International Prostate Symptom Score Scale Research Articles

Comparative analysis of laparoscopic retropubic simple prostatectomy combined with provisional clamping of internal iliac arteries, urethrocystoanastomosis and transurethral resection of benign prostatic hyperplasia

Aim. To provide comparative analysis of laparoscopic retropubic simple prostatectomy combined with provisional clamping of internal iliac arteries, uretherocystoanastomosis (LRP + CIIA + UCA) and transurethral resection of prostate (TURP) for surgical treatment benign prostatic hyperplasia (BPH).Materials and methods. 103 patients of age ³40 years old with refracted symptoms of urinary tract compression caused by BPH. The period of observation: from 2019 until the May 20, 2022; 48 and 51 patients were primary observed before and 6 months after LRP + CIIA + UCA and TURP. Criteria of inclusion: prostatic volume 60–80 cm3.Pre-operative treatment included such parameters as prostate-specific antigen level. Volume of prostate, volume of residual urine, urodynamic parameters, IPSS (International Prostate Symptom Score) + quality of life (QoL) scale result. Postoperative observation after 6 months included uroflowmetry, residual urine volume, evaluation of lower urinary tract symptoms and their influence on IPSS and QoL scale result. Efficacy of treatment of BPH is a summary of all earlier described parameters.Results. Symptomatic regression in patients who underwent LRP + CIIA + UCA and TURP was found among 15 (93.75 %) and 13 (81.25 %) patients relatively; complications distributed throughout 1, 2 and 3 classes by Clavien-Dindo criteria: after TURP – among 71.4, 22.9 and 5.7 % patients, after LPA + CIIA + UCA – among 35.4, 24.2 and 11.3 %, relatively. After 6 months maximal urine flow improved up to 22.7 ± 2.2 ml/seс, 16.8 ± 1.5 ml/seс, relatively.Conclusion. LRP + CIIA + UCA is effective for urodynamic and life quality improvement like TURP. LRP + CIIA + UCA has shown statistically significant advantages of such parameters as blood loss, bladder neck contractures and urethral strictures.

The use of therapeutic massage in benign prostatic hyperplasia: a case study

Background: Benign prostatic hyperplasia is one of the most common urological diseases. It affects men of all ages, and the incidence increases with age. Due to the location of the prostate in the lower urinary tract area, changes within it can impair urinary function. Early intervention, accurate diagnostics, and appropriate treatment are thus important, especially including conservative methods in the first stage. Aim of the study: The aim of the study was to use and to evaluate the effectiveness of therapeutic massage in benign prostatic hyperplasia.Case report: A course of therapeutic massage was given to a 55-year-old patient diagnosed with benign prostatic hyperplasia. The therapy lasted three weeks, with the procedure being performed twice a week. Each massage lasted twenty minutes and involved manipulation of the lining of the stomach. The patient underwent imaging tests before and after the therapy. On the International Prostate Symptom Score scale, the patient scored 3 points before the therapy and 2 points after it. These results indicate mild symptoms. The level of prostate specific antigen was 1.421 ng/ml. The patient had normal results of uroflowmetry [Qmax 19 ml/s, Qmedium 12 ml/s] both before and after treatment. The urine retention after micturition at both intervals was assessed at about 0 ml. Transrectal ultrasound examination revealed a reduction in prostate volume by about 30% after the therapeutic intervention. Conclusions: The positive effect obtained after therapeutic intervention in the form of the reduced prostate volume in this case shows that massage can serve as a complementary method to reduce BPH symptoms. In the future, it is advisable to continue testing on more patients.

