International Prostate Symptom Score Subscores 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.

MP51-12 "LESS IS MORE" REZUM: A PROPENSITY SCORE MATCHED COMPARISON

You have accessJournal of UrologyCME1 Apr 2023MP51-12 "LESS IS MORE" REZUM: A PROPENSITY SCORE MATCHED COMPARISON Clara Cerrato, Mimi V. Nguyen, Dean Elterman, Kevin Zorn, Naeem Bhojani, Bilal Chughtai, and Seth K. Bechis Clara CerratoClara Cerrato More articles by this author , Mimi V. NguyenMimi V. Nguyen More articles by this author , Dean EltermanDean Elterman More articles by this author , Kevin ZornKevin Zorn More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , and Seth K. BechisSeth K. Bechis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to evaluate the effect of a minimal approach of water vapor thermal therapy (Rezum), defined as 1 vapor treatment per prostate lobe, on postoperative outcomes and symptoms compared to patients who received multiple treatments per lobe. METHODS: We performed a multi-institutional retrospective review of patients who underwent Rezum procedure for symptomatic BPH from 2018 to 2022. Propensity score matching (PSM) was utilized to generate patient cohorts based on the number of treatments per lobe (1 per lobe including median lobe if present vs ≥2 per lobe) matched for age, BMI, and pre-operative prostate volume. Primary outcome of interest was post-operative complications and irritative symptoms. We then conducted a non-PSM independent T-test to analyze the differences in International Prostate Symptom Score (IPSS), QOL sub-score, and flow rates both before and after the procedure. Patients with existing urinary retention were excluded. RESULTS: 146 patients were included in the PSM with 73 patients in each arm. The ≥2 treatment group showed higher post-operative de-novo retention (p=0.009) and UTI (p=0.003) and had their median lobe more frequently treated (p=0.021) (Table 1a). On MVA, an increasing number of treatments (HR 1.3, p=0.039) and treatment of the median lobe (HR 4.7, p=0.008) were significant risk factors for post-procedure irritative symptoms (Table 1b). Mean IPSS and IPSS sub-scores were similar by 3 months up to 12 months after the procedure (Figure 1). At 6 months, patients treated with 1 injection per lobe showed comparable Qmax and voided volumes and better post-void residual volumes (Table 1d). CONCLUSIONS: Minimal Rezum treatment approach with a single water vapor injection per lobe, including median lobe, is a safe and effective option for patients undergoing treatment for BPH and is associated with improved postoperative complicationsand irritative voiding symptoms, and with comparable IPSS and flow outcomes. Further studies are needed to investigate the effect of this minimal approach on longer-term outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e697 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clara Cerrato More articles by this author Mimi V. Nguyen More articles by this author Dean Elterman More articles by this author Kevin Zorn More articles by this author Naeem Bhojani More articles by this author Bilal Chughtai More articles by this author Seth K. Bechis More articles by this author Expand All Advertisement PDF downloadLoading ...

Change in Postoperative Storage Symptoms and De Novo Urge Incontinence After Thulium:YAG Laser Enucleation of the Prostate: Results from a Prospective Multicenter Study.

