International Prostate Symptom Score Question Research Articles

Factors Related to Overactive Bladder-like Symptoms in Bladder Cancer.

The aim of the present study was to investigate the factors related to overactive bladder (OAB)-like symptoms in patients with bladder cancer. This study included 59 patients who underwent transurethral resection of bladder tumor (TURBT). OAB-like symptoms were identified based on the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS) questionnaires. The main outcome measures were elucidation of bladder cancer-related factors that might induce OAB-like symptoms. Non-muscle invasive bladder cancer (NMIBC) was observed in 50 patients, and carcinoma in situ (CIS) was observed in 14 patients. OABSS total score, IPSS total score, and quality of life index were 5±3, 12±7 and 3±1, respectively. The OABSS question 1 score, indicating pollakisuria, was significantly higher in NMIBC patients with CIS than in those without CIS (presence of CIS vs. absence of CIS=1.0±0.6 : 0.5±0.6, p=0.02). IPSS question 4 score, indicating urgency (r=0.31, p=0.01), and OABSS question 4 score, indicating urgency incontinence (r=0.29, p=0.03), correlated significantly with the maximum bladder tumor diameter. Multivariate regression analysis demonstrated that presence of CIS in NMIBC cases correlated significantly with pollakisuria (p=0.02), and that maximum diameter of the bladder tumor correlated significantly with both urgency (p=0.04) and urgency incontinence (p=0.01). CIS induced pollakisuria in NMIBC. Larger diameter bladder tumors induced both urgency and urgency incontinence. Patients with bladder cancer who present with pollakisuria might have CIS.

Assessment of Patients With Prostate Cancer and Their Understanding of the International Prostate Symptom Score Questionnaire

The International Prostate Symptom Score (IPSS) is a widely used tool for evaluating patient-reported lower urinary tract symptoms. In this study, we assessed patients with prostate cancer and their understanding of IPSS questions. Consecutive patients with prostate cancer (N=144) self-completed an online IPSS questionnaire within 1 week before their visit at our radiation oncology clinic. At the visit, a nurse reviewed each IPSS question to ensure the patient understood it and then verified the patient's answer. Preverified and nurse-verified scores were recorded and analyzed for discrepancies. Complete concordance between preverified and nurse-verified responses to individual IPSS questions existed for 70 men (49%). In terms of overall IPSS score, 61 men (42%) had a lower or improved IPSS after nurse verification, and 9 men (6%) had a higher or worse IPSS. Before verification, patients overstated their symptoms of frequency, intermittency, and incomplete emptying. As a result of the nurse verification, 4 of 7 patients with IPSS in the severe range (20-35) were recategorized to the moderate range (8-19). Sixteen percent of patients whose preverified IPSS were in the moderate range were recategorized after nurse verification to the mild range (0-7). Treatment option eligibility changed for 10% of patients after nurse verification. Patients frequently misunderstand the IPSS questionnaire, leading them to respond in ways that do not accurately reflect their symptoms. Clinicians should verify patient understanding of the IPSS questions, particularly when using the score to determine eligibility for treatments.

Does the I-PSS Accurately Assess Urinary Function in Prostate Cancer Patients? Evidence From a Study of Nursing Verification of Patient Answers

The International Prostate Symptom Score (I-PSS) is a widely used tool for the evaluation of patient-reported lower urinary tract symptoms (LUTS). Urologists and Radiation Oncologists frequently use the I-PSS to help determine a prostate cancer patient's eligibility for a type of treatment, and to follow up quality-of-life outcomes after treatment. I-PSS is also used to define clinical trial eligibility criteria, and is a common means of comparing patient-reported outcomes between studies. The I-PSS is almost 30 years old and has not been modified in the light of contemporary understandings of patient communication. We sought to assess the degree of patient understanding of I-PSS questions by nursing verification at the time of the patient visit.Men with prostate cancer self-completed an online I-PSS questionnaire approximately one week prior to their visit with the physician. On the day of the visit, a nurse reviewed each I-PSS question with the patient to ensure they understood it, and then verified patient answers. Patient initial scores and nurse-verified scores were recorded, and the results analyzed for discrepancies.I-PSS scores were recorded for 105 men. Complete concordance between patient and nursing scores on all questions was reported for 62 men (59%; 95% C.I. 49%, 69%). The frequency of discordance was highest for urgency (20%), incomplete emptying (22%) and frequency (21%), with lower rates for intermittency (17%), nocturia (15%), weak stream (12%) and straining (7.6%). There was evidence that patients overstated scores compared to nurses for frequency (P = 0.010), weak stream (P = 0.036) and incomplete emptying (P = 0.012); for other domains, there was no evidence for either nurse or patient scores being higher (P≥0.3 for all). For incomplete emptying, nurse scores were lower for 19 men, 15 of whom had a score reduced to zero; for frequency, scores were lower for 14, with 7 reduced to zero.Patient I-PSS scores were moderately concordant with scores obtained after nursing review and verification. Some men appear to have had a poorer understanding of the questionnaire, particularly with respect to items concerning incomplete emptying and frequency. Consideration should be given to rewording the I-PSS to improve patient understanding.

