International Prostate Symptom Score Total Score Research Articles

Tamsulosin 0.8 mg daily dose in management of BPH patients with failed tamsulosin 0.4 mg monotherapy and unfit for surgical intervention

AimThis study aims to evaluate the effectiveness and safety of administering double-dose tamsulosin (0.8 mg) for treating patients with benign prostatic hyperplasia (BPH) who have not responded to the standard single dose of tamsulosin (0.4 mg) and are deemed unsuitable for transurethral resection (TUR) intervention.Materials and methodsBetween November 2022 and July 2023, we prospectively analyzed 111 patients who were experiencing severe BPH symptoms. These patients received a double dose of tamsulosin for one month. We collected baseline characteristics such as age, body mass index, and underlying medical conditions. Various parameters including the International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) levels, prostate volume, peak urinary flow rate (Qmax), voided volume, and post-void residual volume were evaluated before and after treatment.ResultsAll 111 patients completed the study. The mean age, PSA level, and prostate volume were 63.12 ± 4.83 years, 3.42 ± 0.93 ng/ml, and 50.37 ± 19.23 ml, respectively. Of these patients, 93 showed improvement in Qmax, post-void residual volume, and IPSS score (p-value = 0.001). The total IPSS score and total Qmax improved from 24.03 ± 2.49 and 7.72 ± 1.64 ml/sec to 16.41 ± 3.84 and 12.08 ± 2.37 ml/sec, respectively.ConclusionDouble-dose 0.8mg tamsulosin as an alpha-blocker therapy appears to be a viable temporary management option for BPH patients who have not responded to the standard single dose 0.4mg tamsulosin and are not suitable candidates for TUR intervention.

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. 

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 & LUTs did not correlate with UDS findings. Therefore, in patients with MS and LUTs, UDS must be performed for adequate disease assessment

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.

Modeling study of the effect of placebo and medical therapy on storage and voiding symptoms, nocturia, and quality of life in men with prostate enlargement at risk for progression.

Modeling studies using large datasets from men with lower urinary tract symptoms/benign prostate enlargement (LUTS/BPE) can predict changes in International Prostate Symptom Score (IPSS) and risk of acute urinary retention/surgery under different treatment regimens and according to predictors (baseline characteristics) that commonly define risk of progression. We assessed the impact of treatments on different symptom types (storage, voiding, and nocturia), quality of life (QoL; IPSS Q8), and BPH Impact Index [BII]). Generalized least squares models were used to predict each outcome. Data from the CombAT study were used to predict outcomes for active treatments (dutasteride, tamsulosin, combination therapy). Predictors included: age; IPSS total, storage, voiding, nocturia and QoL (IPSS Q8) scores; BII; prostate volume; maximum urine flow rate (Qmax), prostate-specific antigen, postvoid residual urine (PVR); alpha-blocker usage within 12 months. Data from phase III dutasteride monotherapy studies were used to predict placebo outcomes. Results were visualized using an interactive web-based tool ( www.bphtool.com ). Combination therapy provided greater predicted benefit than either monotherapy for all five outcomes for most patient profiles within the CombAT inclusion criteria. PVR and corresponding subscores were significant predictors of change in both storage and voiding subscores. Alpha-blocker use within 12 months, age (storage subscore), and Qmax (voiding subscore) were also significant predictors. PVR, age, Qmax, and nocturia score were significant predictors of change in nocturia. PVR, Qmax, previous alpha-blocker use, total IPSS, and QoL (IPSS Q8) score were significant predictors of change in QoL (IPSS Q8) score. For BII, significant predictors were PVR, age, total IPSS, and BII score. The multivariable effect of covariates and treatments is best visualized through the interactive web-based tool. This predictive modeling study informs our understanding of how risk factors for disease progression interact and affect treatment impact on different symptom types and QoL scores.

