International Prostate Symptom Score Quality Of Life Score Research Articles

Correlation between detrusor pressure and transurethral resection of prostate outcome

Objective To assess the long-term outcome of transurethral resection of the prostate (TURP) in men with different maximum detrusor pressure (Pdet.max).Methods 113 neurologically intact men diagnosed with BPH and undergone surgical intervention in our department were enrolled between Feb.2009 and May 2012.All patients had completed the International Prostate Symptom Score (IPSS) and quality-of-life (QOL) questionnaires and had undergone a full urodynamic analysis before surgery.The outcomes were assessed at 24 months postoperatively using the IPSS score,QOL score,and maximum urinary flow rate (Qmax).Results After 24 months follow-up,3 cases in the poor symptom improvement group could not void.The average Pdet.max of these three patients was (15.7±5.1) cmH2O,which was statistically significantly lower than that of the other three groups [(102.7±39.3),(95.9±42.8),(77.0±27.4) cmH2O] (P＜0.05).Nine cases in the poor functional improvement group whose average Pdet.was (32.5± 16.6) cmH2O,which was statistically significantly lower than that of the other three groups [(115.2±36.3),(87.5±28.7),(75.5±46.9) cmH2O] (P＜0.05).Conclusions Urodynamic analysis plays an important role in judging the efficacy of TURP.Patients with a Pdet.max less than 32.5 cmH2O may not have an objectively successful result from surgery treatment. Key words: Benign prostatic hyperplasia; Urodynamics; Maximum detrusor pressure; Transurethral resection of prostate; Detrusor underactivity

Comparative evaluation of naftopidil and tamsulosin in the treatment of patients with lower urinary tract symptoms with benign prostatic hyperplasia.

Introduction:Naftopidil, approved initially in Japan, is an α1d-adrenergic receptor antagonist (α1-blocker) used to treat lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). It is different from tamsulosin hydrochloride and silodosin, in that it has a higher affinity for the α1D-adrenergic receptor subtype than for the α1A subtype and has a superior efficacy to a placebo and comparable efficacy to other α1-blockers such as tamsulosin. The incidences of ejaculatory disorders and intraoperative floppy iris syndrome induced by naftopidil may also be lower than that for tamsulosin and silodosin, which have a high affinity for the α1A-adrenergic receptor subtype. However, it remains unknown if the efficacy and safety of naftopidil in Japanese men is applicable to Indian men having LUTS/BPH.Material and Methods:Two groups of 60 patients each, having LUTS due to BPH, were treated with tamsulosin 0.4 mg and Naftopidil 75 mg for three months. Ultrasonography (for prostate size, post-void residual volume), uroflowmetry, and the International Prostate Symptom Score (IPSS) and Quality of Life (QOL) score were recorded at the beginning of the study, and then at one and three months.Results:The prostate size, post-void residual volume, all the uroflowmetry variables, and the IPSS QOL scores showed a statistically significant improvement (P < 0.001) in both the groups. The improvement in the average flow rate and the QOL index was better in the naftopidil group on the intergroup comparison and was statistically significant (P < 0.001).Conclusion:Although the QOL life index was significantly better in the naftopidil group, overall both naftopidil and tamsulosin were found to be equally effective in the treatment of LUTS due to BPH.

Randomized Controlled Trial to Assess the Efficacy of the Combination Therapy of Alfuzosin and Tadalafil in Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia.

The purpose of our study was to evaluate the effect of alfuzosin and tadalafil as combination therapy compared with each monotherapy, in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Men over the age of 50 years with LUTS secondary to BPH and an International Prostate Symptom Score (IPSS) 8 or higher, were randomized to receive 10 mg alfuzosin (n = 25), 10 mg tadalafil (n = 25) or the combination of both the drugs (n = 25) once daily for 3 months. Symptoms were assessed at baseline, 6 weeks and 3 months. The primary endpoint was the change in IPSS from the baseline. Secondary endpoints were changes in IPSS storage and voiding subscores, peak urinary flow rate, residual urine volume, IPSS quality of life score and erectile domain score. There were significant improvements in all IPSS scores, peak urinary flow rate and IPSS quality of life score from baseline at both 6 weeks and 3 months in all the three groups (P < 0.003). Combination therapy was better than monotherapy in improving IPSS scores and reducing post-void residual urine volume (P < 0.005). Combination therapy was similar to alfuzosin regarding improvement in maximum urine flow rate (P = 0.22), similar to tadalafil in improvement on erectile function (P = 0.22) and better than each monotherapy in improving the IPSS quality of life (P ≤ 0.015). Alfuzosin and tadalafil combination therapy provides greater symptomatic improvement as compared to either monotherapy in men with LUTS due to BPH.