Comparison of a Visual Prostate Symptom Score and International Prostate Symptom Score: A Prospective Multicenter Study and Literature Review

To evaluate the correlation between Visual Prostate Symptom Score (VPSS) and the International Prostate Symptom Score (IPSS) and uroflowmetry parameters in men with lower urinary tract symptoms (LUTS) with literature review. Patients were pooled from 4 different urology clinics in Turkey and divided into 3 groups according to their educational level. The scores of IPSS and the VPSS questionnaire, assistance requirement, and completion time of the questionnaires were recorded. Maximum flow rate (Qmax) and average flow rate (Qave) were determined with uroflowmetry test and the results are recorded. A total of 342 patients were evaluated (group 1, n=168; group 2, n=108; group 3, n =66). Median age of all groups was 61 (40-89). There was a significantly higher rate of the completion of VPSS than IPSS without assistance in total (P < .001). Educational level was not found as an independent factor with assistance requirement to complete VPSS while university educational level was found as an independent factor to complete IPSS (odds ratio=9.735, P < .001).There was a significantly lower completion time for VPSS in all groups when compared to IPSS (P < .001 for all groups). Significant positive correlations were found between VPSS and IPSS questions (P < .001). There were significant negative correlations between total score and weak stream question of VPSS and Qmax and Qave, separately (P < .001). VPSS can be more practical than IPSS to evaluate LUTS in men with low educational levels and/or in large populations. Some modifications are needed to increase the availability of VPSS.

Comparison of Visual Prostate Symptom Score with the International Prostate Symptom Score and uroflowmetry parameters in assessing men with lower urinary tract symptoms in Dr. Cipto Mangunkusumo National General Hospital, Indonesia.

BackgroundThe complexity of International Prostate Symptom Score (IPSS) as an objective questionnaire for lower urinary tract symptoms might be overcome with alternative questionnaire such as the Visual Prostate Symptom Score (VPSS) which uses pictograms instead of questions to illustrate some of the questions addressed in IPSS.MethodsMale patients older than 45 years with lower urinary tract symptoms were evaluated with Indonesian version of the IPSS and VPSS, for uroflowmetry parameters using a transabdominal ultrasound. Appropriate statistical analysis was used.ResultsOf all participants, 24.2% and 11.1% require assistance when answering IPSS and VPSS questionnaires, respectively. The mean age, IPSS total score, VPSS total score, Qmax, voided volume, and postvoid residual volume were 67.4 ± 8.9 years, 13.4 ± 7.8, 10.8 ± 2.7, 13.6 ± 8.6 mL/sec, 248 ± 136 mL, and 54.9 ± 68.3 mL, respectively. Total IPSS, IPSS quality of life (QoL), IPSS question (Q) 2, IPSS Q7, and IPSS Q5 were significantly correlated with total VPSS, VPSS QoL, VPSS Q1, VPSS Q2, and VPSS Q3 [correlation coefficient (r) P value: 0.57, <0.001; 0.76, <0.001; 0.39, <0.001; 0.72, <0.001; 0.50, <0.001, respectively]. VPSS Q3 was significantly correlated with Qmax (r, P value: −0.26, <0.001). There was a significant relationship between the level of education and the ability to complete IPSS questionnaire (P < 0.001). There was no significant relationship between the level of education and the ability to complete VPSS questionnaire (P = 0.649).ConclusionThe VPSS was significantly correlated with IPSS and Qmax. The novel questionnaire proved useful as an alternative tool for IPSS for assessing men with lower urinary tract symptoms, especially for those with lower level of education.

