International Prostate Symptom Score Score Research Articles

Correlation Between Prostate Volume and Lower Urinary Tract Symptoms: A Hospital-Based Study

Background: Lower urinary tract symptoms (LUTS) are manifestations of storage and voiding disorders involving the urinary bladder, urethra and the prostate gland. This study aimed to correlate prostate volume and lower urinary tract symptoms.  Materials and methods: This study was a prospective cross-sectional study carried out among 120 males aged 40 years and above who presented with LUTS for prostate ultrasonography at the Radiology department within a period of six months. Informed consent and ethical approval were obtained from participants before commencement of the study. Severity of LUTS was evaluated using the International Prostate Symptom Score (IPSS). Each question was scored between 0 to 5 and the sum recorded as total IPSS score. The total score was graded as mild (0-7), moderate (8-19) or severe (20-35). Quality of life due to urinary symptoms was also evaluated and scored between 0 (delighted) and 6 (terrible). Prostate volume estimation was done by transabdominal ultrasonography using an ultrasound scanner fitted with a 3.5-MHz curvilinear transducer (Logic F6, General Electric, USA, 2017). Measurements were taken and the average values computed; volume calculation was obtained by default using the inbuilt computer algorithm in the ultrasound machine. The data obtained were statistically analyzed using the Statistical Package for Social Sciences (SPSS) software version 24 (International Business Machines, USA, 2016), and the results presented in tables, charts, and percentages. Pearson’s correlation coefficient was used to correlate between variables with P-values < 0.05 considered significant.  Results: Results showed that the cumulative mean age of the participants was 65.1 ± 9.6 years with majority of the participant’s between 60 and 69 years. The most common presenting LUTS was nocturia (98.0%), followed by frequency (92.7%). Overall, the mean IPSS score was 13.2 ± 4.6 while quality of life (QoL) was 4.1 ± 1.2. The mean prostate volume was 69.8 ± 63.5cm3, with 79.2% of the subjects having a prostate volume ≥ 30cm3. Pearson correlation between prostate volume and IPSS was significant (r = 0.304, p = 0.001). Conclusion: The study established a positive significant correlation between prostate volume and International Prostate Symptoms Score (IPSS). This implies that sonographic PV assessment could be useful in objective assessment of LUTS severity and should be considered in management decisions and follow-up of patients with lower urinary tracts symptoms. 

The Association between Estrogen Levels and Prostate Volume in Obese and NonObese Benign Prostatic Hyperplasia (BPH) Patients

Objective: To investigate the association between prostate volume and estrogen levels in obese and non-obese individuals suffering from Benign Prostatic Hyperplasia (BPH).   Study Design and Setting: Cross-sectional, analytical study   Methodology: The International Prostatic Symptom Score (IPSS) was used in the study to recognize sixty participants with BPH. The study examined patients' height, weight, waist circumference (WC), and body mass index (BMI). An IPSS score of less than 7 was seen as healthy. Using standardized BMI (25) and waist circumference (90cm), patients were split into two groups, with obese patients being placed in group A and non-obese patients being placed in group B. Using trans-rectal ultrasonography(TRUS), prostate gland's dimensions were measured, and blood samples were taken to determine serum estrogen levels.   Results: In comparison to the non-obesity group, which had a mean prostate volume (PV) of 31.21±6.771 ml, the obese group's PV was 36.13±3.673ml. It was statistically significant that there was a difference between the two groups (p=0.001). In the non-obese group, average level of estrogen was 309.72±73.62pmol/l, compared to 328.21±115.05pmol/l in the obese group (p=0.462). Correlation study (r=0.279,p=0.031) revealed a significantly ideal relationship between participants' blood estrogen levels and PV. Among patients who were obese, there was a significant positive correlation among blood estrogen levels and prostate size(r=0.638, p=0.0001).   Conclusion: When compared to the non-obese group, obesity significantly raises prostate volume in study participants, leading to benign prostatic hypertrophy. In addition, prostate volume and blood estrogen levels in obese males showed a significant positive association.

