International Prostate Symptom Research Articles

Outcome of transurethral resection of the prostate (TURP) using 5% dextrose water as irrigant.

TURP remains the gold standard for simple prostatectomy presently. Different fluids have been used for irrigation while performing monopolar TURP. The choice of irrigation fluid depends on a lot of factors. We sought to find out if the outcome of monopolar TURP using 5% dextrose water in our setting compares with findings in other studies using different fluids as irrigation fluid in monopolar TURP. This was a prospective study of 220 patients who had monopolar TURP using 5% dextrose water as irrigation fluid from 2015 to 2020. The study was completed by 220 patients. The mean age was 66.25 yrs. The mean weight of prostate was 53.2 g, and mean resected weight was 30.10 g using a mean irrigation volume of 45.35 liters, 5% dextrose water over a mean resection time of 66.08 mins. The mean changes in International Prostate Symptom Score/quality of life score (IPSS/QOLS) were statistically significant. Early complications recorded were postoperative hematuria with clot retention (1.4%), urinary tract infection (UTI) (13.2%), and secondary hemorrhage (10%). TURP syndrome was not recorded. Late complications seen within 2 years follow-up were transient urinary incontinence (6.4%), urethral stricture (4.1%), and bladder neck contracture (2.3%). There was no repeat TURP for residual adenoma within this period. TURP using 5% dextrose water has comparable outcomes to other irrigation fluids for monopolar TURP. It is a good alternative to any other irrigation fluid.

Does Preoperative Bladder Compliance Affect Long-Term Functional Outcomes after Laser Prostatectomy?

We assessed the effects of preoperative bladder compliance on the long-term functional outcomes, especially focused on postoperative storage symptom changes, after laser prostatectomy. From January 2008 to March 2014, 1,608 men who underwent laser prostatectomy, including holmium laser enucleation or photo-vaporization of the prostate, were included in the analysis. We divided patients into 3 groups according to bladder compliance on a baseline urodynamic study: <12.5, 12.5-25, ≥25 mL/cmH2O. A multivariable analysis was performed to determine the impact of bladder compliance on changes in long-term functional outcomes after laser prostatectomy. Bladder compliance was less than 12.5 mL/cmH2O in 50 (3.1%), 12.5-25 mL/cmH2O in 232 (14.4%) patients. As bladder compliance decreased, the baseline International Prostate Symptom (IPSS) total score and storage sub-score were increased; the voiding sub-score remain unchanged. At postoperative 12 and 36 months, absolute improvements in the IPSS total score and storage sub-score were higher in <12.5 mL/cmH2O group compared to other groups, although those were equivalent at postoperative 1 months. On the multivariable analysis, decreased bladder compliance <12.5 mL/cmH2O was significantly associated with superior improvement in storage sub-score at postoperative 36 months, although it was not associated with voiding sub-score. In patients with preoperative bladder compliance <12.5 mL/cmH2O, storage symptoms could be further improved at 36 months after laser prostatectomy compared to others. Thus, laser prostatectomy could be a considerable treatment option for patients with severely decreased bladder compliance.

Long-Term PAE Results: What Do We Know.

Prostatic artery embolization (PAE) is a minimally invasive technique with proven safety and efficacy to treat lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) or benign prostatic hyperplasia (BPH). In this review, we discuss the required level of evidence to implement and adopt treatment options for patients with LUTS due to BPO/BPH. Focus is given on the long-term (>3 years) data after PAE with reported outcomes including cohort sizes, follow-up times, reintervention rates (repeat PAE and prostatectomy), need for LUTS/BPO medical therapy, and improvements in International Prostate Symptom Score/quality of life score, peak flow rate (Qmax), postvoid residual, prostate volume, and prostate-specific antigen. The durability of treatment effects after PAE and need for prostatic reinterventions need to be taken into consideration when discussing treatment options with patients and referring colleagues from other medical specialties. Developments in medical devices used for PAE have allowed for a continuous drop in unilateral PAE rates over the last 12 years and will probably play a role in optimizing technical and thus clinical outcomes for patients with LUTS due to BPH/BPO.

