Lower Urinary Tract Symptom Score Research Articles

Assessment of prevalence of sexual dysfunction in patients having lower urinary tract symptoms with benign prostatic hyperplasia and effect of various treatment modalities on sexual function.

Sexual dysfunction affects a couple's relationship and quality of life of the patient and the partner irrespective of age. In Lower urinary tract symptoms (LUTS) with benign prostatic hyperplasia (BPH), sexual dysfunction is highly prevalent. This study aims to evaluate prevalence of sexual dysfunction in patients having LUTS with BPH and effect of various treatment on it. The study is hospital based prospective cross-sectional study. Total 106 patients were included in this study. Fifty-six patients underwent medical treatment and 50 patients underwent transurethral resection of prostate (TURP) according to lower urinary tract symptom score along with grades of prostate. We measured prevalence of lower urinary tract symptoms, erectile dysfunction (ED), ejaculatory dysfunction (EJD).We compared the pre and post treatment ED, EJD scores in both medical and TURP group. In our study, 11 (10.4%) patients had very mild ED, 12 (11.3%) had mild ED, 54 (50.9%) had moderate ED and 23 (21.7%) had severe ED. In our study, 11 (10.4%) patients had very mild EJD, 7 (6.6%) had mild EJD, 28 (26.4%) had moderate EJD and 2 (1.9%) had severe EJD. In medical group, ED pre-treatment versus ED post treatment was statistically significant (p = 0.0046), treatment of LUTS improves ED. EJD pre-treatment versus EJD post treatment was not statistically significant (p = 0.8368), treatment of LUTS associated with deterioration of EJD. In TURP group association of ED pre-treatment versus ED post treatment was statistically significant (p = 0.0319). Post TURP patients shows improvement in ED Association of EJD pre-treatment versus EJD post-treatment was statistically significant (p = 0.03000). Post TURP EJD deteriorate. We concluded that the severity of sexual dysfunction correlates with severity of LUTS. Ejaculatory function deteriorates after treatment of TURP compared to medical.

(A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS.

Our study aimed to develop a noninvasive model using a combination of the set of clinical data and uroflowmetry (UFL) to differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in non-neurogenic male patients with lower urinary tract symptoms (LUTS). Data from 229 men with LUTS, diagnosed with DU or BOO on a pressure-flow study (PFS), were retrospectively analyzed, including medical history, Core Lower Urinary Tract Symptoms score (CLSS) questionnaire, UFL and PFS. Uni- and multivariate logistic regression were utilized for the prediction analyses. Of the cohort, 128 (55.9%) patients were diagnosed with DU. A multivariate logistic regression analysis identified less prevalent nocturia (OR 0.27, p < 0.002), more prevalent intermittency (OR 2.33, p = 0.03), less prevalent weak stream (OR 0.14, p = 0.0004), lower straining points in CLSS (OR 0.67, p = 0.02), higher slow stream points in CLSS (OR 1.81, p = 0.002), higher incomplete emptying points in CLSS (OR 1.31, p < 0.02), lower PVR ratio (OR 0.20, p = 0.03), and present features of fluctuating (OR 2.00, p = 0.05), fluctuating-intermittent (OR 3.09, p < 0.006), and intermittent (OR 8.11, p = 0.076) UFL curve shapes as independent predictors of DU. The above prediction model demonstrated satisfactory accuracy (c-index of 0.783). Our 10-factor model provides a noninvasive approach to differentiate DU from BOO in male patients with non-neurogenic LUTS, offering a valuable alternative to invasive PFS.

Clinical effect of phytosterol-enriched saw palmetto extract on urinary function in healthy middle-aged and older males: a double-blind, placebo-controlled randomized comparative study

