International Prostate Symptom Score Storage Subscore Research Articles

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 add-on medications for persistent storage symptoms after α-blocker treatment in BPH patients – a network meta-analysis

BackgroundPatients with benign prostatic hyperplasia (BPH) receive α-blockers as first-line therapy to treat lower urinary tract symptoms; however, some individuals still experience residual storage symptoms. Antimuscarinics, β3-agonists, and desmopressin are effective add-on medications. Nevertheless, there is currently no evidence for the appropriate choice of the first add-on medication. This systematic review aimed to investigate the clinical benefits of antimuscarinics, β3-agonists, and desmopressin, in addition to α-blockers, for persistent storage symptoms in BPH patients.MethodsA comprehensive literature search of randomized controlled trials (RCTs) comparing the efficacy of different add-on medications in BPH patients with persistent storage symptoms despite α-blocker treatment was conducted. Clinical outcomes included the International Prostate Symptom Score (IPSS), IPSS storage subscore, nocturia, micturition, and urgency. A network meta-analysis was performed to estimate the effect size. Surface under cumulative ranking curves (SUCRAs) were used to rank the included treatments for each outcome.ResultsA total of 15 RCTs were identified. Add-on imidafenacin and mirabegron resulted in significant improvement in all outcomes assessed. Other add-on medications such as desmopressin, tolterodine, solifenacin, fesoterodine, and propiverine showed positive benefits for most, but not all, outcomes. Based on the SUCRA rankings, add-on desmopressin was the best-ranked treatment for IPSS and nocturia, and add-on imidafenacin was the best for the IPSS storage subscore and micturition.ConclusionsBPH patients presenting with persistent storage symptoms despite α-blocker administration are recommended to include additional treatment. Desmopressin and imidafenacin may be considered high-priority add-on treatments because of their superior efficacy compared with other medications.

Efficacy of Tamsulosin Alone versus Tamsulosin Plus Tadalafil in Treatment of LUTS due to BPH: A Comparative Study

1. Background: Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) are common disorders whose prevalence increases with advancing age. Recent large-scale epidemiological studies reported a statistically significant association between these two conditions, independent of age and cardiovascular co-morbidities. Furthermore, a significant association between the increased severity of LUTS and the increased severity of ED has been confirmed. Objectives: The purpose of the study is to offer a clinical evaluation to verify the safety and efficacy of the combination of tamsulosin 0.4 mg/day plus tadalafil 5 mg/day vs. tamsulosin 0.4 mg/day alone to treat patients with LUTS due to BPH. Materials & Methods: This comparative study was conducted in the Department of Urology, Dhaka Medical College Hospital. The duration of this study was 1 year from April 2018 to March 2019. A total of 170 patients, with a history of symptomatic BPH who attended the Urology Outpatient Department, Dhaka Medical College Hospital, were selected as per inclusion and exclusion criteria. Of them, 85 patients were treated with tamsulosin 0.4mg/day in group A whereas 85 patients were treated with tamsulosin 0.4mg/day plus tadalafil 5mg/day in group B. The general medical condition of the patients was evaluated through history, physical examination. The size of the prostate and PVR were evaluated through ultra-sonogram, and Qmax was assessed with uroflowmetry. The outcome of the patient was assessed by IPSS, IPSS total, IPSS voiding subscore, IPSS storage subscore, IPSS nocturia questionnaire, QOL, International Index of Erectile Function (IIEF-5) questionnaire, Qmax, USG of KUBP with MCC with PVR. Follow-up will be recorded in 4 visits in screening, week 0 randomization, 6 and 12. Results: One hundred and forty patients completed the study. Improvements in IPSS score and IPSS-QOL were significant with both treatments but greater with.....

Outcomes of Artificial Urinary Sphincter Implantation in Patients with Detrusor Underactivity and Postprostatectomy Incontinence.

