Lower Urinary Symptoms Research Articles

Assessment of lower urinary symptom flare with overactive bladder symptom score and International Prostate Symptom Score in patients treated with iodine-125 implant brachytherapy: long-term follow-up experience at a single institute

BackgroundThe aim of this study was to evaluate the combined use of the overactive bladder symptom score (OABSS) and International Prostate Symptom Score (IPSS) as an assessment tool for urinary symptom flare after iodine-125 (125I) implant brachytherapy. The association between urinary symptom flare and prostate-specific antigen (PSA) bounce was investigated.MethodsChanges in the IPSS and OABSS were prospectively recorded in 355 patients who underwent seed implantation. The percentage distribution of patients according to the difference between the flare peak and post-implant nadir was plotted to define significant increases in the scores. The clinicopathologic characteristics, treatment parameters, and post-implant dosimetric parameters were compared between the non-flare and flare groups. PSA bounce was defined as an elevation of ≥0.1 ng/mL or ≥0.4 ng/mL compared to the previous lowest value, followed by a decrease to a level at or below the pre-bounce value.ResultsA clinically significant increase required an IPSS increase of at least 12 points and an OABSS increase of at least 6 points based on a time-course analysis of total scores and the QOL index. Assessment only by IPSS failed to detect 40 patients (11%) who had urinary symptom flare according to the OABSS. Univariate and multivariate analyses revealed that patients treated with higher biologically effective doses and those without diabetes mellitus had higher risks of urinary flare. There was no statistical correlation between the incidence and time of urinary symptom flare onset and that of a PSA bounce.ConclusionsTo our knowledge, this is the first report to prove the clinical potential of the OABSS as an assessment tool for urinary symptom flare after seed implantation. Our findings showed that persistent lower urinary tract symptoms after seed implantation were attributed to storage rather than to voiding issues. We believe that assessment with the OABSS combined with the IPSS would aid in decision-making in terms of timing, selection of a treatment intervention, and assessment of the outcome.

Urodynamic findings in Susac syndrome: first reported filling cystometrogram

Susac syndrome is a rare neurological disease, with only 300 cases reported in the literature. Lower urinary symptoms are not an uncommon feature of the disease, yet there is no...

IJU this issue

Seven Original Articles with three Editorial Comments, two Reviews with two Editorial Comments, three Urological Notes with three Editorial Comments and one Editorial were published in this issue of the International Journal of Urology. The Review Article on preventing infectious complications after prostate biopsy provided very important information. Togo and Yamamoto (Hyogo, Japan) presented a straightforward antimicrobial prophylaxis flow chart for the transrectal biopsy procedure. Risk factors, including large prostate volume, diabetes mellitus, steroids, severe dysuria, immunocompromised status and previous antimicrobial use should be considered for this procedure. Takagi et al. (Tokyo, Japan) presented the surgical outcomes in patients with chronic kidney disease who had undergone a partial nephrectomy. Renal function was preserved equally after robot-assisted laparoscopic and an open procedure. However, the robot-assisted laparoscopic partial nephrectomy was less invasive in terms of estimated blood loss, ischemic time and postoperative complications. Two randomized studies on urinary disturbance carried out in Japan are presented in this issue. Yamanishi et al. (Mibu, Japan) reported the results of the DIrecT Study. That study was a randomized, open-label, controlled trial consisting of two treatment arms, namely, the tamsulosin + dutasteride group and the tamsulosin + dutasteride + imidafenacin group. Patients pretreated with tamsulosin (at least 8 weeks) with a large prostate volume (≥30 mL) were enrolled. Adding dutasteride offered significant improvements to the overactive bladder symptoms score and the International Prostate Symptom Score. The combination with imidafenacin provided further significant improvements to both symptom scores. Another study reported by Takeda et al. (Yamanashi, Japan) combined tadalafil with an ongoing alpha-1 blocker in men with lower urinary symptoms suggestive of benign prostatic hyperplasia. Adding tadalafil did not clinically change blood pressure or pulse in that study, but offered a significant reduction in the International Prostate Symptom Score voiding subscore. These studies provide new information on how to treat urinary dysfunction. None declared.