Five-year Outcomes of the Transection of Synthetic Suburethral Sling Tape for Treating Obstructive Voiding Symptoms After Transobturator Sling Surgery

To evaluate the outcomes of sling transection in treating obstructive voiding symptoms after transobturator sling surgery and the recurrence rates of stress urinary incontinence after 5-year follow-up. Between January 2004 and March 2006, we retrospectively reviewed 461 patients who underwent the transobturator sling procedure. Of 461 patients, 28 patients (6.1%) underwent transection of suburethral sling tape under local anesthesia and followed up for at least 5 years after sling transection. We analyzed the overall success rates and recurrence rates of stress urinary incontinence using uroflowmetry with post-void residual measurement, 5 cm visual analogue scale for assessment of postoperative goal achievement, obstructive domain of International Prostate Symptom Score (IPSS) and quality of life (QoL). Mean maximal urinary flow and post-void residual were 21.8 ± 4.1 mL/s and 38.8 ± 3.4 mL at 5-year follow-up after sling transection. The mean 5 cm visual analogue scale, O-IPSS and IPSS QoL scores were 4.3 ± 1.4, 2.8 ± 2.9, and 2.3 ± 1.9, respectively, at 5-year follow-up. The objective and subjective success rates were 100% and 68%. Six patients (24%) redeveloped stress urinary incontinence. According to our long-term (≥ 5 years) follow-up results, the transection of suburethral sling tape is a simple and effective method to treat obstructive symptoms after the transobturator sling procedure.

The Potential Role of a Self-management Intervention for Benign Prostate Hyperplasia

To tentatively evaluate the usefulness of self-management interventions in improving the lower urinary tract symptoms (LUTS) and quality of life (QoL) in patients with benign prostatic hyperplasia (BPH). Two-hundred twent-two men were recruited from a teaching hospital at Peking University from March 2008 to September 2009. They were referred by general practitioners to urologic outpatient departments because of BPH after 3-month administration of α-blockers. Participants were randomized to attend either a self-management program or undergo standard care. Difference of scores of International Prostate Symptom Score (IPSS) and BPH-specific QoL scale between 2 groups was analyzed at the enrollment period, and at the first week, third month, and sixth month. All participants had been followed for 6 months. There was no significant difference in IPSS score and QoL score between the 2 groups at the enrollment period and first week, whereas at the third month and sixth month, the IPSS scores and QoL self-management interventional group scores were statistically significant lower than those of the standard care group. Self-management intervention may be associated with decreased LUTS symptoms and may improve QoL in BPH patients with α-blocker administration.

Tadalafil Administered Once Daily for Treatment of Lower Urinary Tract Symptoms in Korean men with Benign Prostatic Hyperplasia: Results from a Placebo‐Controlled Pilot Study Using Tamsulosin as an Active Control

Assess the efficacy and safety of once-daily tadalafil or tamsulosin versus placebo during 12 weeks on lower urinary tract symptoms (LUTS) in Korean men with benign prostatic hyperplasia (BPH). Following a 4-week placebo run-in period, 151 Korean men were randomly assigned to receive once-daily tadalafil 5 mg, tamsulosin 0.2 mg, or placebo for 12 weeks. The International Prostate Symptom Score (IPSS) least squares mean changes from baseline to endpoint were numerically but not significantly improved in the tadalafil (-5.8) and tamsulosin (-5.4) groups compared with placebo (-4.2, P > 0.05). Decreases in IPSS obstructive and irritative subscores, IPSS Quality of Life score, and BPH Impact Index from baseline to endpoint were largest in the tadalafil group followed by tamsulosin, though none separated significantly from placebo. Increases in maximum urinary flow rate were small and not significantly different than placebo; the increase was largest in the tadalafil group (2.5 mL/sec), followed by the placebo (2.3 mL/sec) and tamsulosin (2.1 mL/sec) groups. The percentage of subjects reporting at least one treatment-emergent adverse event was 26.5, 13.7 and 3.9% in the tamsulosin, tadalafil and placebo groups, respectively. In this pilot study in Korean men, those with BPH and treated with tadalafil 5 mg or tamsulosin 0.2 mg once daily experienced a reduction in LUTS, which was numerically (but not statistically) significant compared with the placebo. Tadalafil was well tolerated and few subjects discontinued the study due to treatment-emergent adverse events. Larger studies in Asian men with BPH and LUTS treated with phosphodiesterase type 5 inhibitors are needed.