Objectives: To assess the change of storage symptoms (SS) and their impact on quality of life in men undergoing thulium:YAG laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH). Materials and Methods: BPH patients requiring surgery were prospectively evaluated (April 2019-October 2020). Inclusion criteria: International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate ≤15 mL/s, and urinary retention. Exclusion criteria: previous urethral/prostatic surgery, pelvic irradiation, bladder/prostate cancer, neurogenic bladder, concomitant transurethral surgery, and active urinary tract infection. IPSS, International Continence Society-Overactive Bladder (ICIQ-OAB) and International Continence Society-Overactive Bladder Quality of Life (ICIQ-OABq) scores were gathered before surgery and 1, 3, 6, and 12 months after surgery. Results: In total, 117 men were included. Mean age was 68.0 ± 7.7 years. Mean prostate volume was 86.6 ± 34 cc. Mean IPSS subscore was 8.7 ± 3.1 and 11.7 ± 4.7 for storage and voiding symptoms, respectively. Mean ICIQ-OAB was 29.1 ± 16.8. Mean ICIQ-OABq was 80.3 ± 30.6. Voiding IPSS decreased 72.8% at 1 month, whereas the reduction of storage IPSS was 38.0%. ICIQ-OAB decreased 49.6% at 1 month. ICIQ-OABq showed a 30.0% reduction. One year after surgery, the reduction of voiding IPSS was 94.8%, ICIQ-OAB 85.5%, storage IPSS 76.7%, and ICIQ-OABq 60.5%. Urge incontinence was present in 26.5% of men at 1 month, 15.4% at 3 months, and 4.3% at 6 months. Four (3.4%) patients complained of urge incontinence 12 months after surgery. Conclusion: Both storage and voiding lower urinary tract symptoms significantly decreased after ThuLEP, but storage symptoms showed less reduction with a significant impact on patients' quality of life, particularly during the first 3 months.

Evaluation of lower urinary tract symptoms among male COVID-19 patients during the second wave: An observational study.

Coronavirus disease-19 (COVID-19) pandemic has affected almost all age groups globally, and lower urinary tract symptoms (LUTS) may be one of the early manifestations of COVID-19, especially in elderly patients. This study aimed at evaluating LUTS in male COVID-19 patients during the COVID-19 s wave. A prospective observational study was conducted between March 15, 2021, and March 25, 2021, at the Prince Hamza Hospital in Amman, Jordan. Newly admitted COVID-19 confirmed male patients who were able to fill the LUTS (validated) questionnaire were included. Vitally unstable patients requiring intensive care unit admissions or medical or surgical intervention (except catheterization) for their presenting symptoms were excluded. Two-hundred and four patients (mean age: 51.1 ± 17.3 years) were included; among COVID-19 symptoms, augmented urinary frequency (3.4%) was the commonest urological symptom, followed by dysuria (1.0%), and acute urinary retention (1.0%). Twenty-four patients (10.8%) had benign prostatic hyperplasia, two patients had bladder cancer, and one hadprostate cancer. Most patients exhibited mild symptoms on international prostate symptom score (IPSS) before (n = 149, 67.1%) and during (n = 157, 70.7%) COVID-19, and this difference between IPSS scores was statistically significant (P = 0.025). Both IPSS sub-scores of storage (IPSS/S) and voiding (IPSS/V) had a positive correlation with pre- and post-COVID-19 scores (IPSS/S: P < 0.001, r = 0.63; IPSS/V: P < 0.001, r = 0.76). This study demonstrated a strong correlation between COVID-19 and LUTS; therefore, COVID-19 infection should be investigated and excluded in any patient presenting with LUTS during the current pandemic. Further research is needed to elucidate the exact pathophysiology of this correlation.

Differences of Lower Urinary Tract Symptoms Degree In Benign Prostatic Hyperplasia Patients With and Without Diabetes Mellitus

Background. Benign Prostatic Hyperplasia (BPH) is a benign tumor that most often occurs in men. Many risk factors could cause BPH, one of which is diabetes mellitus (DM). Diabetes mellitus (DM) is a metabolic disease, characterized by hyperglycemia. Method. This study was conducted at the Urology Polyclinic of the Universitas Sumatera Utara Hospital from August to September 2019. A total of 102 patients diagnosed with BPH were registered by cross-sectional study approach. Detailed medical history and physical examination were performed for all patients to diagnose BPH. While the diagnosis of DM was according to patient history or diabetic-medicine use. International Prostate Symptom Score (IPSS) were completed by all patients to obtain a LUTS degree. Result. From a total of 102 patients diagnosed with BPH there were 97 patients were selected. The mean age of patients was 70.43 ± 7.52 year (range 50-88 year) and the total IPSS score was 17.55 ± 6.55. DM patients were more likely to report severe LUTS and the symptom score evaluated with IPSS was significantly higher than in non non-DM group: 21.69 ± 5.41 vs 16.70 ± 6.41 (p=0.005). For the IPSS subscores, the DM group also show higher storage: 8.38 ± 4.57 vs 5.88 ± 3.72 (p = 0.02), voiding: 9.69 ± 2.47 vs 8.14 ± 3.21, (p= 0.039) and post micturition: 3.63 ± 1.26 vs 2.69 ± 1.744, (p= 0.045) symptoms significantly. Conclusion: Benign Prostatic Hyperplasia patients with DM manifested more severe lower urinary tract symptoms. Storage, voiding, post micturition, and urgency symptoms were also greater.