Evaluation of the efficiency of transurethral enucleation with bipolar energy according to prostate volume for patients with benign prostate hyperplasia

BackgroundThis study evaluated the efficiency and safety of transurethral enucleation with bipolar energy (TUEB) using a spatula loop according to prostate volume. MethodsWe retrospectively evaluated 398 patients who underwent TUEB for benign prostatic hyperplasia at a single tertiary hospital between August 2018 and December 2022. The patients were divided into three groups according to estimated prostate volume (ePV): ≤40 mL (n = 67), 40–80 mL (n = 200), and ≥80 mL (n = 131). To compare the efficiency of TUEB, perioperative parameters including TUEB and enucleation efficiencies, were calculated as enucleated tissue weight per operation time and enucleated tissue weight per enucleation time, respectively. Preoperative and postoperative functional outcomes such as the International Prostate Symptom Score (IPSS), quality-of-life (QoL) score, maximum flow rate (Qmax), and post-void residual urine volume (PVR), were also compared. ResultsThe IPSS total score, voiding sub-score, Qmax, and PVR improved after TUEB in all groups (all p < 0.05). The TUEB and enucleation efficiencies increased with increasing ePVs (all P < 0.001). When comparing the three prostate volume groups, there were no significant differences in functional outcomes within 12 months after TUEB (all-Bonferroni adjusted P > 0.017). A total of 57 patients experienced adverse events after TUEB, with no significant differences between the three groups (p = 0.507) ConclusionAs prostate volume increases, the perioperative efficiency of TUEB is enhanced. Meanwhile, small prostates did not show significant differences in the improvement of functional outcomes and complications in comparison with larger prostates.

Factors Related to Overactive Bladder-like Symptoms in Bladder Cancer.

The aim of the present study was to investigate the factors related to overactive bladder (OAB)-like symptoms in patients with bladder cancer. This study included 59 patients who underwent transurethral resection of bladder tumor (TURBT). OAB-like symptoms were identified based on the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS) questionnaires. The main outcome measures were elucidation of bladder cancer-related factors that might induce OAB-like symptoms. Non-muscle invasive bladder cancer (NMIBC) was observed in 50 patients, and carcinoma in situ (CIS) was observed in 14 patients. OABSS total score, IPSS total score, and quality of life index were 5±3, 12±7 and 3±1, respectively. The OABSS question 1 score, indicating pollakisuria, was significantly higher in NMIBC patients with CIS than in those without CIS (presence of CIS vs. absence of CIS=1.0±0.6 : 0.5±0.6, p=0.02). IPSS question 4 score, indicating urgency (r=0.31, p=0.01), and OABSS question 4 score, indicating urgency incontinence (r=0.29, p=0.03), correlated significantly with the maximum bladder tumor diameter. Multivariate regression analysis demonstrated that presence of CIS in NMIBC cases correlated significantly with pollakisuria (p=0.02), and that maximum diameter of the bladder tumor correlated significantly with both urgency (p=0.04) and urgency incontinence (p=0.01). CIS induced pollakisuria in NMIBC. Larger diameter bladder tumors induced both urgency and urgency incontinence. Patients with bladder cancer who present with pollakisuria might have CIS.

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.

Chronological Changes of Lower Urinary Tract Symptoms in Elderly Patients with Prostate Cancer after Low-Dose-Rate Prostate Brachytherapy.

To compare chronological changes in lower urinary tract symptoms (LUTS) after low-dose-rate prostate extended-release therapy (LDR-BT) using the overactive bladder symptom score (OABSS) in patients aged ≥ 75 years (elderly group) versus those aged < 75 years (control group). Patients with prostate cancer who underwent LDR-BT at Gifu University Hospital were included in this study. The International Prostate Symptom Score (IPSS), OABSS, and quality of life-based on urinary symptoms (IPSS-QOL) were evaluated before and after LDR-BT. We compared chronological changes in IPSS, OABSS, and IPSS-QOL in the elderly group with those in the control group and assessed the association between the resolution of OABSS and clinicopathological covariates. A total of 484 patients were enrolled in this study. In the elderly group, the total IPSS, OABSS, and frequency scores increased at 1 month postoperatively, whereas the control group showed an increase at 3 months postoperatively. Multivariate analysis identified changes from baseline to the maximum OABSS and pre-treatment OABSS as significant predictors of delayed resolution of OABSS after LDR-BT. Changes in pre-treatment OABSS and pre- and post-LDR-BT OABSS values were independent predictors of delayed resolution of OABSS; however, no correlation was found with age.

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 ...