441 Serum total testosterone level is not associated with nocturia in men with erectile dysfunction without LUTS/benign prostatic

Recent studies focusing on the link between nocturia and serum testosterone (tT) levels have shown conflicting results, irrespectively of benign prostatic hyperplasia (BPH). To better understand the association between nocturia and tT we analysed prevalence of and severity of nocturia and its possible association with tT in patients seeking first medical help for new onset erectile dysfunction (ED) without LUTS/BPH (BPH-). Demographic, clinical and laboratory data from 355 consecutive patients men seeking first medical help for ED (ED+/BPH-) were analysed. Exclusion criteria were: concomitant ED and LUTS/BPH; history of diabetes mellitus; current therapy with diuretics, hormones, or 5-alpha-reductase inhibitor agents; previous surgery for BPH. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients were invited to complete the International Prostate Symptom Score (IPSS) and International Index of Erectile Function – Erectile Function (IIEF-EF) domain. Nocturia was defined as ≥1 nocturnal voiding episodes. Nocturia was assessed using IPSS question 7. Descriptive statistics and logistic regression models tested the association between clinical and hormonal variables and nocturia prevalence.

Causative factors for de novo inguinal hernia after robot-assisted radical prostatectomy.

To determine causative factors for de novo inguinal hernia (IH), after robot-assisted radical prostatectomy (RARP). This was a retrospective, single-center study, which included patients undergoing RARP for prostate cancer at our institution, from February 2012 to January 2015. Cox proportional hazards models were used to determine the relationships between de novo IH and various factors. A total of 284 patients were included in the analysis. Forty-two (14.7%) patients developed IH at a median period of 8months after RARP. On multivariate analysis, preoperative international prostate symptom score question 6>2, and a patent processus vaginalis were significantly correlated with de novo IH (hazard ratio (HR) 4.17, 95% confidence interval (CI) 2.07-8.37, p<0.001; HR 3.67, 95% CI 2.36-5.69, p<0.001). Preoperative urinary straining and a patent processus vaginalis were predictive of de novo IH after RARP.

Triptorelin for the relief of lower urinary tract symptoms in men with advanced prostate cancer: results of a prospective, observational, grouped-analysis study.

Lower urinary tract symptoms (LUTSs) may develop in men with prostate cancer (PCa) and can impact quality of life (QoL). Gonadotropin-releasing hormone (GnRH) agonists as androgen deprivation therapy are standard treatment for PCa, however, data are limited on their effects on LUTSs. A grouped analysis of national observational, non-interventional studies initiated in clinical practice was performed to assess the effectiveness of triptorelin in reducing moderate or severe LUTSs, measured using the International Prostate Symptom Score (IPSS) in men with advanced or metastatic PCa. Men with PCa and LUTSs scheduled to receive triptorelin (3-month or 1-month extended release formulation) were recruited into prospective, non-interventional studies at centres in Algeria, Australia, Belgium, China, Hungary, Romania and South Korea. The primary effectiveness endpoint was the proportion of patients with moderate or severe LUTSs, assessed by IPSS, after 48 weeks. Secondary endpoints included: total IPSS, QoL due to urinary symptoms (IPSS Question 8) and prostate-specific antigen (PSA) levels at 24 and 48 weeks. A total of 2701 patients were recruited; 1851 patients with moderate or severe LUTSs at baseline (IPSS > 7), received triptorelin and had follow-up IPSS (efficacy population). The proportion of patients with moderate or severe LUTSs was reduced to 67.2% from baseline at week 48, following a reduction to 75.9% at week 24: the overall time effect was significant (p < 0.001). QoL due to urinary symptoms significantly improved from a mean score of 3.7 at baseline, to adjusted means of 2.5 and 2.1, at weeks 24 and 48, respectively (p < 0.001 versus baseline). Mean PSA levels were reduced from 158.8 ng/ml at baseline to 11.5 and 16.0 ng/ml at weeks 24 and 48, respectively. Within the limitations of these observational studies, improvements in LUTSs and QoL observed after 24 weeks and maintained at 48 weeks indicate that triptorelin-induced effects improve LUTSs in patients with advanced PCa.

Quantitative analysis of genitourinary toxicity after iodine-125 brachytherapy for localized prostate cancer: Followup of the International Prostate Symptom Score and Overactive Bladder Symptom Score