Can We Use the Silodosin as Second Line Treatment of Benign Prostate Hyperplasia?

Objective: We aimed to investigate the efficacy of silodosin in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) refractory to previous α-adrenergic receptor (AR) blocker therapy. Materials and Methods: Patients who did not benefit from alpha-blocker therapy but avoided surgical treatment constitute the population of our study. Seventy-five patients were studied in each group; Group 1 was given 8 mg of silodosin, while Group 2 continued the previous alpha-blocker treatment. Results: The initial mean international prostate symptom score (IPSS) was calculated as 20.81±0.97 in Group 1, in the third month there was a decrease of 17.12±1.25 (p&lt;0.05). No significant change was observed in Group 2. In addition, a significant decrease was observed in IPSS subscores (storage and voiding symptoms) in Group 1 compared to baseline at the third month. There was an improvement in residual urine in the silodosin group and no improvement in the other group. Conclusion: In patients with BPH who refuse surgical treatment and could not achieve adequate symptom relief with other α-blockers in routine practice, silodosin was found superior in terms of LUTS recovery. Silodosin is also an effective option in patients who cannot undergo surgical treatment due to comorbidities.

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Association between Nocturnal Frequency and Erectile Function in Eugonadal Men with Benign Prostatic Obstruction: A Cross Sectional Study.

PurposeWe aimed to evaluate the association between nocturnal frequency and erectile dysfunction in patients with benign prostatic obstruction.Materials and MethodsTo evaluate the association, we simultaneous evaluated urodynamic study, prostate ultrasound, nocturnal tumescence test (nocturnal penile tumescence) for sleep-related erection (SRE) and two questionnaires, international prostate symptom score (IPSS) and 5-item version of the international index of erectile function (IIEF-5). Patients with hypogonadism or nocturnal polyuria were excluded.ResultsForty-six patients were registered over 4 years. The mean age, prostate size, IPSS score, and IIEF-5 score were 67.65±5.51 years, 65.10±22.12 mL, 24.67±7.89, and 9.50±7.01, respectively. Among the IPSS subscores, nocturia was most significantly related to the total IIEF-5 score (p<0.001). More severe nocturia was associated with less frequent SRE (p=0.003) and shorter total duration of SRE (p=0.002), which in turn elucidated that nocturia was significantly related to the total amount of rigidity signals (rigidity activity unit, RAU) or tumescence signals (tumescence activity unit, TAU). Among objective urodynamic parameters, bladder compliance also correlated to RAU and TAU. Individual subjective erectile function (IIEF-5) was significantly related to both RAU and TAU.ConclusionsSleep fragmentation due to benign prostate obstruction related nocturnal frequency caused by reduced bladder compliance could decrease the frequency and duration of SRE, which decreases the total amount of SRE and reflects the patient's relevant erectile function.

RELATIONSHIP BETWEEN THE NATIONAL INSTITUTES OF HEALTH CHRONIC PROSTATITIS SYMPTOM INDEX AND THE INTERNATIONAL PROSTATE SYMPTOM SCORE IN MIDDLE-AGED MEN ACCORDING TO THE PRESENCE OF CHRONIC PROSTATITIS-LIKE SYMPTOMS