MP24-16 THE LURN SI-10 AND IPSS SIMILARLY QUANTIFY IMPROVEMENT FOLLOWING BPH SURGERY, BUT THE LURN SI-10 ALSO CAPTURES SYMPTOMS INCLUDING INCONTINENCE AND PAIN DURING RECOVERY

You have accessJournal of UrologyCME1 Apr 2023MP24-16 THE LURN SI-10 AND IPSS SIMILARLY QUANTIFY IMPROVEMENT FOLLOWING BPH SURGERY, BUT THE LURN SI-10 ALSO CAPTURES SYMPTOMS INCLUDING INCONTINENCE AND PAIN DURING RECOVERY David Nusbaum, Clark Judge, George Javitch, Brian Helfand, Abigail Smith, James Griffith, and Alexander Glaser David NusbaumDavid Nusbaum More articles by this author , Clark JudgeClark Judge More articles by this author , George JavitchGeorge Javitch More articles by this author , Brian HelfandBrian Helfand More articles by this author , Abigail SmithAbigail Smith More articles by this author , James GriffithJames Griffith More articles by this author , and Alexander GlaserAlexander Glaser More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The LURN SI-10 was designed for comprehensive but practical clinical use in the assessment of lower urinary tract symptoms (LUTS). The LURN SI-10 was previously shown to demonstrate convergent validity with the International Prostate Symptom Score (IPSS) at baseline while also identifying other common and bothersome symptoms such as pain and urinary incontinence (UI), but to date the LURN SI-10 has not yet been evaluated in the postoperative setting. We hypothesize that the LURN SI-10 will show similar responses to treatment as the IPSS while also capturing UI and pain. METHODS: Clinical variables and responses to LURN SI-10 and IPSS were compared at baseline, 6 weeks, and 3 months postoperatively following BPH surgeries. Proportions of patients reporting pain and UI on LURN SI-10 were compared. Multivariate analysis was performed to determine predictors of improvement. RESULTS: 333 men underwent BPH surgery: 157 underwent Aquablation, 48 Rezum, 33 Urolift, 34 TURP, 54 PVP, and 7 robotic simple prostatectomy. Baseline characteristics were similar across groups, except for prostate volume, which was larger for Aquablation and simple prostatectomy (median 88 ml and 160ml, respectively). IPSS and LURN SI-10 scores, as well as respective improvements in bother and quality of life scores, decreased similarly at postoperative timepoints, reflecting expected improvement after surgery (p<0.001 for all; Figure). However, the LURN SI-10 also detected symptoms including UI and pain during the postoperative period, and these symptoms were associated with higher total LURN SI-10 and IPSS scores (Table; Figure). CONCLUSIONS: The LURN SI-10 and IPSS instruments respond similarly after surgery, but the LURN SI-10 has the additional benefit of assessing symptoms that may be important during recovery including UI and pain. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e324 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Nusbaum More articles by this author Clark Judge More articles by this author George Javitch More articles by this author Brian Helfand More articles by this author Abigail Smith More articles by this author James Griffith More articles by this author Alexander Glaser More articles by this author Expand All Advertisement PDF downloadLoading ...

Effects of Vitamin D Supplementation on Testosterone, Prostate, and Lower Urinary Tract Symptoms: A Prospective, Comparative Study.

Several studies have associated the serum vitamin D level with total testosterone levels and the prostate volume. Herein, we investigated the effect of vitamin D supplementation on testosterone, prostate, and lower urinary tract symptoms (LUTS) in men. Men over 40 years of age diagnosed with a vitamin D deficiency (25[OH]D <20 ng/mL) who received vitamin D supplementation for one year were included in the study and administered 25,000 IU of cholecalciferol every 2 weeks. Prostate ultrasound, uroflowmetry, postvoid residual urine volume measurement, and serological tests (serum testosterone levels, etc.) were performed upon diagnosis and one year later. Participants also answered the International Prostate Symptom Score (IPSS) and Aging Males' Symptoms Scale (AMS) questionnaires. A significant increase was observed in the vitamin D level following one year of vitamin D supplementation, with a significant decrease in the postvoid residual urine volume, total IPSS score and without a significant change in the prostate volume. Improved psychological subscale score of AMS questionnaire was observed with a statistical significance. Vitamin D supplementation suppressed the increase in the prostate volume and improved the LUTS. Although there is no direct effect on serum testosterone levels, vitamin D supplementation helped improve hypogonadal symptoms.