Knowledge and Health Care Seeking Behaviors of Old Age Patients with Benign Prostatic Hyperplasia at Assiut University Urology Hospital, Egypt

Background: Benign Prostatic Hyperplasia is a common condition in the elderly population. It affects the physical health status in persons over 65 years and interferes with their daily activities. Study Aim: to assess the knowledge and health care seeking behaviors among old age patients with Benign Prostatic hyperplasia Sample: old age patients aged 60 years and above diagnosed with benign prostatic hyperplasia. The total sample size was 218 elderly. Cross-sectional research design was used in this study. Setting: The study was conducted in outpatient clinic at Assiut University urology hospital. Tools: Three tools were used, the first tool was an interview structured questionnaire that includes demographic data, present and past history and patient's knowledge regarding benign prostatic hyperplasia. The second tool was the questionnaire of the principal reasons for patients to seek medical advices and the third tool was International Prostate Symptom Score/quality of life questionnaire. Results: Ninety percent of the sample had poor level of knowledge and 39.9% of them had sever benign prostatic hyperplasia symptoms. Conclusion: the present study showed that the majority of the studied elderly patients had poor knowledge score. Recommendation: Providing designed programs to increase the knowledge of elderly patients with benign prostatic hyperplasia about disease: causes, risk factors, treatment, and complications,

The Advantages of DiLEP Operation in the Treatment of BPH Patients and the Observation of Postoperative Urinary Control Effect

Objective: To evaluate the efficacy of Semiconductor laser trefoil enucleation of the prostate (DiLEP) in the treatment of patients with benign prostatic hyperplasia (BPH). Methods: 120 BPH patients scheduled for prostate surgery in our hospital were randomly divided into two groups: study group (DiLEP treatment) and control group (transurethral plasma bipolar resection of the prostate treatment), with 60 cases in each one. Surgical process indicators, postoperative rehabilitation indicators, Qmax before and after surgery, post-void residual volume (PVR), international prostate symptom score (IPSS), hemoglobin (Hb), urinary control and surgical complications for two groups were compared. Results: The operation time, intraoperative blood loss, bladder irrigation time, urinary catheter indwelling time and hospital stay in the study group were lower than those in the control group (P&lt;0.05). The weight of resected tissue in the study group was higher than that in the control group (P &lt;0.05). The difference in Qmax, PVR, IPSS scores and Hb between the study group and the control group before operation and one month after operation had no statistical significance (P&gt;0.05). The Qmax and Hb scores in the study group were higher than those in the control group (P&lt;0.05), while the PVR and IPSS scores were lower than those in the control group (P&lt;0.05); five days and two weeks after operation, the urinary control rates in the study group were all higher than that in the control group (P&lt;0.05); one month after operation, the difference in the urinary control rates between the two groups had no statistical significance (P&gt;0.05); the difference in the surgical complication rate between the study group and the control group had no stastiscal significance (P&gt;0.05). Conclusion: DiLEP is beneficial for early recovery of urodynamics in patients with BPH, with less trauma and faster recovery of urinary control after surgery.

The predictive ability of response to first dose of tamsulosin in symptomatic patient with benign prostatic obstruction

ABSTRACT OBJECTIVES: To study the effects of the first single dose of tamsulosin 0.4 mg on lower urinary symptoms tract (LUTS) in patients with benign prostatic hyperplasia (BPH) as an indication of the response at 3 months after treatment. PATIENTS AND METHODS: This was a prospective study that included patients> 45 years old with LUTS / BPH. In all patients, tamsulosin was administered orally 0.4 mg once a day for 3 months. The degree of international prostate symptoms (IPSS), quality of life (QoL), residual urine volume (PVR) and maximum urine flow rate (Q max) were measured before treatment, 6 hours, 10 days, 1 month and 3 months after treatment. Data before and after treatment were compared using appropriate statistical analysis tests. Results: The group included 60 patients. They ranged in age from 45 to 70 years (56.38 ±7.25 years). No significant differences were observed between baseline data and the sixth hour after treatment. IPSS, QoL points, PVR and Qol data of 49 (81.7%) of the patients have improved significantly from the tenth day to the end of study after 3 months (p <0.05). Eleven patients (%18.3) did not respond to the tamsulosin and another treatment options for their LUTS/BPH had been offered. Conclusion: Tamsulosin hydrochloride has achieved a significant improvement of patients with LUTS/BPH in terms of IPSS, QoL points, PVR and Qol 10 days after treatment. There is no relationship between the tamsulosin effect achieved after the initial dose and its mid-term effectiveness.