Association of detrusor wall thickness (DWT) with lower urinary tract symptom severity in benign prostatic hyperplasia: a cross-sectional study

Background and Objective: Benign prostatic hyperplasia (BPH) manifests as lower urinary tract symptoms (LUTS) and prostate gland enlargement, leading to bladder outlet obstruction (BOO) with consequent structural and functional impacts on the bladder. Urodynamic studies are resource-intensive and invasive. DWT assessment offers a cost-effective, reproducible alternative for evaluating LUTS severity in males with BOO, utilizing ultrasonographic examination. Methods: This prospective cross-sectional study, conducted at a tertiary care center from May 2023 to January 2024, included 171 patients with LUTS who underwent transabdominal ultrasound for DWT measurements. LUTS severity, assessed using International Prostate Symptom Scores (IPSS) classified participants into mild and moderate-to-severe symptom groups. Pearson’s correlation coefficient assessed the association between DWT and IPSS, and an independent sample t-test compared means, using a significance level of 5% (P-value ≤ 0.05). Results: This study involved participants aged 65.01±11.55 years with an IPSS score ranging from 1 to 35, with a mean for mild and moderate-to-severe symptom groups were 4±2.12 and 15.93±6.74, respectively. DWT mean of 1.64±0.38 mm for mild, and 2.4±0.43 mm for moderate to severe symptoms. Pearson’s correlation (r=0.697, n=171, P<0.001) indicated a strong DWT-LUTS correlation and a significant DWT mean difference between mild and moderate-to-severe symptom groups was found via an independent t-test (P<0.001, 95% CI: -0.8970 to -0.6414). Conclusion: The study establishes the value of transabdominal ultrasound-detected DWT as a cost-effective, noninvasive, and reproducible tool for assessing LUTS severity in males with BPH.

Effect of acupuncture on quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial.

To observe the effect and safety of acupuncture on quality of life, pain, and prostate symptoms in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Seventy patients with CP/CPPS were randomly divided into an acupuncture group (35 cases, 1 case was eliminated) and a sham acupuncture group (35 cases, 3 cases dropped out). The patients in the acupuncture group were treated with routine acupuncture at bilateral Zhongliao (BL 33), Huiyang (BL 35), Shenshu (BL 23) and Sanyinjiao (SP 6), while the patients in the sham acupuncture group were treated with shallow needling at non-meridian and non-acupoint points beside bilateral Zhongliao (BL 33), Huiyang (BL 35), Shenshu (BL 23) and Sanyinjiao (SP 6),without manipulation to induce arrival of qi (deqi). Both groups retained the needles for 30 min, with one session every other day, three times a week, for a total of 8 weeks (24 sessions). Before and after treatment, and at the follow-up of 24 weeks after treatment completion, the scores of MOS 36-item short-form health survey (SF-36, including 8 dimensions of physical function [PF], role physical function [RP], bodily pain [BP], general health status [GH], vitality [VT], social function [SF], role emotional [RE], and mental health [MH], which can be summarized as physical component summary [PCS] and mental component summary [MCS]), pelvic pain visual analogue scale (VAS), National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), and international prostate symptom score (IPSS) were evaluated, and safety of both groups was assessed. After treatment and at the follow-up, the scores of each dimension and PCS, MCS scores of SF-36 in the acupuncture group were higher than those before treatment (P<0.05, P<0.01); compared before treatment, the RP, BP, and SF scores and PCS score in the sham acupuncture group were increased after treatment (P<0.05, P<0.01). After treatment, the acupuncture group had higher scores in RP, BP, GH, MH and PCS, MCS than those in the sham acupuncture group (P<0.05, P<0.01); at the follow-up, except for PF and RE dimensions, the scores in each dimension and PCS, MCS scores in the acupuncture group were higher than those in the sham acupuncture group (P<0.05, P<0.01). After treatment and at the follow-up, pelvic pain VAS, NIH-CPSI, IPSS scores in the acupuncture group were lower than those before treatment (P<0.01); in the sham acupuncture group, pelvic pain VAS, NIH-CPSI scores were lower after treatment, and NIH-CPSI score at the follow-up was lower compared with those before treatment (P<0.01). After treatment and at the follow-up, pelvic pain VAS, NIH-CPSI, IPSS scores in the acupuncture group were lower than those in the sham acupuncture group (P<0.01, P<0.05). No significant adverse reactions were observed in both groups, and the incidence rates of adverse reactions had no significant difference (P>0.05). Acupuncture could effectively improve the quality of life, reduce pain levels, alleviate prostate symptoms, and shows favorable long-term efficacy in patients with CP/CPPS.