Background: Saw palmetto extract (SPE) is one of the most widely used supplements for benign prostatic hyperplasia (BPH) due to its pharmacological effects. β-sitosterol-enriched saw palmetto oil (VISPO™) contains more than 3% β-sitosterol and 85% total fatty acids and has been shown to improve symptoms in patients with BPH. Lower urinary tract symptoms (LUTS) require primary preventive measures in countries with accelerated population aging, including Japan. VISPO™ is expected to be effective against the early symptoms of LUTS. However, the effect of VISPO™ on urinary function in healthy individuals has not been elucidated. Objective: This clinical study evaluated the efficacy and tolerability of VISPO™ in the management of urinary complaints among healthy middle-aged and older men who did not require treatment. Methods: We conducted a randomized, double-blind, placebo-controlled trial that included 54 male participants who were assigned to consume VISPO™ or placebo (olive oil) capsules for 12 weeks. Biometric data, uroflowmetry results, and salivary hormone levels were assessed at weeks 1 and 12. Urinary function and quality of life were assessed at weeks 1, 4, 8, and 12 using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Core Lower Urinary Tract Symptom Score (CLSS), and WHOQOL-26. Results: Two-way analysis of variance revealed that IPSS and OABSS were significantly lower in the VISPO™ group that in the placebo group. However, there were no significant differences in urine volume, urinary flow rate, or salivary hormone levels. In addition, no participants reported adverse effects (diarrhea, abdominal pain, etc.). Conclusion: The results of the present study, which is the first randomized controlled trial of VISPO™ conducted among healthy participants, demonstrate the effectiveness of VISPO™ in the management of lower urinary tract complaints that do not require treatment. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000046386). Keywords: saw palmetto, VISPO™, β-sitosterol, fatty acids, healthy subjects, primary preventive, IPSS, OABSS, lower urinary tract symptoms (LUTS)

Urinary tract symptoms that should be improved to enhance post-operative urinary quality of life in patients treated with low-dose-rate brachytherapy for prostate cancer: An importance-performance analysis.

To evaluate international prostate symptom score and urinary quality of life in patients with prostate cancer who underwent low-dose-rate brachytherapy, and to identify lower urinary tract symptoms that must be improved to enhance post-operative urinary quality of life and factors associated with lower urinary tract symptoms. This study included 193 patients who underwent low-dose-rate brachytherapy alone (145 Gy). Importance-performance analysis was conducted to identify lower urinary tract symptoms that should be prioritized to improve urinary quality of life. Association between lower urinary tract symptom scores and each factor was investigated. Receiver operating characteristic curve analysis was used to evaluate dosimetric parameters related to lower urinary tract symptom score to predict an average score of ≥ 3. Cut-off values were determined. One to nine months post-implantation was a period of significantly increased urinary quality of life scores compared with baseline (p < 0.05 each). The importance-performance analysis conducted for 1-9 months revealed that frequency, nocturia, and weak stream required improvement. Multivariate analysis showed that each lower urinary tract symptom score presented a significant association with its baseline value (p < 0.001 each, positive correlation). Frequency, incomplete emptying, urgency, and straining scores were significantly associated with prostate volume, whereas weak stream and intermittency scores were associated with dose covering 90% of the prostate and dose covering 90% of the urethra, respectively (p < 0.05 each, positive correlations). Cut-off values for these doses were 167.01 Gy and 136.84 Gy, respectively. This study highlights the importance of prioritizing specific lower urinary tract symptoms for improvement in post-operative urinary quality of life, and identifies the associated factors that can help in personalized treatment planning and goal-setting for better patient satisfaction.

Lower urinary tract symptoms among male patients on hemodialysis: Prospective and multi-central cross-sectional study.

Lower urinary tract symptoms are common and can significantly impact quality of life, especially in men with co-morbidities and end-stage renal disease. The presence of lower urinary tract symptoms affect the quality of life of patients on hemodialysis. The purpose of this study is assessing the presence and severity of lower urinary tract symptoms among male patients on hemodialysis. Factors that may exacerbate lower urinary tract symptoms were assessed and studied. The impact of lower urinary tract symptoms on quality of life was also identified. A prospective, multi-central, and cross-sectional study of male patients on hemodialysis was conducted. Demographics, clinical data, and core lower urinary tract symptoms score questionnaire were all collected. A correlation has been made between all variables. One hundred forty-five patients were enrolled. Eighty-seven percent of hemodialysis patients had at least one storage symptom, and 85% had at least one voiding symptom. The prevalence of storage symptoms (frequency, nocturia, urgency, and urgency incontinence) was found to be 3%, 70%, 44%, and 12%, respectively. The voiding symptoms were mainly weak stream, straining, and incomplete emptying, which were found in 60%, 43%, and 36%, respectively. Fifteen percent of the cohort had a negatively significant impact on their quality of life. The absence of voiding symptoms was statistically linked to a better quality of life (p < 0.05). Hemodialysis patients who are over 60 years old, smokers, or obese were found to be significantly more likely to report storage symptoms (18%, 9%, and 79%, respectively; p < 0.05). Bladder pain was significantly correlated to the dialysis duration of more than 24 months (p < 0.05). Storage and voiding lower urinary tract symptoms are common among hemodialysis male patients with a minor impact on their quality of life. Age, smoking, and obesity are major risks of exaggerating such symptoms.