There is insufficient evidence for postoperative outcomes of artificial urinary sphincter (AUS) implantation for postprostatectomy incontinence (PPI) with detrusor underactivity (DU). Thus, we assessed the impact of preoperative DU on the outcomes of AUS implantation for PPI. Medical records of men who underwent AUS implantation for PPI were reviewed. Patients who had bladder outlet obstruction surgery before radical prostatectomy or AUS-related complications that required revision of AUS within three months were excluded. Patients were divided into two groups based on the preoperative urodynamic study including pressure flow study, a DU group, and a non-DU group. DU was defined as a bladder contractility index less than 100. The primary outcome was postoperative postvoid residual urine volume (PVR). The secondary outcomes included maximum flow rate (Qmax), postoperative satisfaction, and international prostate symptom score (IPSS). A total of 78 patients with PPI were assessed. The DU group consisted of 55 patients (70.5%) and the non-DU group comprised 23 patients (29.5%). Qmax was lower in the DU group than in the non-DU group and PVR was higher in the DU group as per a urodynamic study before AUS implantation. There was no significant difference in postoperative PVR between the two groups, although the Qmax after AUS implantation was significantly lower in the DU group. While the DU group showed significant improvements in Qmax, PVR, IPSS total score, IPSS storage subscore, and IPSS quality of life (QoL) score after AUS implantation, the non-DU group showed postoperative improvement in IPSS QoL score. There was no clinically significant impact of preoperative DU on the outcome of AUS implantation for PPI; thus, surgery can be safely performed in patients with PPI and DU.

MP74-07 THE EFFECT OF TESTOSTERONE REPLACEMENT THERAPY ON LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyCME1 Apr 2023MP74-07 THE EFFECT OF TESTOSTERONE REPLACEMENT THERAPY ON LOWER URINARY TRACT SYMPTOMS Norichika Ueda, Go Tsujimura, Takahiro Imanaka, Sohei Kuribayashi, Koichi Okada, Kentaro Takezawa, Shinichiro Fukuhara, and Norio Nonomura Norichika UedaNorichika Ueda More articles by this author , Go TsujimuraGo Tsujimura More articles by this author , Takahiro ImanakaTakahiro Imanaka More articles by this author , Sohei KuribayashiSohei Kuribayashi More articles by this author , Koichi OkadaKoichi Okada More articles by this author , Kentaro TakezawaKentaro Takezawa More articles by this author , Shinichiro FukuharaShinichiro Fukuhara More articles by this author , and Norio NonomuraNorio Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both late-onset hypogonadism (LOH) syndrome and lower urinary tract symptoms (LUTS) increase with age and decrease quality of life (QOL). The standard treatment for LOH syndrome is testosterone replacement therapy (TRT). Since the prostate is an androgen-dependent organ, TRT may have some effect on LUTS. However, the effect of TRT on LUTS is not fully understood. The number of patients with both LUTS and LOH syndrome is increasing, therefore it is important to understand the relationship between TRT and LUTS. In this study, we retrospectively examined the effect of TRT on LUTS. METHODS: Ninety-four patients who received TRT for LOH syndrome from May 2017 to August 2022 were evaluated. Three months after the first testosterone administration, Aging males Symptoms rating scale (AMS), Sexual Health Inventory for Men (SHIM), Erection Hardness Score (EHS), International Prostate Symptom Score (IPSS), and IPSS QOL score were assessed. IPSS was also evaluated for the voiding and storage subscores, respectively. RESULTS: TRT improved AMS, SHIM and EHS significantly (all p<0.01). In the evaluation of urinary symptoms, TRT did not improve any of the IPSS total scores, IPSS voiding subscores, IPSS storage subscores, or IPSS QOL scores in the LUTS mild group (IPSS: 8 or less), but in the LUTS moderate-severe group (IPSS: 8-35), TRT significantly improved them all (IPSS total scores: 14.2±0.9 vs 9.8±1.1: p<0.001, IPSS voiding subscores: 8. 0±0.6 vs 5.3±0.8: p<0.001, IPSS storage subscores: 6.3±0.6 vs 4.5±0.5: p=0.003, IPSS QOL scores: 3.9±0.2 vs 3.0±0.3: p=0.002, respectively) (Figure 1). CONCLUSIONS: TRT for LOH patients does not exacerbate LUTS but improves LUTS, especially for moderate or severe LUTS patients. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1071 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Norichika Ueda More articles by this author Go Tsujimura More articles by this author Takahiro Imanaka More articles by this author Sohei Kuribayashi More articles by this author Koichi Okada More articles by this author Kentaro Takezawa More articles by this author Shinichiro Fukuhara More articles by this author Norio Nonomura More articles by this author Expand All Advertisement PDF downloadLoading ...