The Efficacy of Rezum Water Vapor Therapy Among Malaysian Men with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

Purpose: This study investigates the efficacy and safety of Rezǔm water vapor in the management of Malaysian men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).&#x0D; Material and methods: A total of 60 men with symptoms of moderate to severe BPH were enrolled in pilot studies at Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia. All patients were treated with transurethral delivery of water vapor. International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow (Qmax), postvoid residual, and International Index of Erectile Function (IIEF-5) were evaluated at 1 week and 1, 3, and 6 months post-treatment. Safety was also assessed.&#x0D; Results and discussion:  The mean age of our study population was 64.57 ± 9.37 years old with mean prostate volume of 59.98 ± 22.06 cc. Our findings revealed statistically significant improvements throughout the 6 months of follow-up for IPSS score (17.45 ± 6.10 score to 7.53 ± 4.28), the QoL scores (3.52 ± 1.19 to 1.53 ± 0.70) and the urinary flow rate, Qmax (9.74 ± 3.39 mL/s to 17.40 ± 5.92 mL/s). There was no significant difference (p&gt;0.05) was observed in sexual function (IIEF-5 scores) when compared to preoperatively. No adverse events (AEs) related to endoscopic instrumentations were observed. Two cases of urinary retention were classified as procedure-related AE.&#x0D; Conclusion: The Rezǔm water vapor therapy is safe and provides effective relief of symptoms and it should be considered as one of the treatment options in patients with LUTs associated with BPH especially for patients who are keen to preserve sexual function as part of the added benefit in this treatment modality.&#x0D;  &#x0D; Keywords: Benign prostatic hyperplasia, lower urinary tract symptoms, water vapor therapy, minimally invasive&#x0D;  &#x0D;  &#x0D;  

Psychological and sexological assessment of patients with chronic prostatitis

Purpose: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by a multiform clinical presentation requiring a differentiated treatment based on different phenotypes including the psychosocial and sexual domains. The aim of this study was assessing the complex correlations between somatic, psychological, and sexual symptoms of CP/CPPS patients. Materials and methods: We performed a cross-sectional study on patients attending a Prostatitis Clinic. Patients were administered the following questionnaires: National Institutes of Health- Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7), Oxford Happiness Questionnaire (OHQ), and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). Results: Linear regression analyses show highly significant correlations between scores of the NIH-CPSI and the scores of the GAD-7, PHQ-9 and OHQ psychometric questionnaires. IPSS scores correlate significantly with the psychometric scores only when a non-parametric analysis is performed. IIEF and PEDT sexual function scores did not correlate with any of the psychometric tests. NIH-CPSI scores correlate positively with most of the TEMPS-A profiles but the hyperthymic profile correlated negatively with the total and QoL NIH-CPSI and with PEDT scores. Conclusions: Scores measuring anxiety, depression, and psychological well-being in patients with CP/CPPS are strictly correlated with prostatitis-like symptoms although they are poorly correlated with symptoms of prostatism, as measured by IPSS, and not correlated with scores of sexual dysfunctions, as measured by IIEF and PEDT. A hyperthymic temperament may increase resilience against the disease. 

Factors Influencing Prostate Cancer Screening Intentions in Lebanese Men.

The objective of this study is to investigate the perceived obstacles and willingness of Lebanese men aged 40 and above to undergo screening for prostate cancer. A cross-sectional research design was employed. The study utilized a survey questionnaire to collect data on various factors influencing screening behaviors. The research instrument consisted of a comprehensive survey questionnaire that incorporated validated scales to assess barriers to prostate cancer screening, intention to screen, and the International Prostate Symptom Score (IPSS). The study found that the 120 participants had an average IPSS score of 7.20 ± 2.23, most people (70%) had mild symptoms of prostate cancer, whereas others had moderate (20%) or severe symptoms (10%). The majority of the men indicated a low to moderate inclination to undergo screening through Prostate-specific antigen testing, or digital rectal examination (DRE) (PSA), with 76% considering DRE and 70% considering PSA. The main barriers to screening included the dread of receiving distressing outcomes (48%) and a lack of understanding about the screening procedure (54%). The study identified key factors affecting the intention to undergo a prostate cancer screening. Regarding DREs, these factors included the perceived danger of the illness and prior information from doctors about prostate conditions. When it came to the intention to undergo screening through the prostate-specific antigen test (PSA), determinants included the perceived threat of the disease, one's general health perception, and prior information from doctors about prostate-related issues. Additionally, a significant proportion of participants believed that prostate cancer was not a serious illness (56%) and 57% thought DRE was embarrassing. The participants displayed a low willingness to get screened for prostate cancer. Implementing interventions that focus on increasing awareness of the disease and its associated risks could potentially reduce the barriers and boost participation in prostate cancer screening.