Psychometric Properties and Cutoff Value of the Turkish Overactive Bladder Symptom Score.

The Overactive Bladder Symptom Score (OABSS) measures all overactive bladder (OAB) symptoms with graded answers, evaluates urgency symptoms, and reveals the subjective bladder control. However, the Turkish version and the cutoff value of the questionnaire have not yet been studied. The aims of this study were to determine the psychometric properties of the 7-item OABSS and to estimate the cutoff value of the scale. This was an observational study. The internal consistency (Cronbach α) and test-retest reliability were analyzed, and exploratory factor analysis was performed. For the criterion validity, the correlations between the OABSS, the Overactive Bladder Questionnaire, the Bristol Female Lower Urinary Tract Symptoms questionnaire, and outcomes of a bladder diary were used. The cutoff value of the OABSS was analyzed by the receiver operating characteristics curve analysis. Participants with (n = 49) and without (n = 38) OAB were included. The internal consistency was very strong (Cronbach α = 0.95). The test-retest reliability was very strong (intraclass correlation coefficients = 0.93-0.95, P = 0.001). The percentage of explanation of the total variance was calculated as 78%. There was a strong to very strong correlation between the OABSS and the Overactive Bladder Questionnaire and Bristol Female Lower Urinary Tract Symptoms scores and outcomes of the bladder diary. The cutoff value for the OABSS was determined as 10.5. The Turkish OABSS was found to be a valid and reliable scale to determine OAB symptoms and severity. Those who score more than 10.5 on the questionnaire can be considered as at risk of OAB syndrome.

Rezūm water vapor thermal therapy in patients with benign prostatic hyperplasia: Initial real-world data from Japan.

Benign prostatic hyperplasia (BPH) is prevalent in older men. As surgery can be high risk in this group, minimally invasive procedures are preferrable. This study aimed to assess the initial results of minimally invasive Rezūm water vapor thermal therapy (WVTT) in patients with BPH. This single-center retrospective study included 25 consecutive patients with BPH who underwent WVTT between September 2022 and July 2023. Parameters including age, Charlson Comorbidity Index and Geriatric 8 (G8) scores, operative time, and number of vapor injections were evaluated. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, and Core Lower Urinary Tract Symptom Score (CLSS) were used to assess symptoms before the procedure, and at 1 and 3 months after it. Urinary function indicators such as single voiding volume, maximum flow rate (MFR), and post-void residual volume were assessed at the same time points. The mean patient age was 76.0 years and the mean prostate volume was 54.8 mL. The mean G8 score was 14.4 and the Charlson Comorbidity Index score averaged 1.2. The mean operative time was 6.84 min, and included a mean of 4.8 vapor injections. Three months after WVTT, significant improvements were observed in the maximum flow rate (P = .02), post-void residual volume (P = .001), and urine volume (P < .001), as well as in the IPSS incomplete emptying (P = .01) and weak stream (P = .01) domains. No significant changes were observed in the remaining IPSS domains or in the Overactive Bladder Symptom Score or CLSS. This study provides the first report on Rezūm WVTT outcomes in Japan using the CLSS assessment tool. The initial results indicate a promising experience with this new treatment method. With a rapidly aging population, the incidence of BPH is expected to increase, making the minimally invasive Rezūm system a valuable addition to BPH treatment options.

Brazilian Portuguese translation, cross-cultural adaptation, and content validation of the pediatric lower urinary tract symptom score

BackgroundEarly screening instruments for professionals are important to reduce the cost and time of diagnosing pediatric lower urinary tract dysfunction. This study aimed to translate, cross-culturally adapt, and validate pediatric lower urinary tract symptom scores. MethodsThis methodological study was conducted in 2019 in two phases: translation and cross-cultural adaptation, and content validation. In the first phase, we used translators, specialists, and 30 parents of children with voiding dysfunction. In the second phase, validation was performed by 11 pediatric urology specialists. FindingsThe instrument was translated and adapted to Brazilian Portuguese and presented an excellent level of verbal comprehension. Further, the instrument presented a good content validity index >0.8 for all items, except for the nomenclature and clarity of two items, as indicated by the Cronbach's alpha value of 0.75 for internal consistency. DiscussionThe final version showed semantic, idiomatic, experiential, and conceptual equivalence with the original instrument, indicating that it is adequate for other assessments of psychometric qualities. Practice implicationsThe translation and adaptation of an important instrument for diagnosing lower urinary tract dysfunction in children to other countries helps nurses identify the disease early and monitor the treatment.