Background and objectiveThe characteristic symptom of chronic prostatitis (CP) is pain. Patients with CP often complain of lower urinary tract symptoms (LUTS); however, the voiding domain of the Chronic Prostatitis Symptom Index of the National Institutes of Health (NIH-CPSI) is not sufficient to evaluate LUTS. Therefore, we studied the relationship between the International Prostate Symptom Score (IPSS) and NIH-CPSI scores in men. Materials and methodsWe reviewed 870 men who visited our health care center for a general health check-up and com-pleted IPSS and NIH-CPSI questionnaires between January 2014 and January 2019. An NIH-CPSI pain score ≥4 was defined as the presence of a prostatitis-like symptom (Group 1), and an NIH-CPSI pain score less than <4 was defined as the absence of a prostatitis-like symptom (Group 2). The relationship between IPSS and NIH-CPSI sub-scores was investigated. The associations between the IPSS total score and NIH-CPSI sub-scores were assessed using multiple linear regres-sion analysis. ResultsThe mean IPSS total, voiding, storage, and quality-of-life (QOL) scores were higher in Group 1 than in Group 2. Group 1 had fewer subjects in the mild group and more in the moderate and severe groups than did Group 2. Among NIH-CPSI sub-scores, pain score showed the highest correlation between IPSS total (r=0.283), voiding (r=0.266), storage (r=0.237), and QOL score (r=0.263). In regression analysis, only the NIH-CPSI pain score was associated with the IPSS total score (B=0.962, p<0.001). ConclusionsThe NIH-CPSI pain score showed a weak but statistically significant correlation with the IPSS, but the NIH-CPSI voiding score did not. This finding suggests that patients with CP-like symptoms need to be surveyed using the IPSS questionnaire. It will also be helpful to screen for comorbidities of benign prostatic hyperplasia and CP.

Effect of ureteral stent diameter on ureteral stent-related symptoms.

This study investigated the correlation between ureteral stent diameter and stent-related symptoms. This study evaluated 17 patients (53 [74.6%] men, 18 [25.4%] women; mean [±SD] age 59.3 ± 14.2 years) who underwent ureteral stent placement before ureteroscopic lithotripsy (URSL) and in whom the ureteral stent tail was positioned inside the bladder without crossing the midline. All stents were Inlay Optima stents. Stent diameter (6 or 4.7 Fr) and length (24 or 26 cm) were chosen at the surgeon's discretion. Patients were classified into two groups (Group 1, 6-Fr stent; Group 2, 4.7-Fr stent). Urinary symptoms before insertion of the ureteral stents and the day before URSL were assessed using the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). In addition, patient background and changes in the IPSS and OABSS were compared. Factors affecting ureteral stent-related symptoms were evaluated using multivariate analysis. Compared with Group 2, Group 1 had a worse total IPSS (P = 0.02), as well as intermittency (P = 0.009), urgency (P = 0.008), voiding symptoms (Q1 + Q3 + Q5 + Q6; P = 0.046), and storage symptoms (Q2 + Q4 + Q7; P = 0.017) subscores on the IPSS, total OABSS (P = 0.045) and OABSS urgency subscore (P = 0.002). Multivariate analysis revealed that stent diameter was significantly associated with total IPSS (P = 0.007) and OABSS (P = 0.036). This is the first study to show that larger-diameter ureteral stents induce significantly worse urinary symptoms. Ureteral stents with smaller diameters are recommended to improve ureteral stent-related symptoms.

711 Is free testosterone good or evil for lower urinary tract symptoms? : analysis of a Japanese community-based study

Age-related testosterone deficiency may adversely affect the functions of multiple organ systems. Although it causes various clinical symptoms such as low libido, erectile dysfunction, depressed mood, decreased vitality and so on, the relationship between the low androgen level and lower urinary tract symptoms (LUTS) is not clear. We evaluated the relationship between androgen decline and LUTS based on data from a cross-sectional community-based study on LUTS suggestive of benign prostatic hyperplasia (BPH) in Japanese men. In 2007, we conducted a cross-sectional community-based study on BPH/LUTS in aged men in Shimamaki-mura, Hokkaido, Japan. We investigated the International Prostate Symptom Score (IPSS) and measured the prostate volume and free testosterone level. A total of 91 of the 135 participants were eligible for this study. Associations between the free testosterone level and the IPSS and prostate volume were assessed by Spearman’s rank correlation. The median age of the participants was 69 years (range: 53-93). The median IPSS, prostate volume and free testosterone levels were 8 (range: 0-27), 24.5ml (range: 8.7-76.9) and 4.3pg/ml (0.6-9.0), respectively. Free testosterone was significantly and negatively correlated with the storage IPSS subscore (r=-0.239, p <0.05) and the frequency of nocturia (r=-0.280, p <0.05). A low level of free testosterone was also associated with large prostate volume (r=-0.210, p <0.05).