Use of the International Prostate Symptom Score in men with Multiple Sclerosis

Objective : Men with multiple sclerosis (MS) tend to present with urinary symptoms potentially translating to significant findings on urodynamics (UDS). We sought to assess the reliability and prognostic value of the International Prostate Symptom Score (IPSS) and Quality of Life (QoL) in patients with MS. Methods : A prospective study between July 2014 and August 2016 included 40 consecutive men with MS and lower urinary tract symptoms (LUTs) referred for video UDS. All participants completed the IPSS and QoL assessments. Results were compared and correlated to UDS parameters. Results : Mean (±SD) age, IPSS, and QoL were 53.7 ± 13.5 years, 16.7 ± 8.9 and 4.1 ± 1.4, respectively. The most common presenting symptom and UDS finding were urinary frequency (79%) and detrusor overactivity (68%). 72% had moderate-severe symptoms base on the IPSS. Reduced bladder compliance on UDS was associated with intermittency and straining answers on IPSS (p = 0.02 and p = 0.03). QoL did not predict UDS parameters. Conclusion : QoL and total IPSS scores are likely insufficient for MS and LUTs patient assessment due to the variability of UDS findings. However, in these patients, IPSS storage symptom questions had significant correlation with UDS. Furthermore, presenting symptoms in MS &amp; LUTs did not correlate with UDS findings. Therefore, in patients with MS and LUTs, UDS must be performed for adequate disease assessment

Evaluation of early apical release with bipolar Collins knife versus Thulium-Yag laser enucleation of large-sized prostate. A randomized study

ABSTRACT Introduction and objectives Anatomical endoscopic enucleation of the prostate (AEEP) provides durable management for patients with lower urinary tract symptoms (LUTS) secondary to large-sized prostate over other surgical modalities. We aimed to assess the early outcomes of Collins knife-assisted bipolar enucleation (BipolEP) versus Thulium-Yag enucleation (ThuLEP) in a group of patients with LUTS secondary to a prostate larger than 80 grams. Methods We included patients with benign prostatic hyperplasia (BPH) having a prostate volume > 80 grams, international prostate symptom score (IPSS) >7, urine flow (Q-max) <15, and post-void residual (PVR)>150 ml. We excluded those with a history of previous prostatic surgery, stone, or neurogenic bladder. Bipolar enucleation with early apical release was performed using Collins knife at an 80/100-watt setting (Lamidey Noury), while ThuLEP was conducted using 550- micron fiber and 40/15-watt energy (Lisa Laser). Patients were evaluated before then 2 weeks and 3, 6,12 months postoperatively for changes in IPSS, Q- max, PVR, and the incidence of stress incontinence. Result One hundred and twenty patients were equally randomized with a mean prostate size of 104 ± 25 gram. The mean IPSS score was 25 ± 6, Qmax 7.6 ± 1.3 mL/S, and PVR 225 ± 39. There was no significant difference regarding enucleation time, morcellation time, and enucleated tissue volume. Irrigation volume and post-operative hemoglobin drop were significantly lower in the bipolar group (p = 0.008, p = 0.0002), respectively. At the third-month follow-up, IPSS, Q-max, and PVR were comparable across both groups, with stress incontinence at 3.3% in the bipolar group versus 1.6% in the thulium group, showing an insignificant difference (p = 0.5).” Conclusion Both BipolEP and ThuLEP, with early apical release, provide a safe and effective management of large-size prostate resulting in significant decrease in post-operative stress incontinence incidence during early follow-up. Intraoperative irrigation saline volume, and post-operative hemoglobin drop favored the bipolar group.