Delineating the Diagnostic Concordance Between Pediatric Lower Urinary Symptoms Scoring and Voiding Diary in Pediatric Lower Urinary Tract Dysfunction.

This retrospective research endeavored to conduct a comparative evaluation of the Pediatric Lower Urinary Tract Symptoms Scoring (PLUTSS) system and the Voiding Diary (VD). The correlation between these diagnostic tools, their prognostic value for treatment outcomes in pediatric Lower Urinary Tract Dysfunction (LUTD), and their relationship with patients' sociodemographic characteristics were also explored. The study data for the cohort established between December 2005 and September 2006 were obtained from a specialized thesis, while the subsequent expansion from 2022 to 2023 involved a prospective approach, including an additional 73 patients, resulting in a total of 113 pediatric patients (79 females and 34 males). Comprehensive diagnostic evaluations, such as urinalysis, urine culture, renal function tests, urinary tract ultrasound, uroflowmetry-electromyography (EMG), and post-voiding residual urine measurement (PVR), were conducted. The patient's symptoms were assessed using the Pediatric Lower Urinary Tract Symptom Score (PLUTSS) and a two-day-three-night voiding diary. The correlation between the PLUTSS and VD was not absolute but substantial concerning daytime frequency and incontinence. Notably, PLUTSS emerged as the primary predictor of treatment outcomes. No significant association was discerned between sociodemographic characteristics, such as socioeconomic status, sibling count, toilet training, school performance, patientpersonality, and LUTD diagnosis or prognosis. The findings underscore the prognostic value of PLUTSS for treatment outcomes in pediatric LUTD. Although a significant correlation was observed between PLUTSS and VD, they are not interchangeable. As a result, concurrent utilization of both tools is endorsed for comprehensive diagnosis, follow-up, and treatment planning in pediatric LUTD.

Female sexual dysfunction and lower urinary tract symptoms associated with vulvovaginal atrophy symptoms: Results of the GENJA study.

To investigate the main symptoms of female sexual dysfunction (FSD) and lower urinary tract symptoms associated with vulvovaginal atrophy (VVA) symptoms as the core symptoms of genitourinary syndrome of menopause. We extracted the data of 4134 Japanese women aged 40-79 years who participated in the GENitourinary syndrome of menopause in JApanese women (GENJA) study. All participants responded to web-based questionnaires assessing their health situation, including the Vulvovaginal Symptoms Questionnaire, the Female Sexual Function Index (FSFI), and the Core Lower Urinary Tract Symptom Score. Multivariable regression and multivariable logistic regression analyses were applied to analyze the association between VVA symptoms and FSD, and between VVA symptoms and lower urinary tract symptoms. Multivariable regression analysis revealed that VVA symptoms were associated with lower scores for arousal, lubrication, orgasm, satisfaction, and pain domains in the FSFI in sexually active women (p < 0.01). Regression coefficients were higher for lubrication and pain domains than for the other domains. Multivariable logistic regression analysis revealed that women reporting VVA symptoms were more likely to have increased daytime urinary frequency, nocturia, urgency, slow stream, straining to void, feeling of incomplete emptying, bladder pain, and feeling a bulge/lump from or in the vagina (p < 0.05). Adjusted odds ratios were particularly high for straining to void, feeling of incomplete emptying, and bladder pain. Vulvovaginal atrophy symptoms were significantly associated with decreased lubrication and dyspareunia in FSD, and urinary symptoms of straining to void, feeling of incomplete emptying, and bladder pain.

Difference in symptom manifestation between postmenopausal and premenopausal women in acute uncomplicated cystitis: A multi-institutional pilot study.

We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy. This study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020. After registration, we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score (CLSS) questionnaire. After treatment, pyuria disappeared in 60 of the 66 patients (14 premenopausal and 46 postmenopausal). The CLSS total score (range) changed from 13 (3-29) to 4 (0-18) with a significant improvement in all CLSS items. At baseline, nocturia, urgency, and urgency incontinence were more prominent in postmenopausal women than in premenopausal women. In contrast, baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women. After treatment, the CLSS total score was still higher in postmenopausal women, as reflected by the relatively higher scores for nocturia and urgency, irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups. Our results suggest that if storage symptoms persist, they should be carefully interpreted according to menopausal status.