GreenLight Laser photoselective vapo-enucleation of the prostate with front-firing emission versus plasmakinetic resection of the prostate for benign prostate hyperplasia.

BackgroundAlthough the conventional, monopolar transurethral resection of the prostate (TURP) has proven to be an effective and relatively safe treatment for patients with benign prostatic hyperplasia (BPH), many new endoscopic technologies have been introduced to treat BPH. With the development of laser, there are several alternative transurethral procedures embracing laser therapies. Herein, this study sought to explore the efficacy, safety and follow-up of GreenLight laser photoselective vapo-enucleation of the prostate (PVEP) with front-firing emission compared with plasmakinetic resection of the prostate (PKRP) used to surgically manage BPH.MethodsData from patients who underwent either GreenLight laser PVEP or PKRP were retrospectively collected from March 2013 to May 2018. Perioperative data from both groups were compared.ResultsTotally, 43 and 45 patients were included in the PVEP and PKRP groups, respectively. No significant difference was observed in excision efficiency ratio (resected prostate weight/operation time) between the two groups (P=0.372). The efficiency ratio of the first 20 PVEP procedures (0.36±0.09 g/min) was significantly lower than that of the second 23 PVEP procedures (0.45±0.18 g/min) (P=0.042). The PVEP group experienced a shorter duration of catheterization, postoperative hospital stay and irrigation time than the PKRP group (P<0.001, P=0.001 and P<0.001, respectively). There was no statistically significant difference between the two groups (P=0.937) in terms of overall postoperative complications. Three months after surgery, the international prostate symptoms (IPSS) score, quality of life (QOL) score, postvoid residual (PVR) volume and maximum urinary flow rate (Qmax) were decreased in both groups (P<0.001 for all) and were comparable between both groups (P=0.635, 0.662, 0.671 and 0.924, respectively).ConclusionsGreenLight laser PVEP with front-firing emission was safe and effective modality in treating patients with BPH with short-term follow-up. PVEP was associated with shorter catheterization and postoperative hospital stay time compared with PKRP.

A comparative study of prostatic artery embolization in the treatment of benign prostatic hyperplasia with different prostatic volume

Objective: To compare the efficacy of prostatic artery embolization (PAE) in the treatment of patients with benign prostatic hyperplasia (BPH) with different prostatic volume (PV). Methods: In this single-center, retrospective study, 137 patients, mean age (70±11) years, range 50-89 years, undergoing PAE for BPH between January 2015 and May 2017 in Chinese PLA General Hospital were involved and divided into three groups according to the PV (group A, >80 ml; group B, 40-80 ml; group C, <40 ml). The changes of international prostate symptoms (IPSS) score, quality of life (QoL) score, and maximum urinary flow rate (Q(max)) were compared among the three groups at 1, 6, and 12 months post-PAE. Correlation between the proportion of prostate ischemia at 1 month post-PAE and the proportion of PV reduction at 12 month post-PAE were analyzed, also the correlation between both of them with IPSS and QoL score were analyzed, respectively. Results: Mean baseline prostate volumes were 110 ml in group A (n=62), 67 ml in group B (n=47) and 33 ml in group C (n=28). At 12 months post-PAE, the outcomes of IPSS score and Q(max) in group A were better than those in group B and C (all P<0.05).The proportion of prostate ischemia at 1 month post-PAE and proportion of PV reduction at 12 month post-PAE in group A, B, and C were 61.4%, 49.3%, 38.0%, and 47.3%, 29.3%, 24.6%, respectively. The proportion of prostate ischemia in group A was larger than that in group B and C (P=0.049, 0.004), also the proportion of PV reduction in group A was greater than that in group B and C (P<0.01). The proportion of prostate ischemia at 1 month post-PAE in all three groups were positively correlated with the proportion of PV reduction at 12 month post-PAE (r=0.699, P=0.024; r=0.719, P=0.019; r=0.821, P=0.004), and there were positive correlations between both of them and the improvement of IPSS score at 12 month post-PAE (0.5<r<1.0, all P<0.05), while no correlation with the improvement of QoL score. Conclusions: Patients with BPH with PV larger than 80 ml are more suitable for PAE. The proportion of prostate ischemia and prostate volume reduction after PAE can predict the efficacy of PAE.