Day surgery in the treatment of benign prostatic obstruction with photoselective vaporisation of the prostate: A single‐institution experience

AbstractAimTo assess the feasibility, efficacy and safety of performing photoselective vaporisation of the prostate (PVP) as a day‐surgery procedure for patients with benign prostatic obstruction.Patients and MethodsA prospective single‐arm observational study was performed involving patients with benign prostatic obstruction (BPO) who received PVP between 2017 and 2021. Data were collected on demographics, prostate volume by transrectal ultrasonography, mean peak flow rate (Qmax), post‐void residual urine volume, International Prostate Symptom Score (IPSS) with quality‐of‐life (QoL) index, length of stay, success in weaning off catheter on the day of operation and complications.ResultsPVP was performed successfully in all 37 men between 2017 and 2021. Their mean age was 67 years. The mean prostate volume was 54 mL. The mean duration of operation was 80 min. The mean peak urinary flow rate improved from 9.14 to 16.8, 17.3 and 15.4 mL/s at post‐operative 1, 3 and 12 months, respectively (P = .001). The mean IPSS score improved from 19.5 to 8.94, 6.40 and 5.63 at post‐operative 1, 3 and 12 months, respectively (P &lt; .001). The mean QoL index improved from 4.07 to 2.43, 2.25 and 1.81 at post‐operative 1, 3 and 12 months, respectively (P = .001). The mean duration of catheterisation after PVP was 5.81 h. Thirty‐three (89.2%) patients were discharged on the same day. Overall, the 30‐day complication rate was 27%. The most common complication was haematuria (6 patients, 16.2%). Five patients (13.5%) required readmission and inpatient care. There was one Clavien–Dindo grade III and IV complication (2.6%), respectively.ConclusionThis study demonstrated the feasibility of performing PVP as a day‐surgery procedure with good short‐ and medium‐term functional outcomes and safety profiles.

Evaluation of functional and oncological outcomes of localized prostate cancer after different minimally invasive therapeutic methods: A single center experience.

To study the functional and oncological results of minimally invasive treatment methods: cryoablation, brachytherapy, and high-intensity focused ultrasound (HIFU) therapy of localized prostate cancer in a single hospital. One hundred sixty patients with localized prostate cancer were treated with minimally invasive methods (53, 52, 55 patients with cryoablation, brachytherapy and HIFU therapy, respectively). Prostate-specific antigen and evaluation of post-procedure biopsies were used as an assessment. The review of functional indicators and quality of life was made with International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL) questionnaires. Patients after cryoablation showed worse results of oncological control according to positive repeat biopsies, best indicators were observed after brachytherapy. When considering the IPSS results, there were statistically significantly worse scores in the brachytherapy group in the early postoperative period, these differences do not reach statistical significance in the late period in the brachytherapy and cryoablation groups. Patients in the cryoablation group showed worse indicators of IIEF-5; in the early postoperative period; in the late follow-up period, the indicators of erectile function in patients in the cryoablation group did not statistically significantly differ from those in patients after brachytherapy. Patients after HIFU therapy showed fewer cases of de novo erectile dysfunction during the follow-up period of 3 years, higher average IIEF-5 scores, lower IPSS scores and better QoL results. The recurrence of prostate cancer was statistically significantly higher in the International Society of Urological Pathology (ISUP) 3 grade group. HIFU therapy had better urination indicators compared to other groups, that can be associated with the laser enucleation of prostatic hyperplasia. The advantage was noted in patients after HIFU therapy when comparing the parameters to the IIEF-5 thus, HIFU treatment had a better impact on patients' QoL with localized prostate cancer.

Association between oral frailty and lower urinary tract symptoms among middle-aged and older adults in community-dwelling individuals: a cross-sectional study.

We assessed the association between oral frailty risk and LUTS among middle-aged and older adults in a community-dwelling population. This cross-sectional study was conducted among 586 subjects aged ≥ 40years who participated in the Iwaki Health Promotion Project in Hirosaki, Japan. We used the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS) to assess LUTS. LUTS was defined as an IPSS score of 8 or higher or meeting diagnostic criteria for OAB. Oral frailty risk was defined as experiencing two or more of the following: decreased chewing ability, decreased biting force, and dry mouth sensation. Physical performance (10-m gait speed and grip strength) was used for analysis. The association between oral frailty risk and LUTS was examined using multivariate logistic regression analyses. The study included 218 men and 370 women, of whom 140 had LUTS. The mean age of this cohort was 59years. Significant differences were observed between the LUTS and non-LUTS groups, including age, hypertension, history of CVD, depressive status, sleep disturbance, and 10m gait speed. The prevalence of oral frailty risk was significantly higher in the LUTS group than in the non-LUTS group (26% vs. 11%, P < 0.001). Multivariate analysis revealed that age, male gender, and oral frailty risk (odds ratio: 2.67, 95% confidence interval: 1.57-4.51, P < 0.001) were independent factors for LUTS. Moreover, oral frailty risk was an independent factor in both participants aged < 65years and participants aged ≥ 65years. Oral frailty was independently associated with LUTS.