EFFICACY AND SAFETY OF INITIAL DESMOPRESSIN DOSE OF 50 μg IN ELDERLY MALE PATIENTS WITH NOCTURNAL POLYURIA

(Introduction) Low-dose desmopressin is now available for the treatment of nocturia associated with nocturnal polyuria in men, and its usefulness in a dose-dependent manner has been reported. Since side effects such as hyponatremia have reported frequently, the initial dose has been set at 25 μg in many cases considering age and other factors. In the present study, we investigated the efficacy and safety of an initial dose of 50 μg in elderly patients. (Subjects and methods) At Chikugo city hospital, 45 patients were started on desmopressin at an initial dose of 50 μg for nocturia with nocturnal polyuria. Efficacy and safety after one and four weeks were evaluated based on bladder (micturition) diary. The investigated parameters included frequency of nocturnal urination, nocturnal polyuria index, time to first nocturnal void, first nocturnal urine volume, nocturnal urine volume, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Athens Insomnia Scale. Physical examinations were also carried out, along with blood tests. (Results) The mean age of the patients was 78.3 years, which was higher than that reported in prior studies. After one week of treatment, there was a significant decrease in the frequency of nocturnal urination and nocturnal urine volume, as well as a prolongation of the time to first nocturnal void, improvement in nocturnal polyuria index, and improvement in IPSS, IPSS-QOL, OABSS, and Athens Insomnia Scale. In terms of safety, adverse events were observed in eight patients (17.8%), and hyponatremia was observed in seven patients (15.6%), which was comparable to the findings of prior reports. (Conclusion) Good therapeutic results were obtained in elderly patients at an initial desmopressin dose of 50 μg, indicating that the drug could be safely administered to elderly patients with regular follow-ups and appropriate withdrawal and dose reductions.

Modified Benign Prostate Hyperplasia (BPH) Specific Quality of Life Scale and IPSS in Assessment of Quality of Life in Lower Urinary Tract Symptom Patients due to BPH

Introduction: Lower Urinary Tract Symptoms (LUTS) in association with Benign Prostatic Hyperplasia (BPH) are common in elderly males. Almost half of this age group over fifth-decade of age complain of moderate to severe degree of LUTS which impedes their Quality of Life (QoL). Aim: To assess the QoL in patients with LUTS due to BPH and compare the outcomes on modified BPH-QoL scale and International Prostate Symptom Score (IPSS) scale. Materials and Methods: An observational study was conducted from November 2019 to November 2020. A total of 400 men were selected for the study. The responses on both the scales (IPSS and BPH specific QoL scale) were noted and the total score was calculated. The BPH-specific QoL was compared with the IPSS scale by using the Pearson coefficient relation test. Results: Most men were in age group 50-60 years with median age of 58 years. The correlation of BPH-specific QoL scale questions with QoL question of IPSS was found to be statistically significant. The correlation coefficients of BPH-specific QoL questionnaire were found to be r=0.560 (p<0.0001) with the total IPSS and r=0.376 (p<0.0001) with the QoL score of IPSS. The reliability i.e., Cronbach’s alpha for BPH specific QoL was 0.879. Adverse symptoms of BPH in the form of fear of cancer and fear for surgery were noted while conducting the study. Conclusion: The correlation of BPH specific QoL scale and IPSS was found to be statistically significant. The BPH specific QoL scale is very useful and more comprehensive in addressing the QoL in patients with LUTS due to BPH than the IPSS scale. The BPH specific QoL scale was brief and easy to administer. It is the first study in India to use the BPH specific QoL scale to assess QoL and compare it with IPSS.

Masks of Chronic Prostatitis: Overactive bladder and Myofascial Syndrome. Case study

Prostatitis is a chronic disease that does not respond well to therapy. It is prone to frequent relapses and does not have a clear and unambiguous clinical picture, which can lead to diagnostic failure. A case of overactive bladder and myofascial syndrome described. The clinical picture was interpreted as «chronic prostatitis» erroneously. Differentiated analysis of the International Prostate Symptom Score (IPSS) and NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) questionnaires, as well as palpation of trigger points made it possible to establish the correct diagnosis. The following drugs were prescribed: Trospium chloride (Spasmex® ) 15 mg twice a day, Baclоfen (Baclophenum) 10 mg daily, Combilipen (B vitamins multicomplex) intramuscularly, Nimesulide (Nimesulide) orally, and locally low-intensity laser therapy. The patient noted a marked improvement after 14 days: the pain intensity decreased from 8 points to 1, urination urgency was not noted, nocturia stopped. The quality of life (QoL) accordingly improved to 1 point on the IPSS scale. The total score for domains III and IV decreased from 11 to 3 according to the NIH-CPSI symptom scale of chronic prostatitis. The pronounced positive dynamics of the patient’s state of health has confirmed the accuracy of the diagnosis and treatment.

Extent of Hunner lesions: The relationships with symptom severity and clinical parameters in Hunner type interstitial cystitis patients.

