International Prostate Symptom Score Questionnaire Research Articles

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery.

This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes. We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery. The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor. In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.

Six-Month Prostate Cancer Empowerment Program (PC-PEP) Improves Urinary Function: A Randomized Trial.

Purpose: This is a secondary analysis examining a six-month home-based Prostate Cancer-Patient Empowerment Program (PC-PEP) on patient-reported urinary, bowel, sexual, and hormonal function in men with curative prostate cancer (PC) against standard of care. Methods: In a crossover clinical trial, 128 men scheduled for PC surgery (n = 62) or radiotherapy with/without hormones (n = 66) were randomized to PC-PEP (n = 66) or waitlist-control and received the standard of care for 6 months, and then PC-PEP to the end of the year. PC-PEP included daily emails with video instructions, aerobic and strength training, dietary guidance, stress management, and social support, with an initial PFMT nurse consultation. Over 6 months, participants in the PC-PEP received optional text alerts (up to three times daily) reminding them to follow the PFMT video program, encompassing relaxation, quick-twitch, and endurance exercises; compliance was assessed weekly. Participants completed baseline, 6, and 12-month International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC) questionnaires. Results: At 6 months, men in the PC-PEP reported improved urinary bother (IPSS, p = 0.004), continence (EPIC, p < 0.001), and irritation/obstruction function (p = 0.008) compared to controls, with sustained urinary continence benefits at 12 months (p = 0.002). Surgery patients in the waitlist-control group had 3.5 (95% CI: 1.2, 10, p = 0.024) times and 2.3 (95% CI: 0.82, 6.7, p = 0.11) times higher odds of moderate to severe urinary problems compared to PC-PEP at 6 and 12 months, respectively. Conclusions: PC-PEP significantly improves lower urinary tract symptoms, affirming its suitability for clinical integration alongside established mental health benefits in men with curative prostate cancer.

Evaluation of Lower Urinary Tract Symptoms in Males and Urinary Incontinence in Females in Primary Health Care in Greece.

Background and Objectives: The significant prevalence of Lower Urinary Tract Symptoms (LUTS), erectile dysfunction (ED), and associated adverse effects calls for increased attention in primary care settings. In Greece, there is a lack of sufficient data for LUTS and ED screening in primary care. Therefore, the aim of our study was to estimate the prevalence of LUTS and ED, identify associated risk factors, and evaluate their impact on quality of life among adult primary healthcare users aged 40 years and older in Crete, Greece. Materials and Methods: A cross-sectional study was conducted to explore the prevalence of LUTS and ED in 1746 primary health care users visiting rural primary health care practices in Crete, Greece. Participants underwent a comprehensive evaluation including demographic parameters, screening for LUTS utilizing the validated International Prostate Symptoms Score (IPSS) questionnaire and for ED using the International Index of Erectile Function (IIEF-5), in males, and for urinary incontinence in women with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Participants with a prior diagnosis of LUTS or ED were excluded (n = 183). Results: Out of 536 participants finally included (n = 1746 screened), 32% of males and 36% of females exhibited moderate to severe LUTS. Following adjustments, we identified advanced age, retirement, and the presence of diabetes type 2 as factors associated with the occurrence of LUTS in men. Patients with LUTS also had a substantially increased likelihood of experiencing ED. Moreover, it was observed that women with hypertension or diabetes type 2 and lower education levels face an increased likelihood of developing LUTS, which adversely affects their quality of life. Conclusions: In conclusion, the findings of this study reveal a high occurrence of LUTS and ED in adults aged 40 years and older who utilize primary healthcare services, with a negative impact on their quality of life.

(126) Application of HIFEM Therapy Improves Orgasmic, Urinary and Erectile Function by Stimulation of Pelvic Floor Muscles