Relationship Between Serum Testosterone and Severity of Lower Urinary Tract Symptoms Among Malaysian Men

Background Lower urinary tract symptoms (LUTS) are commonly experienced among ageing males. The increasing prevalence of late-onset hypogonadism suggests a possible relationship between serum testosterone and severity of LUTS. This study examines the association between serum testosterone and severity of lower urinary tract symptoms among Malaysian men, as reflected by the International Prostate Symptom Score (IPSS). Method A total of 163 men with LUTS were enrolled in a cross-sectional study in Hospital Canselor Tuanku Mukhriz, Malaysia. Full examination, IPSS, and serum total testosterone (TT) levels were evaluated. Categorical and continuous correlations were analyzed using chi-square test and age-adjusted Pearson’s partial correlation, respectively. Result Mean age was 66.25 (SD = 7.05), with mean serum TT of 16.74 nmol/L (SD = 6.32). Twenty eight percent (n = 46) had low testosterone levels. Severity of LUTS (mild, moderate, severe) was not found to be dependent on TT status (normal, low, severely low), (χ2 [4, N = 163] = 4.24, P = 0.37). Weak negative correlations between total IPSS and IPSS storage sub-score with serum TT levels were exhibited respectively (r = −0.17, P &lt; 0.05; r = −0.17, P &lt; 0.05). Conclusion Among elderly Malaysian men, severity of LUTS and TT status were not found to be associated, despite a weak negative correlation between IPSS and serum testosterone levels. Nonetheless, with a high prevalence of hypogonadal ageing men, further research regarding serum testosterone measurement among this population may be valuable as part of a multimodal approach to treatment.

Evaluation of sexual function after dutasteride treatment in patients with once negative prostate biopsy and benign prostate hyperplasia.

ABSTRACT Introduction 5α-reduced inhibitors (5ARIs) are usually administered to patients with benign prostatic hyperplasia, however, whether 5ARIs affect sexual function remains a controversial issue for both patients and urologists. Objective In this study, we evaluated the impact of dutasteride treatment for erectile function in patients with once-negative prostate biopsy and benign prostate hyperplasia. Methods 81 patients with benign prostate hyperplasia were enrolled in a one-arm prospective study. They were administrated 0.5 mg/day of dutasteride for 12 months. Patient characteristics, change of IPSS and IIEF-15 scores at baseline and 12 months after dutasteride administration were examined. Results The mean ± SD age of the patients was 69.4 ± 4.9 years and the prostate volume was 56.6 ± 21.3 mL, respectively. The mean ± SD prostate volume and PSA levels were decreased 25.0% and 50.9%, respectively, after 12 months of dutasteride administration. IPSS total, voiding subscore, storage subscore, and QOL score significantly improved after 12 months of dutasteride administration. No significant change was observed in any of the IIEF scores after 12 months. There was no decrease in EF severity. Conclusion Twelve months administration of dutasteride for patients with BPH improved urinary function and did not increase the risk of sexual dysfunction. Disclosure Work supported by industry: no.

Association between urine 6-sulfatoxy-melatonin level and intravesical Bacillus Calmette-Guerin treatment-induced sleep quality deterioration in patients with non-muscle invasive bladder cancer.

The level of 6-sulfatoxy-melatonin (SaMT), a metabolite of melatonin, in first-void morning urine reflects blood melatonin levels from the previous night. We investigated the association between urine SaMT and sleep quality deterioration in patients with non-muscle invasive bladder cancer (NMIBC) treated with intravesical Bacillus Calmette-Guerin induction therapy (iBCG). We enrolled 51 patients who received iBCG once weekly for 6 or 8weeks. Patient-reported outcomes were assessed with questionnaires including the International Prostate Symptom Score (IPSS) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQC30). Questionnaires were completed before (baseline), during, at completion, and 1 and 3months after iBCG. Melatonin and SaMT levels at baseline were measured in serum and first-void morningurine samples, respectively. Based on changes in the QLQC30 insomnia subscale, 28 (55%) patients experienced sleep quality deterioration (deterioration group). Urine SaMT values in the deterioration group were lower than those in the non-deterioration group (P = 0.0015; 7.5 vs 15.4ng/mg creatinine, respectively). Nocturia scores in the non-deterioration group decreased over time, while those of the deterioration group remained high after completion of iBCG. A binary logistic regression analysis revealed that low urine SaMT levels (≤ 9.6 ng/mg creatinine), high IPSS nocturia scores at baseline, and high IPSS storage subscores at baseline were associated with BCG-induced sleep quality deterioration. This study confirmed the association among urine SaMT levels, nocturia, and sleep disturbance in patients with NMIBC who receive iBCG. We should be aware of treatment-induced impairments to aid in appropriate decision-making.