To assess the clinical impact of Hunner lesions in patients with Hunner type interstitial cystitis (HIC). The clinical records of 94 HIC patients who underwent their first hydrodistension (with lesion fulguration) were retrospectively reviewed. At surgery, the extent of each lesion was classified in terms of the relative involvement for the whole-bladder luminal surface; we defined four grades of involvement: <10%, 10-24%, 25-49%, and ≥50%; and two grades of severity: <25% (focal) and ≥25% (extensive). We examined the relationships between the extent of the lesions and all demographic characteristics, symptom scores, voiding symptoms, and bladder capacity. Factors predictive of the need for repeat hydrodistension were also explored. Symptom severity worsened as the lesional extent rose. Those with extensive lesions scored higher on the O'Leary and Sant Symptom (P = 0.004) and Problem Index scales (P < 0.001), the pain visual analog scale (P = 0.011), the International Prostate Symptom Score scale (P = 0.012), and a quality-of-life index (P = 0.020); and exhibited greater daytime urinary frequency (P = 0.040), more nocturia (P = 0.041), and a smaller bladder capacity (P = 0.007) than the focal group. No symptomatic or clinical parameters predicted the need for repeat hydrodistension. The extent of Hunner lesions was associated with both symptom severity and bladder capacity but not with other clinical parameters, including the need for repeat hydrodistension, in patients with HIC.

Predictors of the international prostate symptoms scores for patients with lower urinary tract symptoms: A descriptive cross-sectional study.

Background:Lower urinary tract symptoms (LUTSs) can significantly reduce men's quality of life and may point to serious pathology of the urogenital tract. This study aimed at finding predictors of symptoms score on the International Prostate Symptom Score (IPSS) for patients with LUTS.Materials and Methods:The study was cross-sectional conducted among 225 Ghanaian men visiting the urology clinic at Komfo Anokye Teaching Hospital. Trained interviewers used the IPSS, which adds a quality of life question to the American Urology Association symptom index to determine the extent to which patients are troubled by their symptoms. Five milliliters of blood was collected for total prostate-specific antigen (PSA) measurement. Transrectal ultrasonography was performed to evaluate the prostate volume (PV).Results:The mean age of the participants was 67.96 ± 14.57. The average score obtained from the study participants using the IPSS scale was 17.52 ± 7.83. There was a significant association between bother score and IPSS symptoms grade (P < 0.0001). Regression plot of the participants' points for IPSS in relation to the age, PSA, and PV showed statistically significant positive associations (P < 0.05). However, the coefficients of determination (R2) were 0.156, 0.022, and 0.048, respectively. This means that each unit increase of age, PSA, and PV only influences 15.6%, 2.3%, and 4.8% of the change in the symptom score. There was statistically significant association between age and moderate-to-severe LUTS with age range of 75 years above recording the highest odds (adjusted odds ratio (AOR) = 18.72, (1.15–99.78), P < 0.0001). The PSA range 20.1–50 ng/ml was significantly associated with moderate-to-severe LUTS (AOR = 17.37 (2.19–223.45), P = 0.006). Moreover, other factors, which were significantly associated with moderate-to-severe LUTS, were smoking (AOR = 0.32 (0.11–0.94) P = 0.038) and being widowed (AOR = 0.05 (0.002–0.52), P =0.010) respectively.Conclusion:The study found a statistically significant correlation between age, PSA, PV, and IPSS scores; however, these influences were mild.

Single-Fraction High-Dose-Rate Brachytherapy Using Real-Time Transrectal Ultrasound–Based Planning in Combination With External Beam Radiation Therapy for Prostate Cancer: Dosimetrics and Early Clinical Results