MP71-10 LONGITUDINAL EVALUATION OF LOWER URINARY TRACT SYMPTOMS POST ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH THE CORE LOWER URINARY TRACT SYMPTOM SCORE

You have accessJournal of UrologyCME1 Apr 2023MP71-10 LONGITUDINAL EVALUATION OF LOWER URINARY TRACT SYMPTOMS POST ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH THE CORE LOWER URINARY TRACT SYMPTOM SCORE Yuma Waseda, Minato Yokoyama, Kasumi Yoshitomi, Masaki Kobayashi, Bo Fan, Yuki Nakamura, Motohiro Fujiwara, Yudai Ishikawa, Shohei Fukuda, Hajime Tanaka, Soichiro Yoshida, and Yasuhisa Fujii Yuma WasedaYuma Waseda More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Kasumi YoshitomiKasumi Yoshitomi More articles by this author , Masaki KobayashiMasaki Kobayashi More articles by this author , Bo FanBo Fan More articles by this author , Yuki NakamuraYuki Nakamura More articles by this author , Motohiro FujiwaraMotohiro Fujiwara More articles by this author , Yudai IshikawaYudai Ishikawa More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While the artificial urinary sphincter (AUS) can significantly improve continence status, improved continence has been shown to worsen slightly over time. However, few studies have evaluated the trend in lower urinary tract symptoms (LUTS) other than incontinence. The frequently used International Prostate Symptom Score questionnaires may not adequately assess LUTS due to a lack of queries regarding incontinence and pain. The Core LUTS Score (CLSS) allows for an overall assessment of LUTS, which addresses 10 important symptoms from the 25 defined by the International Continence Society standardization steering committee. The CLSS questionnaire was used to assess LUTS after AUS implantation, longitudinally. METHODS: The subjects were 19 male who underwent initial AUS implantation at Tokyo Medical and Dental University from 2018 to 2021. LUTS were assessed before AUS implantation as well as one month (early use) and 12 months (late use) after implantation. CLSS data was collected from 13 patients before implantation and 19 patients during early and late use. This study was approved by our ethics committee (approval number: #2018-157). RESULTS: The median age at surgery was 74 years. The causes of urinary incontinence were radical prostatectomy and benign prostatic hyperplasia surgery in 18 and one patient, respectively. All patients achieved social continence of ≤1 pad/day, and the quality of life index improved significantly from 5.6 to 1.8 (0: delighted to 6: terrible) in early use (p<0.001) in 13 patients with preoperative evaluations. The most bothersome symptom was urinary incontinence in 11 (85%) patients and frequent urination in 2 (15%) patients before use, while two in early use and four in late use listed incontinence-related symptoms. Longitudinal change between early and late use showed improvement in voiding and post-micturition symptoms. On the other hand, no apparent improvement in storage symptoms was observed (Figure 1). On late use, 3 (16%) were receiving medication for overactive bladder. CONCLUSIONS: Post AUS implantation, urinary incontinence distress decreased, and other LUTS became more prominent. There was no trend toward improvement of the storage symptoms over time, and pharmacotherapy should be adiministered as needed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1018 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuma Waseda More articles by this author Minato Yokoyama More articles by this author Kasumi Yoshitomi More articles by this author Masaki Kobayashi More articles by this author Bo Fan More articles by this author Yuki Nakamura More articles by this author Motohiro Fujiwara More articles by this author Yudai Ishikawa More articles by this author Shohei Fukuda More articles by this author Hajime Tanaka More articles by this author Soichiro Yoshida More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

The role of the bladder diary in phenotyping men with LUTS.

The aim of this study was to compare the clinical characteristics of men with lower urinary tract symptoms(LUTS) grouped by 24-hurine output determined from a bladder voiding diary. An online database was queried to identify men who completed a 24-hour bladder diary (24HBD), and the Lower Urinary Tract Symptom Score (LUTSS) questionnaire from 2015 to 2019 using a mobile app. Data from the bladder diary and questionnaire were contemporaneously matched within a 2-week period. Additional data, including maximum uroflow (Qmax ) and postvoid residual urine (PVR), were obtained from the electronic medical record (EMR). The cohort was divided into three groups: normal, oliguria, and polyuria based on their 24-hour voided volume (24HVV). The LUTSS, 24HVV, maximum voided volume (MVV), maximum flow rate (Qmax ), and PVRwere compared between those with oliguria and polyuria. A total of 327 men (mean age 62, SD: 19) completed the LUTSS questionnaire and contemporaneous 24HBD. Of these, 61% had a normal 24HVV, 13% had oliguria, and 26% had polyuria. A total of 147 patients from the study cohort had contemporaneous Qmax and PVR abstracted from the EMR. There was no difference in symptom severity, bother, or PVR among the three patient groups. However, several objective metrics were significantly correlated with urine output. Men with oliguria, as compared to men with polyuria were older (65 vs. 55years) and had lower MVV (260vs.470 mL), fewer voids/24 h (8 vs. 13),and lower Qmax (8.5vs. 18.3 mL/s). These observations suggest that men with oliguria or polyuria and LUTS constitute easily distinguished phenotypes that might require different diagnostic and therapeutic algorithms. Those with oliguria were older, and had lower MVVs and much lower uroflows, suggesting that they are more likely to have underlying disorders such as bladder outlet obstruction and detrusor underactivity or may be patients with overactive bladder who reduced fluid intake to improve symptoms.