Clinical features of detrusor underactivity in elderly men without neurological disorders.

To investigate the clinical features of detrusor underactivity (DU) in elderly men without neurological disorders. A total of 336 men aged ≥50 years without neurogenic disorders who underwent pressure flow studies and who had DU or bladder outlet obstruction (BOO) were reviewed retrospectively. According to the bladder contractility index (BCI) and the BOO index (BOOI), the subjects were classified into the following three groups: (a) pure DU group, BCI < 100 and BOOI < 40; (b) DU + BOO group, BCI < 100 and BOOI ≥ 40; and (c) pure BOO group, BCI ≥ 100 and BOOI ≥ 40. Subjective and objective parameters were compared among the three groups, and the predictors for pure DU were evaluated by multivariate analysis. Of the 336 patients, 205 who met the study criteria were included in the analysis: 63 (30.7%) with pure DU, 48 (23.4%) with DU + BOO, and 94 (45.9%) with pure BOO. The proportion of the pure DU group increased with increasing age. Prostate volume was the lowest in the pure DU group. Frequency, urgency on the International Prostate Symptom Score (IPSS), and the IPSS storage subscore were the lowest in the pure DU group. Multivariate analysis showed that age (odds ratio [OR] 1.114 [95% CI, 1.032-1.203], P=.005), prostate volume (OR 0.968 [95% CI, 0.949-0.987], P=.001), and urgency (OR 0.623 [95% CI, 0.431-0.900], P=.012) were predictors of pure DU. Older age, smaller prostate volume, and less urgency may be clinical features of pure DU.

Tadalafil 5 mg Once Daily Improved Each IPSS Subscore, QOL, and Nocturia in Elderly BPH Patients over 70 Years Old in a Real-World Clinical Setting

Objective: No reports have evaluated the treatment effects of tadalafil by age group in a positive, noninterventional observational study of Japanese men. The present study aimed to evaluate the treatment effects of tadalafil by age group in a positive, noninterventional observational study of Japanese men. We therefore divided patients into 2 groups about the age of 70 years and investigated the treatment effects of tadalafil regarding voiding and storage functions by age group. Methods: Changes from baseline in each parameter (International Prostate Symptom Score [IPSS], quality of life [QOL] score, Overactive Bladder Symptom Score [OABSS], and residual urine volume) at 4, 12, and 24 weeks after initiating tadalafil for benign prostatic hyperplasia (BPH) patients were compared between groups (50–69 years vs. ≥70 years). In addition, side effects of tadalafil were investigated by age group. Results: In the 50–69 years group, significant improvements from baseline were seen in IPSS total and QOL score for all time points. In addition, significant improvements in IPSS storage subscore from baseline were observed at the 4- and 24-week time points. In the ≥70 years group, significant improvements from baseline were seen in IPSS total, IPSS voiding and storage subscores, and QOL score at each time point. Conclusions: Tadalafil 5 mg once daily appeared effective in clinical settings for elderly BPH patients even over 70 years old.

A randomized placebo-controlled study: Phellodendron Bawei tablets combined with standard management can improve storage symptoms, sleep quality, and medication compliance in patients with benign prostatic hyperplasia compared to placebo with standard management.