Abstract Introduction The weak pelvic floor in men contributes to various urological disorders. Treatment can be accomplished by strengthening the pelvic floor muscles (PFM) through pelvic floor muscle training. Nevertheless, such development of PFM is time-consuming and heavily dependent on the subject's ability to perform selective muscle contractions. An advantageous approach is the targeted stimulation of PFM which can be accomplished via electromagnetic stimulation. Particularly, the pelvic floor muscles can be non-invasively and selectively stimulated via the HIFEM field. This results in the natural development and rehabilitation of PFM, which, among other functions, plays a vital role in facilitating orgasmic, urinary and erectile function. Objective The aim of this study is to assess the safety and efficacy of the HIFEM pelvic procedure for the treatment of erectile dysfunction. Methods In this study, 28 males with a median age of 56 (30-72 years) were enrolled. The treatment was composed of ten weekly 28-minute sessions. Outcome measurements were collected via questionnaires and ultrasound imaging prior to and after the last treatment. To assess changes in erectile and sexual function, and prostate-related symptoms, the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) were used. Transverse B-Mode ultrasound video scans were recorded along the long axis of the penile shaft from the tip to the base with the penis in a flaccid state. A linear transducer was used, the depth was set at 2 cm, and the frame rate was approximately 30 frames per second. Separate video recordings of the left and right cavernosum were taken. The ultrasound scans were processed by the Morphometrix cloud-based algorithm. Adverse events were monitored during the study. Results All evaluation methods proved the efficiency of treatment on a statistically significant level. A significant improvement was detected in the majority (4 of 5) of the domains of IIEF, with the overall score improvement from a baseline value of 45.14±2.42 to 48.75±2.86 (+3.61 points). The most exceptional improvement was found in Sexual desire (+18.78%; p=1.06x10-3), Erectile dysfunction (+13.03%; p=5.7x10-4), and Orgasmic function (+10.69%; p=7.04x10-5) domains. The mean difference in the total score of the IPSS questionnaire reached -3.04 points (p=5.1x10-6), exceeding the corresponding minimal clinical difference (MIC=3 points). Overall, subjects, on average, shifted from moderately symptomatic (9.57±1.37 points) to mildly symptomatic (6.54±0.91 points). An increase in vascularity of both cavernosal was measured within 57% of patients who underwent ultrasound examination; specifically, a significant improvement was recorded in tissue segment count (TSC; +104%; p=1.17x10-4) and density (TSD; +81% p=2.20x10-3), pointing to better blood flow and delivery in examined tissues. No adverse event was observed. Conclusions The therapy administering HIFEM technology of the pelvic floor for selective PFM stimulation demonstrated significant improvement of erectile and orgasmic function and urinary symptoms. The questionnaire results corresponded with ultrasound measurements using a novel algorithm, identifying positive changes in the penile vascular system. Overall, the treatment may be considered a safe and a possible first-line solution for male patients suffering from dysfunctions linked to weakened pelvic floor muscles. Further investigation is needed. Disclosure Yes, this is sponsored by industry/sponsor: BTL. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: AFFIRM Science.

Prevalence and Distribution of Postvoid Residual Urine Volume in a Hospital-Based Sample of Men with Symptomatic Benign Prostatic Hyperplasia.

Benign prostatic hyperplasia (BPH) is a known cause of bladder outlet obstruction (BOO) in aging men. Patients present with lower urinary tract symptoms (LUTS), elevated postvoid residual urine (PVR), and reduced peak flow rate of urine. Although urodynamic study is the gold standard for diagnosing and quantifying BOO, it is invasive and as such urologists in their routine practice frequently rely on less invasive methods like PVR estimation to objectively assess BOO. To study the prevalence and distribution of PVR in a hospital-based population of men with symptomatic BPH. Patients aged 40 years and above were enrolled for the study. History was taken from each of the 170 participants recruited, and physical examination was done including digital rectal examination. Every one of them completed the International Prostate Symptom Score (IPSS) questionnaire and also had ultrasonography assessment of PVR. Relevant laboratory investigations (PSA, renal function test, full blood count, urinalysis, and urine culture) and uroflowmetry to determine the peak flow rate of urine (Qmax) were done. A total of 170 subjects who met the inclusion criteria were enrolled for this study. The mean age of the subjects was 63.70 ± 9.92 years with a range of 42-88 years. The subjects had a mean PSA of 2.68 ± 0.91 ng/ml and a mean prostate volume of 70.8 ± 39.5 ml. The prevalence of significant PVR was 57.06%. The distribution of PVR was skewed with values ranging from 4.0 ml to 382.9 ml, a median value of 60.5 ml (interquartile range, IQR, =25.0-100.76), and a mean value of 77.70 ± 69.30 ml. An IPSS range of 8 to 23 with a mean value of 13.64 ± 4.14 and a median value of 13 (interquartile range = 10.0-16.0) was observed. The Qmax range was from 5 ml/s to 50 ml/s with a mean value of 20.25 ± 9.70 ml/s, and a median value of 18.0 ml/s (interquartile range = 14.0-24.0). This study showed that the prevalence of significant PVR volume among men with symptomatic BPH in our environment is high. There was also a high variation in the distribution of PVR among the subjects. Therefore, it is essential to create more public awareness especially among men in their fourth decade of life and above to visit a urologist whenever they have BPH symptoms so as to avoid impairment in quality of life and renal function associated with neglected significant PVR.