Toileting Behaviors and Lower Urinary Tract Symptoms Among Female Physicians and Medical Students.

A greater understanding of the relationship between toileting behaviors and lower urinary tract symptoms (LUTS) has the potential to generate awareness and improvement of overall bladder health in specific populations. The aim of the study was to investigate the prevalence and correlation between maladaptive toileting behaviors and LUTS among female medical trainees and attending physicians. We surveyed female medical students, residents, fellows, and attending physicians at an academic hospital, capturing demographics, voiding behaviors, LUTS, and fluid intake using the Bristol Female Lower Urinary Tract Symptoms Short Form, the Toileting Behavior-Women's Elimination Behaviors, and the Beverage Intake Questionnaire. A total of 146 medical students and physicians participated in the study. Eighty-three percent reported at least 1 LUTS, most commonly storage symptoms, particularly incontinence (30%, stress urinary incontinence > urgency urinary incontinence). Altered toileting behaviors included "worrying about public toilet cleanliness" (82%), "emptying the bladder before leaving home" (81%), "delaying emptying their bladder when busy" (87%), and "waiting until they could not hold urine any longer" (57%). Total Toileting Behavior-Women's Elimination Behaviors scores were significantly associated with total Bristol Female Lower Urinary Tract Symptoms scores (β = 0.27; 95% CI, 0.12-0.42; P<0.01). This remained true after adjusting for total fluid intake in medical students (β = 0.41, P<0.01) and resident physicians (β = 0.28, P = 0.03) but was not correlated among attending physicians (β = -0.07, P = 0.77). Female physicians and medical students experience a high prevalence of LUTS. Many engage in maladaptive toileting behaviors, which highly correlate with LUTS (especially among medical students and residents) and may lead to impaired bladder health.

Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study.

To determine whether sacral transcutaneous electrical nerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs). A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3 months. Symptom progression was assessed using the voiding calendar and the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS), excluding questions 3 and 4 -referring to enuresis- so that progression of daytime symptoms only (LUTS variable) was analyzed. 66 patients -50% of whom were female- were included, with a mean age of 9.5years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1 baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions (8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume in the voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresis was the only variable refractory to S-TENS. Complication rate was 3% (2 patients with dermatitis in the S-TENS application area). S-TENS is effective and safe in the short-term in patients with OB refractory to Achs. Further studies assessing long-term efficacy and potential relapses are required.

Polyuria in patients with lower urinary tract symptoms: Prevalence and etiology.

Patients with lower urinary tract symptoms (LUTS) can be subcategorized into polyuria, normal or oliguria groups. Polyuria may be caused by pathologies including diabetes mellitus (DM), chronic kidney disease (CKD), diabetes insipidus (DI), or primary polydipsia (PPD). While fluid restriction is appropriate for some, doing so in all may result in serious complications. This study investigates the prevalence of these pathologies in LUTS patients with polyuria. Two databases were retrospectively queried for men and women who filled out a lower urinary tract symptom score (LUTSS) questionnaire, 24-hbladder diary (24HBD) and were polyuric (>2.5 L/day). Patients were divided into four groups: poorly controlled DM, DI, anCKD grade 3 and PPD. One-way analysis of variance compared 24HBD and LUTSS questionnaires. Pearson correlation examined LUTSS and bother with 24-h voided volume (24 HVV), maximum voided volume (MVV) and total voids. Among 814 patients who completed a 24HBD, 176 had polyuria (22%). Of the patients with complete data, 7.8% had poorly-controlled DM, 3.1% had DI, 4.7% had CKD grade 3% and 84.4% had PPD. Amongst the four different sub-groups, significant differences were seen in 24 HVV (p < 0.001), nocturnal urine volume (NUV) (p < 0.001), MVV (p = 0.003), daytime voids (p = 0.05), nocturnal polyuria index (NPi) (p < 0.001) and nocturia index (Ni) (p = 0.002). Significance was also seen between LUTSS and bother subscore (r = 0.68, p < 0.001), LUTSS and total voids (r = 0.29, p = 0.001) and bother sub-score and total voids (r = 0.21, p = 0.019). 22% of patients with LUTS were found to have polyuria based on a 24HBD. Within this cohort, four sub-populations were identified as being demonstrating statistically significant differences in 24 HVV, NUV, MVV, daytime voids, NPi and Ni. Identifying the underlying etiology of polyuria should be carried out to safely treat patients with LUTS.