Robot-Assisted Sacrohysteropexy and Sexual Function

Uterine prolapse exerts a negative influence on female sexual function. Many surgeons have performed hysterectomy during treatment of uterine prolapse. Nowadays, sacrohysteropexy is believed to be the definite treatment for uterine prolapse in healthy women. However, there is paucity of literature that describes sexual function with respect to uterus preserving sacrohysteropexy. Hence, we evaluated female sexual function before and 12 months after sacrohysteropexy. From January 2012 to December 2016, 29 consecutive patients with uterine prolapse were evaluated, where 23 patients were completed the study. Robot-assisted sacrohysteropexy was applied to all patients. A questionnaire (female sexual function index: FSFI) was used to evaluate sexual function before and 12 months after surgery. Inclusive criteria were 1) sexually active women aged 70 years or less, 2) having symptoms such as vaginal heaviness, lower urinary symptoms, dyspareunia, and so on, and 3) uterine prolapse stage 2 or more. Exclusive criteria were 1) patients who had any uterine disease (when hysterectomy was necessary), 2) hysterectomy state, or 3) history of pelvic irradiation.

MP86-10 RELATIONSHIP BETWEEN OVERACTIVE BLADDER AND METABOLIC SYNDROME: A CROSS-SECTIONAL STUDY AMONG JAPANESE MEN AND WOMEN.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making V1 Apr 2017MP86-10 RELATIONSHIP BETWEEN OVERACTIVE BLADDER AND METABOLIC SYNDROME: A CROSS-SECTIONAL STUDY AMONG JAPANESE MEN AND WOMEN. Yoshitaka Aoki, Chieko Matsumoto, Yosuke Matsuta, Hideaki Ito, Yukinori Kusaka, and Osamu Yokoyama Yoshitaka AokiYoshitaka Aoki More articles by this author , Chieko MatsumotoChieko Matsumoto More articles by this author , Yosuke MatsutaYosuke Matsuta More articles by this author , Hideaki ItoHideaki Ito More articles by this author , Yukinori KusakaYukinori Kusaka More articles by this author , and Osamu YokoyamaOsamu Yokoyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2693AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Metabolic syndrome (MetS) has been implicated in the aetiology of lower urinary symptoms and a few previous epidemiological studies have suggested a relationship between MetS and overactive bladder (OAB) in women. We thus aimed to evaluate the relationship between OAB and MetS or components of MetS among Japanese men and women. METHODS We collected data on 12,478 individuals (5,313 males and 7,165 females) who participated in a multiphasic health screening in 2015, in Fukui, Japan. As part of a multiphasic health screening, waist circumference, blood pressure, fasting blood sugar, triglycerides and HDL-cholesterol were measured. All participants were asked to answer a standardized self-reported questionnaire for OAB screening (SQOAB, Screening Questionnaire for Overactive Bladder) [Int J Urol, 2009].We analyzed the relationships between OAB and other variables including age, gender, waist circumference, high blood pressure, impaired glucose tolerance, and dyslipidemia. The relationships between OAB and MetS were also analyzed. MetS in the Japanese criteria was diagnosed in individuals who had a high waist circumference (≥ 85 cm in men and ≥ 90 cm in women) plus any 2 of the following: (a) high blood pressure (systolic blood pressure ≥ 130/85 mmHg and/or current use of antihypertensive medicine); (b) impaired glucose tolerance (fasting glucose concentration ≥ 110 mg/dL and/or current use of antidiabetic medication); and (c) dyslipidemia (triglyceride concentration ≥ 150 mg/dL and/or HDL-cholesterol level < 40 mg/dL). The chi-square test and logistic regression modeling were used for statistical analyses. Values of p<0.05 were considered statistically significant. RESULTS The median age of participants was 69 (18-95) years. The overall prevalence of OAB and MetS were 13.5% (11.2% for men and 15.2% for women) and 15.2% (24.5% for men and 8.2% for women), respectively. The prevalence was higher in older age groups. A significant association was found between OAB and MetS The age-adjusted odds ratio (95% CI) were 1.22 (1.06-1.39) for men and 1.49 (1.21-1.83) for women, respectively. We also analyzed the relationships between OAB and the number of components of MetS. In the multivariate analysis, a significant association was found between OAB and the following: age (odds ratio = 1.05) and high waist circumference (1.24) for men, and, age (1.04) , high waist circumference (1.42) and hyperglycemia (1.17) for women. CONCLUSIONS Our study confirmed the relationship between OAB and MetS in both men and women. These findings suggest that OAB is a facet of the MetS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1160 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yoshitaka Aoki More articles by this author Chieko Matsumoto More articles by this author Yosuke Matsuta More articles by this author Hideaki Ito More articles by this author Yukinori Kusaka More articles by this author Osamu Yokoyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