Clinical evaluation of tamsulosin in the relief of lower urinary tract symptoms in advanced prostate cancer patients.

To assess the effectiveness and safety of tamsulosin combined with androgen deprivation therapy (ADT) for lower urinary tract symptoms (LUTS) in advanced prostate cancer (PC) patients. Ninety PC patients with moderate-to-severe LUTS randomized into two groups of 45 each. One group received ADT (group 1), and the other received ADT plus tamsulosin (group 2) for 24weeks. The outcome measures were changes in the International Prostate Symptom Score (IPSS), IPSS obstructive and irritative subscores, quality of life (QoL), maximum urinary flow rate (Q max), post-voiding residual (PVR) and prostate-specific antigen (PSA) from baseline. The treatment response was monitored at 8, 16 and 24weeks. Both ADT monotherapy and ADT plus tamsulosin significantly improved IPSS,QoL score, Q max and PVR at the end of the treatment period. ADT plus tamsulosin had a greater impact on total IPSS, IPSS obstructive subscore, QoL and PVR at week 8 and week 16 than ADT monotherapy. Tamsulosin group showed greater improvement in Q max than ADT group. Significant improvements of IPSS, IPSS obstructive subscore and QoL were achieved at early treatment stage (week 8) in group 2, whereas similar improvements were achieved at week 16 in group 1. There were no significant differences in IPSS, IPSS subscores, QoL and PVR between the two groups at week 24. Additional administration of tamsulosin showed significantly greater and sooner relief in LUTS than ADT monotherapy, with good acceptability. It is feasible that ADT is used alone after 16-24weeks of combination therapy.

Do female patients with predominant voiding symptoms really have objective voiding-phase dysfunction?

ObjectivesTo investigate whether female patients with predominant voiding symptom really have objective voiding phase dysfunction. MethodsFemale patients with lower urinary tract symptoms who underwent video-urodynamic study between January 2009 and December 2012 were recruited. All patients completed a 3-day frequency-volume chart. Symptom severity was evaluated using International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) and Urogenital Distress Inventory (UDI-6) questionnaires. The patients with IPSS-voiding subscores greater than IPSS-storage subscores and their most bother symptom are one of voiding symptom of IPSS were defined as subjective voiding dysfunction group (SVD group). The demographics, IPSS scores, OABSS scores, frequency-volume charts and urodynamic variables were compared between SVD and non-SVD groups. ResultsOf the 842 enrolled patients, 142 (16.9%) were classified into SVD group. Total IPSS and IPSS-voiding subscores of SVD group were significantly higher than those of non-SVD group. Conversely, IPSS-storage subscores, OABSS and UDI-6 scores of SVD group were significantly lower than those of non-SVD group. The prevalence of urodynamic voiding phase dysfunction was 64.7% in SVD group, which was significantly higher than those of non-SVD group (37.8%, p < 0.01). SVD group showed more prevalent bladder outlet obstruction (50.0% vs. 27.0%, p < 0.01). There were no significant differences in the prevalence of impaired detrusor contractility between SVD and non-SVD group. Detrusor overactivity was more prevalent in non-SVD group (5.6% vs. 18.6%, p < 0.01). ConclusionsEven though the female patients complain of predominant voiding symptoms, only two thirds of them were identified having urodynamic voiding phase dysfunction. On the other hand, in female patients whose predominant complaint are not voiding symptom, around one third of them were found to have urodynamic voiding phase dysfunction. This study clearly indicates that in females subjective low urinary tract symptoms are not necessarily reliable.

