IPSS Questionnaire Research Articles

Assessment of the predictive power the radiation-induced lymphocyte apoptosis method in prostate cancer patients

Due to the better survival of patients with tumorous diseases, it is increasingly important to predict the side effects of radiotherapy, for which the Radiation-Induced Lymphocyte Apoptosis (RILA) method is proving to be effective in multicentric studies. Prostate cancer is the leading cause of cancer-related deaths among men worldwide, which is usually treated with radiotherapy. We recruited 49 patients with localized prostate cancer and performed RILA measurements before radiotherapy. Patients were treated with CyberKnife (35–40 Gy) or high-dose-rate brachytherapy (1 × 21 Gy). We performed chromosome aberration test for five years and graded side effects, IPSS and QoL questionnaire scores were recorded. We found that RILA% correlated with the IPSS increase (p = 0.0016, r=-0.44), which was confirmed with negative binomial regression (p = 0.0013). The negative predictive value for severe urinary side effects according to the IPSS questionnaire was 87.9% at the lower tertile of RILA values. Chromosome aberrations also correlated with side effects, but when we built models including variables of baseline and treatment characteristics of the patients, RILA, and chromosome aberrations, only RILA predicted a late increase in IPSS score (p < 0.0001, adjusted R2 = 68%). The RILA method was shown to be predictive of urinary side effects especially of patient-reported outcomes.

CHARACTERISTICS OF ULTRASTRUCTURE AND PROSTATE MICROCIRCULATORY BED IN BENIGN PROSTATIC HYPERPLASIA IN MEN WITH DIFFERENT BODY WEIGHT

Benign prostatic hyperplasia (BPH) is a common disease among older men. The main factors leading to its development are hormonal, age-related, alimentary and metabolic ones, including excess body weight and obesity. Objective. The aim of the study is to evaluate the severity of clinical symptoms, the area of the microcirculatory bed (MCB) and ultrastructural characteristics of the prostate gland in BPH men with different body weight. Materials and Methods. Patients (n=131) with BPH were divided into 3 groups according to body mass index: group 1 – normal body weight (n=38); group 2 – overweight (n=55); group 3 – class 1 obesity (n=38). One hundred patients were surveyed with IPSS and QoL questionnaires. In some men, a fragment of the surgical prostate capsule was collected intraoperatively. Histological material for light and electron microscopy, and for immunohistochemical detection of CD31 was prepared in a standard way. Results. Patients of groups 2 and 3 report lower quality of life (QoL) and more pronounced lower urinary tract symptoms (LUTS). In these men, the proportion of connective tissue around adenomeres of the prostate glands increases by 18.5 and 19 %, respectively. The relative area of microvascular vessels in overweight decreases by more than 2 times, and in Class 1 obesity – by 4 times. Electron microscopy revealed an increased number of collagen fibers around microvascular vessels. Conclusion. Increased body weight aggravates BPH clinical progression due to increased LUTS severity, decreases the area of microvascular vessels and increases the proportion of connective tissue in the prostate components.

Возможность определения остаточной мочи и эффективности терапии альфа-1-адреноблокатором больных ГПЖ с помощью инновационного отечественного урофлоуметрического комплекса «Сигма»

Goals and objectives. To evaluate the possibility of residual urine verification in the process of uroflowmetric monitoring (UFM) using an innovative domestic uroflowmetric complex «Sigma». Patients and methods. Under our observation was a group of patients observed with the diagnosis of «benign prostatic hyperplasia (BPH)» in the centre «Urinary Pathology», Vladivostok. The mean age in the group (36 cases) was 60,5+ 8,2 years, ranging from 50 to 73 years. The duration of therapy ranged from 2 to 24 months, with an average of 8,4 + 5,5 months. Results. Using the method of mathematical statistics X2 it was shown that the domestic uroflowmetric complex «Sigma» allows to reliably determine residual urine in the process of uroflowmetric monitoring, in addition to this the connection between the symptom of incomplete emptying of the bladder, according to the IPSS questionnaire, and residual urine recorded with the help of uroflowmetric complex was refuted. As a result of alpha-1-adrenoblocker treatment, there was a significant reduction in the severity of clinical symptoms and levelling of lower urinary tract dysfunction. Conclusion. In this study it was proved that the determination of residual urine with the help of domestic uroflowmetric complex «Sigma» is possible. This was verified with a high degree of reliability by ultrasound examination of residual urine volume. It was confirmed that the use of alpha-1-adrenoblockers can statistically significantly reduce the incidence of residual urine formation. In addition, alpha1-adrenoblocker administration has been shown to reduce both irritative and obstructive symptoms of urinary disorders.

Prostate Dimensions and Their Impact on LUTS and Erectile Function: Is Length the Missing Link?