1297 COMPARISON OF PROPHYLACTIC NAFTOPIDIL, TAMSULOSIN AND SILODOSIN FOR 125I BRACHYTHERAPY-INDUCED LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH PROSTATE CANCER: RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111297 COMPARISON OF PROPHYLACTIC NAFTOPIDIL, TAMSULOSIN AND SILODOSIN FOR 125I BRACHYTHERAPY-INDUCED LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH PROSTATE CANCER: RANDOMIZED CONTROLLED TRIAL Hideyasu Tsumura, Takefumi Satoh, Hiromichi Ishiyama, Ken-ichi Tabata, Tetsuo Fujita, Masaki Kimura, Kazushige Hayakawa, and Shiro Baba Hideyasu TsumuraHideyasu Tsumura Sagamihara, Japan More articles by this author , Takefumi SatohTakefumi Satoh Sagamihara, Japan More articles by this author , Hiromichi IshiyamaHiromichi Ishiyama Sagamihara, Japan More articles by this author , Ken-ichi TabataKen-ichi Tabata Sagamihara, Japan More articles by this author , Tetsuo FujitaTetsuo Fujita Sagamihara, Japan More articles by this author , Masaki KimuraMasaki Kimura Sagamihara, Japan More articles by this author , Kazushige HayakawaKazushige Hayakawa Sagamihara, Japan More articles by this author , and Shiro BabaShiro Baba Sagamihara, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.997AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare the efficacy of three alpha1A/alpha1D-adrenoceptor (AR) antagonists, naftopidil, tamsulosin and silodosin, that have differing affinity for the alpha1-AR subtypes in treating urinary morbidities in Japanese men with 125I prostate implantation (PI) for prostate cancer. METHODS This single-institution prospective randomized controlled trial compared naftopidil, tamsulosin and silodosin in patients undergoing PI. Patients were received either naftopidil, tamsulosin or silodosin. Treatment began one day after PI and continued for one year. The primary efficacy variables were the changes in the total International Prostate Symptom Score (IPSS) and post-void residual urine (PVR). The secondary efficacy variables were changes in the IPSS storage score, IPSS voiding score and IPSS quality-of-life (QoL) score from baseline to set points during the study (1, 3, 6 and 12 months). RESULTS 212 patients were evaluated in this study: 71, 70 and 71 patients in the naftopidil, tamsulosin and silodosin groups, respectively. With respect to primary efficacy variables, the mean change in the total IPSS at 1 month after PI in the naftopidil, tamsulosin and silodosin groups was +10.3, +8.9 and +7.5, respectively. There were significantly greater decreases with silodosin than naftopidil at 1 month in the total IPSS (Fig. 1A). The mean change in PVR at 6 months was +14.6, +23.7 and +5.7 mL in the naftopidil, tamsulosin and silodosin groups, respectively; silodosin showed a significant improvement in PVR at 6 months vs tamsulosin (Fig. 1B). With respect to secondary efficacy variables, the mean change in the IPSS voiding score at 1 month in the naftopidil, tamsulosin and silodosin groups were +6.5, +5.6 and +4.5, respectively; silodosin showed a significant improvement in the IPSS voiding score at 1 month vs naftopidil (Fig. 1C). The mean change in the IPSS QoL score at 3 months in the naftopidil, tamsulosin and silodosin groups was +1.3, +1.4 and +0.9, respectively. There were significantly greater decreases with silodosin than tamsulosin in the IPSS QoL score at 3 months (Fig. 1D). CONCLUSIONS Silodosin has a greater impact on improving PI-induced urinary morbidities than the other two agents. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e519 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hideyasu Tsumura Sagamihara, Japan More articles by this author Takefumi Satoh Sagamihara, Japan More articles by this author Hiromichi Ishiyama Sagamihara, Japan More articles by this author Ken-ichi Tabata Sagamihara, Japan More articles by this author Tetsuo Fujita Sagamihara, Japan More articles by this author Masaki Kimura Sagamihara, Japan More articles by this author Kazushige Hayakawa Sagamihara, Japan More articles by this author Shiro Baba Sagamihara, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ultrasound estimated bladder weight in men attending the uroflowmetry clinic