Toxicity and Patient Reported Quality of Life Outcomes Following Prostate SBRT with Focal Boost to MRI Identified Prostate Cancer Lesions: Results of a Phase II Trial

<h3>Purpose/Objective(s)</h3> A focused boost to MRI identified prostate cancer lesions treated with radiotherapy has been shown to improve biochemical disease control without increased toxicity in standard fractionated radiation treatment. Prostate cancer is known to be sensitive to higher radiation doses per fraction and thus stereotactic body radiotherapy (SBRT) has become an increasingly popular treatment method. In this prospective phase II trial, we investigated the toxicity and patient reported quality of life outcomes in patients treated with SBRT to the prostate gland and a simultaneous focal boost to MRI identified intraprostatic lesions while also de-escalating dose to the adjacent organs at risk. <h3>Materials/Methods</h3> Eligible patients included low- or intermediate- risk prostate cancer (Gleason score ≤ 7, PSA ≤20, T stage ≤2b). SBRT was prescribed to 40 Gy in 5 fractions delivered every other day to the prostate, with areas of high disease burden (MRI-identified PI-RADS 4 or 5 lesions) escalated to 42.5-45 Gy and areas overlapping organs at risk (within 2 mm of urethra, anterior rectal wall, and bladder base) constrained to 36.25 Gy (n=98). Patients without a pre-treatment MRI were treated to dose of 37.5 Gy with no focal boost (n=14). Acute and late toxicity were graded using RTOG modified toxicity scales. Patient-reported outcome and quality of life was assessed using the AUA-IPSS lower urinary tract symptom score, IIEF-5 erectile function, and EPIC-26 surveys. Statistical testing was performed in statistical software. <h3>Results</h3> From 2015 to 2022, a total of 112 patients were enrolled with a median follow-up of 36 months. No acute or late grade 3+ GI or GU toxicity was observed. Within the focal boost arm, acute grade 2 GU toxicity during treatment or at 6-week follow-up was seen in 26% of patients. Acute grade 2 GI toxicity was seen in 1 patient. Cumulative late grade 2 GU toxicity was 8%. Rate of alpha blocker medication use following treatment was 26%. Cumulative late grade 2 GI toxicity was 2.3%. Patient reported outcomes showed no significant changes from baseline IPSS lower urinary tract, IIEF erectile function, or EPIC-26 urinary incontinence, urinary irritative, gastrointestinal, or sexual domain quality of life scores following treatment (p >0.05 for all tests via RANOVA). Two patients have had a biochemical recurrence to date, at 42 months and 60 months post treatment. <h3>Conclusion</h3> SBRT to a dose of 40 Gy to the prostate gland with a focal boost up to 45 Gy is well tolerated with no observed grade 3 toxicity and similar rates of acute and late grade 2 GI and GU toxicity as seen in other SBRT regimens without intraprostatic dose boost. Moreover, no significant changes were seen in patient reported urinary, bowel, or sexual outcomes from pre-treatment baseline at any follow-up date. Biochemical control data continue to mature but few treatment failures have been observed to date.

The association between the parameters of uroflowmetry and lower urinary tract symptoms in prostate cancer patients after robot-assisted radical prostatectomy

ObjectiveTo investigate changes in uroflowmetry parameters in men undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer.Materials and methodsFour hundred and twenty-eight patients received uroflowmetry testing before and after RARP from November 2011 to December 2018. Clinicopathological data, including age, initial prostate-specific antigen (PSA), prostate volume, clinical stage, body mass index (BMI), uroflowmetry parameters, and core lower urinary tract symptom scores (CLSS) were retrospectively obtained from clinical records. Changes in uroflowmetry parameters were analyzed for statistical predictors and effects on post-operative outcomes.ResultsA significant increase in maximum flow rate (MFR) and decreases in voided volume (VV) and post-void residual urine (PVR) were seen. In multivariate analysis, age was a negative predictor of MFR increase, while prostate volume was a positive predictor of PVR decrease and MFR increase. VV decrease led to worse incontinence symptoms, while PVR decrease and MFR increase led to improvement in voiding symptoms such as slow stream and straining. Continence recovery curves showed that VV decrease were associated with a delay in continence recovery.ConclusionsSignificant changes were seen in uroflowmetry results after RARP, each parameter directly related to urinary symptoms. In particular, VV decrease was associated with a worsening of incontinence symptoms and continence recovery.