Multi-stage urethroplasy for anterior urethral strictures: objective parameters of long-term efficacy and patient-reported outcomes

Introduction. Multi-stage urethral surgery is used in cases of the most complex urethral strictures. The evaluation of surgical treatment results given by patients is a significant criterion for the efficacy of urethroplasty along with the assessment of urethral patency through instrumental examinations.Objective. To evaluate the long-term efficacy of multistage urethroplasty for complex anterior urethral strictures considering the patients' quality of life and satisfaction with the surgical outcomes.Materials and methods. The study included 73 patients aged 18 – 84 years with anterior urethral strictures who underwent multi-stage urethroplasty in 2010 – 2019. Surgical and functional outcomes of urethroplasty were assessed through general blood and urine tests, physical examination, uroflowmetry, and retrograde urethrography and urethroscopy in case of urinary disorders. Subjective parameters of treatment efficacy were studied using questionnaires: International Prostate Symptom Score (IPSS); Quality of life (QoL); Patient-reported Outcome Measure for Urethral Stricture Surgery (USS-PROM); Patient Global Impression of Improvement (PGI-I).Results. Recurrent urethral stricture was detected in 19 (26,0%) patients with the average follow-up period being 65 months. Independent urination was restored in 71 (97.3%) cases, including repeated interventions. After surgery, there was a significant increase in urinary flow rate parameters (Q max: 8.1 vs 19.1 ml/s, p &lt; 0.0001; Q ave: 5.5 vs 10.7 ml/s; p = 0.0004), decrease in residual urine volume (62.4 vs 18.6 ml, p &lt; 0.0001), decrease in total IPSS score (18.7 vs 5.7 points; p &lt; 0.0001) and QoL index (4.3 vs 1 .8 points, p &lt; 0.0001). A comparative analysis of preoperative and postoperative USS-PROM questionnaire results demonstrated an improvement in indicators assessing LUTS (12.9 vs 3.4 points; p &lt; 0.0001; 3.6 vs 1.7 points; p &lt; 0.0001), and urination-associated quality of life (2.6 vs 0.6 points; p &lt; 0.0001) and overall health (EQ-5D index: 0.73 vs 0.91 points; p = 0.025; EQ-VAS: 68.0 vs 88.1 points, p = 0.004). Fifty-seven (81.4%) men were “very satisfied” or “satisfied” with the treatment outcomes, while nine (12.9%) respondents noted a moderate effect of residual urinary disorders on the quality of life. Significantly higher satisfaction was observed among cystostomy patients and in cases where repeated interventions were unnecessary.Conclusion. Multi-stage urethroplasty for complex anterior urethral strictures achieves efficacy in 97.3% of cases and is accompanied by high levels of quality of life and patient’s satisfaction during long-term follow-up.

PREVALENCE OVERACTIVE BLADDER AT TERTIARY HOSPITAL : A RETROSPECTIVE SINGLE CENTER STUDY

Objective: Overactive bladder (OAB) is a chronic medical condition that has a tremendous impact on the quality of life for both men and women. Urgency is a primary symptom in diagnosing OAB and is closely related to the urge to urinate frequently during the day. Material &amp; Methods : A retrospective study was conducted from January 2018 until December 2020 by using medical records database in our institution. There were 562 patients. Inclusion criteria used in this study are patients with OAB symptoms with any etiology who have undergone conservative, moderate, or future or postoperative measures in the study period. The patient who cannot be cooperative in filling out the International Prostate Symptom Score (IPSS) questionnaire or the patient who refuses were excluded from this study. Statistical analysis was performed using Pearson correlation and linear regression. Results: From the results, linear regression, obtained significance (p &lt;0.05) on the variables of frequency, urgency and nocturia. A linear regression value of y= -0.005 + 0.987X was obtained which illustrates that the higher the frequency, urgency and nocturia variables, the higher the possibility of Lower urinary tract symptoms (LUTS) that can be correlated with OAB. Conclusion: Frequency, nocturia, and urgency are factors that influence the significance of the IPSS variable on the total IPSS score. Questionnaire items on overactive bladder symptoms score (OABSS) have a significant correlation with IPSS scores.