Flower Pollen Extract in Association with Vitamins (Deprox 500®) Versus Serenoa repens in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Comparative Analysis of Two Different Treatments.

Objective: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is re-ported in the literature ranging from 1 to 14.2%. The aim of the present study was to as-sess the impact on patient’s quality of life and symptoms of Flower pollen extract in asso-ciation with vitamins (Deprox 500®) in comparison with Serenoa repens 320 mg (Permix-on 320 mg® by Pierre Fabre) in patients with CP/CPPS.Methodology: All consecutive patients, with a diagnosis of CP/CPPS, referred to our center from January to August 2016, were screened to be enrolled in this single-center, random-ized, controlled trial. The main outcome measure was the evaluation of IPSS/NIH-CPSI (International Prostatic Symptom Score/NIH-Chronic Prostatitis Symptom Index) score variation and the assessment of the quality of life and symptoms at the end of the thera-py. The second outcome measure was the evaluation of the comorbidity role in the CP/CPPS therapy. 63 patients were analyzed; patients were randomized into two groups: 29 patients were treated with Deprox 500® 2 tablets/day for 6 weeks and 34 patients with Serenoa repens 320 mg, 1 tablet/day for 6 weeks.Results: The mean score variation for IPSS was -12.7 ± 4.3 in the Deprox 500® group and -7.8 ± 4.7 in the Serenoa repens group (p=0.0005) while for NIH-CPSI was -17.3±3.1 in the Deprox 500® group and -13.6±4.8 in the Serenoa repens group (p=0.0016). By ac-counting only the symptoms part of NIH-CPSI questionnaire, the mean score variation reported was -11.5±2.5 in the Deprox 500® group and -9.02±4.0 in the Serenoa repens group (p=0.009321). Furthermore, analyzing the comorbidity subgroups, in patients with hypertension, the mean IPSS score variation was -14.3±3.2 in the Deprox 500® group and -9.02±4.0 in the Serenoa repens group.Conclusion: In conclusion, in patients with CP/CPPS, Deprox 500® improves IPSS and NIH-CPSI scores up to 74.5% and 84.5% respectively. Furthermore, in patients with hypertension, the antioxidant effect of Deprox 500® reduces the mean IPSS score of 82.7%.

Changes in Erectile Function after Photoselective Vaporization of the Prostate with a 120-W GreenLight High-Performance System Laser: 2-Year Follow-Up.

PurposeTo evaluate the impact of photoselective vaporization of the prostate (PVP) with a 120-W GreenLight high-performance system on erectile function in a 2-year follow-up study.Materials and MethodsOne hundred seventy-seven patients who underwent PVP during 2008 to 2012 were analyzed retrospectively. The patients were divided into 5 groups according to their preoperative 5-item International Index of Erectile Function (IIEF-5) scores: Group I (IIEF-5: 5~7, n=28), II (IIEF-5: 8~11, n=47), III (IIEF-5: 12~16, n=43), IV (IIEF-5: 17~21, n=34), and V (IIEF-5: 22~25, n=25). The patients were assessed before surgery and 6, 12, and 24 months after the PVP. Their International Prostate Symptom Score/quality of life, maximum urinary flow rate/post-void residual urine volume, and IIEF-5 scores were measured at each visit.ResultsThe mean age and presence of hypertension were significantly different among the 5 groups. Perioperative parameters and postoperative complication rates showed no statistical differences. After PVP, voiding parameters were significantly improved in all the groups and sustained during the 2-year follow-up. The postoperative IIEF-5 scores fell slightly overall, while group V showed the largest significant deterioration. In multivariate analysis, body mass index (BMI) was the only independent predictor of decreased erectile function after PVP.ConclusionsErectile function declined in all the groups after PVP, with the most extensive deterioration observed in patients with normal erectile function preoperatively. Preoperative BMI was the only independent risk factor for a meaningful decrease in erectile function after PVP.