Stereotactic body radiotherapy with CyberKnife® System for low- and intermediate-risk prostate cancer: clinical outcomes and toxicities of CyPro Trial.

Stereotactic body radiotherapy (SBRT) of 35-36.25 Gy in five fractions with the CyberKnife System yields excellent control with low toxicity in low-intermediate-risk prostate cancer patients. We found no differences in biochemical control and overall survival in relation to dose. There were no significant differences in toxicity or quality of life between the two groups. Stereotactic body radiotherapy (SBRT) is an emerging therapeutic approach for low- and intermediate-risk prostate cancer. We present retrospective data on biochemical control, toxicity, and quality of life of CyPro Trial. A total of 122 patients with low- and intermediate-risk prostate cancer were treated with the CyberKnife System at a dose of 35 Gy or 36.25 Gy in five fractions. Biochemical failure (BF)/biochemical disease-free survival (bDFS) was defined using the Phoenix method (nadir + 2 ng/ml). Acute/late rectal and urinary toxicities were assessed by the Radiation Therapy Oncology Group (RTOG) toxicity scale. Quality of life (QoL) was assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and PR25. International Erectile Function Index-5 (IIEF5) and International Prostate Symptom Score (IPSS) questionnaires were administered at baseline, every 3 months after treatment during the first years, and then at 24 months and 36 months. The 1-, 2-, and 5-year DFS rates were 92.9%, 92.9%, and 92.3%, respectively, while the 1-, 2-, and 5-year bDFS rates were 100%, 100%, and 95.7%, respectively. With regard to risk groups or doses, no statistically significant differences were found in terms of DFS or bDFS. Grade 2 urinary toxicity was acute in 10% and delayed in 2% of patients. No Grade 3 acute and late urinary toxicity was observed. Grade 2 rectal toxicity was acute in 8% and late in 1% of patients. No Grade 3-4 acute and late rectal toxicity was observed. Grade 2 acute toxicity appeared higher in the high-dose group (20% in the 36.25-Gy group versus 3% in the 35-Gy group) but was not statistically significant. Our study confirms that SBRT of 35-36.25 Gy in five fractions with the CyberKnife System produces excellent control with low toxicity in patients with low-intermediate-risk prostate cancer. We found no dose-related differences in biochemical control and overall survival. Further confirmation of these results is awaited through the prospective phase of this study, which is still ongoing.

Correlation between Physician-Administered International Prostate Symptoms Score and Peak Urine Flow Rate in Assessment of Benign Prostatic Enlargement Patients.

To determine the correlation between international prostate symptom score (IPSS) questionnaire, completed by benign prostatic enlargement patients with the aid of their physicians and the peak urine flow rate from uroflowmetry. This was a prospective study carried out over a period of one year (which year and which period). IPSS questionnaire was administered, and uroflowmetry done for 76 consecutive patients from urology clinic of University of Nigeria Teaching Hospital (UNTH) who consented to the study. Seventy-six patients were recruited for the study. The mean age of the patients was 63.53 ± 9.84. Using the international prostate symptom score to assess symptoms severity, 16 patients had mild symptoms, 36 patients had moderate symptoms, while 24 patients had severe symptoms. The means quality-of-life score was 4.42 ± 1.83. Fifty-eight patients had obstructed peak flow rate (Qmax) on uroflowmetry, 14 patients had equivocal Qmax, while 4 patients had normal Qmax. Statistically significant, negative medium correlations were observed between Qmax and total IPSS, Qmax and the IPSS voiding and storage subscores, as well as Qmax and disease specific quality-of-life score (QoL). There is a statistically significant medium negative correlation between total IPSS and Qmax. This negative medium correlation was also observed between Qmax and IPSS subscores and between Qmax and QoL.

Comparison of perioperative and short-terms outcomes of en-bloc Holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy: a propensity-score matching analysis.