Background/Objectives: The objective of this study is to explore potential correlations between prostate volume, LUTS, and IIEF, with a particular emphasis on the relationship between prostate dimensions-width, height, and length-and both LUTS and IIEF and to assess patients based on risk factors such as hypertension, diabetes, cardiovascular disease, smoking, alcohol consumption, and PSA levels. Methods: A retrospective multicenter study was conducted between January 2007 and December 2023, focusing on male patients over the age of 40. The study evaluated hypertension, diabetes, cardiovascular diseases, smoking, alcohol consumption, and lower urinary tract symptoms (LUTS) through the completion of the IPSS and QoL questionnaires, sexual function using the IIEF-15, and PSA levels. Abdominal ultrasound was performed to determine prostate volume and its dimensions (width, height, and length). Results: A total of 943 patients were included in the study, with a mean age of 61.89 ± 8.51 years. From the 40-49 age group to the 80-90 age group, IPSS increased from 10.29 to 14.26 points, PSA from 1.1 ng/mL to 3.05 ng/mL, and prostate volume from 23.79 mL to 41.16 mL. Meanwhile, over the same age intervals, IIEF showed a decline from 52.57 to 24.76 points. The IPSS demonstrated a statistically significant positive correlation (p < 0.05) with prostate volume and patient age, while showing an inverse correlation with IIEF. The only statistically significant correlation between IPSS and prostate dimensions was with the length diameter of the prostate (p = 0.011). The severity of sexual symptoms was inversely correlated with both prostate volume and age. Additionally, IIEF was negatively correlated with the width and length diameters of the prostate. Hypertension (p = 0.57), diabetes (p = 0.57), smoking (p = 0.76), and alcohol consumption (p = 0.27) did not have a statistically significant impact on IPSS, and IIEF except for cardiovascular diseases, which showed a significant correlation with IPSS in patients experiencing moderate to severe symptoms (p = 0.0001). The statistically significant correlation between cardiovascular diseases and IIEF was observed only in patients with severe symptoms (p = 0.0001). Conclusions: There is a correlation between prostate volume, IPSS, and IIEF. Only length of the prostate shows a statistically significant correlation with both IPSS and IIEF. PSA levels increase progressively with each decade of age. Hypertension, diabetes, smoking, and alcohol consumption do not have a statistically significant impact on LUTS and erectile function. Cardiovascular diseases show a correlation with patients experiencing moderate to severe LUTS, as well as with those who have severe symptoms according to the IIEF evaluation.

Lower urinary tract symptoms in men after surgery for benign prostatic hyperplasia

BACKGROUND: The development of medical technologies has resulted into a significant increase in the number of patients undergoing minimally invasive surgeries for benign prostatic hyperplasia. However, 29.9–41% of patients after surgical treatment are not satisfied with the surgical treatment results. AIM: To assess the rate and nature of lower urinary tract symptoms in men after surgical treatment of benign prostatic hyperplasia with various surgical techniques. MATERIALS AND METHODS: A telephone survey was carried out among 6117 men aged 59.57 ± 11.11 years (48–83 years), who underwent surgical treatment for benign prostatic hyperplasia with various surgical techniques and 5960 of these patients were surveyed using the IPSS questionnaire in the period 2012–2022. Moreover, to assess urination, patients kept their voiding diaries for 72 hours, a questionnaire to evaluate the symptoms of overactive bladder; ultrasound of the bladder, prostate and upper urinary tract, uroflowmetry, and, if indicated, a urodynamic study were performed. RESULTS: The study showed that 2413 (40.5%) patients were “absolutely satisfied” with the surgical treatment results, 829 (13.9%) patients were “partially satisfied” and noted improved urination, although its quality was assessed as unsatisfactory, and 2718 (45.6%) operated men were “absolutely dissatisfied”. Lower urinary tract symptoms persisted in 2655 (47.9%) men which underwent surgery, and in 3.3% of cases (87 patients) their severity increased in the postoperative period. CONCLUSIONS: The high rate of dissatisfaction with the surgical treatment results of patients with benign prostatic hyperplasia is caused by the persistence of irritative symptoms in the postoperative period and does not depend on the surgery performed. The origin of symptoms in most patients is not associated with benign prostatic hyperplasia, and the surgery indications are overestimated.

Safety and Efficacy of Intra-Prostatic Injection of Betamethasone for Refractory Chronic Nonbacterial Prostatitis: A Prospective Cohort Clinical Study.