805 - Optimization of assessment tool for lower urinary symptom flare in patients with localized prostate cancer treated with iodine-125 implant brachytherapy

805 - Optimization of assessment tool for lower urinary symptom flare in patients with localized prostate cancer treated with iodine-125 implant brachytherapy

Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem

Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily by constipation and/or encopresis. This increasingly common entity is a potential cause of significant physical and psychosocial burden for children and families. BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which at its extreme may lead to renal scarring and kidney failure. Additionally, BBD is frequently seen in children diagnosed with behavioural and neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Patients with concomitant BBD and neuropsychiatric disorders have less favourable treatment outcomes. Early diagnosis and treatment of BBD are critical to avoid secondary comorbidities that can adversely impact children's kidney and bladder function, and psychosocial well-being. The majority of patients will improve with urotherapy, adequate fluid intake, and constipation treatment. Pharmacological treatment must only be considered if no improvement occurs after intensive adherence to at least six months of urotherapy ± biofeedback and constipation treatment. Anticholinergics remain the mainstay of medical treatment. Selective alpha-blockers appear to be effective for improving bladder emptying in children with non-neurogenic detrusor overactivity (DO), incontinence, recurrent UTIs, and increased post-void residual (PVR) urine volumes. Alpha-1 blockers can also be used in combination with anticholinergics when overactive bladder (OAB) coexists with functional bladder outlet obstruction. Minimally invasive treatment with onabotulinumtoxinA bladder injections, and recently neurostimulation, are promising alternatives for the management of BBD refractory to behavioural and pharmacological treatment. In this review, we discuss clinical presentation, diagnostic approach, and indications for behavioural, pharmacological, and surgical treatment of BBD in children based on a thorough literature review. Expert opinion will be used when scientific evidence is unavailable.

Female urinary incontinence and sexuality.

ABSTRACTUrinary incontinence is a common problem among women and it is estimated that between 15 and 55% of them complain of lower urinary symptoms. The most prevalent form of urinary incontinence is associated with stress, followed by mixed urinary incontinence and urge urinary incontinence. It is a symptom with several effects on quality of life of women mainly in their social, familiar and sexual domains. Female reproductive and urinary systems share anatomical structures, which promotes that urinary problems interfere with sexual function in females.This article is a review of both the concepts of female urinary incontinence and its impact on global and sexual quality of life. Nowadays, it is assumed that urinary incontinence, especially urge urinary incontinence, promotes anxiety and several self-esteem damages in women. The odour and the fear of incontinence during sexual intercourse affect female sexual function and this is related with the unpredictability and the chronicity of incontinence, namely urge urinary incontinence.Female urinary incontinence management involves conservative (pelvic floor muscle training), surgical and pharmacological treatment. Both conservative and surgical treatments have been studied about its benefit in urinary incontinence and also the impact among female sexual function. Unfortunately, there are sparse articles that evaluate the benefits of female sexual function with drug management of incontinence.