PurposeTo analyze genitourinary toxicity by followup of the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) after prostate brachytherapy. Methods and MaterialsSix hundred eighty patients were treated with iodine-125 brachytherapy for localized prostate cancer. IPSS, OABSS, and two categories of IPSS questions (storage symptom score [IPSS-S] and voiding symptom score [IPSS-V]) were evaluated. ResultsThe median followup was 54 months (range, 24–108). All scales showed rapid increases followed by gradual decreases. The median times to IPSS peak and resolution were 1 and 6 months, respectively. The resolution rates of IPSS, IPSS-S, IPSS-V, and OABSS at the last followup were 84.2%, 86.3%, 89.5%, and 83.0%, respectively. The difference between IPSS baseline and peak was greater for larger preimplant prostate volumes (≥25 mL, p = 0.004). The time to resolution was longer for higher biologic effective dose (BED) (≥210 Gy, p = 0.019 [IPSS]), in those with larger prostate volumes (≥25 mL, p = 0.025 [OABSS]), in younger patients (younger than 70 years, p = 0.043 [IPSS-S]), and in those with androgen deprivation therapy (ADT) use (p = 0.049 [IPSS-V]). Urge incontinence, included in the OABSS, was observed more commonly in older patients (75 years and older, p = 0.018), with ADT use (p < 0.001), and for higher BED (≥210 Gy, p = 0.006). ConclusionsThe IPSS and OABSS showed similar patterns of change. Urinary symptoms improved more rapidly in those with high baseline IPSS levels. The OABSS was useful for following urinary symptoms after prostate brachytherapy. Age, ADT use, preimplant prostate volume, and BED were significantly associated with urinary outcomes.

A multicenter real-life study of the efficacy of an alpha-blocker with or without anticholinergic agent (imidafenacin) treatment in patients with lower urinary tract symptoms/benign prostatic hyperplasia and storage symptoms.

To evaluate the efficacy and safety of combination therapy comprising a short-acting anticholinergic, imidafenacin and an alpha-blocker compared with monotherapy with an alpha-blocker only in men with lower urinary tract symptoms (LUTS) and storage symptoms. The 12-week, prospective, double-blind, randomised trial enrolled men with LUTS and storage symptom. The inclusion criteria were a total International Prostate Symptom Score (IPSS) ≥12, an IPSS question 4 score ≥2, ≥8 micturitions in 24hours, and a prostate volume >20mL. The primary outcome was a change in the micturition number from baseline. Bladder diary variables, Patient Perception of Intensity of Urgency Scale (PPIUS) scores, IPSS and safety were assessed. Of 260 patients screened, 221 completed the study. Patients were randomly assigned to receive an alpha-blocker only (n=111, group 1) or combination therapy comprising an alpha-blocker and an anticholinergic (n=110, group 2) for 12weeks. Group 1 and 2 showed significant improvement in their 24-hour micturition numbers (-1.87 and -2.08, respectively), nocturia episodes (-0.48 and -0.53, respectively), total IPSS (-9.9 and -8.8, respectively), and PPIUS scores (-0.19 and -0.24, respectively). Micturition number per 24hours, daytime frequency, urgency, the PPIUS score, the IPSS question 4 score and IPSS QoL score improved significantly in the combination therapy group, but changes in total IPSS, nocturia episodes, and safety outcomes did not differ significantly between the groups. Compared with treatment with an alpha-blocker alone, combination therapy comprising an anticholinergic and an alpha-blocker showed superior efficacy and its safety was similar in patients with LUTS and storage symptoms.