Efficacy and safety of tamsulosin hydrochloride 0.2 mg and combination of tamsulosin hydrochloride 0.2 mg plus solifenacin succinate 5 mg after transurethral resection of the prostate: a prospective, randomized controlled trial.

ObjectiveThe objective of this study was to evaluate the safety and efficacy of tamsulosin hydrochloride 0.2 mg (TAM) and its combination with solifenacin succinate 5 mg (SOL) after transurethral resection of the prostate (TURP).Patients and methodsThe patients were randomized into three groups: TURP (group 1), TURP plus TAM (group 2), and TURP plus TAM + SOL (group 3). Patients in group 2 and group 3 received medication for 4 weeks. The primary efficacy end points were the mean change in total International Prostate Symptom Score (IPSS) and IPSS subscores. The secondary end points included quality-of-life score, Overactive Bladder Symptom Score, and short-form voiding and storage score of International Continence Society.ResultsIn total, 37 men (31.8%) in group 1, 37 men (31.8%) in group 2, and 42 men (36.2%) in group 3 completed the study. In total IPSS, no significant improvement was seen from baseline to the end of treatment in groups 2 and 3 compared with group 1. However, in group 2, the decrement in the IPSS storage score was smaller than group 1 (P=0.02), and in group 3, the decrement in the IPSS voiding score was smaller than group 1 (P=0.05). In groups 2 and 3 compared with group 1, improvements in the quality of life score, total score of Overactive Bladder Symptom Score, and short-form voiding score and storage score of International Continence Society were not statistically significant.ConclusionTreatment with TAM and combination of TAM and SOL did not have significant additional benefits for lower urinary tract symptoms during the early recovery period after TURP.

Lower Urinary Tract Symptoms and Incident Falls in Community Dwelling Older Men: The Concord Health and Ageing in Men Project

We sought to determine which lower urinary tract symptoms are associated with incident falls in community dwelling older men. The Concord Health and Ageing in Men Project involves a representative sample of community dwelling men 70 years old or older in a defined geographic region in Sydney, New South Wales, Australia. Included in analysis were 1,090 men without neurological diseases, poor mobility or dementia at baseline. Lower urinary tract symptoms were assessed using I-PSS (International Prostate Symptom Score) and incontinence was assessed using ICIQ (International Consultation on Incontinence Questionnaire) at baseline. I-PSS subscores were calculated for storage and voiding symptoms. Incident falls in 1 year were determined by telephone followup every 4 months. I-PSS storage and voiding subscores were associated with falls. Urgency incontinence was associated with falls (adjusted incidence rate ratio 2.57, 95% CI 1.54-4.30). In addition, intermediate to high I-PSS storage subscores without urgency incontinence were associated with falls (adjusted incidence rate ratio 1.72, 95% CI 1.24-2.38). Other types of incontinence and urgency alone without urgency incontinence were not associated with falls. Lower urinary tract storage and voiding symptoms were associated with falls in community dwelling older men. Of the symptoms of overactive bladder urgency incontinence carried a high risk of falls. Storage symptoms also contributed to the fall risk independently of urgency incontinence. Circumstances of falls among men with lower urinary tract symptoms should be explored to understand how lower urinary tract symptoms increase the fall risk and generate hypotheses regarding potential interventions. Furthermore, trials to treat lower urinary tract symptoms in older men should include falls as an end point.

Improved Lower Urinary Tract Symptoms Associated With Testosterone Replacement Therapy in Japanese Men With Late-Onset Hypogonadism.