Surgical treatment of symptomatic benign prostatic hyperplasia (BPH) has seen an evolution during the last decades. On one hand, en-bloc HoLEP emerged as a valid endoscopic treatment regardless prostate size. On the other hand, robot-assisted simple prostatectomy (RASP) has gained attention in larger prostates showing encouraging results. Herein, for the first time in the scientific scenario, we sought to compare the outcomes of RASP and en-bloc HoLEP cases after propensity-score matching (PSM) analysis. We retrospectively queried our prospectively database of patients treated with HoLEP or RASP between 2017 and 2022 among two high-volume centers. PSM was applied based on the International Prostate Symptom Score (IPSS) questionnaire, prostate volume and max-flow rate. All procedures were performed by a single surgeon per center. Outcomes were assessed at 1, 3, and 6-month postoperatively and therefore annually. Trifecta definition was used to assess "success" in surgical procedures and was defined as the contemporary presence of: a) no postoperative complications within the first postoperative month; b) 1-month postoperative Qmax >15 ml/s and c) no urinary incontinence at 3-month evaluation. Overall, 48 HoLEP and 47 RASPs were matched. Operative time, hospitalization time (median 4 vs 5 days) and catheterization time (median 3 vs 2 day) were found to be shorter in the HoLEP group as compared to the counterpart (p < 0.05). Early postoperative complication rate was also lower in the HoLEP cohort (6.2% vs 12.6%; p = 0.03) as well as postoperative haemoglobine blood level drop (1.4 vs 2.4 g/dL; p = 0.03). On the other hand, postoperative antegrade ejaculation (55.3% vs 6.8%) 1-month max flow (median 28 vs 24 ml/sec) and continence rates (0% vs 20.8%) favored RASP (p < 0.05). Overall, Trifecta rate was similar in the two groups (76.1% vs 82.6%). Both HoLEP and RASP are safe and effective treatments for symptomatic BPH. HoLEP demonstrated to have lower perioperative risks while is affecting by a higher probability of transient early UI. On the other hand, RASP is more effective in reducing postoperative ejaculatory dysfunction.

Low anterior resection syndrome and quality of life after intersphincteric resection for rectal cancer: a propensity score-matched study.

Our aim was to perform a propensity score-matched study to compare the long-term functional outcomes and quality of life following intersphincteric resection vs. low anterior resection (LAR) with very low anastomosis. Patients who underwent intersphincteric resection or low anterior resection with low anastomosis (≤ 4cm from the anal verge) for rectal cancer between January 2017 and June 2020 were retrospectively included. A propensity score-matching process was performed. Functional outcomes and quality of life were assessed using theEuropean Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), EORC-QLQ C30, EORC-QLQ CR29, Low Anterior Resection Syndrome (LARS), Wexner, and International Prostate Symptom Score (IPSS) questionnaires. The primary outcome was the presence of LARS at least 12months after surgery. The second outcome was the postoperative quality of life of included patients. After propensity matching, 128 patients were included, including 58 males and 70 females with a median age of 59.5. Patients in the intersphincteric resection group showed a higher incidence of incontinence to flatus (32.8% versus 14.0%, p = 0.043) and stools (42.2% versus 21.9%, p = 0.046), pain/discomfort (25.0% versus 7.8%, p = 0.001), and bowel dysfunction, while the LARS scores (15.0 versus 13.2, p = 0.461) and major LARS rates (26.6% versus 14.1%, p = 0.078) were comparable in both groups. ISR leads to increased bowel incontinence rate and increased anal pain, without affecting the grade of low anterior resection syndrome, fecal urgency, and clustering. LAR might be the preferred sphincteric-preserving approach when negative resection margins and a safe anastomosis are guaranteed. Patients should be fully informed about potential functional impairment after sphincter-preservation procedures.

Effects of the beta-blocker carvedilol on arrhythmia and long-term clinical outcomes in benign prostate hypertrophy patients.

Benign prostatic hypertrophy (BPH) is associated with autonomic dysfunction and sympathetic nervous system mediated by the alpha receptor. However, limited data exist regarding the effects of the beta-blocker (BB) carvedilol on arrhythmia and urologic outcomes in BPH patients. Our database of patients diagnosed with BPH from 2015 to 2020 was used to obtain echocardiography and electrocardiogram data. Inclusion criteria were BPH patients taking BBs. International Prostate Symptom Score questionnaire were used to evaluate the urinary symptoms and quality of life. Among 448 patients with BPH (69.2 ± 10.9 years) taking BBs, 219 patients took carvedilol (48.9%) and 229 patients took a non-carvedilol BB (51.1%; bisoprolol, 184 patients, 80% or nebivolol, 45 patients, 20%). Difference in the baseline characteristics was not observed. During the median 36-month follow-up, a lower incidence of arrhythmic events (P = .029), total urologic events (P < .001), and less use of additive alpha-blocker was observed in the carvedilol group (P = .022). In multivariate analysis, less carvedilol use (P = .019), heart failure (P < .001), stroke (P < .001), and cardiomyopathy (P = .046) were independent risk factors for arrhythmic events. In addition, less carvedilol use (P = .009) and older age (P = .005) were independent risk factors for urologic events based on BB type at the median 36-month follow-up. The use of carvedilol was associated with less arrhythmic events in BPH patients with palpitation and decreased the incidence of urologic events in BPH compared with the use of non-carvedilol BBs in long-term follow-up.