MP47-18 CONTRIBUTORS TO THE OCCURRENCE OF INGUINAL HERNIA AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV1 Apr 2017MP47-18 CONTRIBUTORS TO THE OCCURRENCE OF INGUINAL HERNIA AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY. Tsuyoshi Majima, Yasushi Yoshino, Yoshihisa Matsukawa, Yasuhito Funahashi, Naoto Sassa, Masashi Kato, Tokunori Yamamoto, and Momokazu Gotoh Tsuyoshi MajimaTsuyoshi Majima More articles by this author , Yasushi YoshinoYasushi Yoshino More articles by this author , Yoshihisa MatsukawaYoshihisa Matsukawa More articles by this author , Yasuhito FunahashiYasuhito Funahashi More articles by this author , Naoto SassaNaoto Sassa More articles by this author , Masashi KatoMasashi Kato More articles by this author , Tokunori YamamotoTokunori Yamamoto More articles by this author , and Momokazu GotohMomokazu Gotoh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1478AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies reported that about 10% of patients who underwent retropubic radical prostatectomy developed inguinal hernia (IH) after surgery. However, few studies have evaluated IH following robot-assisted radical prostatectomy (RARP). We retrospectively investigated the incidence and risk factors for IH after RARP. METHODS Subjects included patients who underwent RARP for prostate cancer in our institution from February 2012 to January 2015. Those with previous/concomitant IH history, concurrent IH-prophylaxis surgery, and follow-up < 1 year were excluded. Demographic and clinical profiles were collected from medical records. Every RARP video record was reviewed by a blinded urologist to verify the existence of a patent processus vaginalis (PPV). Univariate and multivariate Cox proportional hazards models were used to determine relationships between post-RARP IH and age, body mass index (BMI), previous lower abdominal surgery, total International Prostate Symptom Score (IPSS), IPSS voiding score, IPSS storage score, IPSS question 5 (weak stream) and 6 (straining) score, maximum urethral closing pressure (MUCP) and functional profile length (FPL) on urethral pressure profile, prostate weight, and PPV. Pre- and postoperative IPSS, MUCP, and FPL were included. RESULTS Of 284 patients in the study, 41 (14.4%) developed IH at a median 8 months after RARP. On univariate analysis, BMI ≥ 23, IPSS question 5 score ≥ 3, and PPV were significantly correlated with post-RARP IH (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.24 - 0.89, p = 0.02; HR 2.20, 95% CI 1.12 - 4.3, p = 0.02; HR 3.59, 95% CI 2.39 - 5.40, p < 0.001, respectively). On multivariate analysis, IPSS question 5 score ≥ 3, and PPV were significantly correlated with post-RARP IH (HR 2.77, 95% CI 1.40 - 5.51, p = 0.003; HR 3.87, 95% CI 2.46 - 6.07, p < 0.001). PPV was detected on the right (51 patients, 17.9%), left (23, 8.0%), and both (15, 5.2%) sides. Twenty-three of 51 patients (45.0%) with right-side PPV, 5 of 23 (26.0%) with left-side PPV, and 5 of 15 (33.3%) with bilateral PPV developed IH after RARP. Thirty-seven of 41 post-RARP IH cases (95.1%) were indirect, but only 4 cases (4.8%) were combined IH. CONCLUSIONS Weak stream and PPV were predictive of IH after RARP. Prophylactic surgery should be performed during RARP in patients at high risk for post-RARP IH. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e635 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tsuyoshi Majima More articles by this author Yasushi Yoshino More articles by this author Yoshihisa Matsukawa More articles by this author Yasuhito Funahashi More articles by this author Naoto Sassa More articles by this author Masashi Kato More articles by this author Tokunori Yamamoto More articles by this author Momokazu Gotoh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP13-01 COMPARISON OF A MEXICAN VISUAL ANALOG SCALE (GEA SCALE) VS IPSS (NTERNATIONAL PROSTATE SYMPTOM SCORE) IN THE EVALUATION OF LOWER URINARY TRACT SYMPTOMS IN A LOW SOCIO-CULTURAL LEVEL POPULATION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation1 Apr 2017MP13-01 COMPARISON OF A MEXICAN VISUAL ANALOG SCALE (GEA SCALE) VS IPSS (NTERNATIONAL PROSTATE SYMPTOM SCORE) IN THE EVALUATION OF LOWER URINARY TRACT SYMPTOMS IN A LOW SOCIO-CULTURAL LEVEL POPULATION Diego Preciado Estrella, Steven Kaplan, Edgar Mayorga Gómez, Mauricio Cantellano Orozco, Carlos Martínez Arroyo, and Carlos Pacheco Gahbler Diego Preciado EstrellaDiego Preciado Estrella More articles by this author , Steven KaplanSteven Kaplan More articles by this author , Edgar Mayorga GómezEdgar Mayorga Gómez More articles by this author , Mauricio Cantellano OrozcoMauricio Cantellano Orozco More articles by this author , Carlos Martínez ArroyoCarlos Martínez Arroyo More articles by this author , and Carlos Pacheco GahblerCarlos Pacheco Gahbler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.444AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The World Health Organization approved the International Prostate Symptom Score (IPSS) to evaluate lower urinary tract symptoms (LUTS). This scale was developed in industrialized populations. However, there are populations around the world where there may be language and comprehension barriers in interpreting the IPSS making it less reliable. The objective of this study is to compare IPSS versus a new Visual Analog Scale (Gea Scale) and establishing which is more understandable for patients METHODS A transversal, descriptive and comparative study was developed in Gea Gonzalez Hospital. Men> 45 years of age with LUTS were evaluated using 2 clinical tools: IPSS and the GEA scale which was developed with the collaboration of both: a graphic designer and a phoniatrist. Both tools were applied to each patient recording sociodemographic variables, understanding, ability to respond for themselves, accuracy and response time. Statistical analysis was performed using SPSS software (version 22.0). RESULTS 151 men with LUTS were included, with the following results: age 67 (± 11.09), seven years schooling (± 2.5), 35% unemployed, 8% native american dialect speakers (nahuatl, mazateco and otomi). 63 patients (42%) sought help to answer IPSS questions because of socio-intellectual limitations. In contrast 87% (131) of men completed the GEA Scale while only 16 (10%) asked for help and 3 (1.9%) did not complete it because of visual / intellectual barriers (x2 = 11.68, df = 1, p <0.05). The average time to complete the IPSS was 4.8 minutes compared to 2.6 minutes for the Gea Scale (Student t 19.64, df 118, p <0.05). CONCLUSIONS The use of the Gea Scale to evaluate LUTS may be a useful and innovative adjunct to evaluate LUTS in populations with cultural or academic constraints. The results reported herein suggest that the GEA scale was more useful than the IPSS both in time and qualitative responsiveness in a population of men with intellectual, linguistic, academic or sensory limitations. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e152-e153 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Diego Preciado Estrella More articles by this author Steven Kaplan More articles by this author Edgar Mayorga Gómez More articles by this author Mauricio Cantellano Orozco More articles by this author Carlos Martínez Arroyo More articles by this author Carlos Pacheco Gahbler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Relationship between serum testosterone and nocturia in men without benign prostate enlargement.