Does Giant Multilocular Cystadenoma of Prostate Respond to LHRH Agonist or It Is a Case of Cystic Prostate Cancer Wrongly Diagnosed– A Report of 3 Cases and Review of Literature

A retrospective review of radiology registry identified 3 cases of diagnosed giant multilocular cystadenoma of prostate. The first case illustrates a 59-year-old man with worsening voiding and storage symptoms of 2 months duration. The prostate was enlarged with the right lobe being bigger than the left node and his PSA was 9.3 ug/l. MRI showed large Multi cystic mass from the prostate and TRUS biopsy revealed adenocarcinoma prostate. Neoadjuvant LHRH agonist shrunk the mass before radiotherapy. He has no urinary symptoms and PSA consistently less than 0.1. Repeat MRI showed highly shrunken mass. In the second case, we present a 79-year-old patient presenting with rising PSA despite being on finasteride. MRI diagnosed large cystic and solid mass arising from the prostate and extending to the abdomen. Tran’s rectal ultrasound guided biopsy plus aspiration of the fluid from the multiloculated cyst revealed benign cystic adenoma with no evidence of any malignancy. Repeat MRI after 6 months of LHRH agonist showed multiloculated cyst adenoma of the prostate appears stable with no significant reduction in size and his PSA remains high. The third case is an 83-year-old presenting with LUTS, haematuria and rising PSA. He has a past medical history of low grade prostate cancer (diagnosed at TURP). MRI scan showed an enlarged echogenic prostate. TRUS biopsy of the mass identified complex proliferation of atypical glandular epithelium in a rather villous adenomatous pattern. Neoadjuvant LHRH agonist showed reduction in lower urinary symptoms.

Intravesical Migration of Intrauterine Device and Calculi Formation 12 Years Post Missing: A Case Report

Intraunterine device (IUD) is a safe, effective and feasible method used for reversible contraception worldwide. Transvesical migration of an Intrauterine device (IUD) is a rare complication. We describe a case in whom initially a plain abdominopelvic radiography demonstrated calcified string of an IUD in a 42-year-old woman with recurrent lower urinary symptoms (LUTS) and urinary tract infection since 2 years earlier. The IUD had been inserted 12 years earlier and 3 years after placement of the IUD, the patient experienced an uneventful pregnancy and a successful delivery. Sonographic images and later on the cystoscopic procedure confirmed the diagnosis of transvesical migration of the IUD. The IUD was removed using cystoscopic procedure, leaving no complication.

Clinical Commentary: Pelvic Organ Prolapse and Incontinence

Background and Purpose: Pelvic organ prolapse (POP) and urinary incontinence (UI) are more prevalent with increasing life expectancy. Up to 75% of women age 45 to 85 years have some degree of prolapse. Typical symptoms related to POP include pelvic pressure, pelvic and low back pain, urinary and bowel symptoms, and sexual dysfunction. The purpose of this report is to describe the theoretical basis of a novel conservative intervention for the treatment of symptoms related to POP and incontinence in older women through the use of a case description. Methods: The conservative management program combines deep pelvic and hip muscle exercises with pelvic postural inversion. The case description exemplifies the treatment protocol that has the potential to reduce the severity or degree of prolapse and improve symptoms and quality of life in women with POP and associated UI. Conclusion: The basis for the novel conservative approach to treatment of POP and UI revolves around the perspective that POP is the functional failure of the pelvic organ support system and associated lumbopelvic hip musculoskeletal system. The combined organ and musculoskeletal system, the “pelvic core” system, includes all structures within the lower pelvis. As one organ's descent occurs, it leads to alterations in the position of adjacent organs, fascia, and muscles. Postural or positional inversion of the pelvis simultaneous with deep pelvic muscle and pelvic core exercises theoretically realigns the pelvic organs within the pelvic cavity and reduces strain on fascia and ligaments. Without the strain of the organs descending in the pelvis, the pelvic core muscles can theoretically work more efficiently for muscle strengthening and motor control retraining. Organ realignment and deep pelvic core muscle activation theoretically recreates the support system for optimal organ function and symptom-free daily activities.

The Value of Urodynamic Study for Diagnosing the Causes of Lower Urinary Tract Symptoms in Male Patients: A Study From Iran.