We aimed to assess the safety and effectiveness of TRUS guided betamethasone injections in refractory cases of chronic nonbacterial prostatitis. Forty-five patients with refractory CNP were included in a prospective cohort clinical trial. Six injections of betamethasone sodium sulfate were guided by TRUS. After injection: assessment of NIH-CPSI, IPSS, IIEF, GRA and VAS were performed 1, 4, and 12 weeks after injection. Prostatitis symptoms were measured by NIH-CPSI. We considered the minimal clinically important difference (MCID) as a 25% decrease or a six-point reduction from baseline. We considered the MCID of the IIEF to be at least an increase of 4 points. We considered the MCID of the IPSS score to be three points and the MCID for the VAS score to be a 25%-35% change of the initial score. Regarding the global response assessment (GRA), scores 5-7 means significant success rate of perceived treatment. According to total NIH CPSI score, the success rate of injected cases was 71% after 1 week, dropping to 55.6% after 4 weeks and 44.4% after 12 weeks. According to IPSS questionnaire, the MD (mean difference) is -4.09 ± 3.5, -3.8 ± 3.83 and -3.47 ± 3.92. According to the IIEF questionnaire, the success rate was 22% and 26.7% after 4 and 12 weeks respectively. According to GRA, successful pain control was reported in 82%, 71% and 64.4% after 1, 4 and 12 weeks, respectively. Intraprostatic betamethasone injection is a simple, safe, and feasible procedure in refractory cases with CNP with predominant pain and urinary symptoms.

The Impact of Covid-19 on Lower Urinary Tract Symptoms (LUTS) in Patients Treated Conservatively for Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a non-malignant urological pathology characterized by a progressive increase in the volume of the prostate gland and one of the important diseases which affect lower urinary tract symptoms (LUTS). Covid-19 is a new viral infection with epidemiological characteristics of a pandemic. The disease is presented as a respiratory, cardiovascular, and neurological late complication. There is limited data that low urinary tract can be affected and aggravate symptoms and quality of life (QoL). Our pilot study describes a male population treated with conservative methods for BPH and the effect of Covid-19 infection on their LUTS and QoL. This was a case-control study between April 2021 and November 2021. The study included 33 patients with a history of Covid-19 infection. The assessment of LUTS was carried out by processing the data obtained from the completed by the patients IPSS questionnaires (the last one before, immediately, and five months after Covid-19). The control group consisted of 50 patients, which for the management of the selection bias, matched according to demographic and clinical features of the group. All patients underwent ultrasound diagnostics giving information about the volume of the prostate gland and the amount of residual urine. Two years after the beginning of the Covid-19 pandemic, we can confidently say that not all characteristics of this type of infection are sufficiently clear. More in-depth studies on Covid-19 as a cause of worsening LUTS and overall progression of BPH could help identify new aspects of infection leading to significant improvements in its treatment.

Prospective results of the minimally invasive laser enucleation of the prostate (MiLEP).

The objective of the present study is to prospectively analyze the prostate enucleation procedure with Holmium Laser using the minimally invasive technique (MiLEP), comparing the outcomes and their variables pre- and postoperatively. We studied men aged 40 years or over, with prostate volumes greater than or equal to 35 cm³ with lower urinary tract symptoms due to BPH. We performed flowmetry and administered the IPSS questionnaire before and 6 months after the MiLEP procedure. The patients were operated on with a 60 W Holmium Laser (Cyber-Ho Quanta System®) using 54 W of power (energy 1.8 J and frequency of 30 Hz). Enucleation was performed using the en bloc technique with early sphincter release. After enucleation, the tissue was morcellated using a 22 Fr morcescope (RZ-Medizintechnik GmbH, Tuttlingen, Germany) and Piranha (Richard Wolf) morcellator. The final Hemostasis after morcelation was made using laser with 30wW power, energy at 1,0 joules and frequency at 30 Hertz. Student's T test and Man-Whitney was used to statistical analysis (p < 0.05). After selection we submitted 73 patients (mean age= 68.2 years) to MiLEP procedure with a follow up of 6 months. The prostate volume presented an average of 94.53 cm³ (65 to 112 cm³, SD = 5.363) preoperatively. The urinary continence rate after the procedure was greater than 95% after 1 week and 99% in the 1st month. All patients were continent after 6 months. The IPSS questionnaire before (mean = 21.18 points/SD = 6.557) and after (mean = 7.92 points/SD = 2.408) the MiLEP had statistical significance (p < 0.001). The flowmetry(ml/s) before (9.02/SD = 2.842) and after (21.07/SD = 6.228) the MiLEP had statistical significance (p < 0.001). The average time of the procedure was 78.5 min and the bladder catheter was removed after 18 h in mean. In 4 patients (5.8%) we observed hematuria and in 1 case (1.47%) the patient needs urinary catheterization. MiLEP is a safe and effective procedure, with significant improvement in urinary flow and symptoms in the short term. Although the results of this study were satisfactory and the urinary incontinence rate was lower compared to HoLEP data found in the literature, multicenter studies with longer follow-up are needed to confirm these findings.