Recent studies have focused on the relationship between nocturia and serum testosterone because testosterone is thought to be an important factor of prostate growth. However, it remains unclear whether altered serum concentrations of testosterone is associated with an increased risk of nocturia because patients who were taking diuretics or who had a large prostate, which may precipitate nocturia, were not excluded from most previous studies. We analyzed the clinical records of 596 non-benign prostatic enlargement (BPE) male patients to explore the relationship between serum total testosterone and nocturia. All patients were evaluated using a serum prostate-specific antigen (PSA) assay, measurement of serum total testosterone, transrectal ultrasonography, uroflowmetry, and a compilation of the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) questionnaires. Nocturia was defined as ≥2 nocturnal voiding episodes. The number of nocturia episodes was assessed using IPSS question 7. To evaluate the effect of serum testosterone on nocturia, multivariate regression analysis was performed including the covariates of age, IPSS, IIEF score, body mass index, PSA, prostate volume, and maximal urine flow rate. Based on multivariate linear analysis, serum testosterone level was not significantly associated with the severity of nocturia. However, with regard to the relationship between prevalence of nocturia and serum testosterone, prevalence of nocturia was significantly positively associated with age (OR=1.048, p=0.005), total IPSS (OR=1.217, p<0.001), and testosterone level (OR=1.150, p=0.041). Therefore, in men without an enlarged prostate, testosterone may play an opposing role in the etiology of nocturia.

New Visual Prostate Symptom Score versus International Prostate Symptom Score in Men with Lower Urinary Tract Symptoms: A Prospective Comparision in Indian Rural Population.

Introduction:Benign prostrate hyperplasia (BPH) is a leading source of healthcare problem in aging men around the world including India. Both International Prostate Symptom Score (IPSS) and New Visual Prostate Symptom Score (VPSS) are used to assess the lower urinary tracts symptoms (LUTSs) in men. The present study was planned to compare these two scores, IPSS and VPSS in Indian rural men prospectively and their efficacy was compared with urodynamic evaluation of the patients.Materials and Methods:With Institutional Ethical Committee approval, this study was conducted on 100 patients having LUTS and BPH after obtaining written informed consent. Patients’ educational status was noted. All the patients were requested to complete the IPSS and VPSS questionnaire, and they were correlated. The urodynamic study was performed on all the patients with uroflowmeter. Two parameters of uroflowmetry, Qmax (maximum urine flow rate expressed in ml/s) and Qavrg (average urine flow rate expressed in ml/s) were measured and correlated.Results:Most of the patients (55%) in this study were uneducated. Out of 100 patients, 83% were able to fill the VPSS questionnaire without assistance as compared to only 40% patients in IPSS questionnaire (Z = 6.557, P < 0.001). There was a positive correlation between IPSS and VPSS total score in this study (r = 0.453 and P ≤ 0.001). It was noticed that IPSS Question 2 for frequency of urination had a positive correlation with VPSS Question 1 (day time frequency of urination) r = 0.645 (P = 0.000). Similarly, IPSS Question 7 for night frequency when compared with VPSS Question 2 (nocturia); the value for r was found to be 0.536 (P = 0.000). The IPSS Question 5 for straining when compared to the VPSS Question 3, i.e., the question for the strength of stream during micturition; the positive correlation was found to be 0.266 (P = 0.007). There was a negative correlation between IPSS total score and Qavrg with value − 0.368 (P = 0.000) and between IPSS total score and Qmax of − 0.433 (P = 0.000). A negative correlation is also noted between VPSS total score and Qavrg of value 0.497 (P = 0.000) and VPSS total score and Qmax of value − 0.719 (P = 0.000).Conclusion:VPSS correlates significantly with the IPSS to quantify the LUTS due to BPH. The VPSS can be used instead of the IPSS for the assessment of symptom severity in men with LUTS, who are illiterate or have limited education.