Effects of daily tadalafil on lower urinary tract symptoms in young men with multiple sclerosis and erectile dysfunction: a pilot study.

Men affected by multiple sclerosis often experience neurogenic overactive bladder (OAB), lower urinary tract symptoms and erectile dysfunction (ED). The aim of the study was to investigate modifications of urinary and sexual functions after administration of daily tadalafil (TAD) 5mg. Twenty men were enrolled in a single-blind, 4-week prospective study while 10 men without treatment served as controls. Primary outcomes were changes from baseline of International Prostate Symptom (IPSS), OAB questionnaire (OAB-q-short form) and International Index of Erectile Function (IIEF-5) scores. To evaluate the influence of bladder filling on somatic reflexes, we studied variations of the H-reflex evoked by electrical stimuli applied to the tibial nerve at the popliteal fossa and recorded from the soleus muscle. Also testosterone/estradiol (T/E) ratio was measured before and after treatment. In TAD group, an improvement in IPSS (p<0.001), OAB-q (p<0.001) and IIEF-5 (p<0.001) scores was found. Also, an increase in Q max (p<0.01) and T/E ratio (p<0.01) was found with a concomitant reduction in post-void residual volume (p<0.001) without any changes in the H-reflex. The study demonstrates for the first time that daily TAD in patients with multiple sclerosis improves storage symptoms, post-void residual volume, steroid hormone pattern and ED without urodynamic changes.

The Effects of Hyaluronic Acid and Carboxymethylcellulose in Preventing Recurrence of Urethral Stricture After Endoscopic Internal Urethrotomy: A Multicenter, Randomized Controlled, Single-Blinded Study

To evaluate the effects of hyaluronic acid (HA) and carboxymethylcellulose (CMC) on the recurrence of urethral stricture after treatment with endoscopic internal urethrotomy (EIU). A total of 120 patients underwent EIU for urethral stricture. Recruited patients were randomly divided into two groups: group A and B. Patients in group A (60 patients, experimental group) received HA/CMC instillation and patients in group B (60 patients, control group) received lubricant instillation after internal urethrotomy. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), and 24 weeks (V3) after the surgery. The effectiveness of HA/CMC instillation was evaluated based on the International Prostate Symptom Score/Quality of Life, peak urine flow rate, voided volume and postvoiding residual urine volume. The visual analogue scale (VAS) pain score and degree of satisfaction were also determined for each participant. Among 120 initial participants, 53 patients in group A and 48 patients in group B had completed the experiment. VAS pain scores were 0.67±0.76 and 3.60±1.52 (p<0.001), and degrees of satisfaction were 0.28±0.50 and 0.80±0.81 in group A and group B at 1 month after surgery (p=0.001). The recurrence of urethral stricture was observed in five cases (9.4%) in group A and 11 (22.9%) in group B (p=0.029). HA/CMC instillation during EIU may decrease the incidence of urethral stricture recurrence. In addition, the use of HA/CMC was effective in reducing pain during the early postoperative period without an adverse effect.

Effects of Hyaluronic Acid and Carboxymethylcellulose on Urethral Stricture After Transurethral Resections of the Prostate for Benign Prostatic Hyperplasia: A Multicenter, Single Blinded, Randomized Controlled Study

To evaluate the effect of hyaluronic acid (HA) and carboxymethylcellulose (CMC) instillation after transurethral resection of the prostate (TURP) on preventing urethral stricture. A total of 180 patients underwent TURP for benign prostatic hyperplasia. Recruited patients were randomly divided into two groups: Groups A and B. Patients in group A (90 patients, experimental group) received HA/CMC instillation, and patients in the group B (90 patients, control group) received lubricant instillation after TURP. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), and 24 weeks (V3) after the surgery. The effectiveness of HA/CMC instillation was evaluated based on the International Prostate Symptom Score/Quality of Life, peak urine flow rate, voided volume, and postvoid residual volume. The visual analogue scale (VAS) pain score and degree of satisfaction were also determined for each participant. Among 180 initial participants, 80 patients in group A and 81 patients in group B had completed the experiment. VAS pain scores were 0.75±0.75 and 1.75±1.37 (P<0.001), and degrees of satisfaction were 0.63±0.66 and 0.91±0.51 in group A and group B at 1 month after surgery (P=0.002). By retrograde urethrography, urethral stricture after TURP was seen in 1 of 80 subjects in group A and 7 of 81 subjects in group B. HA/CMC instillation after TURP decreased the incidence of urethral stricture. In addition, HA/CMC was effective at reducing pain during the early postoperative period, with no adverse effects.