The Impact of Transoral Robotic Surgery on Erectile Dysfunction and Lower Urinary Tract Symptoms in Male Patients with Moderate-to-Severe Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA), lower urinary tract symptoms (LUTS), and erectile dysfunction (ED) are chronic conditions that seriously affect middle-aged men. This study aimed to evaluate the changes in the presence of these conditions after transoral robotic surgery (TORS) for OSA. This prospective observational study recruited 48 men with moderate-to-severe OSA (mean age 40.6 ± 8.1 years) who underwent TORS from October 2019 to November 2021 at a tertiary center. Baseline polysomnographic parameters, Epworth Sleepiness Scale (ESS), and demographic characteristics were measured. The evaluations of LUTS and ED were based on self-administered International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires, respectively, before TORS. The treatment outcomes were assessed three months postoperatively in the patients undergoing TORS due to moderate-to-severe OSA. There was significant Apnea-Hypopnea Index (AHI) reduction from 53.10 ± 25.77 to 31.66 ± 20.34 three months after undergoing TORS (p < 0.001). There was also a significant decrease in the total IPSS score (5.06 ± 5.42 at baseline to 2.98 ± 2.71 at three months postoperatively, p = 0.001), the storage domain, and the voiding domain (p < 0.05). The ED also improved significantly, as seen in the IIEF score (20.98 ± 3.32 to 22.17± 3.60, p = 0.007). The reduction of AHI was associated with changes in body weight and the lowest oxygen saturation (SpO2) levels during sleep (rho = 0.395, p = 0.005; rho = 0.526, p < 0.001, respectively). However, the reduction in AHI was not significantly associated with improvement in IPSS or IIEF scores (p > 0.05). For men with moderate-to-severe OSA, TORS can significantly improve the polysomnography parameters, sleep-related questionnaire scores, and quality of life, and alleviate ED and LUTS. AHI reduction is not a crucial factor for ED and LUTS improvement after TORS for OSA, especially in ED.

Prospective randomized controlled trial comparing a ureteral stent crossing versus not crossing the bladder midline.

PurposeTo evaluate the correlation between the position of a ureteral stent and stent-related symptoms in a single-center randomized study.MethodsA total of 113 patients who required ureteral stent placement after lithotripsy were randomized at a 1:1 ratio into groups with stents crossing and not crossing the bladder midline. The ureteral stent remained in place until postoperative day 14, when we obtained each patient’s International Prostate Symptom Score (IPSS), overactive bladder symptom score (OABSS), and visual analog scale (VAS) pain score.ResultsComparing changes from baseline IPSS and OABSS scores between the two groups, the midline crossing group had a worse OABSS total score than the not crossing group (3.0 ± 2.8 vs. 2.0 ± 3.3; p = 0.032). There was no significant difference between the crossing and not crossing groups in IPSS total score (6.8 ± 7.6 vs. 5.1 ± 8.5; p = 0.14). The OABSS urgency mean score was significantly lower in the not crossing than in the crossing group (1.1 ± 1.8 vs. 1.6 ± 1.8; p = 0.042). However, there was no significant difference between groups for remaining items of the IPSS and OABSS and the mean VAS total pain score (1.9 ± 2.7 vs. 1.2 ± 1.9; p = 0.14).ConclusionA ureteral stent that crossed the bladder midline led to worse urinary symptoms. Choosing the appropriate stent length for each patient is important to minimize stent-related symptoms.Trial Registration date1 October 2018; number: UMIN000034067.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00345-022-03978-5.