BackgroundMost disorders of the lower urinary tract are functional, so diagnoses are typically based on urodynamic findings. Treatment is likely to fail if the pathology is not correctly diagnosed.ObjectivesThere are various diagnostic tests for lower urinary tract symptoms (LUTS). In this study, we evaluated the value of urodynamic testing to diagnose the causes of lower urinary symptoms in male patients.Patients and MethodsUrodynamic tests were performed in 407 patients referred to the urology clinic in Baqiyatallah in 2014 with complaints of LUTS, and the diagnosis was based on the findings of the tests.ResultsThe mean age of patients in this study was 50.88 years, and most patients were in their third decade (20 - 30 years of age). Urinary frequency (28.8%), enuresis (22.22%), and incontinence (16.12%) were the most common complaints. The most prevalent disorder was bladder sensation disorder.ConclusionsPatients made various complaints, and several pathologies were diagnosed, which emphasizes the importance of using urodynamic tests for subsequent medical approaches as a non-invasive, accessible, and inexpensive tool.

A comparative study on the clinical effects of 1470 nm diode laser vaporization and transurethral resection of the prostate for benign prostatic hyperplasia

Objective To compare the safety and efficacy of 1 470 nm diode laser vaporization of the prostate with transurethral resection of the prostate(TURP) in patients with benign prostatic hyperplasia(BPH). Methods From July 2014 to July 2015, 82 patients diagnosed as BPH were randomly divided into two groups.Forty cases of them underwent 1 470 nm diode laser vaporization and 42 cases for TURP.The operation time, hemoglobin decrease, serum sodium decrease, bladder irrigation time, duration of bladder catheterization and postoperative complications were recorded.The international prostate symptom score(IPSS), maximum flow rate(Qmax) and post-voiding residual volume(PVR) before and after operation were compared. Results No differences were found between the two groups in basic preoperative characteristics, such as: age, prostate volume, IPSS, PVR and Qmax(P>0.05). The mean operative time in the diode laser group was (64.8±14.6) min, slightly longer than tin he TURP group((59.3±14.5) min, P>0.05). The hemoglobin decrease, the serum sodium decrease, the time of bladder irrigating and the time of catheterization of 1470 nm diode laser group were all less than that in TURP group, the differences were significant between the two groups((2.06±1.43) g/L vs.(6.07±1.68) g/L, (1.16±0.67) mmol/L vs.(4.09±3.78) mmol/L, (5.08±2.80) h vs.(25.8±12.7) h, (3.38±1.17) d vs.(4.88±1.42) d, respectively; t=-11.615, -4.845, -10.337, -5.232; P 0.05). All patients were followed up for 3-12 months, the IPSS, PVR and Qmax of 3 months after surgery in 1 470 nm diode laser group and TURP group were all improved significantly compared with that of preoperative in both groups, but no statistical differences could be found between the two groups(IPSS: F inner grouP=527.65, P<0.001; F between groups=0.099, P=0.753; F across groups=0.040, P=0.843, PVR: F inner grouP=509.57, P<0.001; F between groups=2.817, P=0.097; F across groups=1.02, P=0.315; Qmax: inner grouP=60.06, P<0.001; F between groups=0.30, P=0.585; F across groups=0.394, P=0.532). Conclusion 1 470 nm diode laser vaporization of the prostate can significantly improve the patient's lower urinary tract obstruction symptoms, which show similar short-term effects with TURP.It also has advantages of less bleeding, shorter catheter indwelling time and rapid postoperative recovery compared with TURP, suggesting that it is a safe and effective operation for BPH treatment. Key words: Benign prostatic hyperplasia; Transurethral resection of prostate; Diode laser

Sterile pyuria: a practical management guide.