RELATIONSHIP BETWEEN OVERWEIGHT AND OBESITY WITH LOWER URINARY TRACT SYMPTOMS (LUTS) DUE TO BENIGN PROSTATIC HYPERLASIA IN PRE-ELDERLY A PRELIMINARY STUDY

ABSTRACT&#x0D; Objective: The purpose of this study is to find the relation between overweight and obesity with lower urinary tract symptoms due to benign prostatic hyperplasia in pre-elderly.  Material &amp; Methods: This analytical study was conducted in a cross sectional manner to 113 respondents. LUTS assessment uses the International Prostate Symptoms Score questionnaire. Measurements for overweight and obesity, this study uses the BMI and waist circumference methods. Fisher's exact test with SPSS v.25 was used for data analysis. Results: Results from data analysis showed that there was no significant relationship between overweight and obesity based on the BMI method on LUTS, p = 0.122. The results also showed a significant relationship between central obesity and LUTS, p = 0.003. Conclusion: Central obesity can be identified as a risk factor for LUTS while overweight and obesity based on the BMI method cannot be considered as a risk factor. These results can be used as education for pre-elderly to reduce the risk of LUTS due to BPH.&#x0D; Keywords: Overweight, obesity, lower urinary tract symptoms, benign prostatic hyperplasia, pre-elderly.

Transperineal vs. transrectal prostate biopsies under local anesthesia: A prospective cohort study on patient tolerability and complication rates.

An increasing number of urologists is switching from transrectal (TR) to transperineal (TP) biopsy procedures for the diagnosis of prostate cancer. Local anesthesia (LA) might be advantageous in terms of patient management, risks and costs. We aimed to evaluate the tolerability and complication rates of TP prostate biopsy performed under LA. This is a monocentric, prospective, comparative, observational cohort study. Between July 2020 and July 2021 we included 128 consecutive patients (TR, n = 61; TP, n = 67), with a suspicion of prostate cancer. Transrectal vs. transperineal prostate biopsies were both performed under LA. To evaluate the tolerability we administered a validated visual analog pain score (VAS) during the different steps of the biopsy procedure as well as at 12-, 24- and 48-hours post procedure. The International Prostate Symptom Score (IPSS) questionnaire was administered before the procedure and at the same time intervals. The presence of hematuria, hematospermia, rectal blood loss, acute retention and febrile urinary tract infection (UTI) were also monitored. There were no significant differences in pain or IPSS between groups, except for a significantly higher pain score during the LA of the prostate in the TP group. In general, complication rates were similar, only the prevalence of hematuria at 24 hours was significantly higher in the TP group, as was rectal blood loss at 12 hours postprocedure in the TR group. In conclusion, our study showed that transperineal prostate biopsy under local anesthesia could be performed with similar pain scores and complication rates, compared to the transrectal procedure.

An Investigation of Subsequent Lower Urinary Tract Symptoms in Patients With a History of Infection of COVID-19 at Tadbir Clinic in Urmia City During the Period From December 2020 to July 2021

Introduction More associated symptoms have been reported with the increasing number of COVID-19 cases worldwide. However, the precise impact of the disease on the urinary system and related urinary symptoms has yet to be adequately evaluated. The present study aims to investigate the subsequent lower urinary tract symptoms in patients attending Tadbir Clinic in Urmia City who have a history of infection due to COVID-19 within less than two months. Methods This study evaluated patients referred to the Urology Department of Tadbir Clinic in Urmia City between December 2020 and July 2021 who had tested positive for COVID-19 by RT-PCR within the past two months. The patient’s hospitalization history and the occurrence or exacerbation of urinary symptoms were recorded, and they completed the International Prostate Symptom Score (IPSS) questionnaire. Results This study included 150 patients with a mean age of 44.12 years, including 80 males and 70 females. None of the patients had severe urinary symptoms. 92.7% of the patients had mild urinary symptoms, and 7.3% had moderate urinary symptoms. The prevalence of moderate urinary symptoms was significantly higher in females than in males (P-value = 0.04). Individuals with moderate urinary symptoms had a higher mean age than those with mild urinary symptoms (P-value = 0.03). Among patients with or without a history of hospitalization, including those with a history of intensive care unit (ICU) admission, there was no significant difference in the severity of urinary symptoms (P-value = 0.5). Nocturia was the most common symptom reported by patients after the COVID-19 infection. Conclusion The severity of urinary symptoms was higher in females than males, and individuals with more severe urinary symptoms were generally older. There was no significant difference in terms of hospitalization history or the occurrence of severe urinary symptoms. Nocturia and frequency were the most prevalent symptoms among the patients.