A multi-center international study to evaluate the safety, functional and oncological outcomes of irreversible electroporation for the ablation of prostate cancer.

Irreversible electroporation (IRE) is a novel technique to treat localized prostate cancer with the aim of achieving oncological control while reducing related side effects. We present the outcomes of localized prostate cancer treated with IRE from a multi-center prospective registry. Men with histologically confirmed prostate cancer were recruited to receive IRE. All the patients were proposed for prostate biopsy at 1-year post-IRE ablation. The functional outcomes were measured by the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires. The safety of IRE was graded by the treatment-related adverse events (AEs) according to the Common Terminology Criteria for Adverse Events (CTCAE). 411 patients were recruited in this study from July 2015 to April 2020. The median follow-up time was 24 months (IQR 15-36). 116 patients underwent repeat prostate biopsy during 12-18 months after IRE. Clinically significant prostate cancer (Gleason ≥ 3 + 4) was detected in 24.1% (28/116) of the patients; any grade prostate cancers were found in 59.5% (69/116) of the patients. The IPSS score increased significantly from 7.1 to 8.2 (p = 0.015) at 3 months but decreased to 6.1 at 6 months (p = 0.017). Afterwards, the IPSS level remained stable during follow-up. The IIEF-5 score decreased at 3 months from 16.0 to 12.1 (p < 0.001) and then maintained equable afterwards. The rate of AEs was 1.8% at 3 months and then dropped to less than 1% at 6 months and remained stable until 48 months after IRE. Major AEs (Grade 3 or above) were rare. For men with localized prostate cancer, IRE could achieve good urinary and sexual function outcomes and a reasonable oncological result. The real-world data are consistent with earlier studies, including recently published randomized controlled studies. The long-term oncological results need further investigation and follow-up.

Mid-term results of ReMEEX sling system in female stress urinary incontinence with various indications and feasibility of readjustment.

To examine efficacy and safety of ReMEEX implantation in patients with female stress urinary incontinence (SUI) associated with detrusor underactivity (DU), recurrence, or intrinsic sphincter deficiency (ISD). Retrospective cohort study included 303 females who underwent ReMEEX system (March 2008 to May 2021). Patients were stratified into three groups by purpose of surgery (SUI with DU, reoperation, and SUI with ISD) and evaluated with following criteria: cure (absence of subjective complaint of leakage and objective leakage in the stress test), improvement (rare leakage subjectively, but satisfaction regardless of stress test), and failure. Primary outcome was success rate of surgery assessed through patient interviews and a stress test. Surgical outcomes and complications were evaluated. Mean follow-up was 34.4 months (range, 6.0-145.0 months). At the final follow-up visit, 42.9% and 49.2% of patients were cured and improved. Twenty-one point five percent required tension readjustment (mean number, 1.2). The total complication rate was 19.5% (none for grade ≥4). Preoperative Qmax was significantly higher in the ISD group (p<0.001) and preoperative total International Prostate Symptom Score (IPSS) score was significantly higher in the DU group (p=0.044). Moreover, at postoperative 1 year, both total IPSS score and IPSS quality of life score were significantly higher in the DU group (both p=0.001). The success rate of ReMEEX system was 92.1% at mean follow-up of 34.4 months in female SUI with DU, reoperation, or ISD. It also enabled postoperative readjustment of sling tension, as needed, up to 130 months after surgery.

The epidemiology of male lower urinary tract symptoms associated with benign prostatic hyperplasia: Results of 20 years of Korean community care and surveys.