This study aimed to investigate the effects of testosterone replacement therapy (TRT) on lower urinary tract symptoms (LUTS) in men with late-onset hypogonadism (LOH) and to identify parameters predicting the efficacy of TRT in improving LUTS. This study included 60 consecutive Japanese men who were diagnosed with LOH and subsequently received TRT between January 2009 and December 2014. In this series, 250 mg of testosterone was injected intramuscularly every 3 or 4 weeks in all patients. The following parameters were retrospectively reviewed: body mass index (BMI), Aging Male Symptom (AMS) score, International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5) score, residual urine volume, prostate volume, serum levels of the prostate-specific antigen (PSA), and total- and free-testosterone levels before and 6 months after TRT. No significant differences were observed in BMI, residual urine volume, or prostate volume between surveys before and after TRT. The AMS score, IPSS, and IIEF-5 score were significantly improved and significant increases were noted in the serum levels of PSA and total- and free-testosterone levels after TRT. An analysis of IPSS subscores documented the significant improvement in storage symptom scores, but not in voiding symptom scores after TRT. Multivariate analyses of parameters assessed in this study identified the pretreatment AMS score, posttreatment IIEF-5 score, and prostate volume as independent predictors of improvements in IPSS following TRT. This study revealed that TRT appeared to have considerable therapeutic effects on LUTS, particularly on storage symptoms, in men with LOH.

Patients With Prostatic Inflammation Undergoing Transurethral Prostatic Resection Have a Larger Early Improvement of Storage Symptoms

To evaluate the association between prostate inflammation, metabolic syndrome (MetS), and postoperative lower urinary tract symptoms in patients treated with transurethral resection of the prostate (TURP). From April 2011, a consecutive series of patients treated with TURP were prospectively included in this observational study. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. Patients were evaluated at baseline and 1month postoperative with the International Prostate Symptom Score (IPSS), including the storage IPSS (sIPSS) and voiding IPSS (vIPSS) subscores, the Overactive Bladder questionnaire (OAB-q), and uroflowmetry. Prostate volume was evaluated at baseline. Complications were classified using the modified Clavien system. TURP specimens were examined to define grade, location, and extent of the inflammatory infiltrate according to the standardized classification system of chronic prostatitis and/or chronic pelvic pain syndrome. One hundred and thirty-one subjects were enrolled, in which 54 patients (41.3%) presented with MetS. No differences were observed in terms of preoperative prostate-specific antigen, OAB score, IPSS, vIPSS, sIPSS, Qmax, post void residual, and prostate volume in subjects with and without MetS. An incidence of postoperative complications of 10.6% was recorded: 79% were classified as Clavien type I or II; 21% Clavien IIIb. Of 131 subjects, 97 (74.1%) presented with an inflammatory infiltrate. Patients with MetS presented a high proportion of inflammatory infiltrates compared to patients without MetS (45 of 54; 83% vs 52 of 77; 67%, P= .01). Patients with prostate inflammation presented a 50% risk reduction of postoperative storage urinary symptoms. We confirmed the association between MetS and prostate inflammation.Patients with inflammatory infiltrates mostly benefit from TURP, particularly regarding storage symptoms.

Are phosphodiesterase type 5 inhibitors effective for the management of lower urinary symptoms suggestive of benign prostatic hyperplasia?

To review the efficacy of phosphodiesterase type 5 inhibitors (PDE5-Is) in lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (LUTS/BPH). A comprehensive research was conducted to identify all publications relating to benign prostate hyperplasia and treatment with sildenafil, vardenafil and tadalafil. To assess the efficacy, the changes in total international prostate symptom score (IPSS), IPSS subscore including voiding, storage and quality of life (QoL), Benign prostatic hyperplasia Impact Index (BII), maximum urinary flow rate (Qmax) and the International Index of Erectile Function (IIEF) were extracted. A meta-analytical technique was used for the analysis of integrated data from the included studies to evaluate the mean difference in the results. Total IPSS score, IIEF and BII showed a significant improvement in trials in which LUTS/BPH with or without erectile dysfunction (ED) were compared with the placebo. For LUTS/BPH, the mean differences of total IPSS score, IIEF and BII are -2.17, 4.88 and -0.43, P < 0.00001, respectively. For LUTS/BPH with comorbid ED, the mean difference are -1.97, 4.54 and -0.52, P < 0.00001, respectively. PDE5-Is appear to improve IPSS storage, voiding and QoL subscore (mean difference = -0.71, -1.23 and -0.33, P < 0.00001, respectively). Although four doses of tadalafil (2.5, 5, 10 and 20 mg) failed to reach significance in Qmax (mean difference = 0.22, P = 0.10), the 5 mg dose of tadalafil significantly improved the Qmax (mean difference = 0.33, P = 0.03). PED5-Is demonstrated efficacy for improving LUTS in BPH patients with or without ED and could be considered to be the first line treatment for LUTS/BPH.