Protocol-based CT-guided brachytherapy for patients with prostate cancer and previous rectal extirpation—a curative approach

ObjectiveThere are numerous curative treatment possibilities for prostate cancer. In patients who have undergone rectal extirpation for rectal cancer treatment, curative options are limited due to anatomic changes and previous irradiation of the pelvis. In this analysis, we validate the feasibility of CT-guided transperineal interstitial brachytherapy for this specific scenario.Patients and methodsWe analyzed the treatment procedures and outcomes of 5 patients with metachronic nonmetastatic prostate cancer. Ultrasound-guided brachytherapy was not possible in any of the patients. Of these 5 patients, 3 were treated for prostate cancer using temporary brachytherapy with Ir-192 only, and 2 were treated with external-beam radiation therapy and temporary brachytherapy as a boost. CT-guided brachytherapy was performed in all patients. We analyzed the feasibility, efficacy, treatment-related toxicity, and quality of life (EORTC-30, IEFF, IPSS, and ICIQ questionnaires) of the treatments.ResultsMedian follow-up was 35 months. Two out of five patients received boost irradiation (HDR 2 × 9 Gy, PDR 30 Gy). Three out of five patients were treated with PDR brachytherapy in two sessions up to a total dose of 60 Gy. Dosimetric parameters were documented as median values as follows: V100 94.7% (94.5–98.4%), D2bladder 64.3% (50.9–78.3%), D10urethra 131.05% (123.2%–141.2%), and D30urethra 122.45% (116.2%–129.5%). At the time of analysis, no biochemical recurrence had been documented. Furthermore, neither early nor late side effects exceeding CTCAE grade 2 were documented.ConclusionCT-guided transperineal brachytherapy of the prostate in patients with previous rectal surgery and radiation therapy is safe and represents a possible curative treatment option. Brachytherapy can be considered for patients with metachronic prostate cancer in this specific scenario, albeit preferably in experienced high-volume centers.

Optimizing Treatment Strategies of Prostate Adenoma through Analytical Urodynamics

Aim: To investigate the role of urinary obstruction in determining surgical indications based on analytical urodynamics.Materials and methods. To collect observational data, a cohort of patients was selected from those receiving treatment at the Urination Pathology Centre in Vladivostok due to urinary disorders and prostate adenoma. This cohort consisted of patients aged 50 to 73 years (mean age 60.5 ± 8.2 years), with observation periods ranging from 2 to 29.3 months (mean duration 15.5 ± 13.5 months). During a two-day home uroflow monitoring session, the severity of urinary symptoms was assessed using the IPSS questionnaire prior to each monitoring event. The study utilized a domestically designed two-sensor SIGMA uroflowmeter in conjunction with LEVELEST software.Results. The study demonstrated that in patients from all three groups undergoing therapy with an alpha-1 adrenergic blocker, there was a significant reduction in clinical symptoms as measured by the IPSS questionnaire and an increase in the average effective volume of urination. However, despite these improvements, the groups exhibited differing dynamics in urinary obstruction, which ultimately determined the indications for surgical intervention.Conclusion. Home uroflow monitoring with the Sigma uroflowmeter provides an objective assessment of the lower urinary tract function in patients with bladder outlet obstruction, focusing on the urinary obstruction indicator dynamics. Repeated pharmacological testing in patients with prostate adenoma shows potential for long-term patient management, aiming to prevent detrusor failure and evaluate the efficacy of conservative therapy. Analytical urodynamic methods enable the establishment of surgical treatment indications based on uroflow monitoring outcomes.

Acute Toxicity and Early Prostate Specific Antigen Response After Two-Fraction Stereotactic Radiation Therapy for Localized Prostate Cancer Using Peri-Rectal Spacing–Initial Report of the SABR-Dual Trial