Evaluation of the relationship between lower urinary tract symptoms and fall risks in male patients over 65 years old

Objective. In our study, we aimed to evaluate the relationship between LUTS and fall risk in patients over 65 years old.Methods. 183 people over 65 years old who attended to Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital Family Medicine Polyclinics and Recep Tayyip Erdoğan University Family Medicine Polyclinics between February 2017-May 2017 were included in the study and ‘Individual Presentation Form’ prepared by the researcher questioning socio-demographic characteristics was applied to the participants by face-to-face questioning method, International Prostate Symptom Score (IPSS) and Morse Fall Scale (MFS) were completed afterwards and ROC analysis of IPSS was performed for those who have high risk in terms of MFS. Results. When evaluating the relationship between MFS and IPSS, we observed that as all subscores and total score of IPSS increased, the MFS score increased. The MFS scores of the participants whose IPSS classification was evaluated as severe were found to be significantly higher. ROC analysis of IPSS was performed for those who have high risk in terms of MFS. It was found that area under curve is 78.4%, and those with an IPSS of 13.5 and above show a high fall risk with 71.4% sensitivity and 70% specificity.Conclusions. In our study, we found that as the IPSS of the participants increased, the risk of falling increased. Moreover, we found that age, occupation type, type and number of chronic diseases were effective in both fall and IPSS. In addition to LUTS screening in males, evaluation should be done for the risk of falling.

IPSS "bother question" score predicts health-related quality of life better than total IPSS score.

The objective of thisstudy was to investigate the role of bothersomeness of urinary symptoms on the general health-related quality of life (HRQoL) of patients with benign prostatic hyperplasia. We hypothesised that a higher International Prostate Symptom Score (IPSS) would be associated with a higher score on the IPSS bother question (IPSS-BQ), and a higher IPSS-BQ score would be the dominant factor associated with poorer general HRQoL. A case-control, cross-sectional study design was used. Patients were selected according to strict inclusion and exclusion criteria and stratified by IPSS severity group (controls: IPSS < 8; moderately symptomatic: IPSS = 8-18; and severely symptomatic: IPSS > 18). The IPSS-BQ was used to analyse bothersomeness of urinary symptoms. A standardised, multidimensional measure of HRQoL (RAND-36) was used. Data were collected on prostate size, uroflowmetry parameters, prostate specific antigen and comorbidities that were quantified using the Charlson Index and the American Association of Anaesthesiologists (ASA) score. Multiple linear regression models were used to assess the impact of bothersomeness of urinary symptoms on physical and mental HRQoL. Cohen's d was used to determine the effect size. We included 83 patients in the statistical analysis. Linear regression analyses showed that the IPSS was not an independent predictor of HRQoL. Only the highest IPSS-BQ score was associated with both worse physical (P = 0.021) and mental (P = 0.011) HRQoL in the final model. The effect sizes were small to moderate. The IPSS-BQ score is an important predictor of HRQoL. The IPSS-BQ score as a proxy should be regarded as a standard outcome measure and reported in all LUTS-related research.

Impact of drug use on patient symptom score and quality of life in benign prostatic hyperplasia patients

Introduction: To assess the drug use pattern for treating benign prostatic hyperplasia (BPH) patients and its impact on patient symptom score and quality of life (QoL) of these patients. Materials and Methods: After getting approval from the Indian Council of Medical Research, Institutional Ethics Committee and after obtaining written informed consent from 103 BPH patients, their demographic data, drugs prescribed to them, and scores of International Prostate Symptom Score (IPSS) and Benign Prostatic Hyperplasia Impact Index (BII) were recorded. Patients were reassessed for changes in scores of IPSS, BII, and drug prescription (if any) on the 15th, 30th, and 60th days. Results: 68.93% of patients received drug as a single entity. Patients were classified according to their presenting symptoms as severe, low moderate, and mild with a mean total IPSS score of 16.73% ± 6.6. 37.86% of patients were dissatisfied with QoL and 24.27% of patients had mixed opinion with a mean score of 3.39 ± 1.08. There was a low, medium, moderate, and high total score of BII with a mean BII score of 4.02 ± 2.51. Significant changes were seen in total BII score and frequency of urination on day 15; weak stream, nocturia, total score, and QoL on day 30; and intermittency and urgency on day 60. Incomplete emptying of bladder and straining showed nonsignificant changes. Age and total IPSS score, age and QoL, and age and total BII score showed a negative correlation. Total IPSS score and QoL, total IPSS and BII score, and QoL and total BII score showed a positive correlation. Conclusion: Nonsurgical pharmacological intervention had a positive impact on the IPSS and BII score and health-related QoL in BPH patients.