Comparison of efficacy and bladder irritation symptoms among three different ureteral stents: A double-blind, prospective, randomized controlled trial

Objective. Various ureteral stents have been developed to reduce ureteral stent-related discomfort. The aim of this prospective, randomized study was to compare the efficacy and morbidity of three different ureteral stents. Materials and methods. Between June 2012 and May 2013, patients who underwent ureteral stent insertion after ureteroscopic stone removal were randomized in a double-blind fashion to receive three different stents (group 1, Endo-Sof™ double-pigtail ureteral stent, Cook Medical; group 2, Enhanced Durometer loop stent, Bioteq; group 3, Polaris™ Ultra ureteral stent, Boston Scientific). Ninety patients who met the inclusion criteria were administered the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) preoperatively, after 2 weeks with the stent in situ and 4 weeks after its removal. The Visual Analogue Pain Scale (VAPS), presence of gross hematuria and ultrasound for hydronephrosis grade were checked at 2 weeks with the stent in situ and 4 weeks after its removal. Results. After stent insertion, the degree of hydronephrosis was not significantly different among the three groups. Patients in group 3 showed significantly less increase in the total IPSS and storage symptom subscores than did those in the other groups. Mean VAPS after ureteral stent insertion was significantly lower in group 3 than in the other groups. The presence of gross hematuria after ureteral stent insertion occurred more frequently in groups 1 and 2 than in group 3. Conclusions. The Polaris Ultra ureteral stent showed similar efficacy and favorable tolerability in regard to bladder irritation symptoms, stent-related pain and presence of gross hematuria compared with other stents.

Effect of Tadalafil on Male Lower Urinary Tract Symptoms: An Integrated Analysis of Storage and Voiding International Prostate Symptom Subscores from Four Randomised Controlled Trials

BackgroundThe international prostate symptom score (IPSS) evaluates lower urinary tract symptoms (LUTS) in men with suspected benign prostatic hyperplasia (BPH); the total score does not differentiate between storage and voiding and is unevenly weighted (four questions [57%] on voiding, three questions [43%] on storage). ObjectiveTo evaluate the relative contributions of storage and voiding IPSS subscores to total IPSS at baseline and in response to treatment with tadalafil. Design, setting, and participantsIntegrated analysis of data from four placebo-controlled, 12-wk studies of tadalafil (5mg once daily) in 1499 men with LUTS/BPH. Outcome measurements and statistical analysisRelationships between total IPSS and the storage and voiding subscores were assessed using graphical exploration and linear regression modelling. Linear modelling was performed for the baseline and endpoint and for changes in subscores. The optimal storage subscore to total IPSS (S:T) ratio for IPSS improvement was identified using nonparametric regression and gradient-descent optimisation. Results and limitationsThe contribution of storage and voiding subscores at baseline and endpoint was 38.8% and 61.2%, and 39.2% and 60.7%, respectively. This intuitive 40:60 storage-to-voiding ratio was similar at baseline and endpoint by treatment group and for changes in subscores, but spanned the entire range for individuals. Changes in total IPSS were greatest for a storage subscore percentage contribution to total IPSS of 42.7%. There was no statistical association between S:T ratio (≥40% vs <40%) at baseline and response to tadalafil. The main limitation was the use of unvalidated storage and voiding IPSS subscores. ConclusionsA constant S:T ratio of 4:10 was observed at baseline and endpoint. The greatest effect on total IPSS was noted for an S:T percentage contribution of 42.7%. Tadalafil efficacy was unaffected by the level of storage dysfunction at baseline. Patient summaryThis analysis shows that for men with BPH, improvements during treatment with tadalafil apply to both storage and voiding symptoms at a constant ratio. The extent of storage dysfunction before treatment did not affect the response to treatment.