Purpose: SABR-Dual is a phase III trial with an initial phase-I safety cohort, of two-fraction stereotactic radiotherapy (SABR) with optional MRI-based focal boost, using peri-rectal spacing, for localized prostate cancer. This represents the initial report from the phase-I non-randomized cohort. Materials and methods: Subjects had favorable intermediate risk (FIR) or low risk (LR) prostate adenocarcinoma, and gland volume <80cc. All underwent radiopaque hydrogel spacer and fiducial marker placement prior to simulation (CT and 3-tesla T2 MRI). The clinical target volume included the entire prostate, and in FIR patients, 1-2cm of seminal vesicle (SV). A 2mm expansion was applied for planning target volume (PTV), and a dose of 27 Gy was prescribed to the PTV-prostate, 23 Gy to the PTV-SV, with an optional 30 Gy simultaneous boost (SIB) to an MRI-defined dominant lesion. Primary endpoint was 3-month patient-reported changes in quality of life based on the EPIC-26, IPSS, and SHIM questionnaires. Secondary endpoints were 6-month quality of life, acute toxicity (using CTCAEv5) and early PSA response. Results: Among the 20 patients in the phase-I cohort, 95% had FIR disease, and 50% received an SIB. At median follow-up of 8 months, a 3-month minimally clinically important change occurred in 1/20 (5%), 6/20 (30%), 2/20 (10%), 4/20 (20%), and 5/20 (25%) in urinary incontinence, urinary obstructive, bowel, sexual, and hormonal domains. There was a mean increase of 1±5.4 in IPSS and decrease of 1.8±6.5 in SHIM scores. Rates of grade 2 urinary and bowel toxicity 10% and 0%, respectively, with no grade ≥3 toxicities. Mean PSA decrease at last follow-up was 70.4%±17.7%. Conclusion: This generalizable protocol of two-fraction prostate SABR using peri-rectal spacing is a safe approach for ultra-hypofractionated dose-escalation, with minimal acute toxicity. Longer-term outcomes and direct comparison with standard 5-fraction SABR are being studied in the phase-III randomized portion of SABR-Dual.

Transperineal laser ablation (TPLA) of the prostate for benign prostatic obstruction: the first 100 patients cohort of a prospective, single-center study

PurposeTransperineal laser ablation (TPLA) is a new minimally-invasive surgical treatment for patients with benign prostatic obstruction (BPO). We report the perioperative and mid-term functional results of the first 100 consecutively patients undergoing TPLA at our institution.MethodsClinical data from consecutive patients undergoing TPLA at our institution from April 2021 to July 2023 were prospectively collected. Primary endpoints were the postoperative changes in IPSS, QoL and MSHQ 3-item questionnaires and in Qmax and post-void residual volume (PVR).ResultsOverall, 100 consecutive patients underwent the procedure. Median age and prostate volume were 66 (IQR 60–75) years and 50 (IQR 40–70) ml, respectively. In the cohort, 14 (14%) patients had an indwelling catheter and 81 (81%) were under oral BPO therapy at the time of TPLA. Baseline median Qmax (ml/s) and PVR (ml) were 9.1 (IQR 6.9–12) and 90 (IQR 50–150), respectively, while median IPSS and QoL were 18 (IQR 15–23) and 4 (IQR 3–4). At all the follow-up timepoints, the evaluated outcomes on both symptoms and functional parameters showed a statistically significant improvement (p < 0.001). Antegrade ejaculation was preserved in all sexually active patients. No postoperative Clavien-Dindo > 2 complications were recorded.ConclusionsTPLA represents a safe option for selected well-informed patients swith LUTS due to BPO. Our prospective study confirms the feasibility and favorable perioperative and functional outcomes in a real-world cohort with heterogenous prostate volumes and patient characteristics.

Использование тулиевого лазера в лечении стриктуры уретры.

Introduction. The thulium laser is relatively recently used in the treatment of various urological diseases. Only a few studies report the use of thulium laser urethrotomy for urethral strictures. The purpose of this study was to evaluate the results of the use of a thulium laser for the treatment of urethral strictures. Materials and methods. A prospective, observational, uncontrolled study included 45 men with urethral stricture, aged 43 to 85 years (median, 65 years), who underwent thulium laser urethrotomy. The length of the stricture ranged from 0.5 to 2.5 cm (median 1.2 cm). A laser fiber with a length of 200 μm was used at an energy of 0.5 J and a power of 10 W. The success of the treatment was considered the absence of complaints of difficult urination in combination with a maximum urination rate of more than 15 ml/s and no or insignificant amount of residual urine (less than 50 ml). The dynamics of various parameters after surgery were assessed using the Wilcoxon test. The difference between the indicators was considered significant at p&lt;0.05. Results. Postoperative follow-up time ranged from 3 to 48 months (median 18 months). With these follow-up periods, treatment was successful in 32 (71.1%) patients. A significant improvement in the median of the following indicators for the entire group of patients after surgical treatment com- pared with preoperative data was established: maximum urination rate – from 9.2 to 21.1 ml/s (p=0.024); average urination rate – from 4.5 to 10.3 ml/s (p=0.025); residual urine volume – from 110 to 42 ml from 9.2 to 21.1 ml/s (p=0.014); indicators of the IPSS questionnaire – from 20 to 7 points (p=0.011); quality of life according to the IPSS questionnaire – from 5 to 2 points (p=0.017). There were no intraoperative complications. Of the postoperative complications, only urinary tract infection was noted in 5 (11.1%) patients. Conclusions. Thulium laser urethrotomy is a fairly safe and effective method for the treatment of short urethral strictures, regardless of the nature, etiology and localization of the cicatricial process. A small number of observations and a short period of postoperative observations in the world literature dictate the need to continue such scientific research.