To determine if measurements of ultrasound estimated bladder weight (UEBW) provide an additional diagnostic tool when assessing men with lower urinary tract symptoms (LUTS) in the uroflowmetry clinic. One hundred men with LUTS attending the uroflowmetry clinic underwent transabdominal ultrasound measurement of bladder weight, using the BVM 9500 bladder scanner (Verathon Medical, Bothell, WA). These data were explored for any correlation between measurements of maximum flow rate (Q(max)) with UEBW, age, height, weight, body mass index (BMI), ICIQ M-LUTS score, M-LUTS voiding score, M-LUTS incontinence score, IPSS, IPSS quality of life score, voided volume, and post-void residual urine. Based on previously reported probabilities of bladder outlet obstruction (BOO), patients were grouped for analysis (Group 1 = Q(max) <10, Group 2 = Q(max) 10-15, Group 3 = Q(max) >15). A one-way ANOVA was undertaken to assess any difference in mean UEBW between the three groups. Statistically significant negative correlations between Q(max) and age (r = -0.308, P = 0.002), M-LUTS voiding score (r = -0.298, P = 0.003), IPSS (r = -0.295, P = 0.003), and post-void residual (r = -0.213, P = 0.033) were observed. A statistically significant positive correlation between Q(max) and voided volume (r = 0.503, P < 0.01) was observed. No association between Q(max) and UEBW was observed (r = 0.12, P = 0.243). Mean UEBW for the three groups was remarkably similar. One-way ANOVA identified there was no statistically significant effect of UEBW on Q(max) F(2, 97) = 0.175, P = 0.840. Mean UEBW did not differ significantly between the three Q(max) groups. Further work is required to investigate the relationship of Q(max) and UEBW in men with urodynamic confirmation of either BOO or detrusor underactivity.

Ultrasound estimated bladder weight in men attending the uroflowmetry clinic

Aims To determine if measurements of ultrasound estimated bladder weight (UEBW) provide an additional diagnostic tool when assessing men with lower urinary tract symptoms (LUTS) in the uroflowmetry clinic. Methods One hundred men with LUTS attending the uroflowmetry clinic underwent transabdominal ultrasound measurement of bladder weight, using the BVM 9500 bladder scanner (Verathon Medical, Bothell, WA). These data were explored for any correlation between measurements of maximum flow rate (Qmax) with UEBW, age, height, weight, body mass index (BMI), ICIQ M-LUTS score, M-LUTS voiding score, M-LUTS incontinence score, IPSS, IPSS quality of life score, voided volume, and post-void residual urine. Based on previously reported probabilities of bladder outlet obstruction (BOO), patients were grouped for analysis (Group 1 = Qmax 15). A one-way ANOVA was undertaken to assess any difference in mean UEBW between the three groups. Results Statistically significant negative correlations between Qmax and age (r = −0.308, P = 0.002), M-LUTS voiding score (r = −0.298, P = 0.003), IPSS (r = −0.295, P = 0.003), and post-void residual (r = −0.213, P = 0.033) were observed. A statistically significant positive correlation between Qmax and voided volume (r = 0.503, P < 0.01) was observed. No association between Qmax and UEBW was observed (r = 0.12, P = 0.243). Mean UEBW for the three groups was remarkably similar. One-way ANOVA identified there was no statistically significant effect of UEBW on QmaxF(2, 97) = 0.175, P = 0.840. Conclusion Mean UEBW did not differ significantly between the three Qmax groups. Further work is required to investigate the relationship of Qmax and UEBW in men with urodynamic confirmation of either BOO or detrusor underactivity. Neurourol. Urodynam. 30:583–586, 2011. © 2011 Wiley-Liss, Inc.

Beneficial Effect of Increasing the Dose of Tamsulosin to 0.4 mg in Japanese Patients with Benign Prostatic Hyperplasia.