BackgroundBenign prostatic hyperplasia (BPH) is a common micturition disorder in middle-aged and elderly males, and it is one of the most common urology-related diseases worldwide. However, standard therapeutic drugs (α1-receptor blockers + 5α reductase inhibitors) do not provide anti-inflammatory or anti-infective effects. The Phellodendron Bawei tablet is a proprietary Chinese medicine with anti-inflammatory and anti-infective effects. Here, we analyzed whether the combination of standard therapeutic drugs and Phellodendron Bawei tablets has more advantages than placebo with standard management in improving the lower urinary tract symptoms (LUTs), sleep quality, sexual function, and medication compliance in patients with BPH.MethodsThis study was a prospective, double-blind, single-center, 6-month clinical trial in patients with BPH. Male patients, 45–75 years old, a history of moderate-to-severe BPH/LUTs for more than 6 months, moderate-to-severe LUTs [International Prostate Symptom Score (IPSS) ≥8], maximum urine flow rate (Qmax) of <15 mL/s, and prostate volume (PV) of >30 mL. All patients were randomly divided into two cohorts at baseline. The standard management (SM) group was treated with tamsulosin + finasteride + placebo, while the experimental group was treated with tamsulosin + finasteride + Phellodendron Bawei tablets. The clinical indicators were as follows: Age, body mass index (BMI), blood prostate-specific antigen (PSA), PV, Qmax, IPSS; IPSS voiding subscore (IPSS-V), IPSS storage subscore (IPSS-S), and IPSS quality of life (IPSS-QOL)], five-item version of the International Index of Erectile Function (IEFF-5) score, Athens Insomnia Scale (AIS) score, and the Medication Adherence Questionnaire (MAQ). And adverse drug reactions were observed. Student’s t-test was used to analyze results.ResultsWe randomly divided 120 patients into two groups, with 60 patients in each group, and a total of 105 patients completed the study. IPSS-S (P=0.027) and AIS scores (P<0.001) improved more significantly in the Phellodendron Bawei tablets + SM group, and the MAQ score in this group was lower (P=0.003).ConclusionsPhellodendron Bawei tablets combined with α1-receptor blockers and 5α-reductase inhibitors can improve lower urinary tract symptoms associated with urine storage, sleep quality, and medication compliance in patients with benign prostatic hyperplasia compared to placebo with standard management.Trial RegistrationChinese Clinical Trial Registry ChiCTR2100046463.

Combination therapy with curcumin plus tamsulosin and finasteride in the treatment of men with benign prostatic hyperplasia: a single center, randomized control study.

BackgroundTo perform a prospective, randomized, single center study to investigate the efficacy of combined use of curcumin, an anti-inflammatory agent, with the best standard management (BSM, tamsulosin and finasteride) in benign prostatic hyperplasia (BPH) patients.MethodsOne hundred and twenty-two consecutive patients were randomized to receive tamsulosin 0.2 mg, finasteride 5 mg, and curcumin 2,250 mg once a day (curcumin + BSM group, n=61) versus tamsulosin 0.2 mg, finasteride 5 mg, and placebo (BSM group, n=61) for 6 months. The safety of treatments and their efficacy on improving waist circumference (WC), periprostatic fat thickness (PPFT), lower urinary tract symptoms (LUTS), and sexual function were assessed at baseline and month 6.ResultsOne hundred and sixteen patients completed the whole procedure (116/122, 95.1%). There were significant improvements in prostate volume (PV), maximum flow rate (Qmax), the International Prostate Symptom Score (IPSS), IPSS-voiding subscore (IPSS-V), IPSS-storage subscore (IPSS-S), and quality of life (QoL) from baseline after treatment in both groups. Additionally, both WC and PPFT decreased significantly after treatments than those at baseline in the curcumin + BSM group. Also, WC and PPFT in the curcumin + BSM group were significantly lower than those in the BSM group. In addition, IPSS-S, QoL score, and the 5-item version of the International Index of Erectile Function (IIEF-5) in the curcumin + BSM group improved significantly compared with those in the BSM group.ConclusionsWe conclude that curcumin combined with tamsulosin and finasteride has more beneficial effects in reducing PPFT, protecting erectile function, improving urinary retention symptoms, and QoL scores in BPH patients compared to tamsulosin and finasteride alone.Trial RegistrationChinese Clinical Trial Registry ChiCTR2100043800.

Comparison of the Safety and Efficacy of Photoselective Vaporization of the Prostate (PVP) and Transurethral Enucleation with a Bipolar System (TUEB): A Single-Center Retrospective Study.