To investigate the prevalence of lower urinary tract symptoms/benign prostatic hyperplasia in a Korean population. The Korean Prostate &amp; Voiding Health Association provided free prostate-related community health care and conducted surveys in all regions of Korea from 2001 to 2022 with the cooperation of local government public health centers. A total of 72,068 males older than 50 were surveyed and analyzed. History taking, International Prostate Symptom Score (IPSS), transrectal ultrasonography, prostate-specific antigen (PSA) testing, uroflowmetry, and urine volume testing were performed. The mean prostate volumes in males in their 50s, 60s, 70s, and 80s or above were 24.7 g, 27.7 g, 31 g, and 33.7 g, respectively. The proportion of males with high PSA greater than 3 ng/mL was 3.8% among males in their 50s, 7.7% among males in their 60s, 13.1% among males in their 70s, and 17.9% among males 80 years of age or older. The mean IPSS total scores in males in their 50s, 60s, 70s, and 80s or above were 10.7, 12.7, 14.5, and 16, respectively. Severe symptoms were reported by 27.3% of males, whereas 51.7% reported moderate symptoms. The mean Qmax in males in their 50s, 60s, 70s, and 80s or above were 20 mL/s, 17.4 mL/s, 15.4 mL/s, and 13.8 mL/s, respectively. In this population-based study, mean prostate volume, IPSS, PSA, and Qmax were 30.6±15.1 g, 14.8±8.2, 1.9±4.7 ng/mL, and 15.6±6.5 mL/s, respectively. Aging was significantly associated with increased prostate volume, PSA levels, and IPSS scores, and with decreased Qmax and urine volume.

Erectile Dysfunction after Transuretheral Resection of the Prostate in Patients with Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) is commonly associated with lower urinary tract symptoms (LUTS) in aging men, which can significantly impact their quality of life. Transurethral resection of the prostate (TURP) is a standard treatment for BPH, yet its effects on erectile function remain controversial. Objective: To assess the impact of TURP on erectile function in patients with BPH and to evaluate the potential relationship between the relief of obstructive urinary symptoms and changes in erectile function postoperatively. Methods: This single-center, non-randomized study enrolled 177 male patients aged 50 to 80 years with a clinical diagnosis of BPH and an International Prostate Symptom Score (IPSS) greater than 8. Participants underwent monopolar TURP and were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire one month post-surgery. Data were analyzed using SPSS version 21 with Chi-square tests applied to examine the influence of age and IPSS scores on erectile function, considering a p-value ≤0.05 as significant. Results: The mean age of participants was 57.53 ± 6.96 years, and the mean resected prostate tissue weight was 122.82 ± 12.05 grams. Post-TURP, 44.6% of patients were found to have some degree of erectile dysfunction. However, no significant changes in erectile function were observed one month following TURP (p=0.602 for age, p=0.878 for IPSS score). Conclusion: TURP did not significantly affect erectile function one month postoperatively in BPH patients with severe urinary symptoms. While some improvement in erectile function was noted, the results suggest that the benefits of TURP on erectile function may not be immediate. Further longitudinal studies with larger sample sizes are required to provide more definitive conclusions.

Prospective Study Comparing Lower Urinary Tract Symptoms (LUTS) Before and After Laparoscopic Inguinal Hernia Surgery in Adult Patients With and Without Benign Prostatic Hyperplasia with Repaired Hernia

Objective: Benign prostatic hyperplasia (BPH) is the most prevalent cause of bladder outlet obstruction in elderly males. The occurrence of both inguinal hernia and BPH with lower urinary tract symptoms increases with age. This study is aimed at comparing lower urinary tract syndrome using the International Prostate Symptom Score (IPSS) before and after laparoscopic inguinal hernia surgery.Material and Methods: This prospective study was conducted at Somdech Phra Pinklao Hospital. Thirty-five patients who presented with lower urinary tract symptoms (LUTS) and underwent inguinal hernia repair were selected according to inclusion criteria and evaluated using an IPSS scoring chart for urinary symptoms before and after an operation.Results: Thirty-five patients who presented with LUTS symptoms and underwent inguinal hernia repair between 1 December 2020 and 30 November 2021 were included in the study. Statistical analysis by Wilcoxon Signed-Rank test for the 35 patients resulted in an average IPSS that was compared at 2 weeks with a preoperative score of 6.54 and postoperative score of 4.69 (p-value&lt;0.001), preoperative obstructive score of 2.6 and postoperative score of 1.51 (p-value&lt;0.001), preoperative irritative score of 3.94 and postoperative score of 3.17 (p-value&lt;0.001). At 4 weeks, there was an average preoperative IPSS score of 6.54 and postoperative score of 3.86 (p-value&lt;0.001), preoperative of obstructive score of 2.6 and postoperative score of 1.03 (p-value&lt;0.001), and preoperative irritative score of 3.94 and postoperative score of 2.83 (p-value&lt;0.001). At 8 weeks, there was an average preoperative IPSS score of 6.54 and postoperative score of 3.49 (p-value&lt;0.001), preoperative obstructive score of 2.6 and postoperative score of 0.80 (p-value&lt;0.001), and preoperative irritative score of 3.94 and postoperative score of 2.69 (p-value&lt;0.001).Conclusion: Comparison of LUTS before and after laparoscopic inguinal hernia surgery showed a significant decrease in the IPSS score after laparoscopic surgery inguinal hernia at 2, 4 and 8 weeks for both obstructive and irritative scores.

Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta-analysis.

Men with detrusor underactivity (DUA)and concomitant bladder outlet obstruction (BOO)due to benign prostatic enlargement (BPE)may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC). This review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short- and long-term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta-analysis was performed using Review Manager (RevMan) software. There were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eightTURP (transurethral resection of the prostate) studies, fourGreenLight PVP (photoselective vaporization of the prostate) studies, twoHoLEP (Holmium laser enucleation of the prostate) studies, oneGreenLight PVP/HoLEPstudy, oneHolmium laser incision of the prostate study, and onestudy did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long-term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS),lower quality-of-life (QoL) score, better maximum flow rate (Qmax), and lower post-voiding residual (PVR)of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow-up. In this meta-analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow-up period after surgery.

Prostatic Artery Embolization as a Treatment Option for Symptomatic Benign Prostatic Hyperplasia: Results from the Prospective Follow-Up Study in Lithuania.

Background: The endovascular treatment of symptomatic benign prostate hypertrophy (BPH) by prostatic artery embolization (PAE) is one of the new treatments proposed. PAE is a minimally invasive alternative that has been shown to successfully treat lower urinary tract symptoms in BPH patients by causing infarction and necrosis of hyperplastic adenomatous tissue, which decompresses urethral impingement and improves obstructive symptoms. The aim of this study was to evaluate the effectiveness and efficacy of PAE in relieving symptoms in patients with symptomatic BPH. Materials and Methods: The material for the study was collected from 2019 to 2022. A total of 70 men with BPH and PAE were studied. Patients underwent an urological examination to measure the International Prostate Symptom Score (IPSS), Quality of Life score (QoL), International Index of Erectile Function short form (IIEF-5), uroflowmetry with Qmax, prostatic volume (PV), and post-void residual volume (PVR) measurements. Statistical analysis for dependent samples was applied. Measured parameters at 2 months and 6 months follow-up were compared to baseline. Results: At baseline, the age of the male (N = 70) subjects was 74 ± 9.6 years with a median of 73.8, but fluctuated from 53 to 90 years. The mean of PV was almost 111 mL and the Qmax was close to 7.7 mL/s. The average PVR was 107.6 mL. The IPSS score mean was 21.3 points and the QoL score was 4.53 points. The IIEF-5 questionnaire score was almost 1.8 points, which shows severe erectile dysfunction. The mean value of the PSA level was 5.8 ng/mL. After 2 and 6 months of PAE, all indicators and scores except erectile function significantly improved. Conclusions: The outcomes of our study show promising results for patients with benign prostatic hyperplasia after PAE. The main prostate-related parameters (PV, Qmax, PVR, IPSS) improved significantly 6 months after embolization.

Clinical Efficacy and Safety of Transurethral Plasma Enucleation in the Treatment of Benign Prostatic Hyperplasia

Objective: This paper aims to analyze the effectiveness and safety of transurethral plasma enucleation in clinical treatment of benign prostatic hyperplasia. Methods: A total of 100 patients with benign prostatic hyperplasia who received surgical treatment in our hospital from January 2022 to January 2023 were randomly divided into groups by envelope method. 50 patients who received transurethral plasma resection of the prostate were selected as the control group and 50 patients who received transurethral plasma enucleation of the prostate were the study group. The effective rate of treatment, incidence of complications, postvoid residual (PVR) volume, maximum urinary flow rate (Qmax), and international prostate symptom score (I-PSS) were compared between the two groups. Results: By comparison, the effective rate of treatment in the study group was higher (P &lt; 0.05). By comparison, the incidence of complications in the study group was lower (P &lt; 0.05). Before treatment, there was no significant difference in PVR, Qmax, and I-PSS scores between the two groups (P &gt; 0.05). After treatment, the PVR and I-PSS scores of the study group were lower, and Qmax was higher (P &lt; 0.05). Conclusion: In the treatment of benign prostatic hyperplasia, the application of transurethral plasma enucleation can improve the clinical efficacy and clinical symptoms, with high safety and application value.