Objective: Tamsulosin is often administered at a dose of 0.2 mg in Japan, Korea, and elsewhere in Asia, while a dose of 0.4 mg is more common in the West. In order to determine the higher dose might also be appropriate in the North-East Asian setting, we studied whether the effect of increasing the dose to 0.4 mg in Japanese patients who had dysuria associated with benign prostatic hyperplasia.Patients and Methods: Twenty-two cases with a voiding volume ≥ 100 ml assessed by uroflowmetry out of 31 patients with benign prostatic hyperplasia and an IPSS (International Prostate Symptom Score) ≥ 8 whose symptoms were controlled with 0.2 mg of tamsulosin were entered into this study. We evaluated IPSS and QOL (quality of life) score, urinary flow parameters and residual urine volume before and 4 weeks after increasing the dose of tamsulosin.Results: Statistical analyses performed using the Wilcoxon test showed no significant alteration in IPSS total score or QOL score with the increased dose, but Qmax (maximum urinary flow rate) improved from 10.1 ± 5.5 ml/s to 12.1 ± 6.5 ml/s (p = 0.013), and residual urine volume improved from 37.6 ± 26.4 ml to 22.2 ± 24.3 ml (p = 0.012). Two of the 31 patients complained of new symptoms; 1 complained of breast pain and the other complained of dizziness.Conclusions: From the lack of side effects of more than moderate grade in the present study, increasing the dose of tamsulosin might be recommended before switching patients to other drugs.

Symptomatic and quality of life response to tolterodine in subgroups of men with overactive bladder symptoms and presumed non-obstructive benign prostatic hyperplasia

To investigate the symptomatic and quality of life (QoL) response to treatment with tolterodine extended release (ER) in subgroups of male patients with Overactive Bladder Syndrome (OAB) and LUTS suggestive of non-obstructive benign prostatic hyperplasia (BPH) according to age, symptom severity, diabetes mellitus status, and concomitant treatment for LUTS. Patients treated with tolterodine ER 4 mg/day for OAB symptoms, alone or added to unsuccessful alpha-blocker treatment of > or =6 weeks duration, and presumed non-obstructive BPH (Q (max) > or = 15 ml/s) were observed for 12 weeks in a non-interventional study. Patients completed the International Prostate Symptom Score (IPSS) and Overactive Bladder Questionnaire (OAB-q) at baseline and after 12 weeks. 52.4% of 741 patients were aged < or =65 years; 4, 64, and 32% had mild, moderate, and severe symptoms, respectively, according to IPSS; 14% had diabetes mellitus, and in 42% tolterodine was added to alpha blockers. In the various subgroups, mean IPSS total scores improved by 2.8-11.1 points, IPSS QoL scores by 1.8-2.4 points, and all OAB-q subscores by more than 14 points. Only IPSS and OAB-q baseline scores had a relevant impact on changes during treatment, benefits were greatest in patients with more severe symptoms and bother. In men with symptoms of OAB and LUTS suggestive of non-obstructive BPH of all IPSS severity classes, aged < or =65 years or above, with or without concomitant diabetes or alpha-blockers, symptoms and QoL improved markedly during treatment with tolterodine ER.

The effect of α-blocker therapy on erectile functions in patients with lower urinary tract symptoms due to benign prostate hyperplasia

In this study we aimed to evaluate the impact of doxazosin treatment on erectile functions in patients with lower urinary tract symptoms (LUTS) and having erectile dysfunction (ED) at baseline. Fifty-three patients with LUTS (IPSS score > 7) whose maximum flow rate (Q(max)) < 15 mL s(-1) and PSA < 4 ng dL(-1) were enrolled in the study. Patients received doxazosin 4 mg once daily for 6 weeks. Subjective efficacy was assessed by IPSS, IPSS-Quality of Life (IPSS-QoL) for LUTS and efficacy was assessed by International Index of Erectile Function (IIEF) for erectile functions at baseline and sixth weeks. The objective efficacy was assessed by Q(max). The patients were classified according to their self reported erectile status: group I had ED and group II did not have ED. At the endpoint, doxazosin significantly improved the total IPSS score (-7.7 +/- 6.1, P = 0.006), IPSS-QoL score (-1.5 +/- 1.5, P = 0.024) and Q(max) (3.2 +/- 4.6 mL s(-1), P = 0.002) over baseline. Mean decrease in IPSS and IPSS-QoL scores after the treatment period were 6.9 +/- 6.4 (P < 0.001) and 0.95 +/- 1.80 (P < 0.05) in group I, whereas 8.2 +/- 5.8 (P < 0.001) and 1.9 +/- 1.1 in group II (P < 0.001), respectively. Mean changes of Q(max) values were 2.3 +/- 3.3 mL s(-1) in group I (P < 0.05) and 3.7 +/- 5.3 mL s(-1) in group II (P < 0.001). The improvement of IIEF-EF scores after the treatment period was only significant for group I. The efficacy of alpha-blocker therapy for LUTS was better by means of symptomatic relief for patients who did not have ED when compared with patients who had ED at baseline. However, slight improvement in erectile functions with alpha-blocker therapy was only seen in LUTS patients with ED.