Outpatient Photodynamic Diagnosis–guided Laser Destruction of Bladder Tumors Is as Good as Conventional Inpatient Photodynamic Diagnosis–guided Transurethral Tumor Resection in Patients with Recurrent Intermediate-risk Low-grade Ta Bladder Tumors. A Prospective Randomized Noninferiority Clinical Trial

BackgroundTransurethral resection of recurrent low-grade intermediate-risk Ta bladder tumor (BT) in general anesthesia (GA) is burdensome to patients and health care system. Laser technologies enable treatment in office-based settings, reducing morbidity and costs. ObjectiveTo compare 4-mo recurrence-free survival after outpatient department (OPD) diode laser coagulation of BT in local anesthesia and gold standard transurethral resection of BT (TUR-BT) in GA in intermediate-risk Ta low-grade BT, and to evaluate treatment-related morbidity. Design, setting, and participantsA prospective randomized noninferiority trial with 4-mo follow-up, in the hospital setting, was conducted in Capital Region of Denmark from 2016 to 2020. Participants were patients with histologically verified Ta low-grade BT recurrence. A total of 206 patients were randomized; 176 finished treatment and follow-up as per protocol. InterventionLaser photocoagulation of bladder tumor (PC-BT) in OPD using a 980 nm diode laser compared with gold standard TUR-BT in GA, both performed with photodynamic diagnosis (PDD) guidance. Outcome measurements and statistical analysisFour-month recurrence-free survival was assessed; predefined inferiority criterion was set at 15%. The secondary outcomes were pain during PC-BT, postoperative morbidity, postoperative complications, and patient’s preference. Results and limitationsFour-month recurrence-free survival was 8% higher after PC-BT (95% confidence interval [CI]: –8% to 24%). The predefined noninferiority criterion was met. Pain score (1–10) during PC-BT was 2.4 (interquartile range 0.8–3.3). Postoperative lower urinary tract symptom score (0–100) was 13.9 points higher (95% CI: 6.9–21.0, p < 0.001) in the group with transurethral resection of the bladder. The frequency of minor complications was 8.1% higher after TUR-BT (95% CI: 1.0–14.6%, p = 0.026). Of the patients, 98% (95% CI: 92–100%) preferred PC-BT. ConclusionsPDD-guided PC-BT in OPD is as good as TUR-BT in GA to remove recurrent low-grade Ta BT. Postoperative quality of life is better after PC-BT and the frequency of minor complications was lower. Patient summaryThis study evaluates the efficacy of outpatient laser removal of low-grade noninvasive bladder tumor. Outpatient tumor removal with laser was as good as transurethral resection in general anesthesia and less burdensome to patients.

Reliability and validity of the Turkish language version of the Core Lower Urinary Tract Symptom Score.

The purpose of this study was to develop the Turkish version of the Core Lower Urinary Tract Symptom Score (CLSS) and determine its psychometric properties in Turkish subjects. A total of 428 subjects, 259 with lower urinary tract symptoms (LUTS) and 169 without any complaints, were included in the study. In addition, 40 subjects were included in the study for test-retest analysis. After the Turkish version of the CLSS was created, all patients underwent medical history, physical examination, complete urinalysis, urinary ultrasonography, and filled out a CLSS. In addition, men were asked to fill in International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Male LUTS and National Institutes of Health Chronic Prostatitis Symptom Index. Women completed the Bristol Female LUTS-Short Form and IPSS. The patients from the test-retest group were asked to fill out the CLSS two times at 2-week intervals. CLSS showed high internal consistency (Cronbach's α for men and women was 0.909 and 0.767, respectively). The test-retest reliability of CLSS was high for subdomains (intraclass correlation coefficient was 0.739-0.962). Scores of CLSS were significantly higher in the study group than the control group (P < 0.001). In men and women, it showed very strong convergent validity (P < 0.0001) with subdomain related to other questionnaires. In our confirmatory factor analysis, the original model of CLSS was found to be compatible. The Turkish version of CLSS is a valid and reliable questionnaire to evaluate the symptoms and disorders of patients with LUTS.