Unilateral Versus Bilateral Prostatic Arterial Embolization for Lower Urinary Tract Symptoms in Patients with Prostate Enlargement

This study was designed to compare baseline data and clinical outcome between patients with prostate enlargement/benign prostatic hyperplasia (PE/BPH) who underwent unilateral and bilateral prostatic arterial embolization (PAE) for the relief of lower urinary tract symptoms (LUTS). This single-center, ambispective cohort study compared 122 consecutive patients (mean age 66.7 years) with unilateral versus bilateral PAE from March 2009 to December 2011. Selective PAE was performed with 100- and 200-μm nonspherical polyvinyl alcohol (PVA) particles by a unilateral femoral approach. Bilateral PAE was performed in 103 (84.4 %) patients (group A). The remaining 19 (15.6 %) patients underwent unilateral PAE (group B). Mean follow-up time was 6.7 months in group A and 7.3 months in group B. Mean prostate volume, PSA, International prostate symptom score/quality of life (IPSS/QoL) and post-void residual volume (PVR) reduction, and peak flow rate (Qmax) improvement were 19.4 mL, 1.68 ng/mL, 11.8/2.0 points, 32.9 mL, and 3.9 mL/s in group A and 11.5 mL, 1.98 ng/mL, 8.9/1.4 points, 53.8 mL, and 4.58 mL/s in group B. Poor clinical outcome was observed in 24.3 % of patients from group A and 47.4 % from group B (p = 0.04). PAE is a safe and effective technique that can induce 48 % improvement in the IPSS score and a prostate volume reduction of 19 %, with good clinical outcome in up to 75 % of treated patients. Bilateral PAE seems to lead to better clinical results; however, up to 50 % of patients after unilateral PAE may have a good clinical outcome.

1519 THE ROLE OF ALPHA BLOCKER (TAMSULOSIN) FOR TREATING THE SYMPTOMS RELATED TO INSERTION OF DOUBLE J URETERAL STENTS AFTER URETEROSCOPY

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment/Ureteroscopy II1 Apr 20121519 THE ROLE OF ALPHA BLOCKER (TAMSULOSIN) FOR TREATING THE SYMPTOMS RELATED TO INSERTION OF DOUBLE J URETERAL STENTS AFTER URETEROSCOPY ahmed shelbaia and ahmed elnashar ahmed shelbaiaahmed shelbaia cairo, Egypt More articles by this author and ahmed elnasharahmed elnashar cairo, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1286AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the efficacy of tamsulosin in improving stent-related symptoms and quality of life in patients with double-J ureteral stents after ureteroscopy. METHODS 136 patients with ureteral stones were included in this study. They were prospectively evaluated and distributed randomly into two groups. Group1 was 69 patients with an age ranged from 20 to 56 years with a mean age 35 years and group 2 was 67 patients with a mean age 29 years (range 19to 42 years).Group 1(69 cases), 43 cases had lower Ureteric stones and26 patients had stone upper ureteral .Group 2(67 cases), 47 patients had lower ureteic calculi and twenty cases had proximal Ureteric stones. Ureteroscopy was done for all patients and disintegration of stones was performed and Double j stent (6 Fr.) was inserted post operatively for four weeks. Group 1 received postoperatively tamsulosin 0 .4mg orally once per day for four weeks. International prostatic symptoms (IPSS) questionnaire consists of seven questions, three for irritative symptoms and four for obstructive symptoms. Qualities of life (QoL) was assessed by QoL section of IPSS and assess patients in eight factors, including physical functioning, role limitations due to physical health or emotional disorders, vitality, mental health, social functioning, pain and general health. RESULTS The irritative symptom scores and obstructive symptom scores were significantly lower in group 1 than group2 (p<0.031). The role limitation due to physical health and pain were significantly better in group 1 than group2 (p<0.027). There were no significant differences in any other parameters. Five patients with tamsulosin (7.2%) have side effects in the form of headache and dizziness and the rest of patients had no side effects related to tamsulosin. CONCLUSIONS The administration of a selective alpha1 blocker, such as tamsulosin improves ureteral stent related urinary symptoms after ureteroscopy and disintegration of ureteric stones. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e615 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information ahmed shelbaia cairo, Egypt More articles by this author ahmed elnashar cairo, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Changes in Sexual Function in Benign Prostatic Hyperplasia Patients Taking Dutasteride: 1-Year Follow-Up Results