Eighteen-Month Results of a Randomized Prospective Study Comparing Transurethral Photoselective Vaporization with Transvesical Open Enucleation for Prostatic Adenomas Greater Than 80 cc

None Take Home Message: This is a prospective randomized study showing that for large prostatic adenomas, photoselective vaporization of the prostate requires less blood transfusions, shorter catheterization time and shorter hospital stay compared to open prostatectomy, while achieving similar functional results at the same time. The effectiveness and the safety of photoselective vaporization of the prostate (PVP) was compared to that of open prostatectomy (OP) for the surgical treatment of large prostatic adenomas. 125 patients with prostate glands>80 ml, were randomly allocated to PVP (n=65) or OP (n=60) and prospectively evaluated at 1, 3, 6, 12, and 18 months postoperatively. International prostate symptom score (IPSS) and peak urinary flow rate (Qmax) were chosen as primary treatment-related endpoints. Longer length of operation time, shorter length of catheterization and hospital stay were experienced by patients who underwent PVP. Although patients who underwent OP showed a higher transfusion rate, adverse events in general were minor and of similar profile in both groups. All functional parameters improved significantly compared to baseline values in both groups. There was no difference in IPSS between the two groups at 3, 6, 12, and 18 months postoperatively. Patients who underwent OP scored better in the IPSS-Quality of life score at 18 months postoperatively. At 18 months there were no significant differences between the two groups in the Qmax, post void residual urine volume and in the International Index for Erectile function-5 questionnaire. At three months prostate volume was significantly lower in the OP group and remained as such throughout follow-up. Our results indicate that for an 18 month period photoselective vaporization of the prostate is a highly acceptable treatment alternative to open prostatectomy.

Transurethral Photoselective Vaporization versus Transvesical Open Enucleation for Prostatic Adenomas >80 ml: 12-mo Results of a Randomized Prospective Study

ObjectivesTo compare the effectiveness and the safety of photoselective vaporization of the prostate (PVP) to open prostatectomy (OP) for the surgical treatment of large prostatic adenomas. MethodsA total of 125 patients with prostate glands >80ml were randomly allocated to PVP (n=65) or OP (n=60) and prospectively evaluated at 1, 3, 6, and 12 mo postoperatively. International Prostate Symptom Score (IPSS) and peak urinary flow rate (Qmax) were chosen as primary treatment-related end points. ResultsThe patients who underwent PVP experienced a longer length of operation time, shorter time of catheterization, and shorter hospital stay. Adverse events were minor and of similar profiles in both groups, although patients who underwent OP showed a higher transfusion rate. All functional parameters improved significantly compared to baseline values in both groups. The IPSS did not differ between the two groups at 3, 6, and 12 mo postoperatively. Patients who underwent OP scored better in the IPSS quality of life score at 6 and 12 mo postoperatively. No significant differences between the two groups in the Qmax, postvoid residual urine volume, and International Index for Erectile Function-5 questionnaire were detected. At 3 mo prostate volume was significantly lower in the OP group compared to the PVP group (median value 10ml vs. 50ml; p<0.001) and remained as such throughout follow-up, whereas prostate-specific antigen values reached statistical difference at 6 mo (median value 2ng/ml vs. 2.4ng/ml; p=0.028). ConclusionsOur results indicate that for a 12-mo period PVP is a highly acceptable treatment alternative to OP.