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.

Laparoscopic radical prostatectomy with sparing of the proximal prostatic urethra

Introduction. The most common treatment option for prostate cancer is radical prostatectomy, which involves the removal of the prostate itself and the prostatic urethra in a single block, followed by the formation of a vesicourethral anastomosis. This approach is fraught with postoperative complications, such as urinary incontinence and strictures of anastomosis. In this sense, the clinic's staff faced the question of the possibility of a urethral-sparing variant of operative benefit for a certain category of patients.Objective. To assess the possibility of performing radical prostatectomy with sparing of the proximal prostatic urethra in the laparoscopic version, its advantages, and disadvantages.Materials &amp; methods. From 2021 to 2022, 18 successful laparoscopic operations were performed using this technique at the St. Luke Clinical Multidisciplinary Medical Centre. Patients were selected according to the above criteria. In the preoperative period, patients underwent a standard examination in accordance with guidelines, including a blood test for prostate-specific antigen (PSA), ultrasound, magnetic resonance imaging (MRI) with 3D-modelling, data from a multifocal prostate biopsy, the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF), the Quality of Life (QoL) index due to urinary disorders, assessment by the Partin’s nomogram. Intraoperative ratios, early and late postoperative complications, length of hospital stay, day of catheter removal, and time to complete urethral recovery were evaluated to study the effectiveness of this surgery type. PSA testing, uroflowmetry with post-void residual urine measurement and IPSS questionnaire were carried out one month after surgery.Results. There was an improvement in all measurements one month after surgery: median values of the mean urine flow rate increased by 1.7 ml/s, median values of the max urine flow rate increased by 3.7 ml/s, the IPSS decreased by 12 points.Conclusion. Based on the results of the study, clinical observations, and statistical analysis of the data obtained, it can be concluded that laparoscopic radical prostatectomy with sparing of the proximal prostatic urethra is the preferred surgical option for this pathology, due to its organ-preserving nature.

Does Significant Weight Loss After Bariatric Surgery Affect Sexual Function and Urinary Symptoms? An Iranian Study.

For sexual dysfunction and lower urinary tract symptoms (LUTS), obesity is identified as an independent risk factor. The current study aimed to evaluate the effect of significant rapid weight loss by bariatric surgery on LUTS and sexual function among men and women with class III obesity. A group of patients who were planned to undergo bariatric surgery was enrolled in the study. Male patients were given the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaires. In the female group, they filled in the female sexual function index (FSFI) and the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) questionnaires. Patients were followed up 1year after their bariatric surgery. All questionnaires were completed by eighty-one patients. (mean age ± SD: 39.4 ± 9.2years; mean body mass index (BMI) ± SD: 47.15 ± 5.4kg/m2). The total score of the IPSS questionnaire decreased from 5.83 ± 3.01 preoperatively to 2.37 ± 1.66 postoperatively. The weight loss caused significant improvement in the storage phase of LUTS domains, but there were no considerable changes in the voiding phase. In the IIEF questionnaire, domains of sexual desire, overall satisfaction, and orgasmic function improved significantly. There was not a significant change in any FSFI domains after bariatric surgery. Mean ICIQ-SF decreased, but it was not substantial. Bariatric surgery can significantly improve the storage phase in men, but not the voiding phase. Sexual desire, orgasmic function, and overall satisfaction were significantly improved in men. No significant improvement in sexual function and UI in women was observed.