PurposeThe aim of this study was to compare the safety and efficacy of photoselective vaporization of the prostate (PVP) and transurethral enucleation with a bipolar system (TUEB).Patients and MethodsPatients who underwent PVP or TUEB surgery for lower urinary tract symptoms due to bladder outlet obstruction at our institution from September 2015 to May 2019 were retrospectively reviewed. A total of 83 patients (PVP: n=45, TUEB: n=38) who were available for follow-up at least 12 months after surgery were included. Preoperative characteristics, perioperative parameters, and postoperative outcomes—such as International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and complications―at 3, 6, and 12 months after surgery were compared between the two groups.ResultsAlthough differences in age, IPSS, and QoL were not significant, a significantly greater prostate volume, lower Qmax, and greater PVR were noted in the TUEB group. In perioperative parameters, a significantly shorter operation time, less change in serum hemoglobin, fewer days of catheterization, and shorter length of stay were observed in the PVP group. As for postoperative outcomes, the IPSS storage subscore and PVR were significantly improved in the TUEB group. As complications, stress urinary incontinence was more frequently observed in the TUEB group, and urethral stricture was more common in the PVP group.ConclusionThe present data suggest that PVP and TUEB are efficient and safe surgical treatment options. Management of patients undergoing PVP in the perioperative period appears easy. Improvements of subjective and objective parameters were superior after TUEB than after PVP.

A randomized controlled study of the efficacy of tadalafil monotherapy versus combination of tadalafil and mirabegron for the treatment of persistent overactive bladder symptoms in men presenting with lower urinary tract symptoms (CONTACT Study).

AimTo evaluate efficacy and safety of combination of tadalafil + mirabegron for overactive bladder/benign prostatic hyperplasia (OAB/BPH).MethodsMale patients with lower urinary tract symptoms (50 to 89 years), with remaining OAB symptoms even after administering tadalafil for more than 8 weeks were randomly assigned to either tadalafil monotherapy group (5 mg/day) or tadalafil/mirabegron combination therapy group (5 mg/50 mg/day). The primary endpoint was change from baseline in total OAB symptom score (OABSS) at week 12. The secondary endpoints were changes in International Prostate Symptom Score (IPSS), NIH‐chronic prostatitis symptom index (NIH‐CPSI), and micturition chart parameters at weeks 4 and 12.ResultsA total of 176 patients were randomized to either monotherapy (87 patients) or combination therapy (89 patients). The baseline characteristics of patients in the two groups were similar. The total OABSS (95% confidence interval) of combination therapy was significantly decreased by 1.78 (1.05‐2.50) points compared with that of monotherapy (P < .001). Changes from baseline in OABSS nighttime voiding score, urgency score, urgency incontinence score, IPSS storage subscores, NIH‐CPSI total score, and numbers of voids, nighttime‐voids, and urgency episodes/day in micturition chart were significantly reduced in combination therapy (all P < .001). Patient‐reported outcome was significantly more satisfactory in combination therapy than in monotherapy (P < .001). One moderate adverse event (pain in hip joint) with hardly presumed causal relationship with therapy and seven mild adverse events were noted in monotherapy and combination therapy group, respectively.ConclusionsThe effect of tadalafil/mirabegron combination therapy on relieving OAB symptoms appeared to be greater than that of tadalafil monotherapy and can be safely used.

The role of intravesical prostatic protrusion in the evaluation of overactive bladder in male patients with LUTS.

To evaluate the association of intravesical prostatic protrusion (IPP) and overactive bladder (OAB) in male patients with lower urinary tract symptoms (LUTS). IPP has been suggested to correlate with storage symptoms in addition to bladder outlet obstruction. This was an open-labeled, single-center, prospective study involving 128 men older than 40years presenting with LUTS. We analyzed the relationship of IPP with age, prostate volume, uroflowmetry, post-void residual urine volume (PVR), International Prostate Symptom Score (IPSS), urgency severity scale (USS), and OAB symptom score (OABSS). The patients with an urgency score of ≥ 2 (OABSS question 2) and sum score of ≥ 3 were considered to have OAB. IPP was measured in the mid-sagittal section using transrectal ultrasound. The degree of IPP was classified as grade 1 (≤ 5mm), grade 2 (> 5-10mm), and grade 3 (> 10mm). The mean age of the patients was 64.9 ± 9.2years, and 101 patients were diagnosed with OAB (79%). Mean IPPs were 2.4 ± 1.4mm (grade 1, n = 77), 7.6 ± 1.4mm (grade 2, n = 27), and 14.8 ± 4.4mm (grade 3, n = 24). IPP was positively correlated with age, prostate size, PSA, PVR, and OABSS nocturia subscore, but not correlated with the presence or severity of OAB. Areas under the receiver-operating characteristic (ROC) curves for the diagnosis of OAB were 0.807 and 0.604 for IPSS-storage subscore and IPP, respectively. IPP is not a good predictor of OAB in men presenting with LUTS. However, grade 3 IPP indicates higher frequency of nocturia.