Lower Urinary Tract Symptoms after Radical Perineal Prostatectomy

To clarify the impact of radical perineal prostatectomy (RPP) on lower urinary tract symptoms (LUTS) in patients with clinically localized prostate cancer. A total of 117 patients with a median age of 69 years who underwent RPP alone between August 2002 and August 2005 were included in the study. We measured LUTS on the basis of the International Prostate Symptom Score (IPSS) and IPSS quality of life (QOL) questionnaire before, and 3, 6 and 12 months after surgery. The overall mean total IPSS and IPSS QOL score decreased over time after RPP and was significantly reduced at 12 months after surgery. The decrease of the score was more prominent and rapid in patients with moderate to severe symptoms (IPSS > or = 8), whereas in those with no or only mild symptoms (IPSS < or = 7), the score did not change significantly after RPP. When the patients were divided into groups with baseline scores of 0-1 and 2-5 for each of the seven composites of the IPSS, scores for the 2-5 group improved significantly after RPP in all composites, whereas the 0-1 group had significantly worse scores for voiding frequency and nocturia. No significant change was noted in any of the other five composites. This longitudinal study shows that RPP is significantly beneficial for moderate to severe LUTS, but also has adverse effects on voiding frequency and nocturia in some men with no or mild symptoms. This information is important when counseling patients about treatment options for localized prostate cancer.

Clinical impact of tamsulosin on generic and symptom‐specific quality of life for benign prostatic hyperplasia patients: Using international prostate symptom score and Rand Medical Outcomes Study 36‐item Health Survey

To examine the efficiency of alpha1-blocker treatment on disease-specific and generic quality of life (QOL) in men with clinically diagnosed benign prostatic hyperplasia (BPH), the improvement of QOL scores with International prostate symptom score (I-PSS) and Rand Medical Outcomes Study 36-item Health Survey (SF-36) was prospectively analyzed. A total of 68 newly diagnosed patients with symptomatic BPH that satisfied all inclusion and none of the exclusion criteria were prospectively recruited. All patients received 0.2 mg/day of tamsulosin for 12 weeks. All patients underwent pretreatment documentation of lower urinary tract symptoms (LUTS) and assessment of symptom-specific QOL. Symptoms and general health-related QOL (HRQOL) were assessed using the I-PSS and SF-36, respectively. Also, other objective variables, such as prostate volume, maximal urinary flow and postvoid residual urine volume, were evaluated. After 12 weeks, decrease in I-PSS was 27% compared with baseline (from 16.4 +/- 7.18 to 11.9 +/- 7.56). All questionnaires in the I-PSS showed improvement after tamsulosin treatment and the I-PSS QOL score was improved from 4.51 +/- 1.14 to 3.17 +/- 1.38 (P < 0.0001) at 12 weeks after tamsulosin administration. In intragroup comparisons of HRQOL scores with age-gender adjusted SF-36 Japanese national norms, three SF-36 subscales (bodily pain, BP; social function, SF; and mental health, MH) were worse in the BPH group aged over 70 years, while younger BPH groups aged <70 had better mean SF-36 physical function (PF) scores compared with age-gender adjusted Japanese national norms. In the BPH group with a prostatic volume > or =20 mL, three mean SF-36 scales (BP, SF and MH) were significantly improved after tamsulosin treatment. It is noteworthy that these SF-36 subscales were identical to those observed to worsen in the older BPH group compared to Japanese national norms. Treatment with tamsulosin for symptomatic BPH patients is associated with significant improvement in the generic HRQOL, in addition to disease-specific QOL and symptoms, at 3 months after drug administration. In particularly, for generic HRQOL with SF-36, tamsulosin treatment can efficiently improve three mean SF-36 subscales (BP, SF and MH) that are decreased in older BPH patients.

Natural history of voiding function after radical retropubic prostatectomy

Objectives To report results from a 2-year longitudinal survey of lower urinary tract function and quality of life (QOL) in men after radical retropubic prostatectomy (RP) for localized prostate cancer. Methods Between November 2001 and September 2003, self-report assessments were provided to 225 patients who underwent RP alone. The University of California Los Angeles Prostate Cancer Index (UCLA PCI), the International Prostate Symptom Score (IPSS), and the IPSS QOL score were administered before and 3, 6, 12, 18, and 24 months after RP. Results The overall mean total IPSS and IPSS QOL score progressively improved with time. The mean scores of several components improved significantly postoperatively. No significant difference was observed in nocturia between the baseline assessment and any of the postoperative follow-up assessments. The IPSS of the younger patients continued to recover significantly more rapidly than that of the older patients after RP. According to the UCLA PCI scores, urinary function substantially declined just after RP and continued to recover but scored lower than the baseline. The mean total IPSS and IPSS QOL scores observed in men with a UCLA PCI urinary function score of 80 or more were significantly better than in men with scores less than 80 at 24 months postoperatively. Conclusions Radical retropubic prostatectomy has a significant beneficial effect on lower urinary tract symptoms. The rate of improvement was lowest for nocturia among the seven symptoms of IPSS. Urinary continence after RP and age can affect the recovery of voiding function.