Detrusor Overactivity Does Not Predict Bothersome Storage Symptoms After Photoselective Vaporization of the Prostate With Lithium Triborate Laser

To find out if detrusor overactivity (DO) is a predictor of moderate or severe storage lower urinary tract symptoms (LUTS) persisting 6 months after photoselective vaporization of the prostate (PVP). Patients with bladder outlet obstruction proved by urodynamics who underwent PVP with the lithium triborate laser were followed for 6 months with the International Prostate Symptom Score (IPSS) questionnaire. Moderate-to-severe storage LUTS were defined as IPSS storage domain score >8 and/or a score for an IPSS question on urgency >3. Predictive values of DO, IPSS domains, urgency, prostate volume, bladder outlet obstruction grade, and energy used were tested by logistic regression analysis. Seventy-six men at the age of 66.4 ± 6.8 years underwent PVP, including 36 (47.4%) with DO. Incidence of moderate or severe storage LUTS was decreasing from 60.5% to 48.7% at week 6 and 11.8% at month 6 postoperatively. At a univariate analysis, urgency score and storage domain score were significantly associated with bothersome storage LUTS at month 6. Multivariate analysis confirmed predictive value of preoperative urgency having an odds ratio of 5.7 (95% confidence interval, 1.41-23.16; P = .014). DO was not associated with the defined outcome. In our group, DO was not useful in predicting persistent storage symptoms after PVP. Patients with severe preoperative urgency should be informed about a risk of such outcome.

Voiding characteristics and related hormonal changes in peri-menopausal and post-menopausal women: A preliminary study

ObjectivesTo characterize voiding symptoms during the peri- and post-menopausal periods and to investigate related hormonal changes. MethodsWe enrolled a total of 55 patients between February 10, 2013, and August 15, 2013, to participate in this cross-sectional study. To characterize patients’ voiding symptoms, we administered voiding questionnaires, including the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Sandvik Severity Index. Measured hormones included E2, FSH, TSH, prolactin, progesterone, and testosterone. ResultsIn the univariate analysis, there were significant intergroup differences for all of the hormones except progesterone. Among the voiding symptoms, straining (IPSS question 1), frequency (IPSS question 2), and SUI were significantly different between the two groups (p=0.039. 0.010, and 0.017, respectively). In the multivariate analysis, frequency (IPSS question 2) and SUI were significantly different between the two groups (p=0.020 and 0.011, respectively). Among the hormones, only testosterone was marginally different between the two groups (p=0.059). ConclusionsDuring the transition to menopause, voiding symptoms, such as frequency, can potentially worsen in the peri-menopausal period, and SUI is more prevalent in the post-menopausal period. Additionally, testosterone may have a role in voiding changes that occur during the menopausal transition.

Effects of tadalafil on nighttime voiding (nocturia) in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a post hoc analysis of pooled data from four randomized, placebo-controlled clinical studies

The phosphodiesterase type 5 inhibitor tadalafil is approved for the treatment of signs and symptoms of benign prostatic hyperplasia (BPH). While tadalafil significantly improves overall lower urinary tract symptoms suggestive of BPH (LUTS/BPH), improvements in nocturia were not significant in individual studies. We therefore sought to further assess nocturia based on data integrated from four tadalafil registrational studies. Data were integrated from four randomized, placebo-controlled, double-blind, 12-week registrational studies of tadalafil for LUTS/BPH. Nocturia was assessed as nighttime voiding frequency using the International Prostate Symptom Score question 7 (IPSS Q7). Efficacy results were analyzed using analysis of covariance. For the tadalafil 5 mg once daily (N = 752) and placebo (N = 748) groups, baseline characteristics were well balanced, and the overall severity of nocturia per mean IPSS Q7 was 2.3 ± 1.2. The mean treatment change was -0.4 with placebo and -0.5 with tadalafil; the least-squares mean (standard error) treatment difference was -0.2 (0.05), p = 0.002. For patients receiving placebo and tadalafil, respectively, the proportion with improved nocturnal frequency was 41.3 and 47.5 %, with no change was 44.8 and 41.0 %, and with worsening was 13.9 and 11.5 %. A statistically significant improvement in nocturnal frequency was seen with tadalafil over placebo; however, the treatment difference was small and not considered clinically meaningful. Further studies using voiding diaries and excluding patients with nocturnal polyuria would be needed to more precisely estimate the impact of tadalafil on nocturia associated with LUTS/BPH.