Reassessing Normal Voiding Standards: A Cross-Sectional Study Based on Medical Professionals' Evaluations with Portable Uroflowmetry and IPSS.

Background/Objectives: LUTS and voiding dysfunctions are prevalent in urology clinics, with uroflowmetry and IPSS as the prevailing diagnostic methods. Nevertheless, objective assessment can be constrained by age, gender, and variability in the test conditions. Portable (home) uroflowmetry addresses these limitations, allowing for more natural urinary flow recordings beyond clinic confines. This study aims to characterize spontaneous voiding patterns in healthcare professionals, exploring gender differences, variability in repeated measurements, and correlations among voiding parameters, IPSS, age, and BMI. Methods: This cross-sectional study was conducted during the SIU 43rd Congress in Istanbul using smart uroflow devices such as the Oruba Oruflow Uroflow Recorder, which were installed in public toilets. A total of 431 healthcare professionals participated by providing demographic information and completing the IPSS questionnaire. The data analysis included uroflowmetric parameters such as maximum flow rate (Qmax), average flow rate (Qave), and voided volume (VV), in addition to IPSS and demographic data to assess the possible associations with IPSS, age, BMI, and gender differences. Results: Of the participants, 76% were male and 24% female, with a higher prevalence of LUTS in women. Despite no significant gender difference in voided volume, men with lower volumes demonstrated more severe LUTS. Notably, women exhibited higher Qmax and Qave rates irrespective of their IPSS scores, contrasting with men whose flow rates declined with age and LUTS severity. In men, the total IPSS score was inversely associated with uroflowmetric performance, particularly impacting voiding symptoms over storage symptoms. Repeated measurements revealed noteworthy variability in Qmax and VV, without any influence from gender, BMI, age, or symptom severity. Conclusions: Our findings highlight the importance of gender-specific considerations in evaluating voiding complaints through uroflowmetry and IPSS. The significant variability observed in repeated uroflowmetry studies underlines the need for multiple measurements. Overall, this research emphasizes the significance of portable (home) uroflowmetry and calls for a reassessment of normal voiding standards in (non) clinical settings.

Association of CYP3A4*1B, CYP3A4*22 and CYP3A5*3 polymorphisms carriage with efficacy and safety of tamsulosin in patients with benign prostatic hyperplasia

Tamsulosin is a first-line drug in the treatment of lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH). Despite high estimates of its efficacy and safety, it rates may vary due to genetic polymorphisms of genes for the enzymes involved in the drugs metabolism.The aim of the work was to evaluate the carriage influence of genes polymorphisms of the CYP3A enzymes group of tamsulosin metabolizers on the efficacy and safety of therapy in patients with LUTS in BPH.Materials and methods. A total of 142 patients with LUTS, with an established BPH diagnosis (N40 according to ICD-10) were included in the study and underwent all stages. All patients received monotherapy with tamsulosin 0.4 mg/day for at least 8 weeks. An IPSS questionnaire with the definition of quality of life, a prostate ultrasound with the determination of the prostate volume and residual urine, as well as uroflowmetry, were used to evaluate the results of the treatment. Controls were performed at 2, 4 and 8 weeks from the start of the therapy. The carriage of polymorphic markers CYP3A4 (*1B, *22) and CYP3A5*3 was determined in patients; HPLC was used to determine drug concentrations in blood plasma and levels of cortisol and its metabolite 6-beta-hydroxycortisol in urine to assess the phenotypic activity of CYP3A.Results. No statistically significant associations between CYP3A phenotype (defined by CYP3A4 and CYP3A5 genotypes) and clinical parameters of the tamsulosin therapy efficacy and the safety assessment in the studied sample of patients were found (p &gt;0.05). Similar data were obtained for individual variants of CYP3A4*1B, CYP3A4*22, CYP3A5*3 (p &gt;0.05). The comparison of the tamsulosin residual equilibrium concentration values in patients in the study sample with respect to the carriers of CYP3A4 and CYP3A5 gene variants did not reveal the presence of significant differences in either CYP3A phenotypes and carriers and non-carriers of individual CYP3A4*1B (p=0.57), CYP3A4*22 (p=0.37) and CYP3A5*3 (p=0.76) variants. No association was found between the metabolic ratio of 6-beta-hydroxycortisol / cortisol in urine and the CYP3A phenotype encoded by a combination of genotypes of CYP3A4 and CYP3A5 gene variants (p &gt;0.05).Conclusion. A possible association between the carriage of CYP3A4*1B, CYP3A4*22, CYP3A5*3 variants, a CYP3A activity assessed by the content of an endogenous substrate of this isoenzyme and its metabolite in urine, the level of plasma concentration of the drug, and the efficacy and safety of tamsulosin, has not been confirmed. The contribution of CYP3A4 and CYP3A5 genetic polymorphisms to clinical parameters of the tamsulosin therapy requires a further study.