PurposeSexual adverse events (AEs), a major cause for discontinuing 5α-reductase inhibitor (5ARI) therapy for benign prostatic hyperplasia (BPH), are known to occur most frequently early in therapy and appear to decline over time. The aim of this study was to investigate the changes in sexual function occurring with dutasteride treatment during a 1-year follow-up period in Korean men.Materials and MethodsUsing the International Index of Erectile Function, we prospectively evaluated, after 1, 3, 6, 9, and 12 months of treatment, the changes in sexual function of 55 outpatients (mean age 62.3±7.2 years) with BPH (mean volume 48.9±16.0 g) who had relatively good erectile function (EF) and were treated with dutasteride for at least 1 year.ResultsEF scores showed the most significant decrease at 1 month (p<0.01). Function gradually recovered thereafter but was still significantly decreased after 12 months of treatment (p<0.05). The scores for orgasmic function and sexual desire also showed the most significant reduction at 1 month but were restored to the baseline level at 6 months. No significant correlation was observed between changes in sexual function and prostate-specific antigen level, prostate volume, or International Prostate Symptom Scores.ConclusionsAfter 1 month of treatment, dutasteride therapy resulted in a significant reduction in all investigated sexual functions. Overall, recovery in sexual function was noted at 3 months, and orgasmic function and sexual desire were restored to baseline levels at 6 months. However, EF was still significantly reduced at 12 months.

Effects of Tamsulosin, Solifenacin, and Combination Therapy for the Treatment of Ureteral Stent Related Discomforts

PurposeTo evaluate the effect of tamsulosin, solifenacin, and combination therapy of two agents in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents.Materials and MethodsA total of 168 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease. All patients received polyurethane double-J ureteral stents (6 Fr, 24 or 26 cm), which were removed a mean of 14 days postoperatively. A total of 48 patients were given no medication (Group 1), 43 patients were given tamsulosin 0.2 mg once daily (Group 2), 45 patients were given solifenacin 5 mg once daily (Group 3), and 32 patients were given a combination of two agents postoperatively (Group 4). International Prostate Symptom Score/quality of life (IPSS/QoL) and visual analogue pain scale (VAPS) questionnaires were completed by each patient at 1 day postoperatively and on the day of stent removal.ResultsIn the total group of patients, the mean age was 50.24±12.90 years. There was a significant difference in the IPSS total score between group 1 and groups 3 and 4. Group 4 also differed significantly from group 1 in the irritative subscore. The obstructive subscore differed between groups 2 and 4 and group 1. There was a statistically significant difference between group 1 and group 4 in the QoL score. There were no significant differences in the VAPS.ConclusionsCombination therapy with tamsulosin and solifenacin improved both irritative and obstructive symptoms more than in the other groups. Combination therapy should be strongly considered for patients who complain of stent-related symptoms.