Urinary Function following Laparoscopic Lymphadenectomy for Male Rectal Cancer

ObjectivesUrinary function can be protected following open lateral node dissection (LND) with pelvic autonomic nerve preservation (PANP) for advanced rectal cancer. However data regarding urinary function after laparoscopic LND with PANP have not been reported. The goal of this study was to determine the effects of laparoscopic LND with PANP on urinary function in male patients with rectal cancer.MethodsUrine flowmetry was performed using an Urodyn flowmeter. Patients were also asked to complete the standardized International Prostate Symptom Score (IPSS) questionnaire before surgery and 6 months after. In total, this study consisted of 60 males with advanced rectal cancer.ResultsNo significant differences were seen in maximal urinary flow rate, voided volume or residual volume before and after surgery. The total IPSS score increased significantly after surgery and at least 41 patients (68.3%) reported there was no change in one of the seven IPSS questions.ConclusionsLaparoscopic LND with PANP was relatively safe in preserving urinary function.

Étude des urgenturies postopératoires après photovaporisation prostatique par laser Greenlight®

Urgencies are classically described after prostate photovaporization (PVP). The objective of this study was to analyze the incidence of urgency in patients who underwent PVP using the International Prostate Symptom Score (IPSS) to defined urgencies. This is a single-center prospective cohort study assessing patients who underwent surgery between May 2005 and January 2011. The questions 2 and 4 of the IPSS and open questions were selected to evaluate urgency during the follow-up. Two-hundred and four patients were operated during this period and 93 complete records were analyzed. Twenty-one percent of these patients had a clinical urgency after 1 month and 1,9% at 12 months (significant improvement, P<0.001) corresponding to scores greater than 4 for questions 2 and 4 of the IPSS. Answer scores to questions 2 and 4 improved significantly over 12 months (P<0.001). The clinical urgencies decreased significantly as well as answers to questions 2 and 4 of the IPSS. Urgencies decreased significantly between 3 and 12 months of postoperative follow. Questions 2 and 4 of the IPSS score appeared to be a standardized definition of these urgencies.

Correlations Among Urinary, Sexual, and Testicular Functions and Health-Related Quality of Life

Background: We investigated how urinary, sexual, and testicular functions and generic health-related quality of life (HR-QOL) affect each other in aged men. Methods: Ninety patients who were negative for cancer on prostate biopsies were enrolled in this study. The mean patient age was 66±7 years (mean±s.d.). The mean prostate volume was 44.3±21.9 mL, and the mean serum total testosterone (TT) level was 3.63±1.18 ng/mL. Before conducting the prostate biopsies, the patients were asked to complete questionnaires, including the International Prostate Symptom Score (I-PSS), UCLA Prostate Cancer Index (UCLA-PCI), and the Rand Medical Outcome Study 36-Item Short Form (SF-36), to evaluate urinary symptoms, sexual function, and generic HR-QOL. The relationships between these parameters were analyzed. Other objective variables, such as the prostate volume, maximal urinary flow (Qmax), postvoid residual urine volume, and age, were also evaluated. Results: The TT level was found to be related to the I-PSS Q6 (r=−0.23108, p=0.03230) and Qmax (r=0.44210, p=0.00073). The mental component summary (MCS) score exhibited a significant negative relationship with the presence of urinary symptoms (sum of I-PSS Q1–7). When each I-PSS question was analyzed separately, nocturia (Q7) was found to have the most significant impact on SF-36; the physical component summary (PCS) and MCS were also worsened by nocturia. The UCLA-PCI sexual function was positively related to the SF-36 MCS, SF-36 PCS, and TT level and negatively related to the I-PSS Q3, Q5, Q6, and Q7. Aging also showed a negative impact on nocturia, sexual function, and the SF-36 PCS. Conclusions: TT levels are correlated with the parameters of urination. Urinary symptoms, sexual function, and generic HR-QOL were found to have close relationships. In the management of the health of aged men, physicians should consider urinary function together with testicular and sexual functions as well as overall QOL.