To validate the feasibility of a single-fraction High Dose Rate Brachytherapy (HDRBT) Boost for prostate cancer using real-time Transrectal Ultrasound (TRUS) based planning From August 2012 to September 2015, 126 patients underwent a single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning. External beam radiation therapy (EBRT) (37.5 Gy/15f or 44Gy/22f or 45Gy/25f) was performed before (31%) or after (69%) HDRBT boost. Genito-Urinary (GU) and Gastro-Intestinal (GI) toxicity were assessed 4 and 12 months after the end of combined treatment using the International Prostate Symptom Score Scale (IPSS) and the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. All dose-planning objectives were achieved in 90% of patients. Prostate D90 ≥105% and ≤ 115% was achieved in 99% of patients, prostate V150 ≤ 40% in 99%, prostate V200 < 11% in 96%, urethra D10 <120% for 99%, urethra V125 = 0% in 100% and rectal V75<1cc in 93% of patients. Median IPSS score was 4 at baseline and did not change at 4 and 12 months after combined treatment. No patients developed ≥ grade 2 GI toxicity. With a median follow-up of 10 months, only two patients experienced biochemical failure. Among patients who didn’t receive ADT, cumulative percentage of patients with PSA ≤ 1 ng/mL at 4 and 18 months was respectively 23% and 66%. Single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning achieves consistently high dosimetry quality. In combination with EBRT, toxicity outcomes appear promising. A longer follow-up is needed to assess long-term outcome and toxicities.

Single-fraction high-dose-rate brachytherapy using real-time transrectal ultrasound based planning in combination with external beam radiotherapy for prostate cancer: Dosimetrics and early clinical results

Purpose To validate the feasibility of a single-fraction high-dose-rate brachytherapy (HDRBT) boost for prostate cancer using real-time transrectal ultrasound (TRUS) based planning. Material and methods From August 2012 to September 2015, 126 patients underwent a single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning. External beam radiation therapy (EBRT) (37.5 Gy/15 fractions, 44 Gy/22 fractions, or 45 Gy/25 fractions) was performed before (31%) or after (69%) HDRBT boost. Genito-urinary (GU) and gastro-intestinal (GI) toxicity were assessed 4 and 12 months after the end of combined treatment using the international prostate symptom score scale (IPSS) and the common terminology criteria for adverse events (CTCAE) v3.0. Results All dose-planning objectives were achieved in 90% of patients. Prostate D90 ≥ 105% and ≤ 115% was achieved in 99% of patients, prostate V150 ≤ 40% in 99%, prostate V200 Conclusion Single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning achieves consistently high dosimetry quality.

Single-fraction high-dose-rate brachytherapy using real-time transrectal ultrasound based planning in combination with external beam radiotherapy for prostate cancer: dosimetrics and early clinical results.

PurposeTo validate the feasibility of a single-fraction high-dose-rate brachytherapy (HDRBT) boost for prostate cancer using real-time transrectal ultrasound (TRUS) based planning.Material and methodsFrom August 2012 to September 2015, 126 patients underwent a single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning. External beam radiation therapy (EBRT) (37.5 Gy/15 fractions, 44 Gy/22 fractions, or 45 Gy/25 fractions) was performed before (31%) or after (69%) HDRBT boost. Genito-urinary (GU) and gastro-intestinal (GI) toxicity were assessed 4 and 12 months after the end of combined treatment using the international prostate symptom score scale (IPSS) and the common terminology criteria for adverse events (CTCAE) v3.0.ResultsAll dose-planning objectives were achieved in 90% of patients. Prostate D90 ≥ 105% and ≤ 115% was achieved in 99% of patients, prostate V150 ≤ 40% in 99%, prostate V200 < 11% in 96%, urethra D10 < 120% for 99%, urethra V125 = 0% in 100%, and rectal V75 < 1 cc in 93% of patients. Median IPSS score was 4 at baseline and did not change at 4 and 12 months after combined treatment. No patients developed ≥ grade 2 GI toxicity. With a median follow-up of 10 months, only two patients experienced biochemical failure. Among patients who didn't receive ADT, cumulative percentage of patients with PSA ≤ 1 ng/ml at 4 and 18 months was respectively 23% and 66%.ConclusionsSingle-fraction HDRBT boost of 15 Gy using real-time TRUS based planning achieves consistently high dosimetry quality. In combination with EBRT, toxicity outcomes appear promising. A longer follow-up is needed to assess long-term outcome and toxicities.

Is there a relationship among age, international index of erectile function, international prostate symptom score, and aging males’ symptoms score?