Sterile pyuria (SP) is not an uncommon finding in clinical practice. Nine per cent of patients presenting to their GP with lower urinary symptoms, and who are suspected of having urinary tract infections (UTIs), are found to have SP.1 It continues to pose a diagnostic conundrum to physicians, as well as to allied healthcare professionals (HCPs), because there are no guidelines on its management. Currently no agreed definition for SP exists. It is simply the presence of white blood cells within the urine, in the absence of infection. Typically, the presence of more than 5–8 leucocytes per high-power field on microscopy, in the absence of positive urine cultures, would be classified as an SP. It can also be associated with haematuria, proteinuria, and casts, complicating the diagnosis. Broadly speaking, SP may be classified as infectious or non-infectious. This article reviews the many causes of SP (Figure 1), and aims to create a clear pathway in the management of these patients. ### Infectious causes Simple bacterial urinary tract infections (UTIs) are extremely common within the general population. UTIs are most often successfully treated in the community with empirical antibiotic therapy, with subsequent positive cultures confirming diagnosis. However, a recently treated UTI, usually within 2 weeks, or even after a single dose of antibiotics, can present as an SP. In the younger, sexually active population presenting with SP, Chlamydia …

Photoselective Vaporization with KTP 180-W Green Laser for the Treatment of Lower Urinary Symptoms Secondary to Benign Prostatic Enlargement: Effectiveness and Safety at Midterm Follow-Up

To determine safety, efficacy, and improvement in patient's quality of life (QoL) with 180-W green light laser prostate photovaporization in medium-term follow-up. Observational descriptive analysis. All the patients who were treated with photoselective vaporization with potassium titanyl phosphate crystal 180-W green laser between January 2012 and February 2014 were included. The primary outcome was the change of the International Prostate Symptom Score (IPSS). A descriptive analysis was conducted. Statistic inference was made using nonparametric measurements according to the findings. The Wilcoxon signed-rank test was applied to paired data. Finally, survival curves were used to determine the effectiveness. Two hundred one subjects were included. The mean follow-up was 13.1 months (2-28). Prostate volume was 75.46 ml (30-240). Mean surgical time was 73.29±29.74 minutes, laser time was 44.27±21.03 minutes, and the mean energy used was 271.5±140.1 kJ. Postoperative indwelling catheter time was 15.81±8.87 hours. IPSS decreased 12.79 points, from 19.13±7.79 to 6.34±5.91 (p=0.0001). QoL question of the IPSS shows improvement from 4.16 to 1.27 (p=0.00001). In a maximum follow-up period of 28 months, 85.2% of patients showed an improvement of four points in IPSS. Visual scale of improvement perception showed an increase from 36.49 to 89.84 (p=0.0001). No major complications were reported. Prostate photoselective vaporization with a 180-W green light laser is a safe and effective treatment option for patients with lower urinary symptoms secondary to benign prostate enlargement.

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

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

A review of lower urinary tract symptoms in patients with Parkinson's disease.

To critically review recent literature on lower urinary tract symptoms (LUTS) in patients with Parkinson's Disease.A literature search was conducted using the keywords LUTS, urinary symptoms, non-motor, and Parkinson's disease (PD) via the PubMed/Medline search engine. In the literature, we critically examined lower urinary symptoms in Parkinson's patients by analyzing prevalence, pathogenesis, urinary manifestations, pharmacologic trials and interventions, and prior review articles. The data collected ranged from 1986 to the present with an emphasis placed on recent publications.The literature regards LUTS in PD as a major comorbidity, especially with respect to a patient's quality of life. Parkinson's patients experience both storage and voiding difficulties. Storage symptoms, specifically overactive bladder, are markedly worse in patients with PD than in the general population. Surgical management of prostatic obstruction in PD can improve urinary symptoms. Multiple management options exist to alleviate storage LUTS in patients with PD, ranging from behavioral modification to surgery, and vary in efficacy.Lower urinary tract dysfunction in PD may be debilitating. Quality of life can be improved with a multi-pronged diagnosis-specific approach to treatment that takes into consideration a patient's ability to comply with treatment. A stepwise algorithm is presented and may be utilized by clinicians in managing LUTS in Parkinson's patients.

The "PErFecTED technique": proximal embolization first, then embolize distal for benign prostatic hyperplasia.