Prostate Artery Embolization as Minimally Invasive Treatment for Benign Prostatic Hyperplasia: An Updated Systematic Review.

Background/Objectives: Benign prostatic hyperplasia (BPH) has a significant impact on the quality of life of symptomatic patients. In patients manifesting lower urinary tract symptoms (LUTS), prostatic arterial embolization (PAE) has become a topic of interest in recent years. The purpose of this systematic review is to analyze and review techniques and clinical outcomes of patients who underwent endovascular treatment of BPH, with a special focus on the comparison of surgical and endovascular procedures. Methods: Through the major scientific databases, 1225 articles were selected from the initial research utilizing specific keywords and medical subject headings. Based on the inclusion and exclusion criteria established for selecting relevant studies for our purposes, the systematic analysis of the literature was conducted on a total of seven articles. Results: We collected data on 718 male patients (408 patients underwent PAE and 310 received TURP). The technical success rate varied from 86% to 100% for TAE and was 100% for TURP. During a 12-month follow-up period, both PAE and TURP were comparable on the reduction in IPSS and QoL questionnaire, while TURP showed significant improvements in Qmax and in the reduction in prostate volume. Length and cost of hospitalization were lower for PAE. Complication and adverse events rates were higher in the TURP group rather than in the PAE group (60.6% vs. 35.5%). Conclusions: Prostatic artery embolization represents an emerging minimally invasive procedure for BPH. According to previously released clinical studies, quality-of-life and urological symptom scores of the PAE group were comparable to those of the TURP group. Our research strengthens the evidence supporting the effectiveness and safety of PAE as a therapy for LUTS related to BPH.

Influence of alpha1-adrenoblockers on the ejaculatory function of patients with benign prostatic hyperplasia

BACKGROUND: The cause of ejaculatory dysfunction in patients with benign prostatic hyperplasia can be either the disease itself or its surgical or drug treatment, including the use of alpha1-blockers. AIM: To study the effect of alpha1-blockers on the ejaculatory function of patients with benign prostatic hyperplasia. MATERIALS AND METHODS: Under observation were 90 patients with benign prostatic hyperplasia aged from 56 to 79 years, who were distributed into 3 groups of 30 people. Patients of the group 1 were prescribed tamsulosin at a dose of 0.4 mg once a day, patients of the group 2 were prescribed silodosin at a dose of 8 mg once a day, and patients of the group 3 were prescribed alfuzosin 10 mg once a day. Duration of treatment is 4 weeks. To assess the effectiveness of treatment and its impact on copulatory function before and after treatment, patients filled out the IPSS, IIEF-5, ICF and MSHQ questionnaires. RESULTS: The reduction in the severity of clinical manifestations of benign prostatic hyperplasia and the improvement in quality of life in patients of the three groups were the same. The effect of alpha1-blockers on erectile function has not been noted. A significant decrease in ejaculatory function was revealed in patients of the groups 1 and 2, while in patients of the group 3 no changes in ejaculatory function were observed. CONCLUSIONS: When planning drug therapy for patients with benign prostatic hyperplasia, it is necessary to take into account the specific effects of different alpha1-blockers on ejaculatory function.

A method for determining incomplete urinary bladder emptying by uroflowmetry

Aim. This article aims to assess the effectiveness of uroflowmetry in detecting residual urine and to investigate the relationship between the sensation of incomplete bladder emptying, as measured by the IPSS questionnaire, and the presence of residual urine.Materials and methods. A cohort of patients treated at the Urination Pathology Centre (Vladivostok) for benign prostatic hyperplasia was observed and data were collected. Patients ranged in age from 50 to 73 years (with an average age of 60.5 ± 8.2 years) and were observed during from 2 to 24 months (with an average of 8.4 ± 5.5 months).Results. The analysis of ultrasound data and uroflowmetry results demonstrates convincingly that the SIGMA uroflowmeter can reliably detect residual urine with a high degree of accuracy (p &lt; 0.01). However, during the study, no consistent correlation was found between the symptom of feeling of incomplete bladder emptying, as assessed by the IPSS questionnaire, and the presence of residual urine detected by the SIGMA uroflowmeter.Conclusion. Uroflowmetry conducted with the SIGMA uroflowmeter reliably identifies instances of incomplete bladder emptying, as evidenced by comparison with ultrasound data. At the same time, clinical assessment using the IPSS charts, particularly for the symptom of incomplete bladder emptying, does not adequately indicate the presence of residual urine. Uroflowmetry offers a means to identify incomplete bladder emptying and measure residual urine volume without requiring specialised equipment or medical personnel, thus broadening the diagnostic scope for both conservative and surgical treatment approaches.