To investigate the relationship among the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), and Aging Males' Symptoms (AMS) scale scores in various age groups of males. A total of 307 male patients enrolled in the study. Mean age was 52.3 (range 21-77) years. Group 1 consisted of 51 (< or =39 years), Group 2 consisted of 160 (40-59 years), and Group 3 consisted of 96 (> or =60 years) patients. First five and 15th questions of the IIEF, IPSS, and AMS scale were replied by all the patients. The patients were assessed based on the IIEF for erectile dysfunction (ED), IPSS for lower urinary tract symptoms (LUTS), and AMS scale for Symptomatic Late-Onset Hypogonadism (SLOH). ED, LUTS, and SLOH symptoms were detected in 236 (76.8%), 162 (52.8%), and 184 (59.9%) patients. Except for total AMS scores, IIEF and IPSS scores were significantly different among the groups (p (AMS) = 0.320, p (IIEF) = 0.000, p (IPSS) = 0.000). In the comparisons of the IIEF scores between the each group, significant differences were observed (p (Group1-Group2) = 0.000, p (Group1-Group3) = 0.000, p (Group2-Group3) = 0.000). Nevertheless, IPSS score was significantly lower in the patients with age < or =39 years than the other age groups (p = 0.000). In the present study, ED ratio and LUTS severity significantly increased in older men. We did not find significant relationship between aging and SLOH symptoms. In the light of our results, LUTS seems to be an important risk factor on erectile function.

Linguistic Adaptation and Validation of the Spanish Version of the Benign Prostatic Hyperplasia-Patient Impact Measure (BPH-PIM??)

The Benign Prostatic Hyperplasia-Patient Impact Measure (BPH-PIM) is a self-reported quality-of-life questionnaire for measuring the impact of urinary/prostate symptoms on the quality of life of patients with BPH. The aim of the present study was to adapt the original instrument to Spanish (for use in Spain) and to assess the psychometric properties of the new version. Linguistic adaptation was performed using the standard processes for establishing conceptual equivalence, and was partially conducted in parallel with original instrument development. Psychometric properties were assessed on a sample of 131 patients with BPH who were receiving treatment with doxazosin gastrointestinal therapeutic system (GITS). All the standardised items had response rates > 99%; there were no floor or ceiling effects. Reliability in terms of Cronbach's alpha was 0.96 and the intraclass correlation coefficient was 0.97. Construct validity was confirmed by factor analysis. Convergent validity was confirmed in terms of the relationship to the 12-Item Short-Form Health Survey (SF-12) [p < 0.001], Health Utilities Index Mark III (HUI-3) [p < 0.001] and the International Prostate Symptom Score (IPSS) QOL item (p < 0.001). The instrument showed discriminant validity, in terms of IPSS groups (p < 0.001). The instrument was sensitive to change in terms of the correlation of the domain scores of the PIM to improvements in symptom scores (p < 0.001). Significant differences were observed for those who improved > or = 3 points in the IPSS scale (p < 0.001). A psychometrically valid and conceptually equivalent version of the BPH-PIM questionnaire has been produced in Spanish to be used in Spain in patients with BPH.

CHANGE IN INTERNATIONAL PROSTATE SYMPTOM SCORE AFTER TRANSURETHRAL PROSTATECTOMY IN TAIWANESE MEN WITH BENIGN PROSTATE HYPERPLASIA: USE OF THESE CHANGES TO PREDICT THE OUTCOME

To investigate whether the pre- and postoperative International Prostate Symptom Score (IPSS) change predicts the outcome of transurethral prostatectomy in a Taiwanese population, 99 patients (transurethral prostatectomy candidates) were assessed with the IPSS before and 6-12 months after surgery. All symptoms improved significantly postoperatively. Patients with a greater preoperative IPSS benefited the most. Improvements in preoperative obstructive symptoms (incomplete emptying, intermittency, straining, and weak stream) were greater than those in irritable symptoms (urgency, frequency, and nocturia). A significant correlation was found between IPSS and quality of life (QOL) before and after transurethral prostatectomy. A change of 1 unit on the IPSS scale was found to decrease the QOL score 0.282 units. The positive predictive value of a >or=7-IPSS point decrease depended on the predictive IPSS criteria applied. When the preoperative IPSS was more than 17, the sensitivity was 83.5% and specificity was 30%. Postoperative improvement did not differ significantly between acute urinary retention (AUR) and non-AUR patients. Change in IPSS of more than 7 points predicted symptomatic improvement with high sensitivity. The predictive value depends on the definition of significant improvement (magnitude of IPSS change) and on the level of IPSS symptoms (sufficient to warrant transurethral prostatectomy).