Sexual Activity, Erectile Dysfunction and Their Correlates among 1,566 Older Chinese Men in Southern China

Few studies on sexuality and its correlates in adults have been conducted in Asia; most studies in Asia have focused instead on erectile dysfunction in men rather than sexuality or sexual activities. This study was conducted to evaluate the prevalence and factors associated with sexual activity and erectile dysfunction in elderly Chinese men aged 65 years and above. Sexual activity and sexual functions were assessed using the International Index of Erectile Function-5. Depressive symptoms were measured by the Chinese version of the Geriatric Depression Scale. Lower urinary tract symptoms (LUTS) were measured by the International Prostatic Symptom Score. Cross-sectional data from a large prospective cohort study of Chinese elderly men were used in this study. A questionnaire that included demographic, lifestyle, and medical risk factors and physical examination were administered to 1566 Chinese men aged between 65 to 92 years in Hong Kong. Only 30.7% of men were sexually active in the previous 6 months in this sample and among those who were sexually active, 88% had some form of erectile dysfunction. Being sexually inactive in the previous 6 months was associated with being older (odds ratio [OR] = 1.80; confidence interval [CI]: 1.56-2.09), single (OR = 1.87; CI = 1.19-2.94) and the presence of peripheral arterial disease (OR = 2.43; CI: 1.25-4.71). In multiple multinomial logistic regression, having clinically relevant depressive symptoms (OR = 3.37; CI: 1.31-8.70) and having moderate to severe LUTS (OR = 1.63; CI: 1.01-2.64) were independently associated with increased risk of having erectile dysfunction. We showed that a large proportion of elderly men were not sexually active in Hong Kong. For those who were sexually active, most suffered from some degree of erectile dysfunction. Having clinically relevant depressive symptoms and LUTS were independently associated with increased risk of erectile dysfunction.

Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement

To determine the clinical effectiveness and cost utility of procedures alternative to TURP (transurethral resection of the prostate) for benign prostatic enlargement (BPE) unresponsive to expectant, non-surgical treatments. Electronic searches of 13 databases to identify relevant randomised controlled trials (RCTs). Two reviewers independently assessed study quality and extracted data. The International Prostate Symptom Score/American Urological Association (IPSS/AUA) symptom score was the primary outcome; others included quality of life, peak urine flow rate and adverse effects. Cost-effectiveness was assessed using a Markov model reflecting likely care pathways. 156 reports describing 88 RCTs were included. Most had fewer than 100 participants (range 12-234). TURP provided consistent, high-level, long-term symptomatic improvement. Minimally invasive procedures resulted in less marked improvement. Ablative procedures gave improvements equivalent to TURP. Holmium laser enucleation of the prostate (HoLEP) additionally resulted in greater improvement in flow rate. HoLEP is unique amongst the newer technologies in offering an advantage in urodynamic outcomes over TURP, although long-term follow-up data are lacking. Severe blood loss was more common following TURP. Rates of incontinence were similar across all interventions other than transurethral needle ablation (TUNA) and laser coagulation, for which lower rates were reported. Acute retention and reoperation were commoner with newer technologies, especially minimally invasive interventions. The economic model suggested that minimally invasive procedures were unlikely to be cost-effective compared with TURP. Transurethral vaporisation of the prostate (TUVP) was both less costly and less effective than TURP. HoLEP was estimated to be more cost-effective than a single TURP but less effective than a strategy involving repeat TURP if necessary. The base-case analysis suggested an 80% chance that TUVP, followed by HoLEP if required, would be cost-effective at a threshold of 20,000 pounds per quality-adjusted life-year. At a 50,000 pounds threshold, TUVP, followed by TURP as required, would be cost-effective, although considerable uncertainty surrounds this finding. The main limitations are the quantity and quality of the data available, in the context of multiple comparisons. In the absence of strong evidence in favour of newer methods, the standard--TURP--remains both clinically effective and cost-effective. There is a need for further research to establish (i) how many years of medical treatment are necessary to offset the cost of treatment with a minimally invasive or ablative intervention; (ii) more cost-effective alternatives to TURP; and (iii) strategies to improve outcomes after TURP.

Can External Beam Radiotherapy for Prostate Cancer Help Improve Urinary Symptoms in Men With High IPSS Scores?

In patients with prostate cancer who present with high International Prostate Symptom (IPSS) scores, the effect of definitive External Beam Radiation Therapy (EBRT) on urinary symptoms is not well defined. Furthermore, it is unclear if high IPSS scores predict for greater acute or late genitourinary toxicity.