A Comparative Study on the effectiveness and Tolerability of Mirabegron and Antimuscarinics in the treatment of Overactive bladder

Background: Despite antimuscarinic treatment options being available as the first line agents for overactive bladder (OAB), there is still a need for distinct treatment approaches to manage its suboptimal response and noncompliance. Mirabegron, a β3-adrenoceptor agonist, could be a better alternative to antimuscarinics in OAB treatment with a good effectiveness/tolerability balance. Aim: To compare the clinical profile of mirabegron and antimuscarinics in the treatment of overactive bladder. Method: A prospective, observational study was conducted in two groups of patients who received either mirabegron (n=120) or antimuscarinics (n=120) for the treatment of OAB. Effectiveness of the drugs were assessed at baseline, 4 and 8 weeks after the treatment using the Overactive Bladder Symptom Score (OABSS) and International Prostatic Symptom Score (IPSS) questionnaires. The safety assessment was done by measuring the post-void residual (PVR) urine volume and assessing the adverse drug reactions (ADR). The probability and severity of the ADRs were measured using Naranjo scale and Hartwig’s scale respectively. Also a subgroup analysis was carried out to compare the effectiveness of the two drugs in patients with OAB related to benign prostatic hyperplasia (BPH). Results: The overall effectiveness of antimuscarinics and mirabegron was found to be similar, but mirabegron showed better reduction in the daytime frequency (p=0.049). They also differ in safety profile with the overall incidence of adverse events being significantly higher in antimuscarinics group (15.83%) (19/120) than in the mirabegron group group (1.7%) (2/120) (p&lt;0.001). In the patients with OAB related to BPH also, there was a better reduction in the daytime frequency with mirabegron than with antimuscarinics, with overall effectiveness between groups being similar. In addition, mirabegron did not worsen the voiding symptoms and was found to be a better combination with alpha1 blockers than the antimuscarinics in patients with OAB related to BPH. No significant change was there in the PVR values within and between the groups. Conclusion: Mirabegron is a better alternative to antimuscarinics in the treatment of OAB with a distinct effectiveness/tolerability balance especially in patients with OAB related to BPH.

(450) Max And Average Flow Rate Are Correlated With Severity Of Erectile Dysfunction On Men With Symptomatic Benign Prostatic Hyperplasia

Abstract Introduction Numerous cross-sectional epidemiological studies have reported a clear and clinically significant association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging men worldwide. Objective We aimed to investigate the severity of ED symptoms with flow rate specifically Methods All patients came to our urology clinic, complaining of LUTS for at least 3 months were prospectively included in this study, in one year. Complete medical history including international index of erectile function (IIEF-5) and international prostate symptom score (IPSS) questionnaires, physical examination and comorbidity profile were collected. Patients were stratified according to IIEF-5 score into 4 groups: no or mild ED, mild to moderate ED, moderate ED and sever ED. Standard urofowmetry test was done, and prostate size was calculated through transrectal ultrasound (TRUS). Patients with middle lobe, urethral stricture and previous lower urinary tract surgery were excluded from the study. Database was done with Microsoft Excel and statistical analysis was done by SPSS software. Results 166 patients had complete data and were included in this analysis. The mean age was 57,and 26% were diabetic. When running Kruskal-Wallis Test it, showed that there is a statistical difference between the groups, the lower is the IIEF score (sever ED), the lower is the max flow rate (P&amp;lt;0.049) and the average flow rate (P&amp;lt;0.025). There was an inverse correlation between max flow rate and Prostate volume, the bigger is the prostate the lower tend to be the max flow rate (p&amp;lt;0.000), and same for average flow rate (P&amp;lt;0.001). There was a slight but significant (P&amp;lt;0.006) increase in severity of ED with the increase in prostate volume. The older were the patients the worse is the ED and the worse the flow rate (p&amp;lt;0.000). The flow rate was neither correlated with dyslipidemia nor with BMI. Conclusions Flow rate is correlated with severity of ED symptoms and prostate volume. Disclosure No

MP71-10 LONGITUDINAL EVALUATION OF LOWER URINARY TRACT SYMPTOMS POST ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH THE CORE LOWER URINARY TRACT SYMPTOM SCORE