Adverse effect of radical prostatectomy on nocturia and voiding frequency symptoms

Objectives To evaluate the impact of retropubic radical prostatectomy (RP) on urinary incontinence and obstructive/irritative urinary symptoms, according to global self-assessment instruments. Methods Self-report assessments were provided by 120 patients who underwent RP alone. The University of California, Los Angeles Prostate Cancer Index (UCLA PCI), the International Prostate Symptom Score (IPSS), and the IPSS qualityoflife (QOL) score were administered before and 12 months after RP. Results Overall mean total IPSS and IPSS QOL scores showed statistically significant improvement (both P < 0.001). There were no differences between baseline and postoperative scores in “Voiding frequency” or “Nocturia” related to irritative symptoms. Moreover, RP had adverse effects on the nocturia and voiding frequency composites score when the analysis was limited to those men who reported scores of 0 or 1 for each symptom preoperatively ( P < 0.001 and P = 0.001, respectively). The urinary function score according to the UCLA PCI had substantially declined at 12 months compared with baseline ( P < 0.001); however, no significant differences were observed in urinary bother between the baseline and postoperative scores. Conclusions Although a significant proportion of men complained of urinary incontinence, RP significantly improved IPSS and IPSS QOL scores in men with moderate or severe urinary symptoms. However, RP seems to have a deleterious effect on nocturia and voiding frequency for some men with only mild symptoms.

Development and validation of a quality-of-life scale for Chinese patients with benign prostatic hyperplasia.

To develop and validate a quality of life (QoL) scale for Chinese patients with benign prostatic hyperplasia (BPH). According to the QoL definition of the World Health Organisation, we adhered to the rigorous guidelines of instrument development to form a pool of items, selected items and validated the scale, using data from 256 patients with BPH. A 74-item QoL scale for BPH (prior test version; BPH-QLS), including five domains (disease, physical, social, psychological, satisfaction) was developed and had good reliability and validity. The test-retest correlation coefficient and Cronbach's alpha coefficient of the BPH-QLS were 0.892 and 0.966. Thirteen common factors were extracted according to the conceptual model. The correlations of the BPH-QLS with the Short Form-36, the International Prostate Symptom Score (IPSS), and IPSS QoL score, and a published BPH-specific QoL scale were 0.784, 0.493, 0.462 and 0.762, respectively. The BPH-QLS could be used to discriminate among patients with a different QoL. The new scale is reliable, valid and sensitive, and we recommend using the BPH-QLS in Chinese and Chinese-born patients worldwide to assist in clinical practice.

Voiding diary for the evaluation of urinary incontinence and lower urinary tract symptoms: prospective assessment of patient compliance and burden.

Voiding diary duration may be related to patient compliance and burden. To test this hypothesis, we evaluated patient compliance and burden. Between January and July 2002, we prospectively evaluated 162 patients (57 males and 105 females, mean age 53.0, range 20-81 years) with stress urinary incontinence or lower urinary tract symptoms. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score (I-PSS) assessment and were randomly requested to complete 2-day, 3-day, or 7-day voiding diaries (the three study groups). At the second visit, a simple self-administered questionnaire was completed by all patients. The questionnaire included 11 items on subject demographics and voiding diary-keeping. No significant differences were found in either the accuracy of diary-keeping or the daily average number of omissions when the three groups were compared. However, as the diary duration increased, the mean burden scores increased (P = 0.005), and the mean preferred duration of the diary in the 7-day group was significantly higher than that of the 2-day or 3-day groups (P < 0.001). After categorizing patients into two groups according to the degree of patient burden, members of the group with a greater perceived burden were found to have a significantly higher I-PSS quality of life score (P = 0.045) and to have kept a diary for a longer time (P = 0.038). Our results suggest that keeping a diary for 7 days may increase patient burden and thus, we recommend that the 7-day diary should be reduced to cover fewer days.