Prostatic artery embolization requires a refined technique to achieve good imaging and clinical success. The PErFecTED (Proximal Embolization First, Then Embolize Distal) technique has produced greater prostate ischemia and infarction than previously described methods with clinical improvement of lower urinary symptoms and lower recurrence rates. The microcatheter should cross any collateral branch to the bladder, rectum, corpus cavernosum, gonad, or penis and be placed distally into the prostatic artery before its branching to the central gland and peripheral zone. This technique allows better distribution of embolic material in the intraprostatic arteries and reduces risk of spasm or thrombus. Because benign prostatic hyperplasia develops primarily in the periurethral region of the prostate, the urethral group of arteries should be embolized first. Subsequent distal investigation and embolization completes occlusion and stasis of blood flow to the prostatic parenchyma. Since we added the second step to the PErFecTED technique, we have observed infarcts in all patients submitted to prostatic artery embolization.

Relation between glycemic levels and low tract urinary symptoms in elderly

Introduction: Due the low mortality attributed to BPH, the evaluation of the impacts of LUTS on quality of life of the patients has great importance, especially on the concern of therapeutic choices, except on cases of formal surgery indication. This increase is directly related with difficulties to perform ordinary tasks and a normal living in community.Objectives: Determinate an association among Diabetes mellitus II and BPH symptoms in a group of elder men.Methodology: This is an observational clinic trial, comparative. About 62 male subjects, 60 years old or more have been active interviewed. They were divided in two similarly groups. First was composed by men without diabetes and the second with diabetic men. For the evaluation of prostatic symptoms, it was utilized the IPSS.Results: Mean age on Group I was 67.6 years old, while on Group II was 68.7 years old (p = 0.1521). After questionnaire, 51.5% of participants on Group I and 54.2% on Group II presented Systemic Arterial Hypertension (p = 0.099). IPSS was higher on group II (p < 0.0005).Discussion: Diabetes mellitus was positively associated with the increasing of the LUTS, especially NOCTÚRIA. Patients on group I had a media of 14.2 points on IPSS questionnaire, while those on group II reached the media of 7 points. This pattern was the same even after the age, corporal mass and social/economic adjustment.Conclusion: There is a statistically association between DM and LUTS on Elder men, evaluated through a specific questionnaire.

Do we need the nerve sparing radical prostatectomy techniques (intrafascial vs. interfascial) in men with erectile dysfunction? Results of a single-centre study

To report effect of different nerve sparing techniques (NS) during radical prostatectomy (RP) (intrafascial-RP vs. interfascial-RP) on post-RP incontinence outcomes (UI) in impotent/erectile dysfunction (ED) men. A total of 420 impotent/ED patients (International Index of Erectile Function-score <15) with organ-confined prostate cancer were treated with bilateral-NS [intrafascial-RP (239) or interfascial-RP (181)] in our institution. Intrafascial-RP was indicated for biopsy Gleason score ≤6 and PSA ≤10 ng/ml while interfascial-RP for Gleason score ≤7 and higher serum PSA. Seventy-seven patients with bilateral non-NS-RP were taken for comparison. No patient received pre-/postoperative radiation/hormonal therapy or had prostatic enlargement surgery. UI was assessed 3, 12 and 36 months postoperatively by third party. Continence was defined as no pads/day, safety 1 pad/day as separate group, 1-2 pads/day as "mild-incontinence" and >2 pads/day as "incontinence". All groups had comparable perioperative criteria without significant preoperative morbidities. International Prostate Symptom Score showed severe symptoms in 5 % of patients without correlation to UI. UI-recovery increased until 36 months. Full continence was reported from 56 versus 62 and 53 % patients after intrafascial-RP versus interfascial-RP and wide excision at 3 months, respectively (p = 0.521). Corresponding figures at 12 months were 70 versus 61 versus 51 % (p = 0.114) and at 36 months 85 versus 75 versus 65 % (p = 0.135), respectively. After 12 and 36 months, there was tendency to better UI-results in advantage of NS-technique; best results were achieved in intrafascial-RP group. UI-recovery was age-dependant. Advantage was found in NS-group compared with non-NS-group in older patients (>70 years, p = 0.052). Impotent/ED patients have higher chances of recovering full continence after NS-RP. NS should be planned independently of preoperative potencystatus whenever technically and oncologically feasible. Age and lower urinary symptoms are not restrictions. Current data should be considered in preoperative patient counselling.