Follow-up of vascular-targeted photodynamic therapy in a real-world setting

PurposeVascular-targeted photodynamic therapy (VTP) is an approved treatment option for unilateral low-risk prostate cancer (PCa).MethodsPatients with unilateral low- or intermediate-risk PCa undergoing hemiablation by VTP were evaluated in a real-world setting. Oncological outcome after VTP was measured by MRI-based re-biopsy at 12 and 24 months. Functional outcome after 1 year was investigated by IIEF-5 and IPSS questionnaires. Progression was defined as the evidence3 of ISUP ≥ 2 PCa.ResultsAt any control biopsy (n = 46) after VTP, only 37% of patients showed no evidence of PCa. Recurrence-free survival was 20 months (95% CI 4.9–45.5) and progression-free survival was 38.5 months (95% CI 33.5–43.6 months). In-field and out-field recurrent PCa occurs in 37% (55% ISUP ≥ 2 PCa) and 35% (56% ISUP ≥ 2 PCa). Seventy-nine percent of patients preserved erectile function, respectively. Ten percent of patients presented long-term bladder outlet obstruction. None of the patients presented incontinence.ConclusionDue to the high-recurrence in- and out-field recurrence rate in a mainly low-risk prostate cancer cohort, VTP has to be regarded critically as a therapy option in these patients. Pre-interventional diagnostic evaluation is the main issue before focal therapy to reduce the risk of tumor recurrence and progression.

Toxicity and Patient Reported Quality of Life after PSMA-PET and mpMRT-Based Focal Dose Escalated Definitive Radiotherapy in Prostate Cancer Patients: 2-Year Follow-Up of the HypoFocal Phase II Trial

The prospective, 2-armed non-randomized HypoFocal phase II trial investigates the safety and feasibility of focal dose escalated external beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) for prostate cancer (PCa) patients based on PSMA-PET and multiparametric MRI. This approach improves tumor coverage and thus putatively treatment effectiveness but leads to larger boost volumes. Here we present toxicity and patient reported quality of life (QoL) results after 2 years follow-up (FU) MATERIALS/METHODS: Patients with intermediate- or high-risk PCa and cN0/cM0 stage were included. Patients in arm A received 60 Gy in 20 fractions to the prostate with an integrated boost of up to 75 Gy. Patients in arm B received one session HDR-BT with 15 Gy to the prostate and a boost of up to 19 Gy, followed by EBRT of 44 Gy in 20 fractions. Boost volumes were defined by PSMA-PET and mpMRI based on validated approaches. Genitourinary (GU) and gastrointestinal (GI) toxicity (CTCAE v5.0) and QoL with IPSS and EORTC questionnaires (QLQ30 and PR25) were assessed. Fifty patients were treated in both arms in two centers (Freiburg and Berlin). Table 1 shows patients characteristics. In arm, A grade 2 GU and GI toxicity rates after 2 years were 8% and 4%. There were no grade 3 GU toxicities. Two patients experienced grade 3 GI toxicities due to multifactorial causes. In Arm B grade 2 GU and GI toxicity rates after 2 years were 17% and 0%. No grade 3 toxicities were observed in arm B. Toxicities were not statistically significantly different between baseline and 2y FU (p>0.055). QoL analysis was performed with patients with available questionnaires at baseline and 2y FU (12-15 in Arm A and 13-15 in Arm B). Only bowel function (p = 0.0005, median 4 vs 25 points) in Arm A and sexual- (p = 0.016, median 25 vs 50 points) and bowel function (p = 0.004, median 0 vs 8 points) and dyspnea (p = 0.031, median 0 vs 0 points) in Arm B decreased significantly after 2 year FU. Other QoL items were not significantly different. Bowel symptoms were significantly worse in Arm A compared to Arm B (p = 0.003). Median PSA values after 2 years were 0.23 ng/ml in Arm A and 0.33 ng/ml in Arm B. Despite large boost volumes, the 2 years FU of the HypoFocal-Phase II trials shows no significantly increased GU and GU toxicities compared to baseline symptoms. Patients reported about a good QoL but increased bowel symptoms after 2 years, particularly if treated with EBRT only. Implementation of PSMA-PET into focal dose escalated radiotherapy approaches appears safe and feasible. However, radioproctitis demands careful management. The current PSA values suggest a highly effective therapy, but longer FU is needed to evaluate oncological outcomes. The HypoFocal-SBRT phase III trial will evaluate the PSMA-PET and mpMRI-based focal dose escalated SBRT.