You have accessJournal of UrologyCME1 Apr 2023MP71-10 LONGITUDINAL EVALUATION OF LOWER URINARY TRACT SYMPTOMS POST ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH THE CORE LOWER URINARY TRACT SYMPTOM SCORE Yuma Waseda, Minato Yokoyama, Kasumi Yoshitomi, Masaki Kobayashi, Bo Fan, Yuki Nakamura, Motohiro Fujiwara, Yudai Ishikawa, Shohei Fukuda, Hajime Tanaka, Soichiro Yoshida, and Yasuhisa Fujii Yuma WasedaYuma Waseda More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Kasumi YoshitomiKasumi Yoshitomi More articles by this author , Masaki KobayashiMasaki Kobayashi More articles by this author , Bo FanBo Fan More articles by this author , Yuki NakamuraYuki Nakamura More articles by this author , Motohiro FujiwaraMotohiro Fujiwara More articles by this author , Yudai IshikawaYudai Ishikawa More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While the artificial urinary sphincter (AUS) can significantly improve continence status, improved continence has been shown to worsen slightly over time. However, few studies have evaluated the trend in lower urinary tract symptoms (LUTS) other than incontinence. The frequently used International Prostate Symptom Score questionnaires may not adequately assess LUTS due to a lack of queries regarding incontinence and pain. The Core LUTS Score (CLSS) allows for an overall assessment of LUTS, which addresses 10 important symptoms from the 25 defined by the International Continence Society standardization steering committee. The CLSS questionnaire was used to assess LUTS after AUS implantation, longitudinally. METHODS: The subjects were 19 male who underwent initial AUS implantation at Tokyo Medical and Dental University from 2018 to 2021. LUTS were assessed before AUS implantation as well as one month (early use) and 12 months (late use) after implantation. CLSS data was collected from 13 patients before implantation and 19 patients during early and late use. This study was approved by our ethics committee (approval number: #2018-157). RESULTS: The median age at surgery was 74 years. The causes of urinary incontinence were radical prostatectomy and benign prostatic hyperplasia surgery in 18 and one patient, respectively. All patients achieved social continence of ≤1 pad/day, and the quality of life index improved significantly from 5.6 to 1.8 (0: delighted to 6: terrible) in early use (p<0.001) in 13 patients with preoperative evaluations. The most bothersome symptom was urinary incontinence in 11 (85%) patients and frequent urination in 2 (15%) patients before use, while two in early use and four in late use listed incontinence-related symptoms. Longitudinal change between early and late use showed improvement in voiding and post-micturition symptoms. On the other hand, no apparent improvement in storage symptoms was observed (Figure 1). On late use, 3 (16%) were receiving medication for overactive bladder. CONCLUSIONS: Post AUS implantation, urinary incontinence distress decreased, and other LUTS became more prominent. There was no trend toward improvement of the storage symptoms over time, and pharmacotherapy should be adiministered as needed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1018 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuma Waseda More articles by this author Minato Yokoyama More articles by this author Kasumi Yoshitomi More articles by this author Masaki Kobayashi More articles by this author Bo Fan More articles by this author Yuki Nakamura More articles by this author Motohiro Fujiwara More articles by this author Yudai Ishikawa More articles by this author Shohei Fukuda More articles by this author Hajime Tanaka More articles by this author Soichiro Yoshida More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

Study of correlation between Visual Prostate Symptom Score and International Prostate Symptom Score in men with lower urinary tract symptoms with reference to Uroflowmetry parameters in Indian population.

International prostate symptom score (IPSS) is a complex questionnaire method for objective assessment of Lower urinary tract symptoms. So, there is a need to develop a simple and easy scoring system that could be easily used for illiterates and older aged patients. It was a prospective observational study with 202 participants, conducted at the department of urology of a tertiary care hospital in eastern India. The patients more than 50 years of age, attending urology OPD with Lower urinary tract symptoms were included in the study. Printed IPSS and VPSS questionnaires were given to the patient to answer. Eighty-two percent (82%) of the higher education group and 97% of the lower education group needed assistance to answer IPSS questionnaires while 18% of the higher education group and 44% of the lower education group needed assistance to answer VPSS questionnaires. Sixty-four (64%) of patients in our study belong to the high education level while 36% of patients belong to the low education group. The mean age was 60.1 years. The mean IPSS and VPSS were 19 and 11 respectively. The mean PSA was 1.5 ng/ml. The time taken to fill VPSS questionnaire was much less than IPSS questionnaires. All the patients felt that VPSS was easier. Statistically significant (p-value < 0.05) correlation was found between total IPSS and total VPSS, Q2 IPSS and Q1 VPSS, Q7 IPSS and Q2 VPSS, Q5 IPSS and Q3 VPSS, and IPSS Qol and VPSS Qol. A negative correlation was found between Q3 VPSS and Qmax, and Q5 IPSS and Qmax. VPSS can be used as an alternative tool to IPSS to assess LUTS, which uses pictograms instead of questionnaires, even in patients with limited education.