Comment on "Lower urinary tract symptoms and depressive symptoms among patients presenting for distressing early ejaculation".

We aimed to assess the correlation between premature ejaculation (PE), lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and depression in the cohort of the last 329 patients seeking medical help for distressing early ejaculation at a single tertiary-referral center. All patients completed the premature ejaculation diagnostic tool (PEDT), the International Index of Erectile Function (IIEF), the Beck’s Inventory for Depression (BDI), and the International Prostate Symptom Score (IPSS) at their first assessment. Overall, 133 (0.4) patients had PEDT ≥ 11, suggestive for PE. The characteristics of patients with and without PE according to PEDT findings were compared with the Mann–Whitney and Fisher’s exact tests. Linear regression analysis tested the association between LUTS and PEDT score. Patients with PE depicted lower median scores for IIEF-overall satisfaction, intercourse satisfaction and erectile function than non-PE individuals (all p < 0.004). Similarly, patients with PE showed higher median BDI scores (7 versus 4; p < 0.0002), median IPSS total score (7 versus 5), storage (4 versus 2), and voiding (3 versus 2) subscores (all p < 0.01) compared to those without PE. At linear regression analysis, IPSS storage subscore (Coeff: 0.28; 95%CI: 0.05–0.51, p = 0.01) and BDI score (Coeff: 0.10; 95%CI: 0.01–0.19, p = 0.02) were associated with higher PEDT values, after accounting for IIEF-EF score, patients’ age, body mass index and Charlson Comorbidity Index. Our findings suggest that storage symptoms and depression should be carefully investigated when assessing patients complaining of PE in the real-life setting.

Relationship between Lower Urinary Tract Symptoms and Prostatic Urethral Stiffness Using Strain Elastography: Initial Experiences.

We attempted to visualize the periurethral stiffness of prostatic urethras using strain elastography in the midsagittal plane of transrectal ultrasonography (TRUS) and to evaluate periurethral stiffness patterns in relation to lower urinary tract symptoms (LUTS). A total of 250 men were enrolled. The stiffness patterns of the entire prostate and individual zones were evaluated using strain elastography during a TRUS examination. After excluding 69 men with inappropriate elastography images, subjects were divided according to periurethral stiffness into either group A (low periurethral stiffness, N = 80) or group B (high periurethral stiffness, N = 101). There were significant differences in patient age (p = 0.022), transitional zone volume (p = 0.001), transitional zone index (p = 0.33), total international prostate symptom score (IPSS) (p < 0.001), IPSS-voiding subscore (p < 0.001), IPSS-storage subscore (p < 0.001), and quality of life (QoL) score (p = 0.002) between groups A and B. After adjusting for relevant variables, significant differences in total IPSS, IPSS-voiding subscore, and QoL score were maintained. Men with high periurethral stiffness were associated with worse urinary symptoms than those with low periurethral stiffness, suggesting that periurethral stiffness might play an important role in the development of LUTS.

Lower urinary tract symptoms and depressive symptoms among patients presenting for distressing early ejaculation.

We aimed to assess the correlation between premature ejaculation (PE), lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and depression in the cohort of the last 329 patients seeking medical help for distressing early ejaculation at a single tertiary-referral center. All patients completed the premature ejaculation diagnostic tool (PEDT), the International Index of Erectile Function (IIEF), the Beck's Inventory for Depression (BDI), and the International Prostate Symptom Score (IPSS) at their first assessment. Overall, 133 (0.4) patients had PEDT ≥ 11, suggestive for PE. The characteristics of patients with and without PE according to PEDT findings were compared with the Mann-Whitney and Fisher's exact tests. Linear regression analysis tested the association between LUTS and PEDT score. Patients with PE depicted lower median scores for IIEF-overall satisfaction, intercourse satisfaction and erectile function than non-PE individuals (all p < 0.004). Similarly, patients with PE showed higher median BDI scores (7 versus 4; p < 0.0002), median IPSS total score (7 versus 5), storage (4 versus 2), and voiding (3 versus 2) subscores (all p < 0.01) compared to those without PE. At linear regression analysis, IPSS storage subscore (Coeff: 0.28; 95%CI: 0.05-0.51, p = 0.01) and BDI score (Coeff: 0.10; 95%CI: 0.01-0.19, p = 0.02) were associated with higher PEDT values, after accounting for IIEF-EF score, patients' age, body mass index and Charlson Comorbidity Index. Our findings suggest that storage symptoms and depression should be carefully investigated when assessing patients complaining of PE in the real-life setting.

