) scores, P<0.001] and QOL scores [(2.76±0.68) scores vs (0.12±0.08) scores, P<0.001] than the control group, and higher risk of LUTS [86.49% vs 42.31%, P<0.001], especially moderate LUTS ( 21.62% vs 0, P=0.011). Spearman rank correlation analysis showed that obesity (body mass index≥30 kg/m2) was significantly associated with moderate LUTS risk (r=0.407, P<0.001); Univariate logistic regression analysis showed that systolic blood pressure, insulin, and C-peptide were important risk factors of moderate LUTS in young obese patients (P=0.009, 0.029, 0.002). Systolic blood pressure and fasting C-peptide were independent risk factors by multivariate logistic regression analysis (P=0.011, 0.003). Conclusions The middle severity of LUTS was prevalent in young obese males, and systolic blood pressure and C-peptide were its significant independent risk factors. Key words: Obesity; Prostatic hyperplasia; Males; Lower urinary tract symptoms