Therapeutic efficacy of mirabegron 25 mg monotherapy in patients with nocturia-predominant hypersensitive bladder.

Objective:The objective of this study was to evaluate the efficacy of mirabegron 25 mg daily in patients with nocturia-predominant hypersensitive bladder (HSB).Materials and Methods:This study prospectively investigated 219 consecutive patients with nocturia-predominant HSB and treated with mirabegron 25 mg daily from July 2015 to 2016. Patient with nocturia episode decreased by ≥1/night after treatment was considered successful. The subjective symptom score, such as International Prostate Symptom Score (IPSS), Quality of life index, Overactive Bladder Symptom Score (OABSS), Urgency Severity Scale, patient perception of bladder condition (PPBC), and nocturia episodes per night, was assessed before and 1 month after mirabegron treatment and between successful and failed groups.Results:A total of 219 patients, including 51 women and 168 men, were enrolled. The mean age of the population was 72.3 ± 11.0 years. Totally, 58 (26.5%) of the patients had improvement in nocturia at 1 month after treatment. Among them, 14 (27.5%) women and 44 (26.2%) men had improvement in nocturia episodes after treatment (P = 0.858). Compared the clinical data between successful and failed group, the baseline symptom scores were more severe in successful group, including IPSS-storage subscore (4.84 ± 2.09 vs. 4.11 ± 2.19, P = 0.031), OABSS (3.21 ± 0.67 vs. 2.91 ± 1.00, P = 0.037), and nocturia episodes (3.81 ± 0.95 vs. 3.095 ± 1.32, P = 0.000). Multivariate analysis revealed only a higher nocturia episodes (P = 0.046) predict a successful treatment result. Mirabegron 25 mg daily significantly improved PPBC score along the 3 months' follow-up (P < 0.05), and postvoid residual volume did not increase after mirabegron treatment in overall patients.Conclusions:Mirabegron 25 mg daily treatment showed a limited therapeutic effect on nocturia-predominant HSB patients. The patients with higher OAB symptoms predict a successful result.

Male patients with a higher frequency of nocturnal urinary episodes are more likely to benefit from alpha-blocker therapy for bothersome nocturia.

This retrospective study investigated the therapeutic effects of alpha-blockers on men with lower urinary tract symptoms (LUTS) to identify baseline variables that may predict therapeutic response in terms of nocturia improvement. The study included 348 men with LUTS, including bothersome nocturia, treated with tamsulosin 0.4 mg at bedtime (h.s.) for 3 months. Responders were defined as patients with a decrease of ≥1 nocturia episodes/night after alpha-blocker therapy. Nocturnal urinary frequency, International Prostate Symptom Score (IPSS) voiding and storage scores, as well as the voiding to storage (V/S) ratio, prostate measurements, uroflowmetry, and post-void residual were determined at baseline and 1 and 3 months after alpha-blocker therapy. The overall response rate was 44.8% (156/348). Nocturia improved in 60 patients (17.2%) reporting a reduction of ≥2 episodes/night and in 96 patients (27.6%) reporting a reduction of 1 episode/night. Total and storage IPSS scores, the IPSS V/S ratio and the number nocturia episodes were higher in responders than non-responders. IPSS storage subscores and nocturia episodes were significantly greater, whereas IPSS V/S ratio and maximum flow rate (Qmax ) were lower, in those with a reduction of ≥2 versus 1 episode/night. Multivariate analysis revealed that nocturia episodes and a lower V/S ratio were predictors of responders with an improvement of ≥2 episodes/night. The quality of life index improved significantly more in responders than non-responders. Tamsulosin treatment (0.4 mg, h.s.) for 3 months not only improved voiding and storage symptoms, but also reduced nocturia episodes. Patients with more nocturia episodes may benefit more from alpha-blocker treatment in terms of reducing the number of nocturia episodes.